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Vehicle with 13 immigrants plows into a car and hits students
TEMECULA, Calif. A Chevrolet Suburban fleeing Border Patrol agents crashed at high speed into a passing car outside a high school Tuesday, killing four students and a father driving his son to school and injuring the 13 occupants of the camper. as horrified students arrived for classes at Temecula Valley High School. Wreckage and bodies were strewn across a busy intersection in this fast growing, semirural community in southern Riverside County, renewing controversy over Border Patrol policy on high speed chases.
"There was metal and glass and rubber and people . . . all went up in the sky," said Jason Boles, a driver who witnessed the crash. "There was notebook paper all over the place so I knew there were kids involved. And I could see the dad in the front seat of the Acura with his suit on, and he was dead."
The careening truck also struck and killed two students walking on the sidewalk: a brother and sister whose mother, a reporter, learned of their deaths as she was covering the accident for her newspaper.
"The kids were on the sidewalk just where they were supposed to be and they got killed," said Riverside County Sheriff's Investigator Henry Sawicki.
Four of the suspected illegal immigrants suffered serious injuries when the truck overturned. The driver a suspected smuggler from Mexico and eight other passengers were treated for minor injuries, then turned over to police for questioning. The driver is a juvenile and his name was not released.
The accident revived arguments about Border Patrol chases in cities near Southern California freeway immigration checkpoints.
After Tuesday's tragedy, some angry Temecula residents and officials questioned why immigration agents pursued suspects into a residential area near a school.
The high speed chase began after the Suburban left northbound Interstate 15, drove on surface roads around a Border Patrol freeway checkpoint near here, and returned to the freeway. A Border Patrol vehicle began to chase the Suburban, which left the freeway again and sped into the town.
Officials said the agents slowed down before the accident at the intersection of Rancho Vista and Margarita roads. The Border Patrol vehicle, which was pursuing the truck eastbound on Rancho Vista Road, "slowed its pursuit when its emergency siren and red lights failed," said Gus de la Vina, chief of the San Diego Border Patrol sector. "The vehicle continued to follow the van at a quarter mile distance."
A preliminary investigation indicates that the pursuing agents acted properly, said De la Vina, who blamed the accident on the suspected smuggler driving the Suburban.
Sheriff's detectives have not determined whether the Border Patrol was engaged in a pursuit when the crash occurred or what charges will be filed, Sawicki said.
One witness said the Border Patrol vehicle appeared to slow down. "The Border Patrol car stopped at the top (of the street) like he wanted them to know he stopped chasing them," student Mike Madieros said.
The plainclothes agents followed the truck to the Temecula checkpoint, he said. They asked Border Patrol agents to intercept the truck, but it sped away when agents tried to pull it over at the Rancho California Road freeway exit several miles west of the high school.
"They were following to see its destination," Beasley said. He had no further information about the delay in attempting to stop the truck.
The dead were identified as Temecula banker John Davis, 46, driver of the Acura; his 17 year old son Todd Davis; a friend, fake hermes bag 14 year old student Monisa Emilio, and the brother and sister on the sidewalk, Gloria Murillo, 17, and Jose Murillo, 16.
Sobbing students were led into the school as police and emergency personnel swarmed around the wreckage. One of the many parents who rushed to the school was the Murillos' mother, who writes for a local Spanish language shopping publication, El Remate.
Publisher Elia Esparza, Gloria Murillo's cousin, said Murillo was replica birkin handbags nervous when she headed for the scene, although she knew nothing of her children's deaths.
"She said it was a good thing that she was going to go down and report the story because it would replica hermes handbags outlet give her an excuse to go into the high school and get her kids out," she said.
Esparza criticized the Border Patrol's chase techniques.
"The Hermes birkin bags fake Border Patrol is at fault," she said. "They could stand outside our office in Temecula and catch all the illegals they want to. Why do they have to chase them?"
TEMECULA, Calif. A Chevrolet Suburban fleeing Border Patrol agents crashed at high speed into a passing car outside a high school Tuesday, killing four students and a father driving his son to school and injuring the 13 occupants of the camper. as horrified students arrived for classes at Temecula Valley High School. Wreckage and bodies were strewn across a busy intersection in this fast growing, semirural community in southern Riverside County, renewing controversy over Border Patrol policy on high speed chases.
"There was metal and glass and rubber and people . . . all went up in the sky," said Jason Boles, a driver who witnessed the crash. "There was notebook paper all over the place so I knew there were kids involved. And I could see the dad in the front seat of the Acura with his suit on, and he was dead."
The careening truck also struck and killed two students walking on the sidewalk: a brother and sister whose mother, a reporter, learned of their deaths as she was covering the accident for her newspaper.
"The kids were on the sidewalk just where they were supposed to be and they got killed," said Riverside County Sheriff's Investigator Henry Sawicki.
Four of the suspected illegal immigrants suffered serious injuries when the truck overturned. The driver a suspected smuggler from Mexico and eight other passengers were treated for minor injuries, then turned over to police for questioning. The driver is a juvenile and his name was not released.
The accident revived arguments about Border Patrol chases in cities near Southern California freeway immigration checkpoints.
After Tuesday's tragedy, some angry Temecula residents and officials questioned why immigration agents pursued suspects into a residential area near a school.
The high speed chase began after the Suburban left northbound Interstate 15, drove on surface roads around a Border Patrol freeway checkpoint near here, and returned to the freeway. A Border Patrol vehicle began to chase the Suburban, which left the freeway again and sped into the town.
Officials said the agents slowed down before the accident at the intersection of Rancho Vista and Margarita roads. The Border Patrol vehicle, which was pursuing the truck eastbound on Rancho Vista Road, "slowed its pursuit when its emergency siren and red lights failed," said Gus de la Vina, chief of the San Diego Border Patrol sector. "The vehicle continued to follow the van at a quarter mile distance."
A preliminary investigation indicates that the pursuing agents acted properly, said De la Vina, who blamed the accident on the suspected smuggler driving the Suburban.
Sheriff's detectives have not determined whether the Border Patrol was engaged in a pursuit when the crash occurred or what charges will be filed, Sawicki said.
One witness said the Border Patrol vehicle appeared to slow down. "The Border Patrol car stopped at the top (of the street) like he wanted them to know he stopped chasing them," student Mike Madieros said.
The plainclothes agents followed the truck to the Temecula checkpoint, he said. They asked Border Patrol agents to intercept the truck, but it sped away when agents tried to pull it over at the Rancho California Road freeway exit several miles west of the high school.
"They were following to see its destination," Beasley said. He had no further information about the delay in attempting to stop the truck.
The dead were identified as Temecula banker John Davis, 46, driver of the Acura; his 17 year old son Todd Davis; a friend, fake hermes bag 14 year old student Monisa Emilio, and the brother and sister on the sidewalk, Gloria Murillo, 17, and Jose Murillo, 16.
Sobbing students were led into the school as police and emergency personnel swarmed around the wreckage. One of the many parents who rushed to the school was the Murillos' mother, who writes for a local Spanish language shopping publication, El Remate.
Publisher Elia Esparza, Gloria Murillo's cousin, said Murillo was replica birkin handbags nervous when she headed for the scene, although she knew nothing of her children's deaths.
"She said it was a good thing that she was going to go down and report the story because it would replica hermes handbags outlet give her an excuse to go into the high school and get her kids out," she said.
Esparza criticized the Border Patrol's chase techniques.
"The Hermes birkin bags fake Border Patrol is at fault," she said. "They could stand outside our office in Temecula and catch all the illegals they want to. Why do they have to chase them?"
Van Goghs Ear
This photo of one of Venice's lost but not forgotten 'hangs' was called Van Goghs Ear. fake hermes brown belt whosale The building is actually still there but not Van Goghs Ear, it was open for 24 hours 7 days a week. Many underground artists went there back in the day. I remember seeing John Cusack there a time or two. But it was the cool Vibe of such a place that is very missed. And knowing that after a night of Debauchery, you could have a coffee or a pastry at any hour day or night and still meet fake hermes belt price interesting people. Unmistakable was the large canvas of the Master himself. I'm glad to say I was one of the many who fake hermes belts whosale went there and that Van Goghs Ear is missed quite a lot in Venice.
For our international users, please be aware that the information hermes men belt replica you submit when registering for our services is collected in the United States of America. laws and regulations, which may be different from the laws and regulations of your home country. By registering for this service, you are consenting to this collection, storage, and use.
This photo of one of Venice's lost but not forgotten 'hangs' was called Van Goghs Ear. fake hermes brown belt whosale The building is actually still there but not Van Goghs Ear, it was open for 24 hours 7 days a week. Many underground artists went there back in the day. I remember seeing John Cusack there a time or two. But it was the cool Vibe of such a place that is very missed. And knowing that after a night of Debauchery, you could have a coffee or a pastry at any hour day or night and still meet fake hermes belt price interesting people. Unmistakable was the large canvas of the Master himself. I'm glad to say I was one of the many who fake hermes belts whosale went there and that Van Goghs Ear is missed quite a lot in Venice.
For our international users, please be aware that the information hermes men belt replica you submit when registering for our services is collected in the United States of America. laws and regulations, which may be different from the laws and regulations of your home country. By registering for this service, you are consenting to this collection, storage, and use.
Van Morrison and Me
John McCarthy explores how Van Morrison's music has influenced people's lives. He looks at Van's lyrics and his brown hermes belt replica ability to move people through imitation hermes belt on sale his music at important junctures fake hermes belt price in their lives.
Van talks about growing up in a working class part of Belfast, how he created his seminal album Astral Weeks, what inspires his music and the challenges of performing into his '70s.
Irish musician Glen Hansard performs Van songs in a Dublin pub for the programme and describes their power.
And, John McCarthy and fellow former hostage Brian Keenan describe how in the dark cells of hermes brown belt imitation their imprisonment, somehow they returned to the city where Brian and Van grew up to walk the streets of Cyprus Avenue and along the Beechie River.
(Photo: Belfast born, British musician Van Morrison performs at the 40th Jazzaldia festival in the Spanish Basque city of San Sebastian. Credit: Getty Images)
John McCarthy explores how Van Morrison's music has influenced people's lives. He looks at Van's lyrics and his brown hermes belt replica ability to move people through imitation hermes belt on sale his music at important junctures fake hermes belt price in their lives.
Van talks about growing up in a working class part of Belfast, how he created his seminal album Astral Weeks, what inspires his music and the challenges of performing into his '70s.
Irish musician Glen Hansard performs Van songs in a Dublin pub for the programme and describes their power.
And, John McCarthy and fellow former hostage Brian Keenan describe how in the dark cells of hermes brown belt imitation their imprisonment, somehow they returned to the city where Brian and Van grew up to walk the streets of Cyprus Avenue and along the Beechie River.
(Photo: Belfast born, British musician Van Morrison performs at the 40th Jazzaldia festival in the Spanish Basque city of San Sebastian. Credit: Getty Images)
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off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care
Results Using the Wells score, 647 patients had an unlikely clinical probability of deep vein thrombosis. In these patients (at all ages), deep vein thrombosis could be excluded in 309 (47.8%) using the age dependent cut off value compared with 272 (42.0%) using the conventional cut off value of 500 g/L (increase 5.7%, 95% confidence interval 4.1% to 7.8%). In patients older than 80 years, deep vein thrombosis could be safely excluded in 22 (35.5%) patients using the age dependent cut off value compared with 13 (21.0%) using the conventional cut off value (increase 14.5%, 6.8% to 25.8%). Compared with the age dependent cut off value, the cut off value of 750 g/L had a similar exclusion rate (307 (47.4%) patients) and false negative rate (0.3%).Conclusions Combined with a low clinical probability of deep vein thrombosis, use of the fashion cheap hermes handbags age dependent D dimer cut off value for patients older than 50 years or the cut off value of 750 g/L for patients aged 60 years and older resulted in a considerable increase in the proportion of patients in primary care in whom deep vein thrombosis could be safely excluded, compared with the conventional cut off value of 500 g/L.IntroductionVenous thromboembolism (pulmonary embolism and deep vein thrombosis) is a common disease in elderly people. In fact, the annual incidence of venous thromboembolism rises sharply with age, from an insignificant rate in children (less than five cases per 100000 people) to 450 900 cases per 100000 people in those older than 80 years.1 2 Short term mortality of venous thromboembolism also increases with age, and can occur in more than 15% of elderly patients.1 3 Hence, especially in this age group, accurate and timely diagnosis of venous thromboembolism can be lifesaving.4 However, comorbidity often camouflages typical signs and symptoms of venous thromboembolism, and the diagnosis of deep vein thrombosis and pulmonary embolism is difficult and is often missed in elderly populations.4Accurate exclusion of venous thromboembolism can be improved by the additional use of tests to measure the concentration of D dimer (a degradation product of fibrin). Negative test results are commonly used to rule out patients with suspected venous thromboembolism and a low clinical probability.5 6 However, D dimer concentration increases with age and its specificity for venous thromboembolism decreases in elderly patients.7 8 This effect leads to more false positive test results in elderly people (that is, detection of a lower proportion of these patients in whom venous thromboembolism can be excluded). As a result, many elderly patients could be referred to hospital unnecessarily for additional testing.9 10 11 Many physicians would prefer to rule out venous thromboembolism (especially in frail elderly patients) without an often burdensome referral.To improve the diagnostic strategy of suspected venous thromboembolism in elderly patients, Douma and colleagues10 recently derived and internally validated an age dependent, D dimer cut off value for those with clinically suspected pulmonary embolism in secondary care. The researchers defined this cut off value as age (years)10 g/L in patients older than 50 years (for example, a patient aged 73 years would have a cut off value of 7310=730 g/L). Use of this formula doubled the proportion of patients older than 70 years in whom pulmonary embolism could be excluded, without hampering the false negative rate of such an approach.10 In addition, Haas and colleagues proposed an alternative, fixed cut off value of 750 g/L in patients aged 60 years and older who were referred to secondary care with symptoms of deep vein thrombosis.12 This proposed cut off value also yielded an increased proportion of patients in whom deep vein thrombosis could be correctly excluded.The age dependent value and fixed value can both help safely exclude venous thromboembolism in a large proportion of frail elderly patients without the need for burdensome referrals for further diagnostic work up. However, the age dependent cut off value was not validated for use in patients suspected of deep vein thrombosis. Since deep vein thrombosis and pulmonary embolism can be seen as expressions of the same disease,13 we hypothesised that use of the age dependent cut off value could be extrapolated to patients with suspected deep vein thrombosis. Furthermore, both the age dependent value and the fixed value were not validated in primary care. Before implementing these different cut off values for patients with suspected deep vein thrombosis, a formal validation study would be needed.14 15 Therefore, we aimed to compare the exclusion rate and false negative rate of both proposed cut off values with those of the conventional cut off value of 500 g/L for the exclusion of deep vein thrombosis in a large cohort of patients with clinically suspected deep vein thrombosis in primary care.MethodsPatientsWe performed a retrospective analysis of data from two originally prospective, diagnostic accuracy studies that included 2086 primary care patients suspected of deep vein thrombosis. The first study was a derivation study for a new diagnostic rule to determine the presence or absence of deep vein thrombosis in primary care patients (n=1295).16 On behalf of validation of the newly derived rule, researchers extended the study within the same setting and added 791 patients to the initial cohort9 17 (so called temporal validation).18 19 The characteristics of these studies have been published previously.9 16 20 17In short, the studies were conducted among 110 primary care physicians affiliated with three hospitals in the Netherlands, between 1 January 2002 and 1 January 2006. The three adhering hospitals participated in a diagnostic programme in which the primary care physicians used diagnostic facilities of the hospital without referring the patient to a hospital specialist. All consecutive imitiaton hermes bag adults with a clinical suspicion of deep vein thrombosis were eligible for inclusion. Suspicion of deep vein thrombosis was based on swelling, redness, or pain of the lower extremities. The study excluded patients if symptoms and signs lasted for more than 30 days and if there was a suspicion of pulmonary embolism. The study also excluded patients receiving anticoagulant treatment at presentation or who were unwilling to participate in the studies. Written informed consent was obtained from patients. The studies were approved by the local ethics review boards of the University Medical Center Utrecht, the Netherlands.Each patient was assessed for the clinical probability score according to Wells,21 and measured for plasma D dimer (VIDAS (Biomerieux) or Tinaquant (Roche) assays). On the same day, all patients underwent reference testing by repeated compression ultrasonography of the symptomatic leg, performed with a real time, B mode, linear array sonographic scanner at 5.0 7.5 MHz (system V GE/Sonotion).22 The entire proximal deep vein system was explored for compressibility. In patients with a normal ultrasonography, the test was repeated at day seven. Deep vein thrombosis was established if at least one of the deep veins in the legs was not completely compressible at one of the two compression ultrasonography examinations, or excluded after two negative examinations (that is, revealing completely compressible veins of the legs). The performers and interpreters of the examinations (board certified radiologists) were blinded to information on the patient's history, physical examination, and D dimer test results.Data analysisFor the current analysis, we included only participants for whom D dimer test results were available (n=1374). We calculated the clinical probability of deep vein thrombosis for all patients using the Wells clinical prediction rule. Patients were classified according to the dichotomised Wells score as "likely" (2) or "unlikely" (1) to have deep vein thrombosis.21 We dichotomised D dimer concentrations by using the age dependent cut off value proposed by Douma and colleagues in patients older than 50 years (age in years10 g/L)10; the fixed cut off value of 750 g/L in patients aged 60 years and older, as proposed by Haas and colleagues12; and the conventional cut off value of 500 g/L in patients of all ages.21For patients with an unlikely clinical probability of deep vein thrombosis according to the Wells score, we calculated the proportion in whom deep vein thrombosis could be excluded (based on an unlikely clinical probability and a negative D dimer test result using the different cut off values). We also calculated the corresponding proportions of false negative results that is, prevalence of deep vein thrombosis (as established by compression ultrasonography) among patients with an unlikely clinical probability and a negative test result. We calculated the number of patients needed to undergo a D dimer assay to exclude deep vein thrombosis in one patient (that is, the number of patients needed to test) by dividing 1 by the proportion of patients with a negative test result and indeed without deep vein thrombosis (that is, the proportion of true negatives).23 We did analyses with SPSS version 17.0, and calculated appropriate 95% confidence intervals using a programmable calculator application in Microsoft Office, Excel 2003.24ResultsTable 1 shows the baseline characteristics of all included participants with available D dimer results (n=1374). Mean age was 59.3 years (standard deviation 17.4), and most participants were older than 50 years (936/1374, 68.1%). Prevalence of deep vein thrombosis was 19.7% (270/1374). Of 1374 participants of all ages, 647 (47.1%) had an unlikely clinical probability of deep vein thrombosis (Wells score 1; table 2 ). Using the conventional D dimer cut off value of 500 g/L, 272 of these 647 participants had negative test results (42.0%, 95% confidence interval 38.2% to 46.0%, number needed to test 2.4). Two of these 272 participants had deep vein thrombosis, a false negative proportion of 0.3% (0.04% to 1.1%).Table 1 Baseline characteristics of study patients with clinically suspected deep vein thrombosis. Data are no (%) of patients unless specified otherwiseView this table:View popupView inlineDiscussionThis study showed that the use of an age dependent cut off value (age10 g/L in patients aged >50 years) and a fixed cut off value (750 g/L in patients aged 60 years), combined with an unlikely clinical probability of deep vein thrombosis, resulted in a considerable increase in the proportion of suspected elderly patients in primary care in whom deep vein thrombosis could be safely and correctly excluded, compared with use of the conventional cut off value (500 g/L at all ages). Use of these proposed D dimer cut off values reduced the number needed to test by compression ultrasonography. This increase in diagnostic efficiency rose with age, notably in the eldest group of elderly patients. These findings are important, since further diagnostic testing can thus be avoided in these often frail elderly patients.Strengths and limitations of the studyThis study provides an external validation of two age adapted, D dimer cut off values previously proposed in secondary care patients with suspected venous thromboembolism, and translates these results to a large cohort of patients in primary care with suspected deep vein thrombosis.This study had some limitations. D dimer values were missing in 712 of 2086 participants in the original studies, because only dichotomised D dimer values (high v low) were displayed by the laboratories in the early inclusion phase. Therefore, the availability of the D dimer values was time dependent. Time can change the nature of study populations. For example, a tendency for incidence of venous thromboembolism to fall in suspected patients over time has been reported.2 Therefore, we analysed whether the absence versus presence of a D dimer value was related to observed patient characteristics. Most baseline characteristics (11 of 14) were the same in patients with and without available D dimer values (web appendix 1); the prevalence of deep vein thrombosis and the mean Wells score also did not differ between the two groups (deep vein thrombosis 19.7% v 20.4%, P=0.698; mean Well score 1.66 (standard deviation 1.97) v 1.74 (2.20), P=0.658). Therefore, we believe that the exclusion of the patients with missing D dimer values was probably not related to patient characteristics and thus did not bias our results.We also repeated the entire analysis with the missing D dimer values imputed, using multiple imputation techniques (web appendix 2). This advanced strategy deals with missing values, and is generally preferred over complete case analysis. In short, we based a multiple imputation regression model on the observed D dimer values and corresponding patient characteristics. We then used this model to estimate missing values according to the observed patient's characteristics.25 This analysis yielded the same results sustaining the inferences of the complete case analysis, which further confirmed our assumption that the study findings would not change if the missing D dimer values had been present.Another limitation was that we used two different laboratory techniques VIDAS, an enzyme linked immunosorbent assay (ELISA), and Tinaquant, a latex agglutation test. Although assay dependent thresholds have been suggested previously,26 27 we based our analysis on a conventional cut off point of 500 g/L for both assays. After stratifying for type of assay, we found no differences in safety between the two tests, irrespective of the cut off level applied (table 3). However, deep vein thrombosis could be ruled out more frequently in patients in the Tinaquant assay group than in those in the VIDAS group. These findings accord with those of Di Miso and colleagues,27 who reported a higher safety at the expense of a lower efficiency when using the VIDAS test, compared with the Tinaquant test.We also used serial compression ultrasonography as the reference test. Owing to its Hermes birkin bags fake non invasiveness and its accuracy running close to the gold standard, compression ultrasonography has largely replaced venography in current medical practice. However, ultrasonography has shown a missed diagnosis rate of 0.57% (pooled meta analysis, 95% confidence interval 0.25% to 0.89%) in patients with deep vein thrombosis.28 To lower this misclassification rate, we by design repeated the compression ultrasonography at day seven. However, the true safety of the proposed D dimer cut off values might be replica birkin handbags slightly lower than that based on the present analysis. Moreover, the misclassification rate is known to be lower in patients with a low clinical probability of deep vein thrombosis (0.29%, 0% to 0.70%).28 The current analysis, however, included only patients with an "unlikely" clinical probability. Hence, any possible bias induced by our choice of reference test would probably not change the presented conclusions of our analysis.We also caution the interpretation of our findings in patients older than 80 years, since the number of this subgroup was rather small. Finally, although the data were originally collected in a prospective manner, this study was a retrospective analysis.Comparison with other studiesDouma and colleagues recently derived the age dependent cut off value in three cohorts of patients with suspected pulmonary embolism (total of 5132 participants). They found a similar increase in the proportion of patients in whom venous thromboembolism could be excluded (increases of 6.3%, 5.1%, and 6.2% in derivation set, and validation sets 1 and 2, respectively), compared with the current study (5.7%).10Our results also accord with the findings of Haas and colleagues,12 who found a similar although slightly higher increase in exclusion rate in suspected patients older than 60 years in secondary care (12.8%). This small difference in increase can probably be explained by differences in the spectrum of patients (the range of comorbidities, the clinical setting, and previous test probability) between our study and the Haas study. Variations in patient spectrum have been linked with variations in disease prevalence as well as variations in diagnostic test accuracy.29 30 In the Haas study, the prevalence of deep vein thrombosis in their hospital setting was twice as high as that found in our study (39.1% v 19.7%). This higher prevalence can emerge from a shift spectrum of patients, towards fewer patients with limited forms of deep vein thrombosis and more patients with more manifested forms. This effect in turn could have resulted in a somewhat lower exclusion rate with the traditional cut off value of 500 g/L, and led to a higher increase in the exclusion rate after use of the age adapted cut off value, compared with our study.
Results Using the Wells score, 647 patients had an unlikely clinical probability of deep vein thrombosis. In these patients (at all ages), deep vein thrombosis could be excluded in 309 (47.8%) using the age dependent cut off value compared with 272 (42.0%) using the conventional cut off value of 500 g/L (increase 5.7%, 95% confidence interval 4.1% to 7.8%). In patients older than 80 years, deep vein thrombosis could be safely excluded in 22 (35.5%) patients using the age dependent cut off value compared with 13 (21.0%) using the conventional cut off value (increase 14.5%, 6.8% to 25.8%). Compared with the age dependent cut off value, the cut off value of 750 g/L had a similar exclusion rate (307 (47.4%) patients) and false negative rate (0.3%).Conclusions Combined with a low clinical probability of deep vein thrombosis, use of the fashion cheap hermes handbags age dependent D dimer cut off value for patients older than 50 years or the cut off value of 750 g/L for patients aged 60 years and older resulted in a considerable increase in the proportion of patients in primary care in whom deep vein thrombosis could be safely excluded, compared with the conventional cut off value of 500 g/L.IntroductionVenous thromboembolism (pulmonary embolism and deep vein thrombosis) is a common disease in elderly people. In fact, the annual incidence of venous thromboembolism rises sharply with age, from an insignificant rate in children (less than five cases per 100000 people) to 450 900 cases per 100000 people in those older than 80 years.1 2 Short term mortality of venous thromboembolism also increases with age, and can occur in more than 15% of elderly patients.1 3 Hence, especially in this age group, accurate and timely diagnosis of venous thromboembolism can be lifesaving.4 However, comorbidity often camouflages typical signs and symptoms of venous thromboembolism, and the diagnosis of deep vein thrombosis and pulmonary embolism is difficult and is often missed in elderly populations.4Accurate exclusion of venous thromboembolism can be improved by the additional use of tests to measure the concentration of D dimer (a degradation product of fibrin). Negative test results are commonly used to rule out patients with suspected venous thromboembolism and a low clinical probability.5 6 However, D dimer concentration increases with age and its specificity for venous thromboembolism decreases in elderly patients.7 8 This effect leads to more false positive test results in elderly people (that is, detection of a lower proportion of these patients in whom venous thromboembolism can be excluded). As a result, many elderly patients could be referred to hospital unnecessarily for additional testing.9 10 11 Many physicians would prefer to rule out venous thromboembolism (especially in frail elderly patients) without an often burdensome referral.To improve the diagnostic strategy of suspected venous thromboembolism in elderly patients, Douma and colleagues10 recently derived and internally validated an age dependent, D dimer cut off value for those with clinically suspected pulmonary embolism in secondary care. The researchers defined this cut off value as age (years)10 g/L in patients older than 50 years (for example, a patient aged 73 years would have a cut off value of 7310=730 g/L). Use of this formula doubled the proportion of patients older than 70 years in whom pulmonary embolism could be excluded, without hampering the false negative rate of such an approach.10 In addition, Haas and colleagues proposed an alternative, fixed cut off value of 750 g/L in patients aged 60 years and older who were referred to secondary care with symptoms of deep vein thrombosis.12 This proposed cut off value also yielded an increased proportion of patients in whom deep vein thrombosis could be correctly excluded.The age dependent value and fixed value can both help safely exclude venous thromboembolism in a large proportion of frail elderly patients without the need for burdensome referrals for further diagnostic work up. However, the age dependent cut off value was not validated for use in patients suspected of deep vein thrombosis. Since deep vein thrombosis and pulmonary embolism can be seen as expressions of the same disease,13 we hypothesised that use of the age dependent cut off value could be extrapolated to patients with suspected deep vein thrombosis. Furthermore, both the age dependent value and the fixed value were not validated in primary care. Before implementing these different cut off values for patients with suspected deep vein thrombosis, a formal validation study would be needed.14 15 Therefore, we aimed to compare the exclusion rate and false negative rate of both proposed cut off values with those of the conventional cut off value of 500 g/L for the exclusion of deep vein thrombosis in a large cohort of patients with clinically suspected deep vein thrombosis in primary care.MethodsPatientsWe performed a retrospective analysis of data from two originally prospective, diagnostic accuracy studies that included 2086 primary care patients suspected of deep vein thrombosis. The first study was a derivation study for a new diagnostic rule to determine the presence or absence of deep vein thrombosis in primary care patients (n=1295).16 On behalf of validation of the newly derived rule, researchers extended the study within the same setting and added 791 patients to the initial cohort9 17 (so called temporal validation).18 19 The characteristics of these studies have been published previously.9 16 20 17In short, the studies were conducted among 110 primary care physicians affiliated with three hospitals in the Netherlands, between 1 January 2002 and 1 January 2006. The three adhering hospitals participated in a diagnostic programme in which the primary care physicians used diagnostic facilities of the hospital without referring the patient to a hospital specialist. All consecutive imitiaton hermes bag adults with a clinical suspicion of deep vein thrombosis were eligible for inclusion. Suspicion of deep vein thrombosis was based on swelling, redness, or pain of the lower extremities. The study excluded patients if symptoms and signs lasted for more than 30 days and if there was a suspicion of pulmonary embolism. The study also excluded patients receiving anticoagulant treatment at presentation or who were unwilling to participate in the studies. Written informed consent was obtained from patients. The studies were approved by the local ethics review boards of the University Medical Center Utrecht, the Netherlands.Each patient was assessed for the clinical probability score according to Wells,21 and measured for plasma D dimer (VIDAS (Biomerieux) or Tinaquant (Roche) assays). On the same day, all patients underwent reference testing by repeated compression ultrasonography of the symptomatic leg, performed with a real time, B mode, linear array sonographic scanner at 5.0 7.5 MHz (system V GE/Sonotion).22 The entire proximal deep vein system was explored for compressibility. In patients with a normal ultrasonography, the test was repeated at day seven. Deep vein thrombosis was established if at least one of the deep veins in the legs was not completely compressible at one of the two compression ultrasonography examinations, or excluded after two negative examinations (that is, revealing completely compressible veins of the legs). The performers and interpreters of the examinations (board certified radiologists) were blinded to information on the patient's history, physical examination, and D dimer test results.Data analysisFor the current analysis, we included only participants for whom D dimer test results were available (n=1374). We calculated the clinical probability of deep vein thrombosis for all patients using the Wells clinical prediction rule. Patients were classified according to the dichotomised Wells score as "likely" (2) or "unlikely" (1) to have deep vein thrombosis.21 We dichotomised D dimer concentrations by using the age dependent cut off value proposed by Douma and colleagues in patients older than 50 years (age in years10 g/L)10; the fixed cut off value of 750 g/L in patients aged 60 years and older, as proposed by Haas and colleagues12; and the conventional cut off value of 500 g/L in patients of all ages.21For patients with an unlikely clinical probability of deep vein thrombosis according to the Wells score, we calculated the proportion in whom deep vein thrombosis could be excluded (based on an unlikely clinical probability and a negative D dimer test result using the different cut off values). We also calculated the corresponding proportions of false negative results that is, prevalence of deep vein thrombosis (as established by compression ultrasonography) among patients with an unlikely clinical probability and a negative test result. We calculated the number of patients needed to undergo a D dimer assay to exclude deep vein thrombosis in one patient (that is, the number of patients needed to test) by dividing 1 by the proportion of patients with a negative test result and indeed without deep vein thrombosis (that is, the proportion of true negatives).23 We did analyses with SPSS version 17.0, and calculated appropriate 95% confidence intervals using a programmable calculator application in Microsoft Office, Excel 2003.24ResultsTable 1 shows the baseline characteristics of all included participants with available D dimer results (n=1374). Mean age was 59.3 years (standard deviation 17.4), and most participants were older than 50 years (936/1374, 68.1%). Prevalence of deep vein thrombosis was 19.7% (270/1374). Of 1374 participants of all ages, 647 (47.1%) had an unlikely clinical probability of deep vein thrombosis (Wells score 1; table 2 ). Using the conventional D dimer cut off value of 500 g/L, 272 of these 647 participants had negative test results (42.0%, 95% confidence interval 38.2% to 46.0%, number needed to test 2.4). Two of these 272 participants had deep vein thrombosis, a false negative proportion of 0.3% (0.04% to 1.1%).Table 1 Baseline characteristics of study patients with clinically suspected deep vein thrombosis. Data are no (%) of patients unless specified otherwiseView this table:View popupView inlineDiscussionThis study showed that the use of an age dependent cut off value (age10 g/L in patients aged >50 years) and a fixed cut off value (750 g/L in patients aged 60 years), combined with an unlikely clinical probability of deep vein thrombosis, resulted in a considerable increase in the proportion of suspected elderly patients in primary care in whom deep vein thrombosis could be safely and correctly excluded, compared with use of the conventional cut off value (500 g/L at all ages). Use of these proposed D dimer cut off values reduced the number needed to test by compression ultrasonography. This increase in diagnostic efficiency rose with age, notably in the eldest group of elderly patients. These findings are important, since further diagnostic testing can thus be avoided in these often frail elderly patients.Strengths and limitations of the studyThis study provides an external validation of two age adapted, D dimer cut off values previously proposed in secondary care patients with suspected venous thromboembolism, and translates these results to a large cohort of patients in primary care with suspected deep vein thrombosis.This study had some limitations. D dimer values were missing in 712 of 2086 participants in the original studies, because only dichotomised D dimer values (high v low) were displayed by the laboratories in the early inclusion phase. Therefore, the availability of the D dimer values was time dependent. Time can change the nature of study populations. For example, a tendency for incidence of venous thromboembolism to fall in suspected patients over time has been reported.2 Therefore, we analysed whether the absence versus presence of a D dimer value was related to observed patient characteristics. Most baseline characteristics (11 of 14) were the same in patients with and without available D dimer values (web appendix 1); the prevalence of deep vein thrombosis and the mean Wells score also did not differ between the two groups (deep vein thrombosis 19.7% v 20.4%, P=0.698; mean Well score 1.66 (standard deviation 1.97) v 1.74 (2.20), P=0.658). Therefore, we believe that the exclusion of the patients with missing D dimer values was probably not related to patient characteristics and thus did not bias our results.We also repeated the entire analysis with the missing D dimer values imputed, using multiple imputation techniques (web appendix 2). This advanced strategy deals with missing values, and is generally preferred over complete case analysis. In short, we based a multiple imputation regression model on the observed D dimer values and corresponding patient characteristics. We then used this model to estimate missing values according to the observed patient's characteristics.25 This analysis yielded the same results sustaining the inferences of the complete case analysis, which further confirmed our assumption that the study findings would not change if the missing D dimer values had been present.Another limitation was that we used two different laboratory techniques VIDAS, an enzyme linked immunosorbent assay (ELISA), and Tinaquant, a latex agglutation test. Although assay dependent thresholds have been suggested previously,26 27 we based our analysis on a conventional cut off point of 500 g/L for both assays. After stratifying for type of assay, we found no differences in safety between the two tests, irrespective of the cut off level applied (table 3). However, deep vein thrombosis could be ruled out more frequently in patients in the Tinaquant assay group than in those in the VIDAS group. These findings accord with those of Di Miso and colleagues,27 who reported a higher safety at the expense of a lower efficiency when using the VIDAS test, compared with the Tinaquant test.We also used serial compression ultrasonography as the reference test. Owing to its Hermes birkin bags fake non invasiveness and its accuracy running close to the gold standard, compression ultrasonography has largely replaced venography in current medical practice. However, ultrasonography has shown a missed diagnosis rate of 0.57% (pooled meta analysis, 95% confidence interval 0.25% to 0.89%) in patients with deep vein thrombosis.28 To lower this misclassification rate, we by design repeated the compression ultrasonography at day seven. However, the true safety of the proposed D dimer cut off values might be replica birkin handbags slightly lower than that based on the present analysis. Moreover, the misclassification rate is known to be lower in patients with a low clinical probability of deep vein thrombosis (0.29%, 0% to 0.70%).28 The current analysis, however, included only patients with an "unlikely" clinical probability. Hence, any possible bias induced by our choice of reference test would probably not change the presented conclusions of our analysis.We also caution the interpretation of our findings in patients older than 80 years, since the number of this subgroup was rather small. Finally, although the data were originally collected in a prospective manner, this study was a retrospective analysis.Comparison with other studiesDouma and colleagues recently derived the age dependent cut off value in three cohorts of patients with suspected pulmonary embolism (total of 5132 participants). They found a similar increase in the proportion of patients in whom venous thromboembolism could be excluded (increases of 6.3%, 5.1%, and 6.2% in derivation set, and validation sets 1 and 2, respectively), compared with the current study (5.7%).10Our results also accord with the findings of Haas and colleagues,12 who found a similar although slightly higher increase in exclusion rate in suspected patients older than 60 years in secondary care (12.8%). This small difference in increase can probably be explained by differences in the spectrum of patients (the range of comorbidities, the clinical setting, and previous test probability) between our study and the Haas study. Variations in patient spectrum have been linked with variations in disease prevalence as well as variations in diagnostic test accuracy.29 30 In the Haas study, the prevalence of deep vein thrombosis in their hospital setting was twice as high as that found in our study (39.1% v 19.7%). This higher prevalence can emerge from a shift spectrum of patients, towards fewer patients with limited forms of deep vein thrombosis and more patients with more manifested forms. This effect in turn could have resulted in a somewhat lower exclusion rate with the traditional cut off value of 500 g/L, and led to a higher increase in the exclusion rate after use of the age adapted cut off value, compared with our study.
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Van Gerwen Faces Wright In World Darts Final
An epic battle was expected between the two highest ranked players left in the tournament, but in reality the world No 2 triumphed in a thoroughly one sided contest.
Lewis' scoring could not be faulted, but the two times champion's double hitting was as poor as van Gerwen's was brilliant, resulting in a stunning whitewash in the Dutchman's favour.
Van Gerwen finished with an average of 103.02 and hit fake hermes bag 58% of the doubles he attempted to set up showdown with Peter Wright for the world crown on New Year's Day.
"In the end the score looked a bit easier than it actually was," van Gerwen told Hermes birkin bags fake Sky Sports.
"I did a lot in the right moments. Adrian was struggling on his doubles and his finishes. In the important moments he didn't do well and I took advantage of that."
He added: "Me and Peter played against each other so much last year I won a bit more against him than he (did against) me, but that doesn't say anything, he's played very well this tournament."
Van Gerwen rattled off the first set in just 5 minutes 26 seconds and took out a 146 finish during the second, only to see Lewis hit back by taking out 158 in the next leg.
An 11 darter from last year's runner up saw him take the deciding leg and open up a two set cushion and then Lewis lost his throw at the start of the third set after missing six darts at doubles.
Van Gerwen forged ahead, taking out 72 in two darts to win the set before replica hermes handbags outlet opening the fourth set with imitiaton hermes bag a 121 finish. He broke Lewis' throw in the next leg and then moved 4 0 up in sets thanks to an outrageous 154 checkout.
Lewis then hit a ton plus checkout of his own, but more missed doubles later in the set allowed the second seed to break throw again and take a five set lead.
The sixth set went to a deciding leg, but van Gerwen came through on his own throw to complete the whitewash.
Before this year Wright had not gone past the third round at Alexandra Palace, but such has been his form over the last two weeks he actually went into the clash as a marginal favourite against the world No 4 and 2010 runner up Simon Whitlock but he crushed him 6 2.
He justified that status and more as he raced into a 3 0 lead, Whitlock having no answer to his consistent scoring and reliability on the doubles.
Whitlock did make things a little more competitive thereafter, but he never realistically threatened to mount a serious comeback against an opponent who averaged 100.24.
An epic battle was expected between the two highest ranked players left in the tournament, but in reality the world No 2 triumphed in a thoroughly one sided contest.
Lewis' scoring could not be faulted, but the two times champion's double hitting was as poor as van Gerwen's was brilliant, resulting in a stunning whitewash in the Dutchman's favour.
Van Gerwen finished with an average of 103.02 and hit fake hermes bag 58% of the doubles he attempted to set up showdown with Peter Wright for the world crown on New Year's Day.
"In the end the score looked a bit easier than it actually was," van Gerwen told Hermes birkin bags fake Sky Sports.
"I did a lot in the right moments. Adrian was struggling on his doubles and his finishes. In the important moments he didn't do well and I took advantage of that."
He added: "Me and Peter played against each other so much last year I won a bit more against him than he (did against) me, but that doesn't say anything, he's played very well this tournament."
Van Gerwen rattled off the first set in just 5 minutes 26 seconds and took out a 146 finish during the second, only to see Lewis hit back by taking out 158 in the next leg.
An 11 darter from last year's runner up saw him take the deciding leg and open up a two set cushion and then Lewis lost his throw at the start of the third set after missing six darts at doubles.
Van Gerwen forged ahead, taking out 72 in two darts to win the set before replica hermes handbags outlet opening the fourth set with imitiaton hermes bag a 121 finish. He broke Lewis' throw in the next leg and then moved 4 0 up in sets thanks to an outrageous 154 checkout.
Lewis then hit a ton plus checkout of his own, but more missed doubles later in the set allowed the second seed to break throw again and take a five set lead.
The sixth set went to a deciding leg, but van Gerwen came through on his own throw to complete the whitewash.
Before this year Wright had not gone past the third round at Alexandra Palace, but such has been his form over the last two weeks he actually went into the clash as a marginal favourite against the world No 4 and 2010 runner up Simon Whitlock but he crushed him 6 2.
He justified that status and more as he raced into a 3 0 lead, Whitlock having no answer to his consistent scoring and reliability on the doubles.
Whitlock did make things a little more competitive thereafter, but he never realistically threatened to mount a serious comeback against an opponent who averaged 100.24.
Vergelijking van Volkswagen Polo en Ford Figo
Volkswagen Polo en Ford Figo beide zijn de naam die uw zintuigen te laten zeewinden. En als u worden uw verlangens in de arena van de prijs van vijf tot zes lakh framing dan heb je de beste beschikbare opties in auto segment onder het mom van Polo hermes belts Knockoff en Figo. Beide zijn op hun beste prestaties en komen met aangenaam goodies. Als u wilt dat de beste die kunt u vergelijken beide van hen en kies vervolgens de beste optie om uw verlangens.
Motor is het hart van elke auto. En als u wilt een betere auto optie is het de perfecte ding waarop we vergelijkingen kunnen. Het hart van Volkswagen Polo is geschonken met 1.2 L, 3 cilinder, MPFI technologie. Het wordt geladen voor het genereren van de kracht van 74 Bhp en 110 Nm met de effectieve verplaatsing van 1198 cc dat de prestaties op altitudinous mate kan versterken. En de Ford Figo is gekleed met 1.2 L, 4 cilinder, MPFI engine die is onderworpen aan de kracht fake hermes mens belt van 71 churn Bhp op 102 Nm koppel. Zowel van de auto's hebben het systeem van 5 versnellingen handgeschakelde transmissie.
Prijs is de grote zorg om te vergelijken cos het maakt een groot verschil. De varianten van Volkswagen Polo benzine zijn op iemands verwijdering in de prijsklasse van 4.34 lakhs aan 5.7 lakhs terwijl de Ford Figo van benzine varianten getable in de prijsklasse van Rs 3.6 lakhs tot 4,5 lakhs zijn.
Als u het gevoel te hebben voor een luxe hermes belt price replica zoals hatchback maar alle op het gewenste gebied moeten we ook de afmetingen van vergelijken. De Volkswagen Polo is de indrukwekkende dimensie die u zich op n site bezighouden kunt. Het dat de lengte van 3970 mm, voldoende breedte van 1682mm en hoogte van 1453 mm met de wielbasis van 2456 mm en draaicirkel van 4.97 m. De Ford Figo heeft ook met ontzagwekkende afmetingen 1680 mm, Hermes belt replica paris 1427 mm en 3795 mm. De wielbasis van het is 2489 mm die toereikend is om omhoog aan pari saldo samen met de draaicirkel van 4.90 m die kleiner is dan de concurrerende hatchback en helpt ook te verwerven minder ruimte om te zetten.
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Mensen die genteresseerd zijn in het bovenstaande artikel zijn ook genteresseerd in de aanverwante artikelen hieronder:
De vastlegging van de jeugd voor het besturen van een high tech auto is niet onbekend voor iedereen, maar het feit dat ze de luxe zoals dure kleren vertrekken kunnen en socialiseren voor autorijden zeker veel over hun liefde zegt voor het autorijden. Volgens een onderzoek, ondernomen door Morar en admiraal LittleBox, bleek dat jongeren die tussen 17 en 24 jaar oud vallen zijn bereid op te geven om te genieten van het achter de wielen van een cool voertuig luxe.
Na een ongeval, als u in het bezit van een volledig beschadigd voertuig bent en bent u benieuwd hoe en waar te verkopen van mijn auto in deze voorwaarde, dan bent u bij ons aan het juiste adres. Getotaliseerd auto's zijn degenen die al een weg of andere ongeval dat heeft geleid tot de auto geheel of gedeeltelijk worden verminkt.
Volkswagen Polo en Ford Figo beide zijn de naam die uw zintuigen te laten zeewinden. En als u worden uw verlangens in de arena van de prijs van vijf tot zes lakh framing dan heb je de beste beschikbare opties in auto segment onder het mom van Polo hermes belts Knockoff en Figo. Beide zijn op hun beste prestaties en komen met aangenaam goodies. Als u wilt dat de beste die kunt u vergelijken beide van hen en kies vervolgens de beste optie om uw verlangens.
Motor is het hart van elke auto. En als u wilt een betere auto optie is het de perfecte ding waarop we vergelijkingen kunnen. Het hart van Volkswagen Polo is geschonken met 1.2 L, 3 cilinder, MPFI technologie. Het wordt geladen voor het genereren van de kracht van 74 Bhp en 110 Nm met de effectieve verplaatsing van 1198 cc dat de prestaties op altitudinous mate kan versterken. En de Ford Figo is gekleed met 1.2 L, 4 cilinder, MPFI engine die is onderworpen aan de kracht fake hermes mens belt van 71 churn Bhp op 102 Nm koppel. Zowel van de auto's hebben het systeem van 5 versnellingen handgeschakelde transmissie.
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Als u het gevoel te hebben voor een luxe hermes belt price replica zoals hatchback maar alle op het gewenste gebied moeten we ook de afmetingen van vergelijken. De Volkswagen Polo is de indrukwekkende dimensie die u zich op n site bezighouden kunt. Het dat de lengte van 3970 mm, voldoende breedte van 1682mm en hoogte van 1453 mm met de wielbasis van 2456 mm en draaicirkel van 4.97 m. De Ford Figo heeft ook met ontzagwekkende afmetingen 1680 mm, Hermes belt replica paris 1427 mm en 3795 mm. De wielbasis van het is 2489 mm die toereikend is om omhoog aan pari saldo samen met de draaicirkel van 4.90 m die kleiner is dan de concurrerende hatchback en helpt ook te verwerven minder ruimte om te zetten.
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Prijsverschil is tussen de twee auto's de eerste differentiator. Praten in termen van begroting, zou ik zeggen deze auto's deel uitmaken van een verschillende prijsklasse dan elkaar, maar ik wil hoe dan ook te vergelijken omdat dit zowel kleine hatchbacks en verse nieuwe in Indiase auto markten zijn.
Mensen die genteresseerd zijn in het bovenstaande artikel zijn ook genteresseerd in de aanverwante artikelen hieronder:
De vastlegging van de jeugd voor het besturen van een high tech auto is niet onbekend voor iedereen, maar het feit dat ze de luxe zoals dure kleren vertrekken kunnen en socialiseren voor autorijden zeker veel over hun liefde zegt voor het autorijden. Volgens een onderzoek, ondernomen door Morar en admiraal LittleBox, bleek dat jongeren die tussen 17 en 24 jaar oud vallen zijn bereid op te geven om te genieten van het achter de wielen van een cool voertuig luxe.
Na een ongeval, als u in het bezit van een volledig beschadigd voertuig bent en bent u benieuwd hoe en waar te verkopen van mijn auto in deze voorwaarde, dan bent u bij ons aan het juiste adres. Getotaliseerd auto's zijn degenen die al een weg of andere ongeval dat heeft geleid tot de auto geheel of gedeeltelijk worden verminkt.
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Van Jones Resignation Heaps Criticism Upon Obama
The imitation hermes mens belt resignation of the Obama administration's "green jobs" czar, Van Jones, has caused an uproar within progressive circles. government allowed the Sept. 11 attacks to occur, and after remarks in which he used a derogatory word to describe Republicans.
Caving to strong criticism by conservative political pundits, and more specifically that of Fox News Channel talk show host Glenn Beck, Jones announced his resignation Saturday evening by describing his departure as a result of a "vicious smear campaign" against him and implying that conservatives were to blame.
But Jones' resignation could have political repercussions from progressives, replica Hermes belt france some of whom criticize President Obama for not doing more to defend the man tapped by the White House as Special Adviser for Green Jobs, Enterprise and Innovation for his "strong voice" on environmental issues.
"[The resignation] has a chilling effect," says Ford. But Rucker says the controversy surrounding his resignation has everything to do with a racially motivated agenda by conservatives, Beck and the Fox News Channel.
"It gives people pause, and I think that's the purpose as far as what Beck is trying to do and what Fox is trying to do," says Rucker, who describes Beck as a "race baiter."
Both Ford and Rucker says they are disappointed that the White House did not do more to defend Jones in what some see as a media war launched by conservatives against hermes brown belt imitation the president and his agenda. Ford says the Obama administration is not being fair.
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The imitation hermes mens belt resignation of the Obama administration's "green jobs" czar, Van Jones, has caused an uproar within progressive circles. government allowed the Sept. 11 attacks to occur, and after remarks in which he used a derogatory word to describe Republicans.
Caving to strong criticism by conservative political pundits, and more specifically that of Fox News Channel talk show host Glenn Beck, Jones announced his resignation Saturday evening by describing his departure as a result of a "vicious smear campaign" against him and implying that conservatives were to blame.
But Jones' resignation could have political repercussions from progressives, replica Hermes belt france some of whom criticize President Obama for not doing more to defend the man tapped by the White House as Special Adviser for Green Jobs, Enterprise and Innovation for his "strong voice" on environmental issues.
"[The resignation] has a chilling effect," says Ford. But Rucker says the controversy surrounding his resignation has everything to do with a racially motivated agenda by conservatives, Beck and the Fox News Channel.
"It gives people pause, and I think that's the purpose as far as what Beck is trying to do and what Fox is trying to do," says Rucker, who describes Beck as a "race baiter."
Both Ford and Rucker says they are disappointed that the White House did not do more to defend Jones in what some see as a media war launched by conservatives against hermes brown belt imitation the president and his agenda. Ford says the Obama administration is not being fair.
"They can defend whatever they brown hermes belt replica are prepared to defend," argues Ford. "This is an administration which has a Treasury secretary [Timothy Geithner] who neglected to pay his taxes."
Van Vleck Texas hit by six tornadoes along the Gulf Coast
Seven people were transported by ambulance for medical care and it's not clear how many more may have been taken to hospitals by private vehicle,said Doug Matthes, emergency management coordinator for Matagorda County.
The seven people taken by ambulance didn't appear to have serious injuries, he fashion cheap hermes handbags said.
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Seven people were transported by ambulance for medical care and it's not clear how many more may have been taken to hospitals by private vehicle,said Doug Matthes, emergency management coordinator for Matagorda County.
The seven people taken by ambulance didn't appear to have serious injuries, he fashion cheap hermes handbags said.
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Vandepoele equally cursed blessed
And the misfortune? Same thing.
Curling out of the Victoria Curling Club this winter, Vandepoele is perhaps the best young curler in this province never to have won a major provincial championship and that's at least partly a function of the era in which she's curled.
She has competed in two of the last three provincial junior women's finals and lost both of them. But the identity of the skips who beat her Kaitlyn Lawes in 2009 and Breanne Meakin in 2011 should tell you everything you need to know about the formidable obstacles the 19 year old university student has faced as she continues to try to fake hermes brown belt whosale claim her first provincial curling title.
"It's been great to have been in all those finals," Vandepoele reflected on Thursday, "and I imitation hermes mens belt think I've learned something from every one of those losses.
"It's never easy to have a great week and then not be able to finish it off in the end. It's rough. But hey, it's curling."
Lawes, of course, had a prodigious junior curling career in Manitoba, taking down back to back provincial and Canadian junior titles in 2008 and 2009 before making a seamless transition to the women's game, where she is third on Jennifer Jones's juggernaut and imitation hermes belt on sale was named a first team all star at her position at last winter's national Scotties Tournament of Hearts.
And then there is Meakin, who in beating Vandepoele in last winter's provincial junior final did nothing less than make Manitoba curling history, becoming just the fourth curler to ever win four Manitoba junior women's titles. Meakin then also made a quick and successful transition to the elite women's game, as lead on Cathy Overton Clapham's defending provincial women's champion the past two winters.
So yeah, Vandepoele has lost a lot of big finals. And she even lost another one earlier this month, losing a zone final to another Manitoba great Janet Harvey imitation hermes belt sale that would have qualified Vandepoele for her first trip to the Manitoba women's provincials next month.
On top of that, the only junior provincial final Vandepoele didn't lose in the last three years in 2010 was lost by her current vice skip and lead, Kate Cameron and Sheyna Andries, who lost the 2010 title game to Meakin with a different team.
But given the resumes of the skips who have beaten her in those finals, Vandepoele looks more like a victim of circumstance than one of those athletes who cannot win the big one.
And the good news abounds for Vandepoele right now as she and her team Cameron (who throws last rock), second Abby Ackland and Andries take a tune up tour through the junior Christmas bonspiel this week in preparation for next week's 2012 Manitoba junior women's championship in Minnedosa.
For starters, Meakin and Lawes have now long graduated from the women's game and Vandepoele would appear to be their heir apparent and likely top seed for next week's junior provincials.
And at age 19, Vandepoele still has the rest of this winter and all of next to get some much needed national experience at the junior level in advance of making a transition to the women's game she hopes will be as successful as the ones Meakin and Lawes made before her.
"It seems like the top women's teams are believing a lot in the juniors," says Vandepoele. "They're watching them and they know they can play at their level. I think it's great how they're building the game and the juniors are stepping up and playing with them.".
And the misfortune? Same thing.
Curling out of the Victoria Curling Club this winter, Vandepoele is perhaps the best young curler in this province never to have won a major provincial championship and that's at least partly a function of the era in which she's curled.
She has competed in two of the last three provincial junior women's finals and lost both of them. But the identity of the skips who beat her Kaitlyn Lawes in 2009 and Breanne Meakin in 2011 should tell you everything you need to know about the formidable obstacles the 19 year old university student has faced as she continues to try to fake hermes brown belt whosale claim her first provincial curling title.
"It's been great to have been in all those finals," Vandepoele reflected on Thursday, "and I imitation hermes mens belt think I've learned something from every one of those losses.
"It's never easy to have a great week and then not be able to finish it off in the end. It's rough. But hey, it's curling."
Lawes, of course, had a prodigious junior curling career in Manitoba, taking down back to back provincial and Canadian junior titles in 2008 and 2009 before making a seamless transition to the women's game, where she is third on Jennifer Jones's juggernaut and imitation hermes belt on sale was named a first team all star at her position at last winter's national Scotties Tournament of Hearts.
And then there is Meakin, who in beating Vandepoele in last winter's provincial junior final did nothing less than make Manitoba curling history, becoming just the fourth curler to ever win four Manitoba junior women's titles. Meakin then also made a quick and successful transition to the elite women's game, as lead on Cathy Overton Clapham's defending provincial women's champion the past two winters.
So yeah, Vandepoele has lost a lot of big finals. And she even lost another one earlier this month, losing a zone final to another Manitoba great Janet Harvey imitation hermes belt sale that would have qualified Vandepoele for her first trip to the Manitoba women's provincials next month.
On top of that, the only junior provincial final Vandepoele didn't lose in the last three years in 2010 was lost by her current vice skip and lead, Kate Cameron and Sheyna Andries, who lost the 2010 title game to Meakin with a different team.
But given the resumes of the skips who have beaten her in those finals, Vandepoele looks more like a victim of circumstance than one of those athletes who cannot win the big one.
And the good news abounds for Vandepoele right now as she and her team Cameron (who throws last rock), second Abby Ackland and Andries take a tune up tour through the junior Christmas bonspiel this week in preparation for next week's 2012 Manitoba junior women's championship in Minnedosa.
For starters, Meakin and Lawes have now long graduated from the women's game and Vandepoele would appear to be their heir apparent and likely top seed for next week's junior provincials.
And at age 19, Vandepoele still has the rest of this winter and all of next to get some much needed national experience at the junior level in advance of making a transition to the women's game she hopes will be as successful as the ones Meakin and Lawes made before her.
"It seems like the top women's teams are believing a lot in the juniors," says Vandepoele. "They're watching them and they know they can play at their level. I think it's great how they're building the game and the juniors are stepping up and playing with them.".
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