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Best of Summer 2013
Ah, sweet summertime — the beaches, the road trips, the cookouts and, yes, the music. It's a season for relaxing and catching some rays, and amid all the lounging, there exists an almost universal need to find the perfect songs to soundtrack our most beloved summer activities. That's why the search for the best song of the summer is a time-honored tradition. Each year, we look for those joyous, addictive tunes you can play in the car with the windows down or blast at late-night parties with a cold beer in hand.
But for hardcore music fans, it's about more than merely pondering summer jams. 'Tis the season for getting sunburned while waiting to see your favorite summer festival acts, reading rock 'n' roll books at the beach and combing the Internet for the coolest covers of 'Get Lucky.' (Face it, you couldn't go anywhere without hearing it.) Our Best of Summer 2013 poll questions take into account all of this and more, so vote below and tell us how you've spent the season.
Provided you're not too busy surfing or or barbecuing or doing things that don't involve sitting in front of a computer, you can vote once per hour before polls close at 11:59PM EST on Aug. 24. At the end, we'll tally it all up and report back with an end-of-summer recap.


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(Host) Vermont Yankee says it's stopped the leaks of radioactive tritium and has developed a plan for cleaning it up.
Entergy Vermont Yankee spokesman Larry Smith says plant officials met with state and local officials this morning for an explanation.
(Smith) "Just filling them in on everything about this investigation, and as of yesterday, our successful efforts to locate the source of tritium, stop all of the leaks and now move into remediation of soil and groundwater on the site."
(Host) Smith says two underground drain lines between buildings on the plant site were leaking. A clogged drain allowed water that was contaminated with tritium to escape into surrounding soil and groundwater.
Vermont Yankee has developed a plan for dealing with the contamination. About 150 cubic yards of soil will be excavated and hauled away for disposal.
Smith says there's also a plan for the contaminated water that has been collected.
(Smith) "For the groundwater, the triated groundwater, which we estimate to be about 300,000 gallons, we actually as of today will be pumping that water out of an extraction well that's on site. We'll be putting it in bladders, huge bladders. And we'll actually be processing every single ounce of that water back into the plant for processing. It'll be make-up water in the reactor."
(Host) Vermont Yankee first reported the leaks in January. The company has come under fire because it previously had told state officials that there were no underground pipes on the plant grounds that carried radioactive material.

subset: commoncrawl


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Mooresville, North Carolina. Ever heard of it? I didn't think so. And it's certainly not a town where you'd expect to find any decent pizza. But I happen to have a friend who lives there. And for the past few ...Read More »
Home / Tag Archives: best pizza in north carolina


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How to gross up dividends
After tackling some tougher analysis of late, this issue were taking a look at dividends.
If you've been a little overwhelmed by our recent Investor's Colleges then hopefully this one will deliver some respite. We're going to discuss dividends from the perspective of someone who's new to investing.
Put simply, dividends represent the amount of after-tax earnings distributed to shareholders. That's a pretty straightforward concept. But in Australia, it's complicated slightly by our system of dividend imputation.
Now, don't get us wrong – the dividend imputation system is fair for shareholders and represents an important advantage of investing in Australia over, say, America. To demonstrate, let's look at an example.
Take a fictional company paying out all of its after-tax profit as dividends. If Company A makes $1,000 in pre-tax profits it will have to pay company tax on that amount, currently at a rate of 30%. This means that Company A will pay $300 to Canberra, leaving $700 available to shareholders.
Initially, let's assume you are the sole shareholder. You will receive a cheque for $700 and a tax invoice which will show $300 of 'imputation credits', sometimes called franking credits. This amount represents the tax the company has already paid on your behalf.
So, if your marginal tax rate is 43% the taxman will deem you to have earned $1,000 – a tax liability of $430. Given that $300 has already been paid on your behalf (the imputation credit) you will owe another $130.
If your marginal tax rate is, say, 30% then you won't have any further liability. And, if your rate is lower again, then you will actually receive a refund on the excess imputation credits. This system is a much more favourable outcome than the double taxation that occurs in many other countries.
In the US you would be up for income tax on the face value of the dividend received ($700).
In Australia, if the company has paid no income tax and has no franking credits available from previous years then it may pay an unfranked dividend. In this case you would be liable for income tax on the entire dividend amount you received because the company hasn't paid any tax on your behalf.
Companies may also pay partly franked dividends. That's why our earnings tables usually include the level of franking.
It's unfair to directly compare a stock paying fully-franked dividends with one paying unfranked or partly franked dividends. You have to 'gross up' first. Here's the formula:
Grossed up dividend = dividend x (1 (franking level x (tax rate/(1-tax rate))))
A worked example should make that ugly mess easier to understand. Let's say you want to compare an unfranked dividend of $120 with a 50% franked (at the current corporate tax rate of 30%) dividend of $100 to see which is more attractive. The unfranked dividend is simply worth $120. That's the easy part.
To arrive at the comparable figure for the partly franked amount take the $100 and multiply it by 1 (0.5 x (30/(1-30))).
This simplifies down to $100 x 1.243, or $124.30. So in this case the partly franked dividend is more attractive. That wasn't too hard was it?


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I've blogged about this a dozen times or so, but wood pellets are small pellets of compressed wood that separate into a coarse sawdust when wet or crunched. They don't blow away in the wind, they don't get lifted with the pitchfork, and they blend into the sand nicely to give a fluffier surface.
Since Sydney was still a bit tender footed on Saturday, I was left with some free time so I drove on over to Tractor Supply. Unfortunately, the guy who loaded the pallet into my truck wasn't such a great forklift operator (oh … hahahah - that reminds me of my favorite meme).
I pulled over as quickly as I could and sliced open the plastic shrink wrap. I then had to lift at least 15 bags back into the bed of my truck. I wish I had thought to take a photo of my leaning tower of pellets, but alas, I didn't. I made it back to the barn safely and then had to unload and stack the 50 bags.


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Submitted by farhan on
<Facebook post by Hamish Brown>
Singapore really has only 3 people to thank for smashing all notions that we cannot win gold at the Olympics, set an Olympic record and provide empowerment to our children and their children.
We have to thank them and them alone also for teaching us that if you want something bad enough then with sacrifice, family support, unyielding commitment and unwavering belief in the goal, then nothing and no one can stand in the way of that glory.
Three people and three people alone. They are standing in this picture framed in the glory that should be theirs and theirs alone. Always remember that.
Majullah Singapura!!!!!!!!!
Editor's Note:
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Anupama Rajendra Reclaims Title in KCF All-Girls Nationals
After a disappointing first round in which she only managed a draw against a much lower rated opponent, Anupama Rajendra of Wisconsin rallied to win the KCF All-Girls National Championships in Chicago by winning her remaining five games. It was not an easy start either. On her second round game, Anupama confessed that she felt she had a losing position, and that if it wasn't for a blunder by her opponent, the tournament may have had a very different outcome.
The three-day, six-round event was the largest yet, with a record of 448 total participants coming from 27 states. Across the six sections, this increase in competition and talent made for fierce matches and high quality chess in every round.
On her last round, Anupama Rajendra faced off against Nastassja Matus, who was one of four girls only half a point behind her. Nastassja, being only 11 years old, appeared to be following in Anupama's footsteps, since she was close to winning the event. Indeed, four years ago at the 2012 All-Girls Championships, Anupama entered the event in the U-18 section as an 11 year old and won the event. Her victories continued in 2013. This time, however, experience triumphed over youth, as Anupama won a very convincing game just shy of 30 moves.
Anupama obtained a great position with the Grand Prix attack against the Sicilian. After 15. … Nd5, Anupama said she felt very confident that she would win the event. She pushed 16. c4 and all of her pieces aimed at the kingside. An attack ensued in which, despite Nastassja's sacrifices, mate was unavoidable.
Although her first round result was not intentional, Anupama said that the resultant draw may have helped her with easier pairings throughout the event. However, in the end she was the sole leader with 5 ½ points, half a point ahead of Florizelle Songco and Camille Kao, whose last round victories on boards two and three did not alter the final results of the event. Hunter College High School earned 1st place in the Under 18 team.
Other sections were also very tight. The U-16 section featured two players, Thalia Cervantes from Missouri and local talent Miranda Liu, who tied for first place with 5.5 points each. They faced each other in round four, which ended in a draw, and their remaining games were all victories. In the end, Thalia Cervantes won the first place trophy on tie-breaks after winning her last round game against Brittany Nguyen from Texas. Thalia, whose rating was the only one over 2,000 for her section, mentioned that her tournaments at the Chess Club and Scholastic Center of St. Louis have been great preparation for the All-Girls.
A strange occurrence happened in the last round of the U-14 section. Marissa Li from Illinois was the sole leader of the section with 5 points, a whole point ahead of the field. Six players followed with 4 points. Her opponent, Sophie Morris-Suzuki from New York, desperately needed a win in order to tie for first place. As time pressure mounted on, she outsmarted Marissa and ended up a rook ahead; a decisive advantage! Yet, all other players with four points drew their last round games, which made Sophie and Marissa the only two players tied for first place. Despite her loss against Sophie, Marissa won the first place trophy with the better tie-breakers.
The youngest three sections had the only perfect scores of the tournaments. In the Under 12 section, Minda Chen of Washington State won all 6 of her games and gained 70 rating points, while in the youngest section, Under 8, Kally Wen of California was victorious in all her contests and won the first place trophy for her section, as well as an impressive 200+ rating boost. The Under 10 section, the largest section of the event with 118 players, featured a three way tie for first place in which seasoned Emma Cheng had the better tie-breaks against Beatrice Low and Natalia Zduniewicz, all with 5.5 points.
In the end, the tournament was a resounding success. The players brought their best games to the fore, while the organizers Renaissance Knights and the Kasparov Chess Foundation ensured that this tournament was both memorable and seamless. Congratulations to all involved and see you next year!
Find full standings on the official website and enjoy some more shots by Betsy Dynako below.


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The authority shall have the right to acquire by eminent domain any real property, including fixtures and improvements, which it may deem necessary to carry out the purposes of this Article after the adoption by it of a resolution declaring that the acquisition of the property described therein is in the public interest and necessary for public use. The authority may exercise the power of eminent domain pursuant to the provisions of Chapter 40A.
Property already devoted to a public use may be acquired, provided, that no property belonging to any city or municipality or to any government may be acquired without its consent and that no property belonging to a public utility corporation may be acquired without the approval of the commission or other officer or tribunal, if any there be, having regulatory power over such corporation. (1935, c. 456, s. 11; 1981, c. 919, s. 25.)


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Obstructive Sleep Apnea and the Risk of Sudden Cardiac DeathA Longitudinal Study of 10,701 Adults
Author + information
- Received January 24, 2013
- Revision received April 7, 2013
- Accepted April 7, 2013
- Published online August 13, 2013.
Author Information
- Apoor S. Gami, MD, MSc∗,†,‡,
- Eric J. Olson, MD‡,§⋮,
- Win K. Shen, MD†,‡,
- R. Scott Wright, MD†,‡,
- Karla V. Ballman, PhD¶,
- Dave O. Hodge, MS¶,
- Regina M. Herges, BS¶,
- Daniel E. Howard, MD, MPH‡ and
- Virend K. Somers, MD, PhD†,‡∗ (somers.virend{at}mayo.edu)
- ∗Section of Electrophysiology and Pacing, Midwest Heart Specialists–Advocate Medical Group, Elmhurst, Illinois
- †Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota
- ‡Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- §Sleep Disorders Center, Mayo Clinic College of Medicine, Rochester, Minnesota
- ¶Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
- ⋮Department of Biostatistics, Mayo Clinic College of Medicine, Rochester, Minnesota
- ↵∗Reprint requests and correspondence:
Dr. Virend K. Somers, Mayo Clinic College of Medicine, Division of Cardiovascular Diseases, 200 First Street, SW, Rochester, Minnesota 55905.
Objectives This study sought to identify the risk of sudden cardiac death (SCD) associated with obstructive sleep apnea (OSA).
Background Risk stratification for SCD, a major cause of mortality, is difficult. OSA is linked to cardiovascular disease and arrhythmias and has been shown to increase the risk of nocturnal SCD. It is unknown if OSA independently increases the risk of SCD.
Methods We included 10,701 consecutive adults undergoing their first diagnostic polysomnogram between July 1987 and July 2003. During follow-up up to 15 years, we assessed incident resuscitated or fatal SCD in relation to the presence of OSA, physiological data including the apnea-hypopnea index (AHI), and nocturnal oxygen saturation (O2sat) parameters, and relevant comorbidities.
Results During an average follow-up of 5.3 years, 142 patients had resuscitated or fatal SCD (annual rate 0.27%). In multivariate analysis, independent risk factors for SCD were age, hypertension, coronary artery disease, cardiomyopathy or heart failure, ventricular ectopy or nonsustained ventricular tachycardia, and lowest nocturnal O2sat (per 10% decrease, hazard ratio [HR]: 1.14; p = 0.029). SCD was best predicted by age >60 years (HR: 5.53), apnea-hypopnea index >20 (HR: 1.60), mean nocturnal O2sat <93% (HR: 2.93), and lowest nocturnal O2sat <78% (HR: 2.60; all p < 0.0001).
Conclusions In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.
Sudden cardiac death (SCD) accounts for 450,000 deaths annually in the United States (1). The approach to SCD risk stratification is difficult, as modern therapies after myocardial infarction have altered the prognostic power of many risk factors and because the vast majority of SCD occurs in people without recognized heart disease (2). Recent population studies suggest that the risk of SCD is largely unrelated to traditional risk factors and may involve yet-unrecognized variables that directly affect cardiac function and arrhythmogenesis (3,4).
Obstructive sleep apnea (OSA) may be one such unrecognized risk factor for SCD (5). A growing body of evidence confirms strong associations between OSA and cardiovascular diseases, including coronary artery disease, hypertension, left ventricular dysfunction, and arrhythmias (6). OSA is also associated with increased mortality (7,8). A specific link to SCD was suggested by the finding that SCD is more likely to occur during usual sleep hours in individuals with OSA, which is the time when SCD is least likely in individuals without OSA and in the general population (9). Even though these data demonstrated that individuals with OSA experience an altered day-night pattern of SCD, whether OSA increases the overall risk of SCD is not known.
We hypothesized that OSA is associated with an increased risk of SCD independently of other risk factors and that the severity of OSA is directly associated with the magnitude of this risk.
The Mayo Foundation Institutional Review Board approved the study, and only individuals who authorized their records to be used for research were included. Data were collected from medical records by dedicated cardiovascular research studies unit personnel trained specifically for this study. Standardized, piloted forms were used for data collection, and quality was maintained by direct supervision and feedback by a study physician. A validation series using data from 200 subjects demonstrated agreement (Cohen kappa = 0.91) between data collected separately by a study physician and the research personnel (10).
The study population was derived from all individuals referred for sleep studies to the Mayo Clinic Sleep Disorders Center between July 1, 1987, and July 31, 2003. The indication for sleep studies in the vast majority of subjects was suspected sleep-disordered breathing, and this remained constant during the study period. We limited the study sample to Minnesota residents who were 18 years or older and undergoing their first-ever overnight sleep study (polysomnogram), which necessarily excluded individuals with a prior diagnosis of OSA. We also excluded individuals with a history of resuscitated SCD.
Data collected at the time of polysomnography included variables that have previously been associated with SCD. These included subjects' age, sex, body mass index, and comorbidities. Coronary artery disease was confirmed if the medical record noted a history of angina, myocardial infarction, abnormal cardiac stress or perfusion study, coronary angiogram revealing ≥1 stenoses ≥70%, percutaneous coronary intervention, or coronary artery bypass graft surgery. Cardiomyopathy or heart failure was confirmed if the medical record documented the presence of cardiomyopathy or clinical heart failure, or if any cardiac imaging study demonstrated a left ventricular ejection fraction <50%. Diabetes mellitus was confirmed if the medical record noted the presence of type 1 or type 2 diabetes mellitus or the use of diabetes medications. Hypertension, strokes, transient ischemic attacks, complex ventricular ectopy or nonsustained ventricular tachycardia, prior smoking, and presence of an implantable cardioverter-defibrillator (ICD) were confirmed if the diagnosis was established in the medical record. We did not collect numerical data, such as cholesterol levels, blood pressures, or number of cigarettes smoked. Due to the retrospective methodology, the presence and effects of treatment for these conditions, and the development or resolution of these conditions during follow-up, were not measured.
All individuals' sleep evaluations were conducted by a board-certified sleep specialist at the Mayo Clinic Sleep Disorder Center. We reviewed each individual's first diagnostic polysomnogram, which included measures of the electroencephalogram, electro-oculogram, electromyogram, electrocardiogram, thoracoabdominal excursions, pulse oximetry, and naso-oral airflow. The apnea-hypopnea index (AHI) was calculated as the sum of apneas and hypopneas per hour of sleep. We also collected the awake oxygen saturation, mean nocturnal oxygen saturation, lowest nocturnal oxygen saturation, arousal index, and sleep efficiency. According to American Academy of Sleep Medicine criteria, an AHI ≥5 established the diagnosis of OSA (11).
The collection of follow-up data and confirmation of the primary outcome were performed blinded to the collection of baseline and polysomnographic data and classification of OSA. Follow-up data were obtained for each subject from the date of polysomnography to the date of SCD or resuscitated SCD (see definitions), death from other causes, or last follow-up through December 31, 2003, ascertained with the Mayo Clinic electronic medical record, the Minnesota Department of Health database, and the National Death Index. To ascertain the use of continuous positive airway pressure therapy during follow-up, we considered that continuous positive airway pressure was used by a subject if it was prescribed after the sleep study and if the medical record subsequently confirmed its use. Due to the retrospective methodology, we could not quantify compliance with or effectiveness of continuous positive airway pressure therapy during follow-up.
Classification of SCD
The primary outcome of the study was fatal or resuscitated SCD. Manual review of death certificates and data from the Minnesota Department of Health provided the immediate and underlying causes of death. A state nosologist used the methods of the National Center for Health Statistics to assign causes of death. SCD was established when the cause of death was sudden cardiac death, (fatal) cardiac dysrhythmia, (fatal) cardiac arrhythmia, cardiac arrest, cardiorespiratory arrest, or coronary heart disease or myocardial infarction when the time interval from symptoms to death was specified ≤1 h. SCD was excluded if the medical record or death certificate provided information that explicitly contradicted this definition of SCD: "natural death due to cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute symptoms; preexisting heart disease may have been known to be present, but the time and mode of death are unexpected" and nontraumatic (12). The occurrence of SCD during sleep was an exception to the criteria for "loss of consciousness within 1 h of the acute onset of symptoms."
Resuscitated SCD included out-of-hospital and in-hospital resuscitated cardiac arrest, as well as the first-ever delivery of appropriate ICD therapy for ventricular tachycardia or ventricular fibrillation. By definition, the latter instances occurred in subjects with ICD implanted for primary prevention of SCD, because individuals with previous SCD were excluded from the study sample.
Statistical analysis
Analyses were performed using SAS Proprietary Software (release 8.2, SAS Institute, Cary, North Carolina). A 2-sided p value <0.05 was considered statistically significant for all analyses.
Baseline characteristics of the study population were described by counts (percentages), mean ± SD, or medians (interquartile ranges). Kaplan-Meier time-to-event analyses were performed to identify univariate predictors of SCD. Multivariate time-to-event analyses were performed using Cox proportional hazards regression to identify independent predictors of SCD. A stepwise parsimonious selection technique constructed a model with the possible parameters of age, sex, body mass index, obesity (body mass index ≥30 kg/m2), smoking history, hypertension, diabetes, coronary artery disease, cardiomyopathy or heart failure, and ventricular arrhythmias. To assess the risk of SCD posed by OSA, the following parameters were included into the model independently: OSA status, AHI, awake oxygen saturation, lowest nocturnal oxygen saturation, and mean nocturnal oxygen saturation.
We also performed classification and regression tree analyses to identify thresholds of relevant continuous variables that had the best discriminative power for predicting SCD. These analyses found the following thresholds: AHI 20; and lowest nocturnal oxygenation saturation 78%. These dichotomized variables were introduced into the univariate and multivariate models. A pre-determined subgroup of patients with OSA was created to assess the effects of continuous positive airway pressure therapy.
The study sample consisted of 10,701 adult residents of Minnesota, whose baseline characteristics are described in Table 1. Results of subjects' polysomnographies are described in Table 2. Follow-up occurred up to 15 years and averaged 5.3 years. During this time, 142 subjects had fatal or resuscitated SCD, which reflects an averaged annual risk of SCD of 0.27% for the study population. SCD was due to an unidentifiable or nondefinitive cause (due to out-of-hospital death and lack of autopsy) in 58 subjects, definite ventricular arrhythmia in 44 subjects, acute myocardial infarction in 18 subjects, massive pulmonary embolism in 1 subject, and resuscitated SCD (either via ICD therapy or advanced cardiac life support) in 21 subjects.
Clinical predictors and sleep parameters that predicted SCD in univariate analyses are shown in Table 3. Classification and regression tree analyses found that SCD was best predicted by these thresholds for the following continuous variables: age 60 years (hazard ratio [HR]: 5.53, 95% confidence interval [CI]: 3.84 to 7.94; p < 0.0001), AHI 20 (HR: 1.60, 95% CI: 1.14 to 2.24; p = 0.007) (Fig. 1), mean nocturnal oxygen saturation 93% (HR: 2.93, 95% CI: 1.98 to 4.33; p < 0.0001), and lowest oxygen saturation 78% (HR: 2.60, 95% CI: 1.85 to 3.65; p < 0.0001) (Fig. 2).
Risk factors for SCD in the multivariate analyses are shown in Table 4. In multivariate analysis, the classification and regression tree–determined lowest nocturnal oxygen saturation of 78% had an HR for SCD of 1.81 (95% CI: 1.28 to 2.56; p = 0.0008). The baseline characteristics of the pre-determined subgroup of OSA patients is shown in Table 5, and the results of multivariate analyses in this subgroup are shown in Table 6.
The principal and novel findings of the present study are that in a population of 10,701 adults referred for sleep studies, the presence of OSA predicted incident SCD and the magnitude of risk was predicted by multiple parameters that characterize OSA severity, including the AHI and nocturnal oxygen desaturation. Notably, the severity of nocturnal hypoxemia, which is an important pathophysiological feature of OSA, strongly predicted SCD independently of other well-established risk factors. Our analysis showed that for the lowest nocturnal oxygen saturation, the best discriminating threshold of 78% predicts an 81% increase in the risk of SCD.
Biological plausibility
There is a cascade of possible pathophysiological mechanisms linking OSA to SCD during the daytime and during sleep (6). Obstructive apneic events cause systemic hypoxemia, which is sometimes severe and prolonged. These repetitive oxygen desaturations in OSA patients may cause ventricular ectopy. Hypoxemia, with associated hypercapnia, also activates the chemoreflex, which increases vascular sympathetic nerve activity and serum catecholamines. Tachycardia and surges in blood pressure at the end of apneas result in increased myocardial oxygen demand at a time when oxygen saturation is at its lowest, a situation that may lead to myocardial ischemia and potentially dysrhythmic consequences. Individuals with OSA also have a paradoxical increase in coagulability during the night. Platelet activation and aggregation are increased, fibrinogen levels are increased, and fibrinolytic activity is decreased during sleep in patients with OSA.
An increased risk of SCD in individuals with OSA may also be explained by cardiac autonomic dysfunction. OSA affects mechanisms mediating heart rate variability, including central nervous system coupling between cardiac and ventilatory parasympathetic inputs, the arterial baroreflex, and feedback from pulmonary stretch receptors (13). As a result, heart rate variability is decreased in patients with OSA (14). In addition, the electrocardiographic corrected QT interval, which represents the duration of ventricular repolarization, and corrected QT interval dispersion, which reflects the heterogeneity of repolarization, are abnormal in patients with OSA. Corrected QT interval dispersion correlates directly with the AHI and the duration of nocturnal hypoxemia (15). Furthermore, the increase in sympathetic drive persists during the awake daytime period in individuals with OSA (16). Although the precise link between autonomic function and SCD remain largely unknown (17), chronic sympathetic overdrive has been identified as a risk marker for SCD (18). Also, OSA is present in a large proportion of patients with heart failure, and has been implicated in chronic left ventricular dysfunction (19,20), thus contributing to neurohumoral activation and myocardial remodeling that produce the substrate for SCD.
Previous studies
A controlled, multicenter study showed that during sleep nonsustained ventricular tachycardia occurred in 5.3% and complex ventricular ectopy occurred in 25% of patients with sleep-disordered breathing, which included OSA as well as central sleep apnea (21). After adjustment for comorbidities, patients with sleep-disordered breathing had a 3.4-fold risk of nonsustained ventricular tachycardia and a 1.7-fold risk of complex ventricular activity compared with patients with normal sleep. The only previous controlled longitudinal study assessing the risk of SCD in patients with OSA compared the rate of SCD after an average of 7.5 years in 107 OSA patients who were compliant with continuous positive airway pressure therapy and 61 OSA patients who had discontinued therapy. SCD occurred in 4 patients (7%) with untreated OSA and in no patients (0%) with treated OSA (there was 1 arrhythmic death in a treated patient during coronary bypass surgery) (22). Additional observations supporting the influence of OSA on the occurrence of SCD are the strikingly different day-night patterns of SCD in patients with OSA compared with the general population. We had previously shown that individuals with OSA had an increased risk of SCD from 10 pm to 6 am and that individuals without OSA had a diurnal pattern of sudden death that was similar to that expected in the general population, with a peak between 6 am and noon (9). In that study, individuals with OSA had a 2.6-fold risk of nocturnal SCD, and the severity of OSA correlated with the magnitude of this risk. Our present findings suggest that this increase of SCD during the night may represent "excess" deaths, rather than simply a shift of SCD from other times of the day to the night.
Causes of SCD
The mechanism of SCD is usually considered to be a ventricular arrhythmia. However, a number of other processes can mimic the unexpected and rapidly fatal presentation required by the definition of SCD. In our study sample, 13% of SCD were attributed directly to myocardial infarction, which may be explained by fatal sequelae such as cardiogenic shock or mechanical complications, as well as potential misclassification due to unrecognized ventricular arrhythmias. SCD may also result from other cardiovascular events, such as massive pulmonary embolism (1 subject in our study), aortic dissection, and subarachnoid hemorrhage. Another less recognized but potentially important cause of sudden death in patients with OSA is apnea itself. An obstructive apnea may not terminate due to ineffective arousal mechanisms related to impaired chemosensitivity, which leads to profound cerebral hypoxemia and death. Three such cases, with polysomnographic and electrocardiographic monitoring, have been described (23,24).
Study limitations
To mitigate referral bias, we restricted the study sample to state residents. The study sample was drawn from individuals referred to the sleep disorder center at our institution, which may limit generalization of our findings to nonselected community residents. The average annual rate of SCD in the study population was 0.27%, higher than the estimated annual risk of SCD in the general population of 0.1% to 0.2% (12), thus reflecting the referral pattern to our sleep disorders center.
The limits of a retrospective analysis are inherent to this study, including the 1-time assessment of subject comorbidities at the time of their sleep studies and use of dichotomous variables to classify the presence or absence of specific conditions that exist on a spectrum of risk, such as cholesterol levels or blood pressure. Also, other relevant comorbidities may have existed. The retrospective analysis limits the interpretation of the results of continuous positive airway pressure therapy in the subgroup analysis of individuals with OSA. The medical records rarely contained data regarding the frequency, duration, or effectiveness of continuous positive airway pressure therapy in our subjects, and continuous positive airway pressure machines that assess compliance were generally not used during the study years.
Another limitation relates to the challenges of classifying SCD. We used standardized methods using the best available data and current definitions to confirm or exclude diagnoses of SCD in our study sample. The use of state records and death certificate data has been performed and validated in prior epidemiological studies of SCD, including our regional population (25–27). We improved on past methods by directly reviewing every available death record from the larger population to confirm the diagnosis based on current definitions of SCD (12).
Last, a possible limitation is related to the interpretation of ICD therapies for SCD classification. A subanalysis of an ICD trial has questioned the basis for using ICD therapy as a surrogate for SCD (28). Our methods are in accordance with the vast majority of ICD trials, in which ICD therapy has been considered a resuscitated SCD.
In this cohort study of 10,701 adults referred to a sleep disorders clinic and undergoing diagnostic polysomnography for the first time, the risk of incident SCD after an average of 5 years was significantly and independently associated with OSA, based both on the frequency of apneas and hypopneas and on the severity of nocturnal oxygen desaturations. These findings should encourage ongoing research of the mechanisms of SCD in individuals with OSA, as well as the development of clinical trials of OSA therapy in select populations at risk for SCD.
This research was supported by grants #HL65176 and #NIH 1 UL1 RR024150 from the National Institutes of Health. Dr. Gami has served as a consultant for Medtronic, Boston Scientific, and St. Jude Medical. Dr. Wright has received consulting fees from Roche/Genentech, Sanofi Regeneron, and 3M. Dr. Somers has served as a consultant for ResMed, Medtronic, Apnex Medical, Sova Pharmaceuticals, Deshum, and NeuPro; has received support from a gift from the Phillips-Respironics Foundation to the Mayo Foundation; and is working on intellectual property related to sleep and heart disease with Mayo Health Solutions and Mayo Medical Ventures and Industry Partners. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Abbreviations and Acronyms
- apnea-hypopnea index
- confidence interval
- hazard ratio
- implantable cardioverter-defibrillator
- obstructive sleep apnea
- sudden cardiac death
- Received January 24, 2013.
- Revision received April 7, 2013.
- Accepted April 7, 2013.
- American College of Cardiology Foundation
- ↵(2003) Anonymous. Preventing Heart Disease and Stroke: Addressing the Nation's Leading Killers (Centers for Disease Control and Prevention, Department of Health and Human Services, Atlanta, GA).
- ↵
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- Spooner P.M.,
- Albert C.,
- Benjamin E.J.,
- et al.
- Spooner P.M.,
- Albert C.,
- Benjamin E.J.,
- et al.
- ↵
- Gami A.S.,
- Somers V.K.
- ↵
- Gami A.S.,
- Somers V.K.
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- ↵
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- Priori S.G.,
- Aliot E.,
- Blomstrom-Lundqvist C.,
- et al.
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- La Rovere M.T.,
- Pinna G.D.,
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- et al.,
- ATRAMI Investigators
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- Tkacova R.,
- Rankin F.,
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- Pearce S.,
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- Lohman W.,
- Jacobs D.R. Jr..
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- et al.,
- DEFINITE Investigators


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The advertising regulator has launched an investigation into the government's climate change TV campaign after receiving more than 350 complaints accusing it of scaremongering and misleading the public.
The Department of Energy and Climate Change launched the £6m campaign, in which the government states for the first time that scientific evidence has confirmed that climate change is man-made, earlier this month.
The Advertising Standards Authority has received 357 complaints about the campaign.
Some of the complaints argued that there is no scientific evidence of climate change. Others claimed there was a division of scientific opinion on the issue and that the ad should therefore not have attributed global warming to human activity.
Another complaint was that the ad, which features a father telling his daughter a scary bedtime story about climate change in which a cartoon dog drowns, is inappropriate for children because it is "upsetting and scaremongering".
The ASA has said it intends to investigate the complaints and the assertions on which the campaign has been based.
The campaign marked a step change in the tone of the government's marketing around its Act on CO2 initiative. The DECC came out with the hard-hitting message after research showed that more than half of the UK public think climate change will have no effect on them.
Last week the DECC defended the campaign, and the science behind it, arguing that the goal is to "protect the next generation".
"It is consistent with government policy on the issue, which is informed by the latest science and assessments of peer-reviewed, scientific literature made by the Intergovernmental Panel on Climate Change (IPCC), and other international bodies," said the energy and climate change minister Joan Ruddock.
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and their users, however, to most the problem appears too out of hand.
"Others see potential profit in legalizing drugs and still others
simply believe that individual rights to take drugs should be
protected. The group also acknowledged that the legalization concept
appeals to people who are looking for simple solutions to the
devastating problem of drug abuse" (Internet). Societys answer to
the problem is to trick the drug user by giving him what he wants.
People believe that making drugs legal will take away the temptation
to use them. This idea is wrong and far from logical. If drugs are
legalized then they will be more accessible to the young, addicted,
and ignorant.
"As a result the ready availability of addicting drugs, and as
a result of their heavy use for medical problems, many individuals ...
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Other activities, Children's activities Adventurous house with Boda Borg quests, electric go-karts (capable of doing up to 70 km/h), climbing wall, a laser arena, billiard, mini golf, games arcade. Read more
Bathing, Spa/Health, Children's activities Storsjöbadet pools are both a playground for all the family and an oasis for those seeking a quiet moment for body and soul. For visitors who like action and speed the main attr... Read more


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Combichrist Comments On New Industrial Masterpiece "This Is Where Death Begins"
Combichrist started in Norway in the early '90s by Andy LaPlegua. He was enraptured by the ambiance found in industrial music. While techno bars are a common site in Europe now, LaPlegua's hometown was unaccustomed to the hard beat at this time. Being such a small town, the musicians were part of a close-knit scene where he lent his time to various projects and genres. Metal was his main love and if it weren't for a legendary black metal player, LaPlegua would have never known the dark sonic passageways of industrial music. This new discovery led to him trying something different, which alienated the metal scene but brought in new faces.
While LaPlegua disenchanted his metal scene when he formed Combichrist, now many of his early followers of Combichrist dispute his new-found direction. "This is Where Death Begins," the group's eighth studio full-length, shows the group stepping away from the synth-based electronica of their earlier period and donning a more metallic shell. This new-found direction has led to the most success of the band's career. "This is Where Death Begins" is on pace to be his all-time best selling album. This was done without feeling trapped by the approval of his fans. The band recently played in front of a massive crowd at Knotfest and has been on tour with Cavalera Conspiracy. With a six-man live group, including two drummers and two guitarists, Combichrist puts on an energetic show few can duplicate.
On the off days of the Cavalera tour, Combichrist heads to smaller cities to headline their own shows. These concerts give their fans much meatier performances, including a set list culled from throughout their career plus many current favorites. Before they took the stage in Austin, Texas, Andy LaPlegua spoke with me about their new album and tour.
Rex_84: You're halfway through your North American tour with Cavalera Conspiracy. Tonight is a headline show for you. How's the tour going?
Andy LaPlegua: It's been great. The guys are really cool. We've had a great draw. We're close to the dudes, already. We have some days off that we've filled in with headline shows. It's doing really good. It's good for us with the direction we're taking. It's the right crowd for it. It's funny because it's their "Roots" tour, but it's kind of our roots, too. It's kind of ironic, but we're getting back to our roots from the metal scene but way back. We kind of cruised the electronic and industrial stuff but we're back into it again.
Rex_84: When you started the band, were you more metal? I thought it was synth-based?
Andy: Combichrist in itself was basically electronic/power noise stuff like electronica stuff, but before that I came from metal, hardcore, punk rock and stuff like that in the '90s. Really, the only reason I started Combichrist was to venture out and try something new. I was sick and tired of band members. Nobody knew what they wanted to do. Somebody had a day-job and could never get their ass on tour. I'm 41 and I've been touring since I was 16. Eventually I got sick and tired of people not knowing what I wanted to do, so I was like "fuck it! I'll just get some electronic equipment and fuck around with it." That eventually turned into Combichrist. We're gradually getting back to where we were, but have picked up all of our influences, all the small shit from the whole time of Combichrist and I mixed it with where I came from and packaged it all together.
Rex_84: Europe has a huge techno scene. How much did that play on influencing your music in Combichrist?
Andy: Not in the '90s. In the '90s I was into punk rock, metalcore and metal. That was all I was doing. In the '90s there really wasn't a big electronica scene in my hometown. It was mostly metal, death metal and hardcore. That was my scene. It was such a small city that even the guys that did hip hop and synth pop. Those were the things people were into. We were all musicians. We are all doing bands so I could be sitting in a studio and helping somebody out on a hip hop project one day or play bass for a grindcore band the next time. I would play in my punk band one day and then go and play with my metalcore band the next day. It's kind of a crazy city; it's all so tight. Even the black metal scene was part of our scene at that time.
Rex_84: Did you know any of the big-name black metal bands?
Andy: Yes, I knew all of those guys. I grew up, basically, in the same scene. I kind of discovered industrial stuff kind of early. That was all because of Euronymous. I would go to his record store and get metal stuff all the time. He was the first one in Norway to really start selling dark music. We were in his store all the time picking up cool stuff. He was like, "you have to check this out. It's really dark!" It was full-blown industrial. He was already open to it back then.
Rex_84: He liked the atmosphere.
Andy: Exactly. And that's kind of what I wanted in there when I started doing electronica. I wanted that atmosphere. I remember the first time I saw an industrial band live and it was like, "Fuck! This is darker than any black metal band I've ever seen!" just the atmosphere in itself. That's why I want to keep, no matter how far we're in a metal direction, I want to keep that atmospheric, cinematic, industrial feel into it. Even if we end up being like a metalcore band again, we're still going to have that in there. It needs to be in there because it keeps a certain emotion.
Rex_84: What's it like watching Sepultura perform "Roots every night?
Andy: It's crazy because I remember we played a show when they did the original "Roots" tour. I played with my old metalcore band the day after them in the same venue with Machine Head and Crowbar. We got into the city the day before. I didn't even know they were playing, so I saw them back then on the original tour, so actually being able to play that tour now is fucking crazy.
Rex_84: You have a VIP challenge to your fans, which gives them a chance to win a tour bus party pass. What does this challenge entail? Are you enjoying spending this time with your fans?
Andy: Yeah, dude. We used to the do the meet-and-greets before the show. We used to do like 30 people that came into the venue. It wasn't really personal, so we cut it down to five people and do it on the bus instead of. We just hang out on the bus, 21 and up, and we have a ton of alcohol out. We just drink and bullshit and hang out. It's way more personal. In the VIP challenge we have this one extra thing. It's just a party gag. Sometimes it's a chugging contest. The other day we put a bowl of whiskey on the floor and whoever crawled on the floor, drank it without their hands and meowed would win it. There is different shit. It's whatever we come up with. It's just for the party. Just having a good time.
Rex_84: Combichrist played Knotfest meets Ozzfest last weekend. How was this show? What was the crowd response like?
Andy: It was awesome. We couldn't see shit because it was so dusty. It was in the middle of the desert. There were three mosh pits going on at the same time and it was like watching a Mad Max movie. All we could see was dust and people going crazy. It was awesome. I loved it. It was fun, though. We had a good time. We got to see a lot of good bands. We saw Amon Amarth and Suicide Silence.
Rex_84: Were you on hand for Ozzfest, too?
Andy: We got to see Ozzfest, though we got in kind of late. We got there just in time to see Megadeth. That was awesome. Sabbath was killer, obviously. I've seen Sabbath several times, but this was, hands down, the best Sabbath show I've ever seen. It was so fucking good. They were all on. I think they all gave everything because this was supposed to be their last West Coast show ever. Even Ozzy didn't seem that old when he was up there. He really rocked it. Of course, Slayer fucking killed it. Slayer always kills it.
Rex_84: Playing an event like this and being on a tour of such magnitude must be huge for your career. Do you see your fan base rapidly growing? What do you attribute that to?
Andy: When we do headline shows like this, it's in smaller cities in between. The fan base is pretty much constant because we have that hardcore fan base that will come out. We never really do huge things here, those kinds of festivals, because few of those people come back in. Europe is huge for us now because all we've done in the last few years is like Wacken, Summer Breeze, Rock am Ring. That's been huge for us in Europe. Knotfest was basically the first festival we've ever done in North America. We've never really done any festival shows here. We've just been doing venue shows for years and years. That was definitely awesome. We do Europe all the time.
Rex_84: "This Is Where Death Begins" has been out for a few months. How do you feel about the record now that you can reflect on it for the last few months?
Andy: I'm so happy with it. I'm almost to the point where I don't feel like playing any songs from any of the other albums because of the chemistry of us as a live band now. We have two drummers, two guitarists and a bass player. There are six people on stage now. In the past we had so much electronica stuff. All of that seems gone now. We're basically playing as a full live band now and the atmosphere on stage is just different. We're all energized and we all love the new material. We're having so much fun playing it. That makes a good album for us. If the album was good on record but it didn't feel good live, it wouldn't have been a good album to me.
Rex_84: How's the new material going over live? It seems like there are a lot of songs that have chorus lines and refrain that people can really sing to.
Andy: It's going well. We're still doing a lot of old material because you have to keep people happy as well. After eight albums it's really hard to pick a play list to make everybody happy. It's kind of like our favorite list. There are still a couple of songs from the new album that we haven't played live yet that we really want to the next time we're on. This is kind of like we're teasing into it and promoting the album. We do quite a lot of the new material. The response has been great. A lot of people, like the old school fans, hated it when it came out because they are so hardcore electronica. I hate to look at numbers, but we sold twice as much as we did on the previous album in two years. The album has been out for three months. So with that point, should I really worry about the people that complain about it? I have to be happy about seeing that it's doing well because the album is done. I did it not to be successful. I did it because I'm happy with it. I did it because I wanted to do that album. I never changed anything to get commercial success or anything like that. It's way harder than any other album we've done. It's way darker. Some people don't except change. It's surprising to me because every Combichrist release has been different, so I'm really surprised that people don't get that we will do something new.
Rex_84: There are also songs like "We Are the Plague," "My Life My Rules" and "Don't Care How You Feel About It" about doing things your way and not letting people hold you down. On "Destroy Everything" you even say "you can't be a shark if you're a lamb." Is this a theme on the album?
Andy: It is. Also the title "This is Where Death Begins" is not about death, it's about rebirth. Death begins with life. Death begins with birth. So this is kind of a rebirth of the band, so it's like, "If you don't like what I'm doing with the band, fuck you! If you don't like how I feel, fuck you! If you like what we're doing, you're with us. You understand what we're doing." It doesn't only go for the music. It also goes on a personal level. A lot of people get it. A lot of people get that it's not about what other people want from you, it's about what you want to do with your life. This is what I'm doing with music. I've never done it differently. I lost my entire following in the hardcore scene when I started doing electronica. They were like, "what the fuck are you doing?" and suddenly I wasn't part of the scene anymore. To be honest, I didn't give a shit because that is what I wanted to do.
Rex_84: That's like David Vincent from Morbid Angel lives here and he plays country. People make fun of him, but he's doing what he wants to do.
Andy: Do you know how much shit David got when we did an electronica version of one of Morbid Angel's songs? He didn't give a fuck. He released it because he likes us. We love him, too. We are good friends. He just likes what we're doing. We like what he's doing. Why not cooperate and see where it went?
Rex_84: "Black Tar Dove pt 1" and "Black Tar Dove pt 2" are certainly connected tracks. How does the music and lyrics help tell a story and what story are you telling?
Andy: It's basically one song. I kind of saw the whole song as a short movie. There is no real meaning to real life. I just had this demon figure in my head controlling the world like a puppet master. I had all of these images in my head and I thought, "How am I going to put this all down as words?" That's how it ended up. The music came secondary. I knew I had to get a certain feeling with this track. It needs to be a certain way and then I started working on it and thought it was going in the right direction. People are going to hate it but I don't give a shit. We're bringing "Black Tar Dove" and "Homeward" into the set list for the next tour.
Rex_84: You mentioned imagery. "Homeward" has interesting imagery with the raven. Tell me a little about the raven and the metaphor you're working with?
Andy: The whole idea with "Homeward" where we say "this is where death begins" is about the life circle, it's conceptual throughout the album. It's a life circle and homeward is the end. You're going home, you're done. You're walking through your life and you can see everything that happened. You're following this raven into death. You're catching all of this imagery of your life as you walk through these empty streets. There are riots that you're walking through and nobody even knows you're there. You're walking through this maze. Same thing there, I have this short movie kind of vibe to it. I had this idea of Jack the Ripper times with glowing street lamps, cobblestone roads, and people fighting in the streets with billy clubs. All of these characters have a meaning from this character's life and he's walking to the end. It's kind of like the saying that life flashes before your eyes, that's what "Homeward" is.
What do you have planned for after this tour?
Andy: We're doing a festival in Germany on Christmas. It's going to be a fun one. Except for that, I'm going back to the studio in November and December to work on new material or going through the album and see if we want to do another video. I have so many ideas for different videos. I have some ideas for "We Are the Plague." It's massive. I don't know how to put it into action. We'll see how it goes. Hopefully I can come up with the right way to approach it, get it done on paper and get it out to a director to see what we can do. November and December will be my creative home base month. Next year we'll see what happens. We're already talking about doing another North American tour in the spring. I don't know with who yet. I have a few ideas. I have a few people I've been talking to. Either way if it comes together, it's going to be awesome. We're definitely going to do a bigger production and revamp a little bit. We're kind of bare bones on this production. We don't have a light production. We didn't want to bring anything. We just wanted to do the show to prove ourselves that we didn't really need anything as a live band. People can come out and see us now to see that we put on a good show without the production. So many bands are nothing without production. We just wanted to go out, bare-bones rock 'n' roll on this one, come back and do something more massive. That's the idea at least.
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- 2015-02-13
Laparoscopic Roux-en-Y gastric bypass redo after failed mini gastric bypass
Epublication WebSurg.com, Feb 2015;15(02). URL: http://websurg.com/doi/vd01en4371
Nowadays, bariatric surgery involves a wide range of operative procedures. Among these, there is the mini gastric bypass, which was initially described by Rutledge during the early 2000s. Here, we describe the case of a female patient having undergone a mini gastric bypass in 2009, which led to important weight loss followed by a complete weight regain. The preoperative imaging control with contrast swallow revealed a large gastric pouch. A conversion to a laparoscopic Roux-en-Y gastric bypass was decided upon.


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Novartis' new heart failure medicine LCZ696 cut cardiovascular deaths by 20% vs. ACE-inhibitor in landmark PARADIGM-HF trial
- Study showed significantly more HF-REF patients on LCZ696 regimen were alive, had fewer hospitalizations than those given enalapril regimen1
- On all-cause mortality, LCZ696 doubled the effect that enalapril, an ACE-inhibitor, previously showed vs. placebo when added to current best treatment for HF-REF1,2
- Over 5 million people suffer from heart failure in the United States, facing a high risk of death and poor quality of life, despite currently available medicines3,4,5,6
The magnitude of benefit with LCZ696 against enalapril in HF-REF patients was highly statistically significant and clinically important. In the study, the benefit of LCZ696 was seen early, was sustained and was consistent across subgroups. LCZ696:1
- - reduced the risk of death from cardiovascular (CV) causes by 20% (p=0.00004)
- - reduced heart failure hospitalizations by 21% (p=0.00004)
- - reduced the risk of all-cause mortality by 16% (p=0.0005)
Overall there was a 20% risk reduction on the primary endpoint, a composite measure of CV death or heart failure hospitalization (p=0.0000002).1
"By demonstrating a very significant reduction in cardiovascular deaths while improving quality of life, Novartis' new heart failure medicine, LCZ696, represents one of the most important cardiology advances of the last decade," said David Epstein, Division Head, Novartis Pharmaceuticals. "We want to thank leading cardiologists from around the world for their collaboration with us and their determination in advancing this important new life saving therapy for heart failure patients."
LCZ696, a twice a day tablet being investigated for heart failure, has a unique mode of action which is thought to reduce the strain on the failing heart.7,8 It acts to enhance the protective neurohormonal systems of the heart (NP system) while simultaneously suppressing the harmful effects of the overactive RAAS (renin-angiotensin-aldosterone system).7,8 Currently available medicines for HF-REF work only to block the detrimental effects.9 Despite existing therapies, the mortality rate remains very high with up to 50% of patients dying within 5 years of a diagnosis of heart failure.3 Approximately half of patients with heart failure have HF-REF.10
Analysis of the safety data from PARADIGM-HF showed side effects were manageable in the study.1 Fewer patients on LCZ696 discontinued study medication for any adverse event compared to those on enalapril (10.7% vs. 12.3%, respectively; p=0.03). The LCZ696 group had more hypotension and non-serious angioedema but less renal impairment, hyperkalemia and cough than the enalapril group. The most common adverse events with LCZ696 (incidence ≥10%) compared to enalapril were elevated serum potassium of more than 5.5 mmol/liter (16.1% vs. 17.3%), symptomatic hypotension (14.0% vs. 9.2%) and cough (11.3% vs. 14.3%).1
Novartis plans to file the New Drug Application for review with the US FDA by the end of 2014.
About the PARADIGM-HF study
PARADIGM-HF is a randomized, double-blind, Phase III study evaluating the efficacy and safety profile of LCZ696 versus enalapril (a widely studied ACE-inhibitor) in 8,442 patients with HF-REF.7,11,12 The baseline characteristics showed the patients enrolled were typical HF-REF patients with NYHA Class II-IV heart failure.11 PARADIGM-HF was specifically designed to see if LCZ696 could decrease CV mortality by at least 15% vs. enalapril.7 Patients received LCZ696 or enalapril in addition to current best treatment regimen. The primary endpoint is a composite of time to first occurrence of either cardiovascular death or heart failure hospitalization, and the trial is the largest heart failure study ever done.7
Secondary endpoints are change in the clinical summary score for heart failure symptoms and physical limitations (as assessed by Kansas City Cardiomyopathy Questionnaire) at 8 months; time to all-cause mortality; time to new onset atrial fibrillation; and time to occurrence of renal dysfunction.7 PARADIGM-HF was initiated in December 2009, and in March 2014 the Data Monitoring Committee confirmed that patients given LCZ696 were significantly less likely to die from CV causes, and that the primary endpoint was met, leading to the trial being stopped early.13
About LCZ696 in heart failure
LCZ696 is an ARNI (Angiotensin Receptor Neprilysin Inhibitor) and has a unique mode of action which is thought to reduce the strain on the failing heart.7,8 It acts to enhance the protective neurohormonal systems of the heart (NP system) while simultaneously suppressing the effects of the overactive renin-angiotensin-aldosterone system (RAAS).7,8
Heart failure is a debilitating and potentially life-threatening disease in which the heart cannot pump enough blood around the body. Symptoms such as breathlessness, fatigue and fluid retention can appear slowly and worsen over time, significantly impacting quality of life.4
Heart failure presents a major and growing health-economic burden that currently exceeds $30 billion in the United States, which accounts for both direct and indirect costs.3
The foregoing release contains forward-looking statements that can be identified by words such as "being investigated," "thought," "plans," "growing," "mission," or similar terms, or by express or implied discussions regarding potential marketing approvals for LCZ696, or regarding potential future revenues from LCZ696. You should not place undue reliance on these statements. Such forward-looking statements are based on the current beliefs and expectations of management regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that LCZ696 will be approved for sale in any market, or submitted for approval in any additional markets, or at any particular time. Neither can there be any guarantee that LCZ696 will be submitted or approved for any additional indications or labeling in any market, or at any particular time. Nor can there be any guarantee that LCZ696 will be commercially successful in the future. In particular, management's expectations regarding LCZ696 could be affected by, among other things, the uncertainties inherent in research and development, including unexpected clinical trial results and additional analysis of existing clinical data; unexpected regulatory actions or delays or government regulation generally; the company's ability to obtain or maintain proprietary intellectual property protection; general economic and industry conditions; global trends toward health care cost containment, including ongoing pricing pressures; unexpected manufacturing issues, and other risks and factors referred to in Novartis AG's current Form 20-F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.
About Novartis
Novartis Pharmaceuticals Corporation researches, develops, manufactures and markets innovative medicines aimed at improving patients' lives. We offer a broad range of medicines for cancer, cardiovascular disease, endocrine disease, inflammatory disease, infectious disease, neurological disease, organ transplantation, psychiatric disease, respiratory disease and skin conditions. The company's mission is to improve people's lives by pioneering novel healthcare solutions.
Novartis is on Twitter. Sign up to follow @Novartis at http://twitter.com/novartis.
- McMurray JJV, Packer M, Desai AS, et al. Angiotensin-Neprilysin Inhibition versus Enalapril in Heart Failure. N Engl J Med. 2014. doi: 10.1056/NEJMoa1409077.
- The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. N Engl J Med. 1991;325:293–302.
- Go A, Mozaffarian D, Roger V, et al. Heart Disease and Stroke Statistics––2014 Update: A Report From the American Heart Association. Circulation. 2014;4(129):e28-e292.
- Fauci A and Longo D. Disorders of the Heart. Harrison's 'Principles of Internal Medicine. 17th ed. 2008;4:1442-55.
- Junger J, Schellberg D, Kraemer S, et al. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart. 2002;87(3):235-241.
- Levy D, Kenchaiah S, Larson M, et al. Long-Term Trends In The Incidence Of And Survival With Heart Failure. N Engl J Med. 2002;347(18):1397-1402.
- McMurray JJ, Packer M, Desai AS, et al. Dual angiotensin receptor and neprilysin inhibition as an alternative to angiotensin-converting enzyme inhibition in patients with chronic systolic heart failure: rationale for and design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur J Heart Fail. 2013;15:1062-73. doi:10.1093/eurjhf/hft052.
- Langenickel TH and Dole WP. Angiotensin receptor-neprilysin inhibition with LCZ696: a novel approach for the treatment of heart failure. Drug Discovery Today: Therapeutic Strategies. 2012;9(4):e131-e139. doi: 10.1016/j.ddstr.2013.11.002.
- Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;128:e240-e327. doi:10.1161/CIR.0b013e31829e8776.
- Vasan R, Larson M, Benjamin E, et al. Congestive Heart Failure in Subjects with Normal Versus Reduced Left Ventricle Ejection Fraction. J Am Coll Cardiol. 1999;33(7):1948-1955.
- McMurray JJ, Packer M, Desai AS, et al. Baseline characteristics and treatment of patients in Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF). Eur J Heart Fail. 2014;16:817-825.
- Clinicaltrials.gov. This Study Will Evaluate the Efficacy and Safety of LCZ696 Compared to Enalapril on Morbidity and Mortality of Patients With Chronic Heart Failure (PARADIGM-HF). NCT01035255. http://clinicaltrials.gov/show/NCT01035255. Accessed August 2014.
- Novartis. PARADIGM-HF trial of Novartis' LCZ696 for chronic heart failure closes early based on strength of interim results. Novartis U.S. Newsroom. March 31, 2014. http://www.novartis.com/newsroom/media-releases/en/2014/1772754.shtml. Accessed July 2014.
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text: Due to lack of snow, we've become creative with adding in Saturday events – which will continue EVEN during our April shutdown. Click the 'Events' tab at the top of the page, or check the Bargain Hunter… then join us for some fun! Some are music, some are Trivia or Open Mic – always with some funky beverages and munchies (newest one is Pretzel Bites with Cheddar Beer Sauce or Queso Cheese!)


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Property Description
Here's your rare chance to own 83+/- acres in the scenic landscape of Ozaukee County, Wisconsin. This farmstead is a true gem of Kettle Moraine real estate, boasting a plethora of desired land features. Without a doubt, properties of this magnitude don't shy around too often in Southeastern Wisconsin.
The driveway off of Granville Road takes you back to the 1900s farmhouse where nostalgia instantly settles in. From this point, you can stare out over the nearly 32+/- acres of tillable farm ground. Wooded pockets and fence lines break up the Western backdrop, a perfect spot to view Wisconsin sunsets.
Endless Summers can be spent fishing and swimming in the pond, while having a cookout at the Log Cabin. As Fall approaches, the oaks and maples will begin to paint a different picture, turning this property into a true Wisconsin hunting camp.
In addition to the tillable land, this property features an awesome, varying topography. From oak ridges, marshy lowlands, to the small creek, this property has a little bit of everything. Turkey and deer tracks cover this wonderful piece of dirt. The sheer number of runways, rubs, and scrapes are true to please any level of outdoorsman.
This profound piece of real estate offers many different options for the new owner. Whether looking to construct a private estate, a corporate retreat, or that escape from the city, this property is ready. For more information, showings, and questions, please contact Wisconsin Brokers: Al Wisnefske at 262-305-7494 // [email protected] or Kevin Raether at 920-342-0905 // [email protected]
Property Details
Key Features
- - Land For Sale in Ozaukee County, WI
- - Recreational Land For Sale in Ozaukee County Wisconsin
- - Trophy Deer Hunting Land in Wisconsin
- - Ozaukee County Deer Hunting
- - Al Wisnefske Wisconsin Land Specialist
- - Al Wisnefske Wisconsin Realtor
- - Kevin Raether Wisconsin Land Specialist
- - Kevin Raether Wisconsin Realtor


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Some of my favorite things about the JavaFX SDK Preview
I'm sure you all saw that our JavaFX team released a preview of the SDK at the end of July. I've been happily tinkering with it for the last few days. If you are hacking with AJAX, moonlighting with Silverlight, or fumbling with Flex, I think you should get up close and personal with it too, and see what its all about.
We've been talking about JavaFX in various ways for some time now, so you probably already know that its for building rich client applications, that it itself is built using Java, and that it will span multiple devices - from small mobile phones through TV settop boxes to the PC desktop and browser. Most importantly, if you are a traditional Java programmer (I include myself), you will notice there's a paradigm shift. A shift moving from the Java programming environment, whose generality spans quite an astonishing range of applications, to a programming environment specially designed for those amongst us with more developed visual design skills than technical ones (sadly, I cannot include myself). Those who are focused on one kind of application: interactive and fabulous looking.
Looking ahead a little, the plan here is to release the final version of the SDK for the desktop at the end of this year and a preview of the mobile version next March or so. I say or so, not just because schedules are schedules, but because we are ready to adjust based on the feedback we get from this preview release.
Anyhow, some of my favorite things about this preview release are:-
The Language: JavaFX Script
Described in full in the language guide included in the SDK, this new language is highly declarative (i.e. it says what its going to do, rather than saying how to do it), with features like data binding to let you to bind one variable to another variable. Like,
let oneVariable = bind anotherVariable;
(I did say it was declarative). Or like the triggers feature, so that when the value of one variable is replaced, you can have something else happen at the same time.
attribute oneVariable
on replace doSomethingElse();
To a Java programmer its going to be an easy new language to pick up because it shares much of its syntax with the Java language. To a designer, its going to be an easy new language to pick up because its clean, straightforward and does on the screen what it says in the code. And it has no baggage to carry.
The APIs
Neatly divided into two profiles (which you can see here) - the common profile for all the APIs that will be available on every device, and the desktop profile for all the APIs that make sense only for applications on a desktop. There's a mobile profile to come of course in the mobile release next year, which will have the common profile plus APIs that make sense on mobile devices.
As part of the common profile, you have the scene graph and the media JavaFX APIs. The GUI of an application is modeled as a graph of visual nodes, (each node being a shape, line, piece of text, GUI widget or embedded media), that moves, twists, rearranges as the user interacts with it. The scene graph API in JavaFX is especially well suited to the transition effects and animations that make all the difference between a user experience and a captivating user experience. The media supported in the scene graph includes a player control and support for OS native formats. You'll remember we inked a deal with On2 to provide cross device media support in May. Well that will have to wait a little longer before we can put that in. But we're all crossing our scene graph nodes that it will be soon.
The desktop profile includes the common profile, plus some desktop specific extras like…many of the tried and tested Swing widgets we know and love: buttons, combo boxes, lists and so on. So no shortage of the basics you need there.
And of course, being built in Java and on Java, you can always reach down into the underlying Java APIs for your favorite Java API if you would like to use that in your application too.
NetBeans integration and Project Nile Plugins
Naturally, the SDK is available pre-integrated with NetBeans 6.1 which is how I've been looking at it, as have others. The language and APIs are supported in the IDE with all the things you would expect like syntax coloring and checking, debugging and so on. Together a tutorial and a range of samples. The samples are generally short and to the point. Want to see how to draw polygons ? There's a sample just for that. Want to see how to use keyframe animation to bring life to randomly moving particles ? There's a sample just for that. Transparency, color gradients, bounce a ball ? Check, check, check.
Also included in the SDK is a collection of plugins (codenamed Project Nile) to Adobe Photoshop and Illustrator so you can keep working on the art there, and use Project Nile to export it into your JavaFX application and bring some life to it.
My other favorite thing is that this is all running on Java SE. So applications created in JavaFX aren't just running on any old VM, its running on a supremely stable, scalable and high performing runtime. But I don't have time to tell you about all that just now.
There's more to the SDK than just my favorite things. If you've been curious about JavaFX, now is a good time to take a look for yourself.


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CERTUS Raises the Bar with Same-Shift
"Swab-to-Result" in as little as 8 Hours
The CERTUS System helps food producers save time and money with rapid, in-house pathogen environmental monitoring
(SALT LAKE CITY) June 28, 2018 – CERTUS, innovators in food safety technologies, introduce same-shift results with their revolutionary new in-house pathogen testing system. The CERTUS System provides food producers with a superior alternative to third-party testing, delivering swab-to-result in as little as eight hours. Backed by a comprehensive series of tests and assay optimizations, the rapid performing CERTUS System will be on display at the International Association of Food Protection July 8-11, 2018 in Salt Lake City, Utah (booth #301) with demonstrations every 30 minutes.
Utilizing SERS nanoparticle technology, the CERTUS System features real-time detection which empowers food processors with the timely information they need to keep their products moving and protect their brand from a recall. The CERTUS System's powerful combination of in-house capability coupled with real-time detection means producers have test results in-hand in less time than it takes for a third-party lab to receive samples by mail. By reducing dependence on postage, the CERTUS System eliminates delays and costs associated with mailing samples – including cold pack and hazardous material shipping fees. Small and mid-size producers now gain a significant edge with CERTUS. Instead of paying high rates associated with low-test volumes, the CERTUS System opens the door to a robust and economical way to take control while others are waiting for results.
"The CERTUS System allows you to save money, save time and save your reputation," said CERTUS president, John Coomes. "With in-house same-shift detection, food producers can enhance their quality control measures and establish their reputation as a trustworthy supplier."
As part of its path to AOAC validation, the CERTUS System recently underwent an intensive battery of performance-based tests proving detection of Listeria species at 10(4) cfu during a standard work shift. Results also show that one cfu of Listeria-monocytogenes can be detected in as little as 18 hours from swab to result. In addition, tests clearly demonstrate the ability to detect Listeria in produce wash samples known to have high bioburden. With a range of matrices that includes stainless steel, ceramic, plastic, and concrete sample sites, the CERTUS system provides 98% accuracy, which is equivalent to top competitors.
"While assay optimization is ongoing, this level of accuracy places CERTUS head-to-head with the top rapid pathogen detection systems currently on the market that are much more complex, have longer prep times and require expensive laboratories and technicians," said Coomes.
CERTUS System test methods and results will be on display at IAFP in an academic poster presented by Dr. John Bodner, CERTUS Director of Research & Development. The poster features key assay performance metrics including a full list of inclusivity and exclusivity results proving that all challenging strains of Listeria are accurately detected, and interfering bacteria are excluded from results.
The all in-house CERTUS System is comprised of the Detection Unit, consumable Detection Kits featuring Bio-Lock™ Sampling Swabs, and the Control Pad. The CERTUS Control Pad includes complimentary facility management software that enables plant test scheduling, test site result mapping, instant notifications, and remediation management, while automatically recording critical data points that support FSMA compliance and storing data for instant access to reporting.
For more information on the CERTUS System, stop by CERTUS booth #301 at IAFP or visit www.CertusFoodSafety.com to request a live-web demo.
CERTUS changes the way food safety testing is done and helps reduce food-borne illness with a rapid pathogen detection system that is Simple, Safe and Smart. CERTUS integrates historically embraced values into future technology bringing innovation and expansive vision to the food safety industry. CERTUS joins the Toho Technology group of companies as a new brand specializing in Food Safety.
To learn more, visit certusfoodsafety.com or call us at 872-810-4123.


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Panther Run Engineer's Club – 2020 Winter/Spring Session
Panther Run's 2020 Winter/Spring Session
Grades 2nd to 5th
Dates – Wednesdays – 2:15 to 3:15 p.m.
The Winter/Spring dates are as follows:
January 29
February 5, 12, 19, 26
March 4, 11, 18
April 1, 8, 15, 22, 29
May 6, 13, 20
Content Covered
Computer Programming for Video Game Design
Computer Programming for Graphics & Animation
Creative engineering challenges
NOTE: Repeating engineers will be given different and/or more challenging content.
The cost is $320 for 16 weeks.
Note: We cannot enroll engineers for partial sessions.
Myth: Computer programming is super hard.
Busted: We make programming easy for even young children by making it fun!
Myth: Computer programming is boring – all that typing.
Busted: We introduce the world of programming through drag and drop coding.
Myth: Young kids won't WANT to code.
Busted: We utilize children's affinity for video games and art to motivate them to learn coding – they end up coding their own video games and artistic creations.
Myth: Not all kids are natural programmers.
Busted: Programming is just like math or art, anyone can learn it – even young children.
Myth: Coding isn't for girls.
Busted: Some of the more talented coders we have encountered are female. A majority of our instructors are female. The industry is clamoring for female developers – leaving doors wide open for girls who can program.
Young Makers Lab (YML) is not affiliated or endorsed by the School Board of Palm Beach County or Panther Run Elementary and the activities hosted by YML on Panther Run's premises pursuant to a lease agreement shall not be construed as being conducted, funded, hosted or sponsored by the School Board or Panther Run on behalf of YML. The School Board and Panther Run undertake no responsibility for supervising or monitoring YML's events/ activities and will not be liable for any and all actions of YML on Panther Run's premises.
Click below to see the schedule for our upcoming workshops at these schools.
Addison Mizner
Binks Forest
Citrus Cove
Crystal Lakes
Del Prado
Equestrian Trails
Panther Run


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Hello everyone,
You may remember that a little while ago I made a costume for a friend (see the post here), well that was only the first one. I was also asked to make a second costume for another anime character. This one is quite a bit different from anything I've made before.
This is a character called Sora, from a game series called Kingdom Hearts. His outfit varies a little along the way, but this is the version that came to me for making.
Soooo, it did take me a little while to get going on this one. I had to get it all worked out in my head first. But eventually it came together. There were a few challenges along the way. One of which was to photograph the finished work, it was really hard to get pictures of it because it really needed to be on a body and I don't have a mannequin with legs that it would fit (I only have small child-sized mannequins, which my children refer to as my "dolls") and I don't have a tall 16 year old handy either. But here is what I was able to do:
Lets talk about the pants first. They were the hardest to conceptualise, but I think that they ended up being my favourite piece.
They are made from a combination of stretch knit fabric (the blue part) and a fabric that Spotlight had tagged as "ripstop", which is almost a kind of wet-weather fabric, although I'm not sure if its really waterproof. I needed a fabric that was light enough but stiff enough to hold its shape when ballooned out, but also it had to be heavy enough to be suitable as pants. In the end I really liked this fabric choice, I think it worked well.
These pants have a shaped section in blue that is trimmed with a silver strip, the same silver strip encircles the pant-legs. The pants have a simple gathered waist, with belt loops added, are straight legged with elastic casings to gather the hems. They are approx 3/4 length.
They have red bags to be worn at the sides, these are attached with a kind of webbing of yellow straps – this was a bit of a challenge for me to get my head around, I got confused multiple times doing this.
The belt loops at the sides are actually connected with a snap fastener. This is so that the yellow strapping can be removed.
There are two pieces to the top of this outfit. The first is a really simple tank with a v-neck.
The neckline and arms are trimmed with the same silver strips as the pants – I used this a lot. I did investigate a number of options for doing this part of the costume, considering that its pretty much all over it, and I wanted it to be shiny, I actually ended up using a silver knit fabric that I found in the dance wear section of Spotlight. The silver is printed on it, but its still really stretchy, and I actually think that it will hold up to normal washing. I just cut it into 1.5cm strips from selvedge to selvedge. Sewing it on was a pain, I used metallic silver thread (actually embroidery thread), which as really fiddly, it didn't some off the spool smoothly, so I had to use one of those net things over it, and I had a lot of trouble with it, but I got through it. And I'd do it again.
I appliqued the red panel on the front of the otherwise plain shirt. The back is just plain.
The front panel is intended to align to the panel on the pants. This is a pretty bad photo, but you do get the idea.
So this is the jacket. Its a short sleeved, cropped hoodie. With a whole lot of stuff added. The jacket itself is made from black fleece fabric. The hood is lined with white lightweight knit. I did the lining twice, the first time that I did it, it got caught as I was topstitching, and when I unpicked it there was a tear, so I had to do it again. Frustrating, but not the end of the world. The jacket has the same silver trim down the sides of the zipper in front, all around the hem, and around the sleeves. The zipper is a really cool metallic-plastic separating zipper:
These pockets nearly killed me. I sewed them on, no probes, attached the zip, no probs. Then, I had the jacket on the mannequin to check the shoulders and I noticed the most terrible thing – one of the pockets was about 2 inches higher than the other! I was seriously peeved at myself for that, because I didn't check it, I just did it. So I had to unpick it and do it again. After measuring it this time. Grrrrr.
The shoulders required a bit of creative thinking, the character has these sort of armour things going on. I toyed around with the idea of using a faux leather for them, which would probably look awesome, but I wasn't confident that I could pull that off because I've never sewn with that before, so in the end I used the fleece backed with some lightweight knit on the underside. I just drafted the shape of the shoulders myself, this is actually the second version of them. I made some piping using the silver trim to edge them, and they come from the neckline to attach with a grey snap fastener onto the sleeve itself.
Thankfully the jacket is just plain at the back.
And that's the end. Unless I get some pics of Eric actually wearing it. We'll see…..
Thanks for reading.


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- Add everything to your basket.
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We at Vouchers4U.com always try to update and display the latest codes and offers. Bookmark us and every time before you order from Deon Dane or any other store visit us to grab a great deal which you can use to save some money.
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Along with savings, many people like competitions where they can win free prizes if they like and share a photo or a post by Deon Dane. If you want to hear more about the upcoming competitions, then the best you can do is follow one of Deon Dane social media pages.Last updated on 30 May 2020


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Timely and efficient planning of treatments through intelligent scheduling
Aleida Braaksma
Date: 25 September 2015
Time: 14:30
Location: University of Twente, Waaier 4 (Prof.dr. G. Berkhoff room)
When people experience health problems, this often leads to a period of concern and stress. Both for patients' physical and mental well-being, it is essential that healthcare processes are organized in the best possible way. The thesis aims to support hospitals in realizing excellent quality of patient service, whilst utilizing resources efficiently.
By developing methodologies based on techniques from operations research, also known as mathematical decision theory, the research presented provides decision support for the planning and scheduling of healthcare processes. Three specific challenges are addressed. First, online appointment scheduling, providing patients with prompt responses to their appointment requests. Second, as an alternative, enabling patients to walk in for certain types of diagnostics or treatment without an appointment. And third, integral capacity planning in the inpatient care chain: aligning resource capacities of inpatient wards with the operating room schedule and emergency patient arrivals, and staffing nurses accordingly. All studies in the thesis exemplify how healthcare operations research enables simultaneous improvements in both quality of care and logistical efficiency.
Aleida Braaksma received her M.Sc. degree in Applied Mathematics from the University of Twente in 2010, after which she started working as a consultant for process optimization in healthcare in the Academic Medical Center (AMC) in Amsterdam. Since 2011, she is a Ph.D. candidate at the AMC and at the Center for Healthcare Operations Improvement and Research (CHOIR) at the University of Twente. Her research interests are in planning and scheduling in healthcare, focusing on integral improvements for multiple care providers and patient types. In her work, she focusses on combining theoretically strong research with applications in healthcare practice. After completing her Ph.D., Aleida will become a postdoctoral fellow in healthcare operations research, again at the interface between science and practice. She will be appointed at Massachusetts Institute of Technology – Sloan School of Management in Cambridge, and Massachusetts General Hospital in Boston, both in Massachusetts, United States.


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An exciting opportunity has arisen for a Senior Corporate Tax Manager to join a top 40 firm. This will be a purely advisory role and would suit someone looking to develop quickly on a path to partner.
Based jointly across their stunning Central London and Hertfordshire offices you will be working with clients are across a broad range of sectors which include retail, property, health care, technology and media.
As well as been a strong business developer and people manager you will also lead on technical areas such as M&A, structuring, Employee Incentives, company disposal and acquisition to name but a few.
If you hold relevant experience within a tax practice and are CTA or ACA qualified please send your CV to email@example.com or call Emma on 02072696325.
The Pro-Recruitment Group consists of five distinct brands: Pro-Tax, Pro-Legal, Pro-Finance, Pro-HR and Pro-Marketing.


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Bundt Friday is the 2nd episode of Season 1 of Sabrina the Teenage Witch.
When Libby and her friends start spreading lies around school about Sabrina and Jenny, Sabrina decides to use her magic to set things straight. She does this by pouring "truth sprinkles" from her magic cupboard in the cakes that they are baking in school. The sprinkles soon cause many blunt and hurtful truths to come out. The sprinkles make Jenny reveal she's sweet on Sabrina's love interest, Harvey. Sabrina has to find a way to bring everything to normal again.
Meanwhile, Hilda prepares for a date with Drell - despite him having stood her up over 1,000 times in the past.
- Melissa Joan Hart as Sabrina Spellman
- Nick Bakay as Salem Saberhagen
- Caroline Rhea as Hilda Spellman
- Beth Broderick as Zelda Spellman
- Nate Richert as Harvey Kinkle
- Jenna Leigh Green as Libby Chessler
- Michelle Beaudoin as Jenny Kelley
- Ella Joyce as Mrs. Bogzigian
- Melissa Murray as Cee Cee
- Bridget Flanery as Jill
- Eddie Allen as a Guidance Counselor
- Ariel Felix as a teacher
- Tom McGowan as Principal Larue
- Curtis Andersen as a student Gordie
- Phillip Glasser as a student
Magic Notes
Uses of Magic
- Sabrina uses a spell to pull rabbit out of a hat.
- Hilda conjures in mid air flashing red neon arrow that points at her.
- Sabrina makes napkin fold itself into rose.
- Zelda opens a section of wall.
- Hilda changes her outfit in damsel in distress outfit.
- Hilda changes her outfit in tough chick outfit.
- Hilda changes her outfit in tough chick in distress outfit.
- Sabrina pulls rabbits out of a hat.
To Pull A Rabbit Out Of A Hat
- (Cast by Sabrina Spellman)
- Abracadabra
Silence Spell
- (mentioned by Zelda Spellman)
- Affix the taste organ of a humped ruminant adjacent to one's dentition
- Truth Sprinkles
- Hilda (to Sabrina): Oh no, you look unhappy... Tell Zelda, I can't let you bring me down.
- Zelda: The truth can have some unpleasant side effects. Itching, chafing, hurt feelings...
- Sabrina: Sounds like gym class.
- The fourth outfit for this show's credits is a "mod" red dress and outfit with a purse made out of a stuffed cat. Sabrina says, "As if!"
- Mr. Pool does not appear in this episode.
- Though Hilda's date with Drell is a major subplot, Drell does not actually appear in this episode.
- This episode marks the first appearance of the Slicery.
- Although his character is not named, this episode features the first appearance of Curtis Andersen as Gordie.
- At the end of this episode, Sabrina places all of the bunnies that she has zapped to the Spellman house, back into the top hat that they came out of. Their names were: Trisha, Samantha, Brian, Bernadette and Chloe. Interestingly. Trisha, Samantha, and Brian are all family members of Melissa Joan Hart; Bernadette and Chloe may be as well.
- Emma makes an uncredited, unreferenced appearance, in Home Ec class.
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