June 25, 2009, 6:49 PM CT

Big Tobacco dead by 2047

President Barack Obama's signature on a bill this week to grant the Food and Drug Administration (FDA) regulatory authority over tobacco was historic, and represents a step in the march to eliminate tobacco use in this country by 2047, two national tobacco experts said today (June 25).

The pair published "Stealing a March in the 21st Century: Accelerating Progress in the 100-Year War Against Tobacco Addiction in the United States" in the recent issue of the American Journal of Public Health Michael Fiore and Timothy Baker, director and associate director of the University of Wisconsin-Madison Center for Tobacco Research and Intervention (UW-CTRI), respectively, chart milestones in beating tobacco addiction and map a battle plan to eradicate tobacco use in the next few decades. The scientists analyzed data from the 1960s, when the first systemic tracking of smoking rates began, until the present.

"Numerous observers have claimed over time that tobacco use has plateaued and progress against its use has stalled," the authors write. "However, the remarkable decline in rates of tobacco use since the 1960s belies this claim and underscores the remarkable success of tobacco control efforts to date."

Data from the Centers for Disease Control and Prevention show adults smoking between 1965 and 2007 dropped by an average of one half of one percentage point per year, from 42 percent to the current rate of about 20 percent rate. While this rate of decline hasn't occurred each year, the overall decrease has been quite steady......... Posted by: Scott      Read more         Source

June 23, 2009, 5:11 PM CT

New therapy to prevent heart failure

A landmark study has successfully demonstrated a 29 percent reduction in heart failure or death in patients with heart disease who received an implanted cardiac resynchronization treatment device with defibrillator (CRT-D) versus patients who received only an implanted cardiac defibrillator (ICD-only).

MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) is a clinical trial that enrolled more than 1,800 patients in the United States, Canada and Europe and followed the patients for up to 4 years. The results of the trial were released recently by the University of Rochester Medical Center and Boston Scientific, the study's sponsor. The MADIT-CRT Executive Committee stopped the trial on June 22, 2009, when the trial achieved its primary end point significant reduction in heart failure or death with CRT-D versus ICD-only. Heart specialist Arthur Moss, M.D., professor of Medicine at the University of Rochester Medical Center, led the MADIT-CRT trial.

A previous study (MADIT-II) by Moss and associates in 2002 showed the ICD was effective in reducing mortality. The current MADIT-CRT study sought to determine if CRT-D could reduce the risk of mortality and heart failure, which affects 5.7 million Americans, and the results are very positive......... Posted by: Daniel      Read more         Source

June 12, 2009, 5:24 AM CT

Why smoking increases the risk of heart disease and strokes?

Scientists at Charles Drew University of Medicine and Science in Los Angeles and Western University of Health Sciences in Pomona have discovered a reason why smoking increases the risk of heart disease and strokes.

The study, which will be presented Thursday, June 11 at The Endocrine Society's 91st annual meeting in Washington, D.C., observed that nicotine in cigarettes promotes insulin resistance, a pre-diabetic condition that raises blood sugar levels higher than normal. People with pre-diabetes are at greater risk of developing cardiovascular disease.

Theodore Friedman, MD, Ph.D., chief of the endocrinology division at Charles Drew University, said the findings help explain a "paradox" that links smoking to heart disease.

Smokers experience a high degree of cardiovascular deaths, Friedman said. "This is surprising considering both smoking and nicotine may cause weight loss and weight loss should protect against cardiovascular disease".

The scientists studied the effects of twice-daily injections of nicotine on 24 adult mice over two weeks. The nicotine-injected mice ate less food, lost weight and had less fat than control mice that received injections without nicotine.

"Our results in mice show that nicotine administration leads to both weight loss and decreased food intake," Friedman said. "Mice exposed to nicotine have less fat. In spite of this, mice have abnormal glucose tolerance and are insulin resistant (pre-diabetes)."........ Posted by: Daniel      Read more         Source

June 9, 2009, 5:14 AM CT

Diabetes patients should have regular exercise

To reduce their cardiovascular risk, people with type 2 diabetes should do at least two-and-a-half hours per week of moderate-intensity or one-and-a-half hours per week of vigorous-intensity aerobic exercises, plus some weight training, as per an American Heart Association scientific statement published in Circulation: Journal of the American Heart Association.

The global increase in overweight and obesity has led to an "unprecedented epidemic" in type 2 diabetes (when the body is unable to use insulin efficiently to help turn glucose, or blood sugar, into energy for the body's cells). In 2007, type 2 diabetes in the United States cost an estimated $174 billion in direct medical costs and indirect costs such as disability, lost productivity and premature death. That amount represents a 30 percent increase from the $132 billion estimated in 2002, as per the statement.

Furthermore, heart and blood vessel disease is responsible for nearly 70 percent of deaths in people with type 2 diabetes.

"Given the observed increases in type 2 diabetes in adults over the last few decades in developed countries, and the increasing numbers of overweight and obese individuals throughout the world, we must look at ways to reduce the cardiovascular complications of diabetes, and exercise is one of those ways," said Thomas H. Marwick, M.D., Ph.D., chair of the writing group and professor of medicine and director of the Centre of Clinical Research Excellence in Cardiovascular and Metabolic Disease at the University of Queensland School of Medicine in Brisbane, Australia......... Posted by: JoAnn      Read more         Source

June 5, 2009, 5:05 AM CT

Crowded Emergency Departments and Patients with Heart Attacks

Patients with heart attacks and other forms of chest pain are three to five times more likely to experience serious complications after hospital admission when they are treated in a crowded emergency department (ED), as per a newly released study reported in the journal Academic Emergency Medicine. The authors say that this dramatic difference in rates of serious complications underscores the need for action on the part of hospital administrators, policymakers and emergency physicians to find solutions to what has been termed "a national public health problem." More than six million patients per year come to U.S. emergency departments with chest pain.

"What shocked us is that these complications were not explained by what goes on in the ED, like getting aspirin or a rapid electrocardiogram," says main author Jesse M. Pines, M.D., MBA, an assistant professor of emergency medicine and epidemiology at the Hospital of the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics. "The adverse events occurred after the patient had been admitted to the hospital. Emergency department crowding is really more of a marker of a dysfunctional hospital".

The study followed 4,574 patients who were admitted to the Hospital of the University of Pennsylvania for symptoms of chest pain over an eight-year period. Ultimately, 802 were diagnosed with an acute coronary syndrome (chest pain of cardiac origin); of those, 273 had a true heart attack. There were 251 complications that occurred in the hospital after initial emergency department therapy. Complications included serious events, such as heart failure, delayed heart attacks, dangerously low blood pressure, heart arrhythmias and cardiac arrest......... Posted by: Daniel      Read more         Source

June 1, 2009, 5:12 AM CT

Individualized treatment for heart failure

Telemonitoring systems, by which the symptoms of heart failure can be remotely assessed, now provide a strategy for the improved personalised care of patients, as per Professor John Cleland from the University of Hull, UK.1 He told Heart Failure Congress 2009 that the management of heart failure is complex but most effective when tailored to the individual patients' needs and condition.2 "Unfortunately," he added, "the resources mandatory to offer this tailored therapy outside a hospital setting are generally not available. Current services provide, at best, only a crude attempt to deliver long-term, personalised healthcare, but telemonitoring provides a strategy which could radically change this situation".

Professor Cleland explained that the first generation of home monitoring devices for heart failure were relatively simple. They were designed to measure symptoms, weight, heart rate and rhythm, and blood pressure. But, he said, "from the patient's perspective, they were relatively unrewarding since the systems provide little in the way of advice or feedback. Nonetheless, a series of randomised controlled trials have shown a reduction in mortality and in days spent in hospital, eventhough not in the rate of hospitalisation."

Ongoing trials of second generation equipment, he continued, reflect the same measure of symptom evaluation but a more interactive experience for the patient. "These newer systems," he explained, "provide education, feedback to patients on their results, therapy and appointment reminders and a limited amount of advice on adjusting treatment. They are likely to deliver even greater health gains than first generation systems"......... Posted by: Daniel      Read more         Source

June 1, 2009, 5:10 AM CT

Obesity and diabetes double risk of HF

The twin epidemics of obesity and type 2 diabetes will continue to fuel an explosion in heart failure, already the world's most prevalent chronic cardiovascular disease, as per John McMurray, professor of cardiology at the Western Infirmary, Glasgow, and President of the Heart Failure Association. He reported that around one-third of patients with heart failure have evidence of diabetes, and for them the outlook is very serious. For doctors, he added, effective therapy is "very difficult".

Obesity, like diabetes, is increasing in prevalence. The latest report from Euroaspire, Europe's largest survey of cardiovascular risk factors in coronary patients, observed that the prevalence of obesity had increased from 25 per cent in 1997 to 38 per cent in just ten years and this in people who had already had at least one heart attack.

Now, a session at Heart Failure 2009 emphasises that obesity is not just linked to an increased risk of heart attack, but also and particularly - with an increased risk of heart failure.1,2 "Obesity is at least as great a risk factor for heart failure as it is for heart attack or stroke," says Professor McMurray. "Obesity more than doubles the risk".

The pathways by which obesity plays such a role in heart failure are still not fully understood, but have been shown to have an indirect effect via hypertension, or heart attack, or diabetes and a direct effect on the heart muscle itself. "We know that the underlying changes in the structure and function of the heart appears to be different in obese and non-obese patients with heart failure," says Professor McMurray. An even more "intriguing" suggestion, he added, is that adipose cells might act as an endocrine tissue, secreting substances which may have a harmful effect on heart tissue and blood vessels......... Posted by: JoAnn      Read more         Source

May 15, 2009, 5:25 AM CT

Heart disorder and Alzheimer's disease

Scientists at Intermountain Medical Center in Salt Lake City think that they have made a breakthrough correlation between atrial fibrillation, a fairly common heart rhythm disorder, and Alzheimer's disease, the leading form of dementia among Americans.

In a study presented Friday, May 15, at "Heart Rhythm 2009," the annual scientific sessions of the Heart Rhythm Society in Boston, scientists unveiled findings from the study of more than 37,000 patients that showed a strong relationship between atrial fibrillation and the development of Alzheimer's disease.

The study, which drew upon information from the Intermountain Heart Collaborative Study, a vast database from hundreds of thousands of patients treated at Intermountain Healthcare hospitals, found:

Patients with atrial fibrillation were 44 percent more likely to develop dementia than patients without the heart disorder.

Younger patients with atrial fibrillation were at higher risk of developing all types of dementia, especially Alzheimer's. Atrial fibrillation patients under age 70 were 130 percent more likely to develop Alzheimer's.

Patients who have both atrial fibrillation and dementia were 61 percent more likely to die during the study period than dementia patients without the rhythm problem......... Posted by: Daniel      Read more         Source

May 15, 2009, 5:19 AM CT

Comparison of Three Aspirin Types

For a number of years, it has been known that aspirin is beneficial to patients suffering heart attacks and near-heart attacks. But which of the a number of different types of aspirin is likely to help the most?

A group of scientists led by Dr. Sean Nordt from the University of California, San Diego gave three different types of aspirin to a group of volunteer research subjects: regular aspirin swallowed whole, regular aspirin chewed and swallowed, and chewable aspirin chewed and swallowed. Blood levels of aspirin were then measured, to see which route led to the highest aspirin levels in the body.

The chewable aspirin consistently showed greater and more rapid absorption than the regular aspirin, whether swallowed whole or chewed. This seemingly quite simple finding could lead to improvements in the care of heart attack patients.

The presentation, entitled "Comparison Of Three Aspirin Formulations" will be given by Dr. Sean Nordt in the Cardiovascular forum at the 2009 SAEM Annual Meeting at the Sheraton New Orleans on Friday, May 15 at 1:00 PM. Abstracts are published in Vol. 16, No. 4, Supplement 1, April 2009 of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine......... Posted by: Daniel      Read more         Source

May 8, 2009, 5:28 AM CT

Smoking: mortality and cardiovascular disease

Non-smokers live longer and have less cardiovascular disease than those who smoke, as per a 30-year follow-up study of 54,000 men and women in Norway. Smoking, say the investigators, is "strongly" correlation to cardiovascular morbidity and mortality from various causes.

The results, presented in Stockholm at EuroPRevent 2009, reflect what a number of other studies have indicated, but, says investigator Professor Haakon Meyer from the University of Oslo and Norwegian Institute of Public Health, these results provide a picture of the long-term, absolute "real life" risk.

Behind his conclusions lies a far-reaching follow-up study which began in 1974 with an invitation to every middle aged man and woman (aged 35-49) living in three counties of Norway to take part in a basic cardiovascular screening examination. The invitation had a huge response, with 91% attending for the baseline screen.

Over the next three decades deaths were recorded by linkage to the Norwegian population registry and, between 2006 and 2008, those surviving responded to a follow-up questionnaire. This allowed division of the participants as per their smoking status never-smokers, ex-smokers, current smokers of 1-9 cigarettes a day, 10-19 cigarettes a day and more than 20 cigarettes a day (the last group referred to as "heavy smokers")......... Posted by: Daniel      Read more         Source

May 5, 2009, 5:08 AM CT

Heart disease sleep apnea link

Obstructive sleep apnea, or periodic interruptions in breathing throughout the night, thickens sufferers' blood vessels. Moreover, it increases the risk of several forms of heart and vascular disease.

Emory scientists have identified the enzyme NADPH oxidase as important for the effects obstructive sleep apnea has on blood vessels in the lung.

The results are reported in the May 1 issue of the American Journal of Respiratory Cell and Molecular Biology. C. Michael Hart, professor of medicine at Emory University School of Medicine and Atlanta Veterans Affairs Medical Center, is senior author.

Obstructive sleep apnea is thought to affect one in every 50 women and one in every 25 men in the United States. Standard therapy involves a mechanical application of air pressure. Anything that blunts sleep apnea's effects on blood vessel physiology could reduce its impact on disease risk, Hart says.

Cyclically depriving mice of oxygen - scientists call this "chronic intermittent hypoxia" -- in a way that simulates obstructive sleep apnea gives them pulmonary hypertension. Pulmonary hypertension, which can be life threatening, is a condition in which the right side of the heart has trouble pumping blood because of resistance in the lung's blood vessels......... Posted by: Daniel      Read more         Source

April 28, 2009, 5:15 AM CT

Smoking, high blood pressure and being overweight

Smoking, hypertension and being overweight are the leading preventable risk factors for premature mortality in the United States, as per a newly released study led by scientists at the Harvard School of Public Health (HSPH), with collaborators from the University of Toronto and the Institute for Health Metrics and Assessment at the University of Washington. The scientists observed that smoking is responsible for 467,000 premature deaths each year, hypertension for 395,000, and being overweight for 216,000. The effects of smoking work out to be about one in five deaths in American adults, while hypertension is responsible for one in six deaths.

It is the most comprehensive study yet to look at how diet, lifestyle and metabolic risk factors for chronic disease contribute to mortality in the U.S. The study appears in the April 28, 2009 edition of the open-access journal PLoS Medicine

"The large magnitude of the numbers for a number of of these risks made us pause," said Goodarz Danaei, a doctoral student at HSPH and the main author of the study. "To have hundreds of thousands of premature deaths caused by these modifiable risk factors is shocking and should motivate a serious look at whether our public health system has sufficient capacity to implement interventions and whether it is currently focusing on the right set of interventions." Majid Ezzati, associate professor of international health at HSPH, is the study's senior author......... Posted by: Janet      Read more         Source

April 27, 2009, 5:28 AM CT

Statins may reduce the risk of prostate cancer

Cholesterol-lowering drugs called statins may reduce inflammation in prostate tumors, possibly hindering cancer growth, as per a research studyled by researchers in the Duke Prostate Center.

"Prior studies have shown that men taking statins seem to have a lower occurence rate of advanced prostate cancer, but the mechanisms by which statins might be affecting the prostate remained largely unknown," said Lionel Baez, M.D., a researcher in the Duke Prostate Center and lead investigator on this study. "We looked at tumor samples and observed that men who were on statins had a 72 percent reduction in risk for tumor inflammation, and we believe this might play a role in the correlation between prostate cancer and statin use".

The scientists presented their finding at the American Urological Association's annual meeting on April 26, 2009, and the study was selected to be part of the meeting's press program on April 27, 2009. The study was funded by the United States Department of Defense and the American Urological Association Foundation.

The scientists looked at pathological information from the tumors of 254 men who underwent radical prostatectomy or surgery to remove the entire prostate as a therapy for prostate cancer at the Durham Veterans Affairs Medical Center between 1993 and 2004. The tissue was graded by a pathologist for inflammation on a scale of 0 to 2: 0 for no inflammation, 1 for mild inflammation (less than 10 percent of the tumor) and 2 for marked inflammation (greater than 10 percent of the tumor)......... Posted by: Mark      Read more         Source

April 23, 2009, 5:22 AM CT

Helping doctors follow cholesterol treatment guidelines

A newly released study by scientists at Wake Forest University School of Medicine suggests that patients with high cholesterol receive better care when physicians use a variety of tools to learn and apply a clinical practice guideline for treating the condition.

The study, reported in the April 13 issue of the Archives of Internal Medicine, tracked the adherence to clinical guidelines at 61 primary care practices. The study aimed to improve the therapy of high cholesterol by having doctors use a personal digital assistant (PDA) to assess the patient's risk of heart disease and recommend therapy. Doctors also received copies of the cholesterol guideline and an introductory lecture on it, attended additional presentations on treating high cholesterol, and received a report on their practices' performance on cholesterol management.

"We wanted to know if we could improve guideline adherence with this multifaceted strategy," said Alain G. Bertoni, M.D., M.P.H., an associate professor in the Departments of Epidemiology & Prevention and Internal Medicine, and main author on the study. "When you look at prior quality improvement efforts, it appears that single strategies don't work that well".

Clinical guidelines aim to prevent the under- or over-treatment of a disease. Lowering high cholesterol reduces the risk of cardiovascular disease, the leading cause of death in the United States, but the National Cholesterol Education Program Adult Treatment Panel (ATP III) guideline suggests prescribing drugs only under certain conditions. The complexity of the guideline made it the perfect subject for study, Bertoni said......... Posted by: Daniel      Read more         Source

April 22, 2009, 10:15 PM CT

Benefit of grapes may be more than skin deep

Can a grape-enriched diet prevent the downhill sequence of heart failure after years of high blood pressure?.

A University of Michigan Cardiovascular Center study suggests grapes may prevent heart health risks beyond the simple blood pressure-lowering impact that can come from a diet rich in fruits and vegetables. The benefits appears to be the result of the phytochemicals naturally occurring antioxidants turning on a protective process in the genes that reduces damage to the heart muscle.

The study, performed in laboratory rats, was presented at the 2009 Experimental Biology convention in New Orleans.

The scientists studied the effect of regular table grapes (a blend of green, red, and black grapes) that were mixed into the rat diet in a powdered form, as part of either a high- or low-salt diet. Comparisons were made between rats consuming the grape powder and rats that received a mild dose of a common blood pressure drug. All the rats were from a research breed that develops hypertension when fed a salty diet.

After 18 weeks, the rats that received the grape-enriched diet powder had lower blood pressure, better heart function, and fewer signs of heart muscle damage than the rats that ate the same salty diet but didn't receive grapes......... Posted by: Daniel      Read more         Source

April 22, 2009, 5:08 AM CT

Eating salmon once a week

Eating salmon or other fatty fish just once a week helped reduce men's risk of heart failure, adding to growing evidence that omega-3 fatty acids are of benefit to cardiac health. Led by scientists at Beth Israel Deaconess Medical Center (BIDMC) and reported in today's on-line issue of the European Heart Journal, the findings represent one of the largest studies to investigate the association.

"Prior research has demonstrated that fatty fish and omega-3 fatty acids help to combat risk factors for a range of heart-related conditions, such as lowering triglycerides [fats in the blood] reducing blood pressure, heart rate and heart rate variability," explains first author Emily Levitan, PhD, a research fellow in the Cardiovascular Epidemiology Research Center at BIDMC. "Collectively, this may explain the association with the reduced risk of heart failure found in our study".

A life-threatening condition that develops when the heart can no longer pump enough blood to meet the body's needs, heart failure (also known as congestive heart failure) is commonly caused by existing cardiac conditions, including hypertension and coronary artery disease. Typically heart failure is the leading cause of hospitalization among patients 65 and older, and is characterized by such symptoms as fatigue and weakness, difficulty walking, rapid or irregular heartbeat, and persistent cough or wheezing......... Posted by: Daniel      Read more         Source

April 21, 2009, 5:14 AM CT

Breastfeed your children to prevent heart attack

The longer women breastfeed, the lower their risk of heart attacks, strokes and cardiovascular disease, report University of Pittsburgh scientists as per a research findings reported in the recent issue of Obstetrics & Gynecology

"Heart disease is the leading cause of death for women, so it's vitally important for us to know what we can do to protect ourselves," said Eleanor Bimla Schwarz, M.D., M.S., assistant professor of medicine, epidemiology, and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh. "We have known for years that breastfeeding is important for babies' health; we now know that it is important for mothers' health as well".

As per the study, postmenopausal women who breastfed for at least one month had lower rates of diabetes, hypertension and high cholesterol, all known to cause heart disease. Women who had breastfed their babies for more than a year were 10 percent less likely to have had a heart attack, stroke, or developed heart disease than women who had never breastfed.

Dr. Schwarz and his colleagues observed that the benefits from breastfeeding were long-term ― an average of 35 years had passed since women enrolled in the study had last breastfed an infant.

"The longer a mother nurses her baby, the better for both of them," Dr. Schwarz pointed out. "Our study provides another good reason for workplace policies to encourage women to breastfeed their infants." ......... Posted by: Emily      Read more         Source

April 17, 2009, 5:09 AM CT

Site where 'bad' cholesterol levels are controlled

UT Southwestern Medical Center have observed that a protein responsible for regulating "bad" cholesterol in the blood works almost exclusively outside cells, providing clues for the development of therapies to block the protein's disruptive actions.

"The fact that it works mostly extracellularly provides more opportunities to develop different kinds of therapies," said Dr. Jay Horton, professor of internal medicine and molecular genetics and co-author of the study, which is available online and appears in today's issue of the Journal of Biological Chemistry. .

The protein, called PCSK9, disrupts the activity of a key molecule called the low-density lipoprotein receptor, or LDLR. This molecule, which is made and secreted in the liver, latches onto the LDL receptor. This binding, however, triggers a chain of biochemical reactions that leads to the destruction of the LDL receptor. With fewer receptors available, more of the so-called "bad" cholesterol remains in the bloodstream.

Dr. Horton said these new findings show that PCSK9 principally acts as a secreted protein to cause the degradation of LDL receptors. "Therefore, approaches to block the protein's activity in the blood should be successful in reducing plasma cholesterol levels," he said......... Posted by: Daniel      Read more         Source

April 17, 2009, 5:04 AM CT

Laughter Coupled With Standard Diabetic Treatment

The correlation between the body, mind and spirit has been the subject of conventional scientific inquiry for some 20 years. The notion that psychosocial and societal considerations have a role in maintaining health and preventing disease became crystallized as a result of the experiences of a layman, Norman Cousins. In the 1970s, Cousins, then a writer and magazine editor of the popular Saturday Review, was diagnosed with an autoimmune disease. He theorized that if stress could worsen his condition, as some evidence suggested at the time, then positive emotions could improve his health. As a result, he prescribed himself, with the approval of his doctor, a regimen of humorous videos and shows like Candid Camera©. Ultimately, the disease went into remission and Cousins wrote a paper that was reported in the New England Journal (NEJM) and a book about his experience, Anatomy of an Illness: A Patient's Perspective, which was published in 1979. The book became a best seller and led to the investigation of a new field, known then as whole-person care or integrative medicine and now, lifestyle medicine.

Background

The unscientific foundation that was laid down by Cousins was taken up by a number of medical scientists including the academic medical researcher Dr. Lee Berk in the l980s. In earlier work, Berk and colleagues discovered that the anticipation of "mirthful laughter" had surprising and significant effects. Two hormones - beta-endorphins (the family of chemicals that elevates mood state) and human growth hormone (HGH; which helps with optimizing immunity) - increased by 27% and 87 % respectively in study subjects who anticipated watching a humorous video. There was no such increase among the control group who did not anticipate watching the humorous film. In another study, they observed that the same anticipation of mirthful laughter reduced the levels of three detrimental stress hormones. Cortisol (termed "the steroid stress hormone"), epinephrine (also known as adrenaline) and dopac, (the major catabolite of dopamine), were reduced 39, 70 and 38%, respectively (statistically significant in comparison to the control group). Chronically released high levels of these stress hormones can be detremential to the immune system......... Posted by: JoAnn      Read more         Source