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Improved health-related quality of life after lung volume reduction surgery and pulmonary rehabilitation.
Chronic obstructive pulmonary disease chronic obstructive pulmonary disease
n. Abbr. COPD
A chronic lung disease, such as asthma or emphysema, in which breathing becomes slowed or forced. (COPD COPD chronic obstructive pulmonary disease.
chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) ) is the fourth leading cause of death in the United States, and it is estimated that it will be the third leading cause of mortality in the United States by 2020. (1) It is the only leading cause of death with a rising prevalence, accounting for more than 130,000 deaths annually. (2) Emphysema emphysema (ĕmfĭsē`mə), pathological or physiological enlargement or overdistention of the air sacs of the lungs. A major cause of pulmonary insufficiency in chronic cigarette smokers, emphysema is a progressive disease that commonly is a progressive form of COPD with significant physical and psychological sequelae sequelae Clinical medicine The consequences of a particular condition or therapeutic intervention .
While a variety of treatments improve the symptoms and quality of life in people with COPD, such as bronchodilators, corticosteroids, and pulmonary rehabilitation, these interventions remain supportive and have not impacted survival in people with end-stage emphysema. (3-5) Long-term oxygen therapy (> 15 hours/day) (6) and smoking cessation smoking cessation Public health Temporary or permanent halting of habitual cigarette smoking; withdrawal therapies–eg, hypnosis, psychotherapy, group counseling, exposing smokers to Pts with terminal lung CA and nicotine chewing gum are often ineffective. (7) have been the only therapies shown to improve survival in advanced emphysema. (5) Lung volume reduction surgery (LVRS LVRS Lung Volume Reduction Surgery
LVRS Lightweight Video Reconnaissance System ) is one of a long lineage of surgical approaches to emphysema and was reintroduced by Cooper in the early 1990s. (8) The National Emphysema Treatment Trial (NETT) (9) demonstrated that LVRS improves survival in a select group of patients with emphysema and this was the first time a new treatment impacted survival since the publication of the supplemental oxygen trials almost 30 years ago. (6,10)
In addition to improving survival, LVRS improves lung function, dyspnea dyspnea /dysp·nea/ (disp-ne´ah) labored or difficult breathing.dyspne´ic
paroxysmal nocturnal dyspnea , and exercise tolerance in selected patients with advanced pulmonary emphysema pulmonary emphysema
See emphysema. . (8,9,11-14) Some investigators argue that symptom relief, dyspnea reduction, improvements in exercise tolerance, and quality of life may be more important to patients than survival when considering LVRS as a treatment option. (15) Although data on patients with emphysema are limited, increasing evidence suggests that health-related quality of life (HRQOL HRQOL Health-Related Quality of Life ) deteriorates with advanced disease and is related to the degree of airflow obstruction and level of dyspnea. (16) Pulmonary rehabilitation is an integral part of the recovery from LVRS and is recommended as a component of care in current practice guidelines practice guidelines Medical practice A set of recommendations for Pt management that identifies a specific or range of range of management strategies. See Peer review organization, Practice standards. Cf 'Cookbook' medicine. because of the resultant improvement in conditioning and quality of life. (4,5,17)
Both general and disease-specific quality of life measures have been developed and used in COPD clinical studies such as the quality-of-well-being scale (QWB-SA), (18) the medical outcomes study 36-item short form (MOS (1) (Metal Oxide Semiconductor) See MOSFET.
(2) (Mean Opinion Score) The quality of a digitized voice line. It is a subjective measurement that is derived entirely by people listening to the calls and scoring the results from SF-36), (19,20) the St. George's Respiratory Questionnaire (SGRQ SGRQ St George's Respiratory Questionnaire ), (21) and the University of California, San Diego UCSD is consistently ranked among the top ten public universities for undergraduate education in the United States by U.S. News & World Report.[3] It is a Public Ivy. [1] For graduate studies, most of UCSD's Ph.D. , shortness-of-breath questionnaire (SOBQ SOBQ Signal Officer Branch Qualification (US Army) ). (22) The MOS SF-36 is the instrument used in this study and is a general quality-of-life questionnaire that measures both physical and mental health concepts as seen from the respondent's point of view. (19,23) There are few studies that have reported on the effects of LVRS on quality of life as measured with the MOS SF-36. Some have reported improvement in aspects of quality of life with the MOS SF-36 after LVRS for up to 3 months (significant improvements in the scales of physical functioning, social functioning social functioning,
n the ability of the individual to interact in the normal or usual way in society; can be used as a measure of quality of care. , general health, and vitality), (8) 6 months (significant improvements in the scales of physical functioning, physical role limitations, general health, vitality, and a mean change in Physical Component Summary measure [PCS (1) (Personal Communications Services) Refers to wireless services that emerged after the U.S. government auctioned commercial licenses in 1994 and 1995. This radio spectrum in the 1. ]), (14,24,25) and only a small number of patients have been followed for longer periods (significant improvements in median score after 1 year; in scales of physical functioning, social functioning, and vitality after 2 years; and in the PCS measure after 5 years). (12,13,26,27) Although studies of HRQOL after LVRS have been published, the unique feature of this study is the long-term follow-up of patients after LVRS and intensive pulmonary rehabilitation on both the Physical Component Summary (PCS) and the Mental Component Summary (MCS) in order to illustrate the nature of improvement in HRQOL.
The main purpose of this study was to report on the efficacy of LVRS followed by a 2-week (10 daily sessions) intensive pulmonary rehabilitation program on HRQOL over time with 18 months of follow-up. This research considered the roles of age and gender on HRQOL as important secondary outcomes. From a public health perspective, the investigation of age and gender is timely, because in 2000, the number of women dying of COPD surpassed the number of men. (1)
The subjects for this study were 49 patients with emphysema who had undergone LVRS and participated in pulmonary rehabilitation after LVRS in a single center clinical trial at Chapman Medical Center (Orange, CA). Subjects in this study were not enrolled in the National Emphysema Treatment Trial. There were 31 men and 18 women in the population analyzed with an age range of 51 to 84 years old. The mean age of the patients was 66.0 [+ or -] 6.7 years.
Surgical Procedure
Bilateral staple LVRS by video-assisted thoracic surgery Video-assisted thoracic surgery (VATS)
A technique used to aid in the placement of chest tubes or when performing decortications when treating advanced empyema. (VATS) was performed by one or both of two thoracic surgeons on the same surgical team. To qualify for surgery, the pattern of the patient's emphysema on computerized tomography (CT) had to be severe and heterogeneous. Radionuclide radionuclide /ra·dio·nu·clide/ (-noo´klid) a nuclide that disintegrates with the emission of corpuscular or electromagnetic radiations.
n. lung perfusion scans were also used to confirm the heterogeneous pattern of emphysema. Exclusion criteria exclusion criteria AIDS Donor exclusion criteria, see there for surgery included current cigarette smoking, severe cardiac disease (congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , significant coronary or valvular valvular /val·vu·lar/ (val´vu-ler) pertaining to, affecting, or of the nature of a valve.
Relating to, having, or operating by means of valves or valvelike parts. disease), history of cancer within the last 5 years, ventilator dependency, or prior thoracic surgery Thoracic Surgery Definition
Thoracic surgery is the repair of organs located in the thorax, or chest. The thoracic cavity lies between the neck and the diaphragm, and contains the heart and lungs (cardiopulmonary system), the esophagus, trachea, pleura, .
No patients received preoperative pre·op·er·a·tive
Preceding a surgical operation.
preceding an operation.
preoperative care
the preparation of a patient before operation. pulmonary rehabilitation at Chapman Medical Center prior to LVRS. The mean length of hospital stay post-LVRS was 8.8 [+ or -] 5.6 days. All patients underwent a similar regimen of intensive 2-week (10 daily sessions) outpatient pulmonary rehabilitation 4 hours/day for 5 days/week at Chapman Medical Center beginning the day following hospital discharge. In accordance with evidence-based guidelines, (4,17) the rehabilitation included a multidisciplinary approach with dietary, nursing, nutritional, physical therapy, psychosocial, occupational, and respiratory therapy respiratory therapy
Medical profession concerned with assisting the respiratory function of individuals who have severe lung disorders. Practices include suctioning to clear secretions from the airway, use of aerosol mists (sometimes medicated) or gases to ease breathing, . The pulmonary rehabilitation program included patient education, physical exercise (ambulation am·bu·late
intr.v. am·bu·lat·ed, am·bu·lat·ing, am·bu·lates
To walk from place to place; move about.
[Latin ambul , strengthening, and stretching), self-monitoring, breathing retraining, and airway clearance instruction. The attendance rate was 100%. No home exercise program was given during the rehabilitation phase.
The Medical Outcomes Study 36-Item Short Form Health Survey (MOS SF-36) was the chosen instrument because it is comprehensive in both its representation of multidimensional health concepts and its measurement of a wide range of health states. It is a 36-item general measure, as opposed to one that targets a certain disease, age, or treatment group. It has been shown to be a valid and reliable instrument to measure health-related quality of life (HRQOL) in patients with COPD. (28,29) The survey was used to assess subjects' perceived levels of function during the 4 weeks prior to the administration of each survey. The MOS SF-36 has nine separate scales including the following: (1) physical functioning, (2) social functioning, (3) role limitations (physical), (4) role limitations (emotional), (5) emotional well-being, (6) energy/fatigue, (7) pain, (8) general health perceptions, and (9) current general health perceptions compared to 1 year ago. (19,23) Data from the ninth scale were excluded from data analyses because they are typically not reported. The sensitivity of measurement for each concept is achieved by a short multi-item scale which is scored using the Likert method of summated ratings. (19,23) All 8 scales are used to calculate the 2 component summary measures. (20) The physical component summary (PCS) measure represents the four physical health scales (ie, physical functioning, role physical, bodily pain, and general health perceptions), while the mental component summary (MCS) measure reflects the 4 mental health scales (ie, mental health, role emotional, vitality, and social functioning). The two summary scores are standardized so that the general population mean score is 50 points with a standard deviation of 10 points for each summary score. The two summary scores were used in this study. These component scores have been demonstrated to explain 70% to 80% of the variance in the individual domain scores, however, the component scores may not have as good a sensitivity for detecting change as the individual domain scores. (30) Higher scores indicate better health status. A clinically relevant change or the "minimally important difference" (MID) of the SF-36 is reported to be 5 units on each summary score, although this has not been replicated in patients with COPD. (31)
All patients provided written informed consent, and the study was approved by the Institutional Review Board at Chapman Medical Center. The MOS SF-36 was administered at the preoperative evaluation and the opportunity to ask any questions was given. The MOS SF-36 surveys were requested from subjects postoperatively at the following time periods: 3 months, 6 months, 12 months, and 18 months. A pre-LVRS survey for each patient served as the baseline for comparison with the post-LVRS data of that patient. The survey was scored according to the protocol established by the MOS SF-36 scoring manual. (20,31) The scores were transformed into a scale ranging from 0 to 100, with 0 denoting poor health. (20,31)
Data Analysis
All data analyses were performed using SPSS A statistical package from SPSS, Inc., Chicago (www.spss.com) that runs on PCs, most mainframes and minis and is used extensively in marketing research. It provides over 50 statistical processes, including regression analysis, correlation and analysis of variance. 16.0 for Windows (SPSS Inc. Chicago, Il). A research design of group X time with stratification for age and gender was used. Groups with nonsignificant non·sig·nif·i·cant
1. Not significant.
2. Having, producing, or being a value obtained from a statistical test that lies within the limits for being of random occurrence. differences for time were compressed when stratifying for age and gender. Patients were divided into 2 age groups: younger than 65 years (n=23) and 65 years and older (n=26). (32) Data were compressed into the following times: 3 months post-LVRS through 6 months post-LVRS (Time 2) and 12 through 18 months post-LVRS (Time 3) for comparison with pre-LVRS baseline data (Time 1). A repeated measures multivariate analysis of variance (MANOVA MANOVA Multivariate Analysis of the Variance , Wilk's criterion) was performed to examine the effects of time on component summary measures in all subjects and in groups stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers.
Arranged in the form of layers or strata. by age and gender. Post-hoc analysis of significant data was determined with the Scheffe's Comparison. Alpha was set at P < .05.
The effect of time was analyzed on both the PCS and MCS measures in all subjects and in groups stratified by age and gender. There was a main effect for time on both the PCS and MCS measures in all subjects. There were significant increases in the mean scores for both Physical and Mental Component Summary measures (PCS and MCS, respectively) at Times 2 and 3 compared to Time 1, P < .05 (Table 1). Analysis between Time 2 and Time 3 failed to reveal significant increases in component summary measures.
There was a main effect for time on MCS when groups were stratified by age. There was a significant improvement for patients younger than 65 years old compared to those 65 years and older at Time 3 on the MCS, P < .05 (Table 2). The interaction for time with age was significant on the MCS, P < .05 (Figure 1). Older subjects had higher mean MCS measures than younger patients preoperatively, but lower measures postoperatively at both Times 2 and 3.
There was a main effect for time on PCS when groups were stratified by gender. There were significant improvements for women compared to men at Time 3 on the PCS, P < .05 (Table 3). A significant time-gender interaction occurred on the PCS, P < .05 (Figure 2). Men had higher mean PCS measures than women preoperatively, but lower PCS measures postoperatively at both Times 2 and 3.
There are few published studies that have evaluated either the HRQOL for patients with severe emphysema or the impact of interventions on HRQOL measures. This study has shown that LVRS and pulmonary rehabilitation can significantly improve health-related quality of life (HRQOL) in people with emphysema. Lung volume reduction surgery is able to improve HRQOL by improving lung function (forced expiratory ex·pi·ra·to·ry
Of, relating to, or involving the expiration of air from the lungs.
relating to or employed in the expiration of air from the lungs. volume in the first second and/or lung volumes lung volumes Physiology A group of air 'compartments' into which the lung may be functionally divided
Lung volumes
Expiratory reserve capacity–ERV The maximum volume of air that can be voluntarily exhaled
), dyspnea, and exercise tolerance in selected patients with advanced pulmonary emphysema. (8,9,11-14) Pulmonary rehabilitation is able to improve HRQOL by improving dyspnea, (33-35) exercise tolerance, (11,14,36) education, and coping strategies while having no effect on pulmonary physiology or function or improved survival in patients with COPD. (4) Pulmonary rehabilitation improves physical deconditioning physical deconditioning Medtalk The deterioration of heart and skeletal muscle, related to a sedentary lifestyle, debilitating disease, or prolonged bed rest Clinical ↓ lean body mass, maximum O2 , peripheral muscle abnormalities, improper pacing during exercise, and fear of dyspnea-producing activities which contribute to the systemic effects of COPD and much of its morbidity. (17,37) The NETT established that pulmonary rehabilitation is essential for patients after LVRS. (38-40) The combination of LVRS and pulmonary rehabilitation provides the greatest benefit for selected patients with severe emphysema, well above the effects of either intervention alone. (24)
Prior to LVRS and rehabilitation, the HRQOL of this study's subjects, as reflected by the Physical Component Summary measure, was profoundly impaired. Preoperatively, the SF-36 mean PCS measure was 25.3 [+ or -] 6.2, which is below both the general U.S. population norms (50 [+ or -] 10) (31) and norms for people with severe emphysema (28.3 + 7.4). (41) Lower levels of PCS in patients with lung disease lung disease Pulmonary disease Pulmonology Any condition causing or indicating impaired lung function Types of LD Obstructive lung disease–↓ in air flow caused by a narrowing or blockage of airways–eg, asthma, emphysema, chronic bronchitis; predict higher mortality. (42) According to these data there is a significant self-reported improvement in the PCS measure from baseline to Times 2 and 3 on the MOS SF-36 following LVRS and rehabilitation (25.3 [+ or -] 6.2, 34.8 [+ or -] 10.7, and 32.7 [+ or -] 11.7, respectively). The improvement in the PCS measure was similar in studies with LVRS. Yusen et al (27) reported means of 26, 40, 35, and 31 on the PCS at baseline, 6 months, 3 years, and 5 years post-LVRS, respectively. There is strong scientific evidence that pulmonary rehabilitation improves HRQOL in patients with COPD, too. (4) Ten weeks of pulmonary rehabilitation, prior to LVRS, improved the PCS measure by a mean change of 2.2 [+ or -] 6.8 as reported by the NETT. (41)
Preoperatively, the impairments were less pronounced with respect to the Mental Component Summary measure (46.0 [+ or -] 13.2) compared to the U.S. population norms (50 [+ or -] 10) and norms for people with severe emphysema (50 [+ or -] 15). (43) Subjects significantly improved their MCS measure from baseline to both Times 2 and 3 (46 [+ or -] 13.2, 53.8 [+ or -] 10.2, and 52.8 [+ or -] 9.8, respectively). Significant improvements in MCS are corroborated by other researchers who reported similar improvements after LVRS and pulmonary rehabilitation, however, those data are reported differently than data from this study such as scales of mental health, median values, or quality adjusted values and therefore direct comparison with the MCS measure from this study is not possible. The MCS measure is most correlated with the mental health, role-emotional, and social functioning scales from the SF-36. (31) There was a significant mean 2.1 improvement after rehabilitation in the MCS after pulmonary rehabilitation in the NETT. (41)
Advancing age is a strong predictor of mortality in people with emphysema. (44) Patients younger than 65 years old showed significantly improved scores on the MCS at Time 3 compared to subjects 65 years and older (55.9 [+ or -] 6.6 and 50.0 [+ or -] 11.3, respectively). Anxiety and depression often accompany COPD and approximately 45% of patients with moderate-to-severe COPD have depressive symptoms. (45) Furthermore, depression may increase the sensation of breathlessness. (46,47) While the data suggest similar gains until 18 months post-LVRS and rehabilitation between the 2 age groups, the results indicate greater focus should be given to the emotional needs of our older patients.
There are gender differences in the natural history of emphysema. Women were significantly more improved than men at Time 3 on the PCS. Hamacher et al (26) did not find any significant differences between the MOS SF-36 responses of 39 men and women 24 months following LVRS. The Nurse's Health Study reports that women whose general mental health (as determined by the MCS measure) was initially poor and had improved over 4 years did not experience a higher mortality than did those whose health remained consistently good over the same time period. (48) What these data suggest is that even after declines in health, women can improve HRQOL later in life, and that improvement may help to delay mortality.
It has been suggested that disease-specific measures are significantly more responsive to clinical change compared to general measures of HRQOL. (49) Evidence from this study indicates that the MOS SF-36, a general measure of HRQOL, was able to detect significant clinical change following LVRS and rehabilitation. General measures have some advantage because comparisons can be made with other benchmarks. For example, the impact of COPD can be compared with the impact of other chronic diseases. Subjects at baseline in this study were comparable to patients with lumbar stenosis (PCS=26.6). (50) Their HQOL was lower than patients with cancer (PCS=38.4). (51) These comparisons cannot be made with disease-specific measures.
The question has been raised as to what portion of the measured benefits is attributable to the operation per se and what portion is attributable to the ongoing rehabilitation. Miller et al (14) compared the efficacy of LVRS and medical treatment (including pulmonary rehabilitation and pharmacologic therapy) and showed that the LVRS group had a significantly better outcome on the PCS of the SF-36 than the medically treated group after 6 months, whereas the MCS was not significantly different between the 2 groups. Although surgeons attempt to restore improvements in lung function through LVRS, the affective issues concerning this disease cannot be dealt directly with surgery. Patients with emphysema experience their disease differently from each other both physically and affectively. These differences, which may limit function, must be addressed independently with each patient. (19,23,52) It is critical for optimal treatment that all health professionals, including physical therapists, take into account differences among disability, subjective evaluations of personal health, and general well-being. (23,53)
These results seem to indicate an increased ability to perform activities of daily living post-LVRS. According to self-report on the MOS SF-36, patients after surgery and rehabilitation are better able to perform vigorous activities such as lifting heavy objects and moderate activities such as pushing a vacuum or playing golf. Patients also report improvements in carrying groceries, ascending stairs, bending down, walking farther distances, and bathing themselves.
Research is needed to define the exact contributions of pulmonary rehabilitation in other forms of lung disease and for other pulmonary interventions. There is strong scientific evidence that postoperative pulmonary rehabilitation allows the maximum benefit to be realized from LVRS. Work needs to determine the mechanism that improves survival with LVRS to enhance these treatment effects and produce even more potent and durable responses to therapy. Further work is needed to compare other HRQOL measures, develop standardized methods for assessing the minimally important difference for this population, and to translate the measures' scores into clinically meaningful results.
Lung volume reduction surgery and 2 weeks (10 daily sessions) of intensive pulmonary rehabilitation appears to improve quality of life in patients with emphysema up to at least 18 months postsurgery. According to the responses extracted from the MOS SF-36, the physical and mental limitations associated with emphysema are not as great after surgery and rehabilitation. More research is needed to assess the long-term effects beyond 18 months.
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(43.) Stahl E, Lindberg A, Jansson S-A, et al. Health-related quality of life is related to COPD disease severity. Health Qual Life Outcomes. 2005;3:56.
(44.) Martinez FJ, Foster G, Curtis JL, et al. Predictors of mortality in patients with emphysema and severe airflow obstruction. Am J Respir Crit Care Med. 2006;173:1326-1334.
(45.) Mills TL. Comorbid depressive symptomatology symptomatology /symp·to·ma·tol·o·gy/ (simp?to-mah-tol´ah-je)
1. the branch of medicine dealing with symptoms.
2. the combined symptoms of a disease.
n. : isolating the effects of chronic medical conditions on self-reported depressive symptoms among community-dwelling older adults. Soc Sci Med. 2001;53:569-578.
(46.) Di Marco F, Verga M, Reggente M, et al. Anxiety and depression in COPD patients: the roles of gender and disease severity. Respir Med. 2006;100:1767-1774.
(47.) Neuman A, Gunnbjornsdottir M, Tunsater A, et al. Dyspnea in relation to symptoms of anxiety and depression: a prospective population study. Respir Med. 2006;100:1843-1849.
(48.) Kroenke CH, Kubzansky LD, Adler N, Kawachi I. Prospective change in health-related quality of life and subsequent mortality among middle-aged and older women. Am J Public Health. 2008;98:2085-2091.
(49.) Guyatt GH, King DR, Feeny DH, Stubbing D, Goldstein RS. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. J Clin Epidemiol. 1999;52:187-192.
(50.) Fanuele JC, Birkmeyer NJO NJO New Jedi Order
NJO New Jersey Online , Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients. Have we underestimated the effect? Spine. 1999;25:1509-1514.
(51.) Anderson JP, Kaplan RM, Coons SJ, Schneiderman IJ. Comparison of the Quality of Well-Being Scale and the SF-36 results among two samples of ill adults: AIDS and other illnesses. J Clin Epidemiol. 1998;9:755-762.
(52.) Hynninen KM, Breitve MH, Wiborg AB, Pallesen S, Nordhus IH. Psychological characteristics of patients with chronic obstructive pulmonary disease: a review. J Psychosom Res. 2005;59:429-443.
(53.) Agusti A. COPD as a systemic disease. COPD. 2008;5(2):133-138.
Janna Beling, PT, PhD
Professor, California State University, Northridge CSUN offers a variety of programs leading to bachelor's degrees in 61 fields and master's degrees in 42 fields. The university has over 150,000 alumni. It's also home to a summer musical theater/theater program known as TADW (TeenAge Drama Workshop) that leads teenagers through an , Department of Physical Therapy, Northridge, CA
Address correspondence to: Janna Beling, California State University, Northridge, Department of Physical Therapy, 18111 Nordhoff Street, Northridge CA 91330-8411 Ph: 818-677-7445, Fax: 818-677-7411 (email@example.com).
Table 1. PCS * and MCS ([dagger]) Summary Mean Scores (n=49) Mean [+ or -] Range of Variable Score SD Scores PCs Time 1 25.3 6.2 10.0-42.9 Time 2 34.8 10.7 14.7-57.2 ([dagger]) Time 3 32.7 11.7 11.5-57.0 ([dagger]) ([dagger]) MCS Time 1 46.0 13.2 19.2-70.9 Time 2 53.8 10.2 21.7-69.8 Time 3 52.8 9.8 29.3-66.5 * Physical Component Summary ([dagger]) Mental Component Summary ([double dagger]) Significantly improved from Time 1, P < .05 Table 2. Means and Standard Deviations of Scores by Subsets of Gender and Age over Time on the MCS Measure of the MOS SF-36 Pre-Surgery 3-6 Months Groups Time 1 post-LVRS/PR < 65 yrs (n=23) 45.9 [+ or -] 14.1 54.4 [+ or -] 10.3 [greater than 46.0 [+ or -] 12.6 53.3 [+ or -] 10.2 or equal to] 65 yrs (n=26) Male (n=31) 45.0 [+ or -] 14.4 51.9 [+ or -] 11.6 Female (n=18) 47.6 [+ or -] 10.9 57.2 [+ or -] 6.0 12-18 Months Groups post-LVRS/PR < 65 yrs (n=23) 55.9 [+ or -] 6.6 * [greater than 50.0 [+ or -] 11.3 or equal to] 65 yrs (n=26) Male (n=31) 51.2 [+ or -] 10.4 Female (n=18) 55.4 [+ or -] 8.2 NOTE. MCS = Mental Component Summary; LVRS = lung volume reduction surgery; PR-pulmonary rehabilitation. * Subjects < 65 yrs significantly greater than subjects 65 yrs and older, P<.05 Table 3. Means and Standard Deviations of Scores by Subsets of Gender and Age over Time on the PCS Measure of the MOS SF-36 Pre-Surgery 3-6 Months Groups Time 1 post-LVRS/PR < 65 yrs (n=23) 24.8 [+ or -] 5.8 36.4 [+ or -] 11.5 > 65 yrs (n=26) 25.8 [+ or -] 6.6 33.2 [+ or -] 9.9 Male (n=31) 26.4 [+ or -] 6.3 33.5 [+ or -] 9.6 Female (n=18) 23.5 [+ or -] 5.7 36.8 [+ or -] 12.4 12-18 Months Groups post-LVRS/PR < 65 yrs (n=23) 34.8 [+ or -] 12.8 > 65 yrs (n=26) 30.9 [+ or -] 10.6 Male (n=31) 30.2 [+ or -] 9.8 Female (n=18) 37.1 [+ or -] 13.6 * NOTE. PCS=Physical Component Summary; LVRS=lung volume reduction surgery; PR-pulmonary rehabilitation. * Women significantly greater than men, P<.05
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For those who aren't familiar with butter kuchens yes, the filling is suppose to be runny. That's what makes it gooood. There are other butter kuchens out there that have firmer fillings but this is a spoon kuchen or a sopping kuchen. You're suppose to cut a piece of it and then dip it in the goo that's in the bottom of the pan. If you want a firmer filling then simply add another egg to the filling and omit the water. I think it makes it taste too eggy though when you do that.
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Why are drinks in America so large?
- Das Ubergeek Sep 7, 2006 05:11 PM
I went to Panda Express (now hush, the orange chicken is tasty once in a blue moon -- all 500 calories and 27g fat of it) and as part of my lunch, I ordered a drink.
"Small, medium or large?" asked the cashier.
"Small," I said.
The small drink -- I measured later -- was 24 fl. oz. (709 mL).
The medium was probably a quart (32 fl. oz./946 mL).
The large was, after I asked, 44 fl. oz. (1301 mL).
Now, I know that a large chunk of the cup is taken up with ice, but are there really people who require 1.3 litres of Coke at one time?
A large Coke at McDonalds, which is 32 fl. oz. (946 mL), by the way, has 310 calories, or more than one-sixth of a typical American woman's dietary needs for the day.
The same thing is happening with coffee... after a long winter's sojourn in Canada, where I depended upon Tim Horton's to keep me from freezing my behind off, and where the large coffee is 12 fl. oz. (355 mL), I returned to the U.S., went into the donut shop near my house (cunningly marked "HAMBURGER TERIYAKI ICE CREAM") to get a large coffee.
She pulled down a fire bucket and filled it up with AN ENTIRE POT OF COFFEE. Now, this fire bucket of coffee cost me $1.80, and would have required twelve packets of sugar and a cup of milk. I ended up sharing it with three coworkers.
Even at Starbucks/CB&TL/Peet's/insert your favourite chain coffeeshop here, a large is usually 20 oz... of coffee!!
Why on earth do we need this much to drink? It can't be healthy.
I have started only ordering the smallest size, but even then the sizes creep up. In the case of Starbucks, there's an off-menu size ("short"), which is 8 oz., but not all baristas know it... but when I was a kid in New Jersey, a cup of coffee was 6 oz. in a small coffee cup.
Thank you for letting me rant... I know portion sizes are ridiculous, but the drink thing is getting out of hand.
You make me laugh...
So what do you do in McD's when you want a large fries but a small drink with your meal? Keep 'em waiting at the drive thru line while they re-work the cash register? :-)
Seriously though, I happen to drink a lot of liquid. I remember my mom having me checked for ?? as a kid. In college I had to be careful with the booze because I can drink fast and large amounts of liquid easily :-)
BTW: I am not overweight, (before pregnancy I was about a 4) and I work out...just require liquids and I do not drink coke. I do allow myself a diet coke, once in a while.
Anyway, I always used to order the largest size in CB & TL (Oh, how I miss it) and in other places...now, I make a concerted effort to order a medium of anything (or smaller) and monitor my pace...now that I am pregnant, I have to be extra careful of everything except water so I tend to stay away from the rest, except a small cup of coffee in the am, half caf. My point being...now that I abstain, I am aware of how large beverages are everywhere and even though there are smaller sizes offered, very few people go for the smaller size. Perhaps it is the financial thing... larger sizes offer better deals?
re: Michele4466
Why are drinks in America so large?
The same reasons AMERICANS are so large!
I would guess that there's a demand for larger drinks. There are lots of people addicted to caffeinated drinks like Coke who need their gallon a day. In Supersize Me there was a comparison of the size of portions at McD here and overseas. The standard drink in Japan is equivalent to a child size cup here.
Portion sizes are out of control in the US. I would relate this directly to the Obesity thread.
re: cheryl_h
I agree about obesity and portion control in the US... I was leaning toward the cost/ value thing but you are right, we just got used to bigger and bigger portions.
I could not sit through Supersize Me, I was seriously ill a few minutes in but I got the gist...
re: Michele4466
I also started to feel ill during the movie and I never eat junk food. I found it funny that when the film started, about half the audience had their standard buckets of popcorn, soda and armloads of candy bars. As the movie progressed, more and more of the junk made its way to the floor.
re: cheryl_h
I routinely drink 32oz of soda but have never tasted Coke in my life. Does anyone actually drink sugar sodas anymore? I am 37 and have never heard of someone ordering regular coke.
Now, I have heard various speculation that diet soda is making Americans fatter though I don't buy any of it. Calories in calories out is all that I think matters at the end of the day. I actually heard someone suggest that because diet sodas are so sweet they tweak our tastes to want sweeter foods. That is interesting though since I almost never eat anything sweet or any of the processed savory foods that are actually full of corn syrup I would say I'm an argument against this theory.
And yes, I've switched over to water which I consume in even huger quantities than diet Coke, but I still get a 32oz cup at least a couple of times a week!
re: Kater
Oh, yes there are those of us who will only drink carbonated beverages without 'fake sweetener'.
and then there are even more extreme among us, who wait for Kosher Coke...so as not to consume high fructose corn syrup...just like we grew up with....
re: Kater
the slightest bit of artificial sweetener hugely increases my appetite. i don't know the mechanism, but living things are a lot more complicated than calorimeters, which is what the calorie unit is measured in. ie. we have hormones and all kinds of other factors that process food. we don't just "burn" it.
re: Sharuf
It's strange because apart from the Diet Coke I consume a largely organic diet with no processed foods of any kind. Someone once gave me jello made with Nutra Sweet and I wasn't sure if I would go on living - just awful!
But I genuinely like Diet Coke and have the Aaack! reaction if someone accidentally gives me real Coke. It tastes so flat and sugary!
re: Das Ubergeek
I am able to down a can of diet coke in no time, unfortunately, and a large soda at the movies with ease. Not good in the long run. I think I am going to try to stick to my new regime even after the baby is born. Water ALL day long, sneak a diet coke every so often, out to dinner I drink a large pelegrino (seriously, with ease), one cup of coffee max in the am (half decaf) and of course, red wine and martinis are a given :-)
I must say, I do feel good...
Drinks are large because soft drink companies shifted tactics about 25 years ago from selling small units of soda made with more expensive ingredients, to selling large units of soda made with cheap ingredients.
The idea is to make the consumer think s/he is getting a relative bargain: 32 oz. of soda for the same price as 10 oz. used to be! And the strategy has worked beautifully in the US.
NYCnosh* http://nycnosh.com
Hi... Here in So. California, where cigarette smokers are generally ostracized in public, I think the oral fixation solution that formerly was served by cigarettes is now served by a constant straw protruding out of supersized drinks. Without cigarettes readily available (or approved of) to puff non-stop, the oversized beverage now keeps some people (smokers) placated with a pleasant and relentless sip of reassurance. In Europe where smokers still publically puff away with abandon, the beverage sizes are smaller, right? I reckon the timeframe marking the years that smoking has become taboo ( in the USA) parallels the timeframe marking the increase in beverage cup size. That's my theory...
re: silence9
At least here in Spain, people don't tend to drink their beverages with straws (unless you are under 8 years old).
The beverages are also a lot less sweet--especially juices, which I believe are required to contain at least 50% or more juice. You will never see a person slurping a soda in their car, walking down the street, or in a metro. It has more to do with virtually universally accepted cultural norms than anything else.
Anything more than a can of soda is verboten. Bars and restaurants are required to sell sodas and other drinks in tiny bottles (not cans or fountain sodas). People will linger over one drink for an hour--whether they are smoking or not--there's a lifestyle of tomando copas (having a drink and relaxing with friends) that is very deep seated. Moderation is very important part of the culture here.
I remember the thrill of excitement I felt the first time I saw a Big Gulp. My parents were old world types and keep our eating habits on a tight leash. It was sort of exhilarating to see such an absurdly large (at the time only 32 ounces, I think) tub of soda. It was such a brilliant marketing ploy... give the public more than they ever dreamed that they wanted.
re: butterfly
I agree with you on the concept of 'tomando una copa', but you must not forget the concept of the 'botellona'. :)
The beloved botellon: For about 15 Euros, any store/gas station/bar will assemble you a 'kit' - 1 fifth of hard liquor, 1 large container of soda pop mixer (fanta, coca, etc), bag of ice, and disposable cups - all in a plastic bag. Imagine 300 young adults enjoying these, whether by riverside or in an empty parking lot. All to get waaaasted. :)
re: Prav
Yeah, I live near two very popular botellón plazas, but it is really nothing compared to the binge drinking in the US... it's just more out in the street (like pretty much everything else). The thing is that most kids here have zero disposable income, so they can't afford to go to the terrazas. They have to make their own party and it's tolerated for the most part--until they cross the line.
re: silence9
Funny you should say that about SoCal specifically, because I've noticed a significantly larger number of smokers here than I ever did in the Bay Area. Every time I'm at Walgreen's someone's buying smokes! I was surprised because I too thought smokers were ostracized in LA.
Ahh, yes, the good ol' days ... when a Big Gulp was actually considered BIG!
By the way, Das, I'm very impressed that you actually have the time and gumption to do all of this ...
I would also suggest that the larger drink with tons of ice stays colder longer, and you may toss what you don't want.
I preferred the various slightly flavored (unsweetened) seltzers myself. At the movie theatre, if its concession stand is properly constructed (some chains' are not), I order a "cashier's special" as it came to be known at a number of theatres: a large drink full of soda water (a separate tap exists on properly designed cinema soda fountains) on ice, topped by a very thin layer of lemonade.
i avoid all ridiculously oversized portions by ordering kid's meals when going for fast food. The now kid's sized drink is what the old small used to be....and the free water cup is what the old kid's cup used to be. That or i go for the juice boxes. Saves me money and i don't waste a ton of food or over consume.
I generally drink once an hour during a cardio work out. After I finish working out, I drink about 20 oz of liquid immediately and then another 20 oz shortly after. And then some more throughout the day depending on what I do. It's a good thing they offer those large bottles/cups. At night, I probably drink 3 to 4 cups of liquid. I know that's a lot, but I require that much. It is not a matter of indulgence.
As some one posted earlier I like to consume a lot of liquid. I also have to be careful with alcoholic drinks as noted above on another post. I also love water. I consume in a day a cup of tea in the morning, at work about 2 1/2 quarts of water, a 20 oz diet coke at lunch, and usually between 2 and 4 -12 ounce glasses of a seltzer, diet cranberry mixture, I also may have a mix drink or 2 or a glass of wine. I also work out on a treadmill or eliptical 5 days a week for 50 minutes at a fairly high intensity - on days I don't I do notice less fluid intake
Its all about increased sales and profit margins (from the sellers side) and precieved value (from the customer side). If they can sell you a soda that is twice as big, and sell it for less than double the price, the customer believes they are getting a bargain. So say a 16 oz soda sells for 1.20, and the 32 oz for 1.80, the sellers cost for the materials (cup and soda) increase only by a few cents, but since they are now bringing in .60 more, the margin is greater since employee and overhead costs are practically the same if they fill a 16oz cup vs. 32 oz.
See its a win/win situation, except for the fatties who can't control themeselves.
I just have to ask...have you tried the Hamburger Teriyaki Ice Cream? How is it?
(Remember, I'm the guy who makes pulled pork ice cream!)
I think the posts talking about the economics for the seller have it right -- they can get you to buy more than you normally would by making it seem a bargan. A friend of mine owned a chain of mini-marts and I asked him how he made money by selling 32 oz fountain sodas for some miniscule price like a dollar. He said that his biggest expense was the cost of the cup, which was like half a cent, and that the cost of ice, soda water and syrup were negligible on a per cup basis. A 16 oz soda might be 75 cents so getting double the amount of soda for only another 25 cents seems like a great deal to the customer, and his expenses remained pretty close to the same whether it was a 16 oz or 32 oz soda -- doubling the amount of liquid did not meaningfully impact his cost of production.


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www.allposters.com Casting our net far and wide this Friday morning... Cheers star Ted Danson would like you to conserve the ocean's resources. (AP) A judge throws out a lawsuit accusing Tyson Foods of hiring illegal immigrants to drive down wages. (AP) The influential United Food and Commercia ... More >>
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Recall alert: Sunscreen for babies could be contaminated
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There haven't been any reports of children getting sick from it.
Both sunscreens are sold in the USA & Canada online and at major retailers as well as independent food co-ops and pharmacies.
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November 25, 2014
MADISON, Wis. (AP) -- A new report shows that school property taxes increased 3.4 percent this year.
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text:
All contents herein is subject to our General Disclaimer and Medical Disclaimer.
This is an opinion website that offers information of a general nature and none of the opinions should be construed as advice. Nothing contained within the site is the advice, opinion or otherwise the view of any host, owner, server or other provider of services to Good Looking Loser. Nothing stated shall be construed to serve as a replacement for competent advice from professionals.
Podcast 1 - 2014
Finally got decent audio hooked up.
Later this year, if Apple approves, we'll be on iTunes.
(it's long - download it and listen to it away from your computer)
You can download our 2 hour long chat for your iPod here-
Topics - Table of Contents
0:00 Introduction
01:30 Scotty's Training (UPDATED 2014 AGENDA)
04:00 Why Scotty got laid more when he STARTED (1st-2nd year) than now.
05:45 Above-average fundamentals + Obsession/Momentum = Get Laid a lot quickly
08:40 The "Golden Era"
10:30 Going out and hanging out a with a cool guy and seeing him WIN and LOSE is really helpful
14:15 No matter how much you read this website, watch videos - you may not be comfortable with the idea of hitting on girls until you do it (or see someone cool do it).
16:30 Eye Contact with Scotty
25:00 Good Looking Loser attitude - BY ANY MEANS NECESSARY
26:45 Kratom and Performance enhancement
39:45 Scotty doesn't ever approach girls in groups?! Why not?
43:30 Chris and Scotty differ slightly on the importance of a "gameplan" & "Sexual Intent"
49:15 On "sexual vibe"
54:40 If you can LOOK GOOD and SAY HI (basic guy game) - you can get plenty
55:15 What is the ONE THING a beginner should focus on?
56:40 Scotty Scumbag is also a Gentleman
58:30 Scotty's "Fuck the World..." attitude that got him started - results and got him in trouble.
1:02:40 Stages in your life: "It's pathetic that your life revolves around girls!" Not true.
It perfectly NORMAL and HEALTHY to be in your 20-30s and want to dedicate several years to getting pussy and partying.
1:06:40 Insecurity is a great motivator
1:13:00 Scotty living at his parent's house
1:17:00 Small victories should be appreciated
1:19:00 Beating fear of rejection: It'll always be there but gets easier and you don't care anymore
1:25:40 After you fuck that FIRST GIRL (from approach) - you'll okay on your own
1:31:30 If Scotty hits up 70-100 girls and doesn't get laid, will he get down on himself?
1:38:30 What do we wish we heard when we started in 2006-2007?
01:46:00 You can be insecure and get laid. Just LOOK GOOD and TALK TO GIRLS.
Thank you for taking time out of your day to it spend with us.
I hope our stuff enriches your life. I really do.
This Fall, Good Looking Loser is supporting the Palmetto Health Foundation - we donated $2000 on October 15th to support Walk/Race for Life.
Thank you if you purchased something through our links!
We don't sell any of our own products and that is how our community pays the bills.
You can read about some of our past charitable efforts here - Good Causes.
Have a nice day!
easier for me too.. no cute pictures/cartoons though
yep lets hope so...
absolutely - the day I took my first androgen was my 20th birthday. but make sure you know what your doing
Very interesting, I agree with regards to eye contact. The eyes can be powerful if you know how to use them properly. Very informative podcast. Keep them coming, great to see the site returning to it's original heights.
Just listened to this on my road trip down to Galveston. One thing though you said whatever crutch you get your hands on to use it well I'm 20 and thinking about using steroids to get in the best shape, best bod in my life. That is my #1 goal right now. What do u think GLL? I am no stranger to fitness and want to take my results to the next level.
GLL your site is off the fucking hook. Thank you so much man. You should get a medal for all this.
You are a role model and a gift from the heavens above!!!!!!!!!
Read More...
comment 26220 - "How to Pickup Girls if You Are Nervous... (Nervous Guy Game)"


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Water leak coming from rear of motor above starter, 99 Suburban
Discussion in 'Chevy Suburban Forum (GMC Yukon XL)' started by Quikfire, Oct 5, 2013.
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Game Night 1/28: Bruins at Falcons
Submitted by pete on January 28, 2006 - 23:09
Springfield Falcons
Compared to the shellings the Falcons have endured this year against Providence, tonight was a positive sign. PRO-4 SPR-3 (SO)
Gerald Coleman
stopped 36 of 39 before losing in the shootout. Travis Brigley scored his first goal as a Falcon and added an assist.
Marek Kvapil
also had a goal and
Jay Rosehill
scored his first professional goal. The Falcons came within 29 seconds of victory, but Coleman couldn't quite shut the door.
Gerard Dicaire
's point streak was stopped at 4, but he did finish second on the team in shots behind Brigley with 4 tries on net. Game sheet from [url=http://ahl.leaguestat.com/stats/game-summary.php?game_id=1001654]TheAHL.com.[/url]
HPK Loses in OT to Tappara
Karri Ramo
and HPK lost in overtime today to Tappara 4-3. Ramo stopped just 22 of 26 shots faced in the defeat. His record drops to 7-6-3 on the season.
Game Day 1/28: Lightning at Flyers
Submitted by pete on January 28, 2006 - 16:59
Tampa Bay Lightning
How satifying was that to watch? TB-6 PHI-0 Sean Burke made a 38 save shutout look all to easy. The Lightning were paced by a Fredrik Modin hat trick that included 2 deflection goals on the power play. Lightning youngsters Craig, Artyukhin and Ranger all pointed. Artyukhin drove to the net off a
Ryan Craig
breakout pass using his speed around the corner to generate an easy rebound chance for a Dan Boyle goal. Craig later added a quick snap shot goal off the wing from the left circle in the third period with the secondary assist going to
Paul Ranger
. With Darryl Sydor leaving the game in the second period after taking a puck to the chin, Ranger was forced to play 21:38 in the game. He played well defensively turning in a +2 performance with 1 shot and 2 blocked shots. Ryan Craig was also +2 in 11:11 of ice time with 3 shots on goal in third period garbage time.
Evgeny Artyukhin
again played a sparing 4:19 with just 7 shifts on the game and 2 shots on goal. His role in setting up Dan Boyle's opening goal, however, was indispensible. Game sheet from [url=http://www.nhl.com/scores/htmlreports/20052006/GS020753.HTM]NHL.com.[/url]
Coach Anzalone: Falcons Will Trade One of Their Goaltenders, Greco Out For Season
Submitted by pete on January 27, 2006 - 23:26
Johnstown Chiefs
Springfield Falcons
In an interview with Mike Mastovich of the Johnstown Tribune-Democrat published Friday, Chiefs Head Coach Frank Anzalone [url=http://www.tribune-democrat.com/prosports/local_story_026234118.html]dropped the bombshell that
Jonathan Boutin
's recall is due to the impending trade of one of Springfield's goaltenders.[/url] Anzalone goes on to point out that the Chiefs only had 14 players on their roster as of Thursday night and that Lightning prospect
Brady Greco
will be gone for the rest of the season with shoulder surgery. Anzalone speculates that the many callups Springfield has made recently will be in the AHL to stay and that the Lightning organization feels that Boutin is ready for the AHL level for good. In order to fill their need for a netminder before Friday's game against Dayton, the Chiefs signed emergency backup Craig Rehodge.
Game Night 1/27: Chiefs at Bombers
Submitted by pete on January 27, 2006 - 21:36
Johnstown Chiefs
As best as the Chiefs tried to blow this game, Dayton's utter incompetence carried the day. JHN-8 DAY-6 Morgan Cey made 44 saves on 50 shots faced. JB Bittner poured in a goal and four assists. Justin Kelly added 1 goal and 3 helpers. Lightning prospect Brandon Elliot had 1 assist in the game. Of concern: the Chiefs were outshot by 50-19 by one of the worst clubs in the league. Doug Andress returned from a very short recall to Omaha of the AHL in the game. Game sheet from [url=http://www.echl.com/cgi-bin/ppublic.cgi?action=box&id=2738]ECHL.com.[/url]
Game Night 1/27: Falcons at Pirates
Submitted by pete on January 27, 2006 - 21:27
Springfield Falcons
The first night of the
Jonathan Boutin
audition finished in dramatically positive fashion. SPR-4 POR-3 (OT) Boutin made 21 saves on 24 shots faced in the victory, his first AHL win.
Gerard Dicaire
had a pair of power play assists to extend his point streak to four. Chris Dingman had a goal and added a pair of helpers. Jason Jaspers had a pair of goals including the game winning overtime goal. New acquisition Travis Brigley did not suit up for the game. Game sheet from [url=http://ahl.leaguestat.com/stats/game-summary.php?game_id=1001639]TheAHL.com.[/url]
Falcons Acquire Brigley/Loan Out Harlan Pratt
Submitted by pete on January 27, 2006 - 15:38
Springfield Falcons
The Springfield Falcons [url=http://www.falconsahl.com/detpages/pressbox2916.shtml]have announced that the New York Islanders have assigned LW Travis Brigley to the Falcons.[/url] In exchange, the Falcons assigned defenseman Harlan Pratt, who had been previously assigned to Johnstown of the ECHL, to the Islanders' affilate in Bridgeport of the AHL. Brigley, a 6'1" 200 lb 27 year old, has had a journeyman professional career that included 55 games in the NHL as well as stints in the IHL, AHL, BISL (Great Britain) and ECHL. Drafted by Calgary in the 2nd round in 1996 out of the Lethbridge Hurricanes of the WHL, Brigley's best AHL season came in 1998-99 when he had 15 goals and 50 points in 74 games for the St. Johns Flames. Brigley has 7 goals and 17 points in 39 games this season for Bridgeport. Brigley is considered a good two way player with above average skating ability whose offensive game hasn't emerged as hoped since juniors.
But/Koshechkin Contribute to Victories
Submitted by pete on January 27, 2006 - 15:32
Anton But
scored a goal today in Yaroslavl's 2-1 victory over Khimik. The goal was But's 15th of the season. In other Superleague action, Lada Togliatti and
Vasily Koshechkin
defeated Molot Perm 3-2. Koshechkin held Perm scoreless for over 50 minutes before his opponents broke through with a pair of goals in an unsuccessful comeback attempt. Koshechkin improves to 15-11-4 on the season.
Game Night 1/26: Devils at Lightning
Submitted by pete on January 26, 2006 - 20:58
Tampa Bay Lightning
Both this game and the Atlanta game were probably the team's two best of the season. The common denominator was John Grahame who just posted his second straight shutout. NJ-0 TB-1 (OT) Ruslan Fedotenko with the quick wrister from the right circle beat Martin Brodeur for the game winning goal. 20 saves on 20 shots faced for Grahame.
Paul Ranger
played 19:12 with one shot on goal.
Ryan Craig
played 15:23 with one blocked shot.
Evgeny Artyukhin
played a painfully sparing 3:50 with two hits. Norm Milley was a scratch. Game sheet from [url=http://www.nhl.com/scores/htmlreports/20052006/GS020743.HTM]NHL.com.[/url]
Boutin Recalled to Springfield
Submitted by pete on January 26, 2006 - 16:31
Johnstown Chiefs
Springfield Falcons
The Springfield Falcons [url=http://www.falconsahl.com/detpages/pressbox2915.shtml]have announced the recall of goaltender
Jonathan Boutin
from Johnstown of the ECHL.[/url] The move comes less than 24 hours after Boutin's start in the 2005-06 ECHL All-Star Game in Fresno. No word as of yet on either
Gerald Coleman
Brian Eklund
going down to Johnstown to make room. (More on the flip.)
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Nokia X7 Symbian Anna smartphone
When you buy a mobile, you know that you're likely to be stuck with it for the life of your contract. Good news: you'll get used to its quirks and differences. Bad news: you can only watch as gorgeous handsets are released for the next year or two. Nokia X7 Smart move? Nokia's X7 But what's trickier about the new Nokia X7 is …
...and Zoidberg...
Is the reason why people are bashing Symbian and because every idiot reviewer who does a review of a Symbian phone does it in 5 minutes from the pub and therefore wouldnt know the phones ass from its elbow.
Then you have the traditional Nokia stance of 'advertising...? whats that then?'... and the rest is fanboi-tastic. I swear the Symbian platform has gotten more advertising from negative reviews than it has from anything else. Alot of people wouldnt know it exists otherwise.
Its fun to poke fun at Symbian v5 and even AAS have done it on occasion, lambasting Nokia for gormless product decisions (N97 anyone?). However people seem to miss the point and its an important one. The ONLY place the Symbian handsets lag is in their current UI.
Listen carefully folks - this is the important part.
In practically every other field they are either better, equal, or much better. Theyve had features that are touted as new by other OS manufacturers for years...
Dual processors - Nokia E70 206mhz - 2006
Output to Projector - Nokia E70 - 2006
Output to TV - Nokia N93 onwards - 2007
Discriminate Graphics Processor- N93 again - 2007
Need I go on?
The OS runs on much less intensive cores, so when its idling its using a fair amount less power processor for processor, but this is another important part, when its working its little heart out to play your futurama episodes out to the TV via TV-Out or HDMI.... its using substantially less power to do that, so even at full power it might be using less mA than a iPhone at 50% processor usage.
I would venture to suggest that if the new Belle update concentrates more on the UI than on other improvements (which to be fair are not really needed all that much since the system is comparable in function to anything else) then Elops idea to hum unto the Microsoft might fall down round his ears - and Apple might find their wheezy cameras and limited functionality are really getting put to the test function for function. Android... crashtastic, flakey signal, cr-app-tastic is also at risk, because to make a usable 'droid phone you need a step up in processor power, and therefore a step up in component costs.
The only OS of the top three that I havent tested is iOS, mainly because even touching apple products makes me feel dirty. I have had two manufacturer baked Android phones, and they've been pitiful on signal (no signal where the E70 gets 4/6 bars) and flakey on software, spontaneous reboots. Ive had a dual booting HTC diamond for a while and the Android on that was painful to say the least. Yet an E70 with 206mhz processors, that is 6 years old, can run rings around them.
But the really ironic thing... the thing that makes me laugh, is that Windows Mobile 6.1/6.5 outperforms Android - is much more stable - and can do everything that the current flock can do, and ALWAYS COULD.
But it wasnt pretty enough was it - and you had to think to use it - so now its confined to its coffin with dead iOS fanbois put to good use as the nails.
I dont recall the definition of the word progress as being "take all the functions off it, make it simple to use, use processors that need the power output of the falcons hyperdrive, and make it crash every second hour' but then I learned English...
Not Fan-glish.
You were going well...
Until you entered the "viva winmo 6.5, down with android" rant.
I don't know which android phones you had and with what firmware, but I can tell you my N1 and my wife's Sapo A5 get better signal and are much more stable than the crap N96 (the last nokia I ever bought) I still have here gathering dust. And comparing to a friend's winmo 6.5 HTC I always get a stronger signal on any of the androids - besides the androids being faster, more flexible, and much more stable. Saying that winmo is more stable, in what do you base that? I've seen it crash during normal usage, and it never seemed particularly stable. Never mind you had to hunt for specially hacked firmwares to get it to upgrade, or else just get stuck in the early, buggy version it was released with.
In the end, most HTCs with winmo have older, inferior hardware (even compared to the cheap ZTE/Sapo A5) and an abandoned OS, and while the N96 had a great camera ans speakers, it had that god awful symbian ui, and the crash happy firmware that won't even let me use it as a GPS because it will reset for sure as soon as we are near an intersection.
I think my last good nokia was the 6600 (the original one).
Really, I don't understand the android bashing in your post, and the lies about the ZTE on other posts. Android is a great, stable, fast and flexible OS with a extremely involved community (something that is missing from ALL the other phone OS), the hardware ranges from the so-so to the great, and it really is faster and more powerful than winmo on the same hw - just ask anyone who has upgraded an HTC HD2, all my friends went from winmo 6.5 to android in a second.
.. because you are still missing the point...
Why should I buy a phone that drops its pants to google when I turn on the GPS, and is crippled if I dont allow the phone to do so.
You are entirely missing my point. I can and do have a fully functional winmo smartphone with a 260mhz processor, there are at least 4 different UI options for it, which it can run without issue. Its capable of taking 16gb MicroSD cards. Why is it that you are bouncing around with pleasure when your phone needs a 800mhz processor to run its OS as smoothly as a Symbian does with a 200mhz processor.
It does exactly the same as the Android phones you are so enamoured of - with the added advantage its rock solid stable and always, like the symbian you so loathe, has signal 24/7 where android phones wont dare to tread. Oh yes, and theres the part where you can still syncronise your Gmail account, with push, for free, without being shafted by google.
Why on earth do you seem to think that its progress to require more and more power to run a phone OS? Surely the whole point of progress is to make devices that have more ability whilst using less power, or learn to use the phone you have to the full extent of its capabilities..
And I would like to make one last point. I personally have been physically attacked twice, I would much rather have a symbian/winmo phone with me, in case of emergencies, that will get and hold a signal... than be in urgent need of assistance and find my iOS/Android phone has zero signal.
I wonder how many girls and women have been put in dangerous or lethal situations because the phone advertising they fell for, lumbered them with battery hungry mobile phones that excel at taking pictures and giving them a headache, but either have a flat battery or no signal, when some nutter who is far to close to his mother is intent on raping or strangling them...
I'm not the one missing the point
Stability, in Nokia/Symbian, ended in the N95. On the aforementioned N96 (and others), the only way to have the GPS find where it is quickly is to replace the supl.nokia.com with supl.google.com, and that won't help you on the N96 as it will still reboot when the GPS has to deal with a large intersection.
It isn't smooth - I had to wait minutes for that crap to finish booting before being able to do anything. If I dared try to access contacts or dial while it was still loading some background crap, it would happily reboot again.
As for the signal - any of my android phones gets a signal with more ease than the last nokias (plural) I had. The only phone I had that had better reception (and still does) is a really venerable nokia 7100 - from when they knew how to make phones. Even the 6600 had worst reception than my "matrix" nokia.
I agree with you, that for the same functionality, one should need less power with newer generations of phones. However, the android has so much more functionality, and functionality that I can use immediately instead of having to hunt through a complicated and messy menu system, that it will use that power. You can use something like setcpu to put your cpu clock constantly at 260MHz and still use it well for phone calls, etc., all the basic phone stuff. But with a more powerful phone you can do a lot of other stuff, from playing games to sending photos and videos to the family, to sshing into a server in case of need, etc. Btw, you'll have to tell me how to get push functionality working on a series 3 symbian - it never worked on my N96.
As for your final straw man, on what to do in case of an attack - I see you keep insisting on an android phone having less signal. I don't see that here. I see winmos being unstable, crash happy crap that can't do a call reliably, even with full signal power, and I see recent nokias also becoming crash happy, slow, and getting less signal than any of my androids. And here the signal reception is crap in many places - but my android never let me down.
didn't they put a 12 Mpx camera in there? i did quite a bit of searching online for my new phone, focusing on the best cam and the N8 outshone all of the others, most by quite a margin. now they've taken what was the most appealing feature for me in the N8 out of the package.
I think i'll go and see if i can get a second hand N8.....
quality != megapixelas
Jeez, I thought even the most ignorant people were past the stage of megapixels = quality for a camera. The Nokia phone cameras are better because they have better optics. Better/larger sensors help but I am not going to go find the actual comparisons. And then there is the software which really is a deal breaker when it sucks - which it does on so many phone cams.
Very happy with my Nokia C7
- Latest Symbian OS is pretty slick - hardly any lag
- It has an FM transmitter - play music in the car or anywhere with a radio
- TV output
- 720HD recording
- feels solid
£30 on upgraded contract - sweet...
another step closer
Well the last linux phone has gone (meego really to come out?) the last symbian is now out so Nokia is dead by christmas then?
I mean winpho 7 actually going to save them?
wow Nokia finally make a phone that I would want to buy. a pity then that's it's already a museum piece
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Upscale Vegetarian?
Hey Chowhounds,
I need your help. I've recently taken to an ovo-lacto-vegetarian diet (purely for ascetic reasons and only temporary) and am looking for a restaurant to take my girlfriend out to. Our schedules usually don't match up so when she told me she didn't have to work this Friday I jumped at the opportunity to wine and dine her.
Any location is fine but Westside is preferred. I currently work and live in the Santa Monica/WLA area. I'd like to try something new so off-the-beaten-path suggestions are welcome, but something along the lines of Lucques/Grace/Josie would be awesome.
Thanks in advance!
Take the time and drive up to Topanga. Go to:
Inn of the Seventh Ray for sure
Check out the Vegan duck??!!
Here's a website to look at.
re: Kitchen Queen
This is an awesome website! Thanks so much!
re: Kitchen Queen
It's definitely more upscale, but the food is just OK at the Inn of the Seventh Ray. The bread's pretty terrible (it's more like a badly-made granola bar than a badly-made loaf of bread).
If you can make it to the Valley, Madeleine Bistro in Tarzana, a few miles west of the 405, is upscale vegan cuisine, and it's very good -- I posted a review not long ago.
re: Das Ubergeek
I'll second your opinion of Inn of the Seventh Ray. It's great for the surroundings, and the occasional celeb sighting is fun for out of towners, but certainly don't go for the food.
re: JudiAU
Is Grace's menu online current?
I was wondering that, myself. What's there doesn't look too encouraging viz. meatless cuisine...
I ended up making a reservation at La Cachette - any insight into their vegetarian/vegan dishes? I hear good things about this place so I'm excited!
Thanks to everyone's suggestions, as well.
Inn of the Seventh Ray has really deteriorated of late.
Try the Vegetarian Tasting menu at Melisse.
I never realized that La Cachette had vegetarian dishes per se (except for maybe the salads?), much less the fact that they offer vegan dishes. That being said, everything that I have had at La Cachette has ranged from very good to excellent.
re: rdabke
Only for the serious die-hard raw foodies. They do the cutesie thing of calling their raw food by cooked food names - like "raw fries" which are dessicated bits of vegetables rolled in some seasoning powder.
I found it distinctly underwhelming.
I liked Bistro Madeline, though.
This will sound crazy but- Steakhouses have the best veggie sides if you can stand to be around meat. Mastro's is really nice in beverly hills, The Ivy has a perfect vegetable plate that is huge and super filling and you will have a second meal for the next day because it is just that big. (it may not list on menu but they still make with artichokes, corn, tons of versatile veggies) Real food Daily isn't nice- but the food is good- depending on what you get. BOA is another suggestions with the concept stated above in the SM area. I have been veg for 20 years and for the most part any of the nicer restaurants will hook you up especially if you call before hand. Leaf is quite hardcore and is also not nice but strict veg. Not a fan in the inn of the seventh ray was really dirty last time I went and so I never went back.
re: rachme
I've tried the whole "get a bunch of the veggie sides" thing and while it's enjoyable sometimes, I'd like to step it up and look for a restaurant that actually has vegetarian entrees. Thanks for the suggestion though - I definitely do it, and it's fun!
/rant on
Why bother, though? Vegetable sides are just that. Why pay top dollar if the chef doesn't have the inclination, interest, or imagination to come up with something for a vegetarian that meets his/her standards for the rest of the menu? I once had to have a business dinner up in SF at a well-known steak place - I was part of a group and a couple of our guests were from Japan and wanted to have steak at this place. I had the vegetable sides and was ill for the next couple of days because I think they soaked up a lot of the meat juices from the pans they were cooked in.
I expect to try the vegetarian offering at Josie in the near future but after 12 years in LA, I have to figure that this kind of cooking isn't on the radar of the local chefs and will never be if people keep accepting, "Well, we can make you a plate of grilled vegetables" excuse.
/rant off
i'm a vegan and madeleine bistro definitely fits the bill. it doesn't have the ambiance or warmth i crave (like i find at millennium in san francisco), but the food is inventive and outstanding. i suspect you'll enjoy it, too, since my omni husband loved it - dubbing it "the best vegan meal he's ever had." worth the drive. (i did hear that they may be opening a spot on the westside, which would be incredibly welcome.)
i like the inn of the seventh ray for the romantic ambiance, but the food didn't make a memorable impression. it's a little new-agey, too, which may be off-putting for some people.
i, too, love sides at steakhouses. some of my favorite meals have been experienced in them. so ironic.
good luck and enjoy your evening together!
Real Food Daily isn't quite as upscale as you may be looking for, but It beats Inn of the Seventh Ray in terms food quality any day. But the place is a celeb hangout and is certainly a lot a nicer than most of the good hole in the wall asian vegetarian restaurants you find. I recommend it highly.
re: SebastianRedSox
My problem with RFD is that they seem to subscribe to the theory of mortification of the flesh for the good of the soul -- somehow veganism means absolutely no taste, no spice, no seasoning, and most of all no salt.
re: Das Ubergeek
I went to RFD the other day and was satisfied with their sesame-peanut noodles (something like that) but the rest of the food was average.
Native Foods, on the other hand, was delicious. I had a tempeh sausage burger with tomato sauce and pesto. I'd get it right now for lunch if I could (too far from work).
I went to the Westwood Village branch.
re: Das Ubergeek
I took a cooking class from the owner and the food was all awful. And these were her tried-and-true show off recipes. Yuk.
i tried mastros and ordered the iceberg lettuce salad with blue cheese.
what a huge disappointment.
the lettuce was soggy.
the blue cheese was only of fair quality.
(would have done better going to the counter where they use a good-quality blue cheese).
the pretzel rolls, at mastros, though, were very good.


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A piece of fruit can become a fabulous vase! Carve out the centre, rinse the shell and fill with water. Try this with any summer flowers.
Remind friends and family how special they are with a balloon gift from Serenata. It's different, fun and always brings a smile to the recipients face. Helium balloons make great gifts for all occasions.