text:
Will ripping CD's have any negative effect on my DVD drive?, Ripping |
Will ripping CD's have any negative effect on my DVD drive?, Ripping |
Jan 3 2013, 13:31
Group: Members Posts: 21 Joined: 12-July 09 Member No.: 71413 |
Hello everyone,
I recently bought a new laptop. It has got this DVD writer - "hp DVD-RAM UJ8B1 SATA CdRom". I wish to rip a few audio cds at thee same time i don't want to damage my drive. Since in my PC i had ripped few cd's both using dbpoweramp and EAC. And now it is having problems reading DVD's. i doubt this is because of the ultra secure ripping of dbpoweramp which stresses the drive. I am not sure about EAC though whether it stresses the drive as much as dbpoweramp ultra secure mode. All i need is my Cd's accurately ripped to FLAC without damaging my DVD drive in anyway and keeping it as it is. 1) Since you people may have had issues with your own drive kindly tell me how to rip accurately without causing any stress/damage on the dvd drive. 2)Does ripping CD's cause problems with the drive due to the extreme stress on the laser. If yes then how to tackle it? 3) Is there any link where these issues are discussed in much detail kindly tell me. 4)Is it recommended while ripping with EAC to cool the drive in intervals of few minutes by stopping the process? Any help would really be appreciated. Thanks. |
Jan 4 2013, 11:27
Group: Members Posts: 1424 Joined: 9-January 05 From: In the kitchen Member No.: 18957 |
Can't say about laptops, but I've turned a couple of desktop DVD drives into doorstops by ripping a lot of CD's very rapidly. Every one died from rotation motor bearing death.
-------------------- -----
J. D. (jj) Johnston |
Lo-Fi Version | Time is now: 27th April 2015 - 17:25 |


text:
Subject Directories: Commercial
Yahoo.com is an example of a commercial subject directory. Subject directories are collections of websites that people have selected and organized.
Sometimes links are annotated so you'll know before clicking on them what a site contains.
Many commercial subject directories, such as Yahoo, also have a search engine function.
Best for browsing topics that are broad or general. You may have to click through categories and subcategories. Other commercial subject directories: MSN.com, About.com
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subset: commoncrawl


text:
See definition in
Oxford Advanced Learner's Dictionary
mu·ti·latePronunciation: /ˈmyo͞odlˌāt/
Definition of mutilate in English:
1Inflict a violent and disfiguring injury on: the leg was badly mutilated (as adjective mutilated) mutilated bodies
More example sentences
- When the sisters' father went to the morgue to check, he found his daughter had not only been killed, but her body had been horrifically mutilated.
- Identification was proving difficult because some of the bodies were severely mutilated.
- He is one of Scotland's most revered monarchs yet his body was mutilated and his head used as a football by the English foe.
1.1Inflict serious damage on: the 14th-century church had been partly mutilated in the 18th century
More example sentences
- Were the images destroyed, desecrated or mutilated because they were potent or impotent?
- Although badly mutilated by quarrying, some of the defences can still be traced, especially on the north and north-west sides.
- 1
- Example sentences
- A good start at rectifying the situation would be the swift arrest and visible punishment of those responsible for the massacre, including the mutilators caught on film.
- In addition to the family of cannibalistic mutilators, there is a whole bunch of weird-looking people in the basement, doing medical experiments on mutants.
- Just like self - mutilators cannot stop cutting, I couldn't stop starving myself or binging and purging.
Pronunciation: /ˌmyo͞od(ə)lˈādər/
Early 16th century: from Latin mutilat- 'maimed, mutilated, lopped off', from the verb mutilare, from mutilus 'maimed'.
Words that rhyme with mutilate
oblate • hotplateDefinition of mutilate in:
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text:
Follow along with a digital media producer and former TV news reporter as he plans and shoots a complete human-interest story.
Learn how to shoot and edit green screen footage and images.
Capture footage of everyday objects and combine it with effects in popular postproduction tools like After Effects and Premiere Pro, resulting in rich, abstract backdrops for your project.
Presents practical tips on shooting video with shots and angles that support your story and make it more visually interesting.
"Because of your lessons, I can go to "class" every night to learn the new programs that are needed for my work and my other projects." —Frances M.
more from our members »


text:
Learn more about clinical trials at this NCCN Member Institution.
Since 1996, the adult oncology collaboration of Dana-Farber Cancer Institute, Brigham and Women's Hospital and Massachusetts General Hospital Cancer Center has enabled some of the world's leading specialists to coordinate research, training, and patient care. These Harvard Medical School-affiliated hospitals are members of Dana-Farber/Harvard Cancer Center, a National Cancer Institute-designated Comprehensive Cancer Center.
Patient care is provided at Dana-Farber/Brigham and Women's Cancer Center and Massachusetts General Hospital Cancer Center. At each site patients are offered the highest standard of care and innovative treatments.
For more than 60 years, Dana-Farber Cancer Institute and Children's Hospital Boston have worked together to provide the best care available for children with cancer. Known as Dana-Farber/Children's Hospital Cancer Care, these neighboring institutions provide a spectrum of services, from diagnosis to long-term management of all types of childhood cancers. Dana-Farber/Children's Stem Cell Transplantation Program is one of the oldest and largest programs in the nation and its Pediatric Brain Tumor Program is the largest in the region. Both programs remain at the forefront of research and technology and are among the most accomplished in the world. Furthermore, the David B. Perini, Jr. Quality of Life Clinic has helped thousands of survivors of childhood cancers cope with the long-term effects of the disease.
About NCCN| NCCN Member Institutions| Patient Resources| NCCN Foundation| Privacy Policy| Legal Notices| Contact Us
275 Commerce Drive, Suite 300, Fort Washington, PA 19034 • 215.690.0300 • Fax: 215.690.0280Copyright © 2015 National Comprehensive Cancer Network, All Rights Reserved


text:
Northgate Mall
1600 N. Jackson St. Tullahoma, TN 37388
Contact Email:
(931) 455-6668
The area's only enclosed mall with numerous specialty shops. Dillards, Goody's and JCPenney as anchor stores.
Tennessee Vacation eGuide
The 2015 eGuide gives you instant access to Tennessee's irresistible attractions and destinations. Peruse venues online, then put in your order to get a free guide delivered to your doorstep.
View on map
City: Tullahoma, TN
Region: Middle Tennessee
Subregion: Nashville & Surrounding Areas
Hours Open:
Mon. - Sat. 10 a.m. - 9 p.m.; Sun. noon - 6 p.m. (extended holiday hours)
Dates Closed:
Thanksgiving, Christmas, Easter


text:
The table below looks at the statistics for knowledge and experience of ServiceNow products and/or services in IT jobs advertised for the Middlesbrough region. Included is a guide to the average salaries offered in IT jobs that have cited ServiceNow over the 3 months to 4 May 2015 with a comparison to the same period in the previous 2 years.
The figures below represent the IT job market in general and are NOT representative of salaries within ServiceNow.
The following table is for comparison with the above and provides statistics for the entire Vendors category in permanent jobs advertised in the Middlesbrough region.


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Now that MHSAA Staff have completed their visits to all five Battle of The Fans Contest Finalists, it's time to engage communities in a final show of support. Starting at 9:00 a.m. on Tuesday, February 17, fans can cast votes for their favorite BOTF Finalist in one (or all) of the four following ways:
Likes, shares, and RTs will be tallied for each Finalist when the vote concludes at 4:00 PM on Thursday, February 19. The MHSAA Student Advisory Council will consider social media activity when selecting the eventual Battle of The Fans Champion for 2015.
Best of luck to all five of our Finalists!
Perennial powers are beginning to emerge as the MHSAA Student Advisory Council embarks again on its quest to reward Michigan's top high school student cheering section. Reigning champion Beaverton is back for Battle of the Fans IV, while 2013 champion Buchanan is a finalist for the third straight year. But more than half of this season's hopefuls applied to the contest for the first time – and Dowagiac, St. Johns and Yale impressed enough to earn their shots at joining the elite by claiming the 2015 championship banner. Those five finalists have been selected for this year's BOTF contest, which will again recognize the top student cheering section from among member schools with the winner crowned in February and then recognized in March during Boys Basketball Finals weekend at Michigan State University's Breslin Center. Finalists will be visited for the following home boys basketball games: Jan 16: Gladwin at Beaverton Jan 23: Almont at Yale Jan 30: Niles Brandywine at Buchanan Feb 6: Haslett at St Johns Feb 13: Edwardsburg at Dowagiac To read more, visit the article on Second Half >>>
The Battle of the Fans is back for the fourth year, and is ready to highlight the best student cheering sections across Michigan. To get involved in the contest, follow these steps before the Jan. 10 (noon) deadline.
Now that MHSAA Staff have completed their visits to all five Battle of The Fans Contest Finalists, it's time to engage communities in a final show of support. Fans can cast votes for their favorite BOTF Finalist in one (or all) of the four following ways:
Likes, shares, and RTs will be tallied for each Finalist when the vote concludes at 4:00 PM on Thursday, February 20. The MHSAA Student Advisory Council will consider social media activity when selecting the eventual Battle of The Fans Champion for 2014.
Sportsmanship is an important part of educational athletics, and student cheering sections can be a key factor in creating a festive high school event. The MHSAA Student Advisory Council wants to see your student section in action, and see how you contribute to a fun and positive experience. The MHSAA Battle of the Fans competition will let us all see who has the top student cheering section in Michigan.
Send us videos of your student section making noise on game night. We want to see videos that reflect enthusiasm and togetherness within cheering sections. We want to witness cheers that pump up the atmosphere without disrespecting all involved in the sporting event. We want to see a mixture of school spirit and positivity within student cheering squads.
Anyone can create the Battle of the Fans video: student section leaders, members of the video production class, yearbook staff, student council or anyone else. We think, though, the best videos will probably use teamwork from the entire student body.
Here's more about the competition…
JUDGING CRITERIA Positive Sportsmanship Student Body Participation School Spirit Originality of Cheers Organization of the Group Student Section Leadership Overall Impression / FUN
VIDEO CONTENT & LENGTH Videos should be between 90 seconds and 3 minutes long, and each video should contain two components. First, you must include at least 30 seconds of a student (or students) explaining how your student section embodies the elements listed in the judging criteria and why your school should be named as the top student section in the state. Second, you must include at least 60 seconds of your student section in action. Show us how loud, organized, positive, and original you can be. And don't forget, sportsmanship is a key component to having one of the top student groups in Michigan.
HOW TO ENTER Upload your video to YouTube, and then email the link to firstname.lastname@example.com or email@example.com. Videos must be submitted no later than noon on January 10, 2015. The MHSAA will create a YouTube playlist highlighting all of the videos.
THE FINALISTS After all videos have been posted (Jan. 11), the MHSAA Student Advisory Council will choose the Top 5 Finalists. At least one Class C or D school will be included in the Finalist group.
FINALIST TOUR Members of the Student Advisory Council and MHSAA staff will visit all Finalists on a home game night. We'll shoot and edit our own video to document our experience at your school. We'll also meet with the school's student leaders and write stories about our experiences. The videos and stories can be found on the MHSAA's Second Half website, and we'll also tweet the links and post to Facebook for other students to see.
DETERMINING A WINNER The MHSAA Student Advisory Council will determine a winner based on the judging criteria listed above. It will also conduct a vote using a Facebook, Twitter and Instagram Likes, Shares and RTs to help in its decision making. Council members will not use the actual number of "votes", rather it will use the number of votes in comparison to the size of the school; 500 votes from a school with 1,000 students is better than 500 votes from a school with 2,000 students.
BOTF IV CHAMPION The winner will be announced Feb. 20 and will be invited to the Class B Boys Basketball Semifinals at the Breslin Center on March 27 to be recognized and receive a championship banner. We will also play a compilation of all five finalist videos on the Breslin Center HD scoreboard during the Girls & Boys Basketball Finals in March.
TIMELINE Jan 10 (noon) - Video submission deadline Jan 16 to Feb 13 - MHSAA/SAC site visits Feb 20 - Announce BOTF IV Winner Mar 27 - Winning school recognized at Breslin Center
FINAL NOTE Even if you don't think you can win or if you have only a few seconds of video, we'd love to see your student section in action! We want everyone to have fun with this contest!
Beaverton's "Bleacher Creatures" student section has filled stands for 35 years. But when leaders decided this fall to get more organized, and then met this for the first-ever Spirit Club meeting, they had one goal in mind:
Win Battle of the Fans III.
After falling just short of making last season's five finalists, the Creatures simply wanted a chance to show what they've been doing since their parents were in high school. They got their chance Friday during the MHSAA's visit for a boys basketball game against Houghton Lake – and showed more than enough to capture the title as the state's top high school cheering section.
Read the full story >>
Buchanan is back to defend its title. But rival Bridgman would love to be the next to hoist the championship banner. And Beaverton, Frankfort and Traverse City West plan to show the best cheering in Michigan isn't reserved for the state's southwest corner. Those five finalists have been selected for the Michigan High School Athletic Association's "Battle of the Fans III," which will again recognize the top student cheering section from among member schools with the winner crowned in March during Boys Basketball Finals weekend at Michigan State University's Breslin Center.
Finalists will be visited for the following home boys basketball games: Jan. 17: Buchanan vs. Niles Brandywine Jan. 31: Bridgman vs. Niles Brandywine Feb. 3: Frankfort vs. McBain Feb 7: Traverse City West vs. Petoskey Feb 14: Beaverton vs. Houghton Lake To read more, visit the article on Second Half >>>
Josh Money had gone to just about every Buchanan boys basketball game during his first three years of high school, usually one in a semi-full section of stands.
But as the senior "Trophy Buck" stood in front of his school's newly-created "Herd" for its first theme night on Dec. 7, he hardly could believe his eyes.
Read the rest of the story...
The champion is back. But the competition is all new and no doubt hungry to become known as the best cheering section in Michigan.
Let "Battle of the Fans II" begin.
Reigning champion Frankenmuth along with Ann Arbor Gabriel Richard, Buchanan, Vandercook Lake and Zeeland East have been selected as finalists for this year's "Battle of the Fans II," which for the second year aims to recognize the top MHSAA student cheering section.
Finalists will be visited for the following home boys basketball games:
Jan. 18: Frankenmuth vs. Bridgeport Feb. 1: Vandercook Lake vs. Michigan Center Feb. 5: Ann Arbor Gabriel Richard vs. Madison Heights Bishop Foley Feb. 8: Zeeland East vs. Muskegon Mona Shores Feb. 15: Buchanan vs. Bridgman
To read more, visit the article on Second Half >>>
Past Champions
2014-15 Contest
Beaverton Buchanan Dowagiac St Johns Yale
BOTF IV Finalists Announced BOTF IV Application Videos (YouTube) BOTF IV Official Rules (PDF) Theme Night Ideas from Sportsmanship Summit (PDF)
2013-14 Contest
Stories Beaverton Buchanan Bridgman Frankfort Traverse City West Tribute to all Applicants Finalists Announced
YouTube Playlists: All Video Applications Meet the 5 Finalists MHSAA Visits
Helpful Resources & Info: BOTF III Poster (PDF) Official Rules (PDF) 12 Tips From BOTF I & II (PDF) Theme Night Ideas (JPG)
Social Media #BOTF on Twitter YouTube: What is Battle of the Fans?
2012-13 Contest
Coverage of the Winner Championship Announcement Championship Banner
YouTube Playlists All Video Applications Meet the 5 Finalists MHSAA Visits
Finalist Stories Ann Arbor Gabriel Richard Buchanan Frankenmuth Vandercook Lake Zeeland East Tribute to All Applicants
Social Media Vote on Facebook #BOTF on Twitter YouTube: What is Battle of the Fans? YouTube: Sportsmanship Summit Review
2011-12 Contest
YouTube Playlists All 19 Applications The Five Finalists MHSAA Official Visits Finalist Stories Frankenmuth Grand Rapids Christian Petoskey Reese Rockford
1. Focus on your school. Encourage and direct comments to your team only. Don't target individuals on the opposing team. Be loud, and be your team's "6th man". 2. Promote a positive atmosphere. Cheers should uplift the crowd and get everyone involved. Be aware that children and parents are there, too.
3. Get organized. Select a group of leaders. Promote the togetherness of the entire student body. Organize theme nights. Develop your own original cheers. 4. HAVE FUN!


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The Norwalk Fire Department and Fisher-Titus Home Health Center have been awarded scholarships to participate in a training conference dedicated to Remembering When: A Fire and Fall Prevention Program for Older Adults, developed by the National Fire Protection Association's (NFPA), Center for High-Risk Outreach. The awarded scholarships provide for travel expenses for two participants, Remembering When curriculum materials and all training.
Chief Doug Coletta of the Norwalk Fire Department and Debbi Cullen, operations manager of Fisher-Titus Home Health Center, will travel to a conference from Dec. 2 to 4 in Boston, Mass. Following the workshop, Norwalk Fire Department will conduct a minimum of five group presentations and at least two train-the-trainer sessions for Fisher-Titus Home Health Center. The home health center will integrate materials from the Remembering When program into its outreach through home visits.
Read the rest of this story in http://activepaper.olivesoftware.com/Default/Skins/Norwalk/Client.asp?Skin=Norwalk&Daily=NRWK&AppName=1"">Today's Reflector...<>/p>


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ok...i need a connect NOW. trying to cop the green version, i guess. 7 3/8ths.
while we're at it i might as well cop the white huf fitted.
its not a white huf fitted
its a black 3m reflective. the flash on the camera made it white
and those are gone


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City-building game
This article possibly contains original research. (January 2015) |
Part of a series on: |
Simulation video games |
City-building games are a genre of strategy video game where players act as the overall planner and leader of a city, looking down on it from above, and being responsible for its growth and management. Players choose building placement and city management features such as salaries and work priorities, and the city develops accordingly.
City-building games such as SimCity or Cities: Skylines are considered a type of construction and management simulation.[1]
This article is incomplete. (February 2009) |
The city-building game genre was established in 1989 with SimCity, which emphasized continuous building rather than a set victory condition. Players followed personal preferences in design and growth. Indicators of success were maintaining positive budget balance and citizen satisfaction. Subsequent SimCity titles such as SimCity 4 soon followed when high sales of the game demonstrated its popularity.
The first sim game, Utopia (1982) developed for the Mattel Intellivision console system, covered many of these same elements, but was limited by the primitive screen resolutions of its era. Unlike the thousands of individual spaces possible a few years later in SimCity, each island in Utopia held only a dozen or so "buildable" spaces for schools, factories and other constructions. The player's score was based on the well-being of his or her people.
A second boost in genre popularity came in 1993 with the release of Caesar, a game which modeled cities in ancient Rome, replacing electricity and mass transit with aqueducts and roads. Subsequent titles in the City Building Series followed, all modeling cities in past civilizations.
The Dungeons & Dragons PC game Stronghold appeared in 1993, and was advertised as "SimCity meets D&D in 3D". Elves, humans and dwarves each built neighborhoods with unique architecture within the player's town. The title also had elements of real-time strategy games when enemies attacked the city, and the line between city-building and RTS games has often been blurred with this kind of hybrid title. True 3D graphics were not yet possible at that time, so the advertised 3D was actually a clever use of 2D graphics (an isometric projection) with mathematically generated terrain and overlaid bitmaps and sprites.
The Anno series started in 1998 and established a high level of detail in graphics as well as an intense economy simulation and a distinct gameplay.
See also[edit]
This article needs additional citations for verification. (January 2010) |
- ^ Rollings, Andrew; Ernest Adams (2003). Andrew Rollings and Ernest Adams on Game Design. New Riders Publishing. pp. 417–441. ISBN 1-59273-001-9.
- Conte P.-A. : « City builders : vis ta ville ! », air le mag, n° 37, mars 2013, pp. 33-35


text: Our Ocean View King Efficiency contains one King bed. This unit is approximately 421 square feet. Perfect for short getaways, this unit has a furnished balcony with a side ocean view. Amenities included to make your stay more comfortable and relaxing include: -Cable TV -Microwave -Compact Refrigerator -Coffeemaker -Complimentary Local Calls -Complimentary Wireless Internet Access


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NOVA 1624-44 Lathe Save $500
One of our most popular lathes is on sale right now! Buy Now $999.99
WoodRiver® Tenoning Jig $69.99
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Nice item!
By Shaker Shoppe
from Cumberland, RI
About Me Professional
Comments about Miniature Barrel Hinge :
Great hinge for jewelry boxes, and other small boxes.
Great Product - Great Customer Service
By Oz Turner
from Sydney, Australia
About Me Avid Do-It-Yourselfer
Ideal for Top End Quality Pen Presentation Cases, Jewelry & Dressing Table Boxes in that they: * Fit a case of minimal wall thickness * No screws required. * Easily fitted * Not obtrusive * Functions perfectly
neat little hinge
By dave
from united kingdom
a small neat hinge for small boxies eg pen box
barrel hinge
By daveswoodcraft
from England
Fab hinge expensive to export to the uk but end product looks great.
easy to work with
By P
from Pittsburgh, PA
easy to install
Perfect for small boxes
By Brad
from Harrisburg, PA
They are perfect for small boxes and easy to install.
Excellant product
By Wooddaddy
from Munster, in
Hard to find but Woodcraft made it easy to buy. [...]
great for small projects
By Mike S
from Reading, Pa.
Great for small boxes
Used for gift boxes
By memphissound
from Memphis, TN
About Me Casual Do-It-Yourselfer
I used these to make gift boxes to hold folding knives. Overall they were worry free. The metric sizing on the instructions makes design and layout a little more cumbersome than it might be. But otherwise they did exactly what I needed. Nothing GREAT, but adequate.
Just the job!
By Master craftsman
from uk
About Me
5mm product most useful found for toymaking


text:
Most of us treat our hair the way we do our teeth – never really providing the necessary attention and care until such time that we begin to suffer from some discomfort. Realizing that you have begun losing hair then triggers off a frantic phase of clutching at all possible straws right from your grandmother's haircare recipe to visiting a trichologist. In reality, hair quality largely depends on several factors of which, some such as heredity may be beyond your control but others such as lifestyle and diet are definitely in your hands.
One important point to remember is that the quality of your hair is a direct outcome of the kind of nourishment you provide it. Since times immemorial, certain oils have been used by people because of their nourishing properties. Although growing back lost hair is a tall order, the judicious use of these oils can help you stem further hair loss and this, in itself, will give you hair that has volume and a healthy sheen and bounce.
Olive Oil
Olive oil is great for hair because of the several properties it has – it is nourishing oil that manages to penetrate the hair shaft much more effectively than other oils; it has good moisturizing action, and is also an excellent hair conditioner. If you use the extra virgin variety, your hair also receives vitamin E and mono unsaturated fatty acids that play an important role in promoting hair growth.
Thehealthsite.com tip: Take a little olive oil in a bowl and microwave for a few seconds until it feels warm, but is not uncomfortably hot. Slowly massage this warm oil into your scalp and onto the strands of hair until their tips. After leaving the oil on for 30 to 45 minutes, wash your hair with a mild shampoo.
Coconut Oil
Ever wondered why people from Kerala have such thick and healthy hair? It has a lot to do with their hair care routine that involves coconut oil. Probably one of the best oils for hair, coconut oil penetrates well within the hair shaft and prevents hair from losing moisture by acting as a sealant. As a result, hair is less likely to suffer damage and stays dense as well as strong. The lauric acid that coconut oil is rich in has significant action against viruses, bacteria and fungi and this ensures you keep away from infections of the scalp, too. Know other beauty benefits of coconut oil.
Thehealthsite.com tip: Massage a little warm coconut oil onto your scalp every day. This helps to moisturize your scalp and prevent dandruff and scalp infections.
Once a week, massage a greater quantity of warm coconut oil on to the scalp and hair strands. Leave on for about an hour or two and then wash with a mild shampoo, but do not wash out all the oil. This allows a little oil to be retained which acts as a wonderful moisturizer for hair.
Almond Oil
When it comes to hair care, sweet almond oil is highly effective because of its emollient or softening action. Rich in vitamins D and E and minerals such as calcium and magnesium, almond oil acts as a natural moisturizer for your hair, preventing it from turning dry and brittle. As a result, there is lesser hair loss. And the nutrition your hair receives ensures it stays healthy, thick and strong, and also grows faster. However, if you have an allergy to nuts, it is best to avoid almond oil.
Thehealthsite.com tip: Warm a little almond oil for a few minutes in the microwave oven and gently rub it over your scalp, allowing the oil to penetrate. Stay with the oil for as long as possible – preferably overnight – and then wash with a mild shampoo.
Lavender oil
Long in use for its calming and relaxing properties, lavender oil is highly effective against nits and lice. It increases the circulation of blood in the scalp and also provides an antibacterial effect that keeps the scalp free from infections, improving the health of your hair. Know why is everybody going gaga over argan oil.
Thehealthsite.com tip: Take a little lavender oil and mix with either coconut or olive oil. Apply daily to your scalp.
To make your own fresh lavender oil, take some olive oil in a glass bottle, drop in a few lavender sprigs, ensure they are submerged within the oil and keep in a dark place for a month or so. Massage a little of this oil daily onto your scalp and leave overnight. Wash your hair the next morning using a gentle, herbal-based shampoo.
Castor Oil
For ages, people in India have consumed castor oil that is obtained from the castor seeds as a home-made laxative to periodically cleanse their intestinal system. Applied externally, the oil has excellent hair growth-promoting properties and is considered an effective remedy for thinning hair. Most of these benefits are due to the oil's contents: triglycerides of ricinoleic acid that have anti-fungal, anti-bacterial and anti-inflammatory properties and vitamin E that has antioxidant action. Here are amazing benefits of castor oil you didn't know.
Thehealthsite.com tip: Massage the castor oil onto the scalp and spread it evenly on hair strands, too. Keep for at least one or two hours and then wash the hair using shikakai (acacia concinna) or reetha (sapindus trifoliatus) powder.
If you find that castor oil alone is too thick for your comfort, mix it with a little coconut oil or olive oil to thin it and follow the same procedure.
While these oils seem like the panacea to all your hair-related issues, they may not be very effective in cases where your hair loss is due to some other underlying medical condition. Besides, hair loss may also be a result of certain medications you take and in such cases, you need to consult your doctor regarding any substitute without this side effect. Along with the regular use of herbal oils, consume a healthy and balanced diet richin minerals and vitamins and keep yourself away from stress and you are bound to notice a definite improvement in the quality of your hair. Here is how you can choose a suitable hair spa treatment.
Image source: Getty Images
For more tips on haircare, check out our haircare section. For daily free health tips, sign up for our newsletter.


text:
Pfizer Inc. (NYSE: PFE) has received approval from the U.S. Food and Drug Administration (FDA) for XELJANZ® (tofacitinib citrate) 5 mg twice daily for the treatment of adults with moderately to severely active rheumatoid arthritis (RA) who have had an inadequate response or intolerance to methotrexate. XELJANZ may be used as monotherapy or in combination with methotrexate or other non-biologic disease-modifying antirheumatic drugs (DMARDs). XELJANZ should not be used in combination with biologic DMARDs or with potent immunosuppressives, such as azathioprine and cyclosporine.
XELJANZ (ZEL'jans') is the first approved RA treatment in a new class of medicines known as Janus kinase (JAK) inhibitors and the first new oral DMARD approved for RA in more than 10 years.
On November 6, at 6:00 P.M. ET, Pfizer will convene a panel, including Pfizer leadership and a prominent RA expert, to discuss the implications of having an additional treatment option for RA patients and rheumatologists. These panelists will be available for a Q&A session following opening remarks.
Pfizer Inc.
Posted in: Medical Condition News | Pharmaceutical News
Tags: Arthritis, Azathioprine, Breastfeeding, Cancer, Cell, Cholesterol, Cyclosporine, Diarrhea, Drugs, Fever, Headache, Hepatitis B, Immunology, Lymphoma, Methotrexate, Oncology, Pain, Pfizer, Pregnancy, Respiratory, Rheumatoid Arthritis, Rheumatologists, Rheumatology, Tuberculosis, Virus
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text:
Manufacturer | Magus Genetics Seeds | |
Height | medium | |
Feminised | Feminised | |
Variety | Mostly Indica | |
Yield | 4-5oz (depending on growers skill level) |
Grows | Greenhouse, Grows Outdoors, Grows Indoors | |
Flowering Time | 7-8 Weeks |
Harvest Month | October |
More Information
Double Dutch is a cross of a Warlock male with a pre-2000 Chronic female.
During the seedling & vegetative growth stages, Double Dutch shows its Indica pedigree with fat leaves, thick stems, and a bushy growth pattern. In the flowering stage Double Dutch produces giant Sativa-like buds.
All tips that receive copious amounts of light will form huge buds similar to elongated popcorn balls. Double Dutch buds must be staked due to their heavy weight.
Performs well in bio, coco and hydro growth mediums.
The Double Dutch aroma is a pleasant fruity wildflower scent.
The buzz is complex and strong.
The high is both cerebral and heavy.


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Almond, walnut harvests in California's Sacramento Valley
Oct 17, 2010Advertisement
Jim Peart, almond grower, Arbuckle, Calif., believes this year's wet bloom period reduced his Nonpareil variety yield by about 25 percent.
More -
Jim Peart and his father are partners in Don Peart Ranch, a 400-acre almond operation in Colusa County, Calif.
More -
The Peart family attached a conditioner implement to the harvester this fall to remove sticks to help the almonds dry faster.
More -
The 2010 California Walnut Objective Management Report predicts production at 517,000 tons, up 17 percent from 2009, according to the National Agricultural Statistics Service.


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Four 18" Chairs & One 30"W x 60"L Rectangle Activity Table Set
reg. $229.95
ECR4Kids' 18" Chair & 30" x 60" Rectangle Activity Table Package is a fun and affordable addition to your classroom. Students will enjoy the comfort of molded plastic shell seats paired with the durability of an attractive, laminated table top. Sturdy steel frames provide lasting support to the chairs and table. The standard rectangle-shaped table is great for group projects. Legs adjust top height 19"-30" to accomodate students of all sizes, and nylon swivel glides protect floors.
This package includes four (4) 18" school chairs with colored seats and swivel glides and one (1) 30" x 60" rectangle activity table with a grey speckle top, matching colored edge and upper legs, 19"-30" adjustable-height legs and swivel glides.
To find the perfect seat height, measure the distance from the floor to the back of the child's knee (where it bends). If the measurement is between two seat sizes, round down to the smaller seat height.
Chairs- Seat Height From Ground: 18"
- Suggested Grade Level: 4th - 12th
- Seat Width: 14 3/4"
- Seat Depth: 15"
- Back Height: 13 1/8"
- Overall Height: 31 1/2"
- Seat Material: K-Resin plastic
- Frame Material: Tubular steel
- Frame Finish: Chrome
- Glides: Swivel
- Stackable: Yes
- Warranty: 10 years
- Table Width: 30"
- Table Length: 60"
- Table Height: 19" - 30"
- Table Material: Particleboard
- Frame Material: Steel
- Top Material: 1 1/8" laminate
- Leg Finish: Powder-coated
- Glides: Swivel
- Warranty: 10 years


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To make reservations by phone, dial freephone 0800 221 222 in the UK, 1 800 409 929 in Ireland, or view our regional telephone reservation numbers.
Our Albany, GA hotel features stylish, modern décor as well as free Wi-Fi throughout the hotel. Marriott Albany,GA right off of Exit 8 ramp, Full Service Bar. You will love the comfort and convenience of our Completely Renovated hotel finished in July 2014. Drop by our Bistro for a healthy breakfast and We Proudly brew Starbucks Coffee or enjoy a cocktail and dinner at our Bistro with full Bar-complimentary USA Today on weekdays. Relax in our pool and whirlpool, or work out in our fitness room. Planning an event? Let us know - our largest space hosts 40 seated and offers full catering. Our Albany, GA hotel is conveniently located to Miller Coors Brewing, and the Marine Corps Logistics Base, as well as the Albany Mall, Proctor and Gamble, Darton College and Albany State University. The Jimmy Carter National Historic Site – as well as great hunting, fishing, and golfing – are also just a short drive away.
Category: Points Needed Per Night
A more rewarding way to travel.


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It's a compendium of stellar mom bloggers edited by Rita Arens of the blog "Surrender, Dorothy" and Redbook editor Stacy Morrison.
Essays (blog posts in another life) on condescending pediatricians, awkward playground encounters, potty training revulsion and the guilt of the reluctant co-sleeper are included.
There's wit. There's wisdom. But none of it's conventional.
The moms -- including Alice Bradley of "Finslippy," who lives in Jersey -- are confused, hostile, insecure and filled with messy, overwhelming love. But they're never dull or trite.
In fact, when it comes to modern parenting, few writers are more entertaining than these moms.


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Results 1 to 3 of 3
- 01-02-2013, 05:48 AM Thread Author #1
Iphone 3gs not up dating
I had an Iphone 3gs which had jail breaker loaded on last month I have tried to up grade to ne IOS but it failed on the final set up and now when I turn it on nothing coming up. I took the phone to apple store they have tried re load the phone but an error message appeard they then told me that the phone has used an un authorised software ( I think they meant Jail breker) so they can't replace the phone. Is any body can help me to resolve the issue all I want is that the error code to disppear when I re load the IOS then Apple can replace the phone please help.
Sukumas -
Iphone 3gs not up dating
How did apple know the phone was jailbroken? Unless they were just able to boot it up! But wouldn't they just throw it on a Mac and restore as new?
But please, as requested above, tell us the errors you are receiving. -
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ODT Online
ODT /directory
A ministry of Economic Development survey has revealed there is a significant shortage of skilled labour in the IT industry, despite the recession and consequent job losses.
The situation has prompted the University of Otago to increase its intake of information science students by up to 100% during the next two years.
New Zealand Information and Communications Technology chief executive Brett O'Riley said the survey, conducted by NZICT on behalf of the ministry, showed 83% of companies surveyed found difficulties in recruiting qualified, skilled and experienced staff, and it was having a medium to major effect on their businesses.
However, the survey also revealed companies were expecting continued growth in staff levels during the coming months, and more than 50% of companies surveyed were planning to appoint technical staff.
Mr O'Riley said it demonstrated continued employment opportunities and demand across a range of highly paid roles, including programming, project management, and network and systems engineering in both the IT and telecommunications industries.
"These roles are essential to New Zealand's drive to improve productivity and also generate foreign exchange."
University of Otago Information Science Department head Prof Martin Purvis said about 80 information technology and computer science students graduated from the university each year, and most - if not all - received multiple job offers as soon as they left.
"These graduates have been swallowed up as quick as we've been able to churn them out over the last couple of years.
"The situation is so serious, places like Telecom are importing skilled IT people from overseas to help fill the need for skilled staff."
Prof Purvis believed the demand for IT staff was now easing, but the shortage was still significant.
The university was now trying to encourage Otago secondary school pupils to study information technology at a tertiary level, in the hope it would help boost the university's intake into the department by up to 100%.
"That will definitely help the situation."
Mr O'Riley said NZICT was also working closely with the education sector and other industry stakeholders with a comprehensive programme to address the skills shortage and ensure students and potential employees are aware of the opportunities that await them.
"ICT roles command above-average remuneration both domestically and internationally, and they are in high demand.
"ICT education and skills are a global employment passport, making a 21st-century OE a highly lucrative opportunity for many young New Zealanders," he said.
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HTC touch
5 Jun 2007 - 9:50pm
8 replies
711 reads
Check out this product: http://www.htctouch.com/
It is by HTC.
Here's the dealio. it is an only touch interface device
It has similar specs as the iPhone (just no iPoding).
It concentrates more on video and photo than music.
touch-gestures for navigation.
It is built on top of Windows Mobile 6 but with significant customization.
Further they show the UI in their commercial on their web site.
The hardware is not nearly as compelling as the iPhone, but still not bad.
Oh! and nothing on the site demonstrates a means for doing text entry
through touch typing or speech or otherwise.
-- dave
David Malouf


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Why You Should Be Using The Female Condom
A new study shows female condoms are a surprisingly effective way to stop the spread of HIV. But does anybody actually use them? Turns out, people do — if they know how.
A program that gave away 200,000 female condoms to women in Washington, DC prevented 23 HIV infections, according to a study published in the journal AIDS and Behavior. Why female condoms rather than the more common male variety? The study authors wrote, "It is critical that there are HIV prevention interventions entirely under the control of women, and female condoms are the only such woman initiated intervention currently on the open market." But will women actually use them?
An AIDS Healthcare Foundation worker demonstrates a female condom.
Women I talked to were skeptical. Said one, "I wouldn't use a female condom unless I had to. I prefer contraception to be relatively discreet, aesthetically speaking — whether as unseen as an IUD or the Pill, as removed from the moment as a diaphragm, and/or as clingy and sort-of camouflaged as a male condom — and my perception of the FC is that it's far from aesthetically pleasing or discreet, due to the ring hanging out. " Another said that she thought they were less effective than male condoms (true, at least for preventing pregnancy), more expensive (also true), and difficult to find (true, although it may be getting easier). A third said, "I guess I wouldn't be opposed, but I have to admit I don't think I've ever spoken to someone who has" used one. She added that if someone she knew had used one and liked it, she might be more inclined to try.
Planned Parenthood is hoping to make that more likely. Leola Reis of Planned Parenthood Southeast told me some pluses of the method. First of all, she says the new Female Condom 2 is way better than the old version — it's made of nitrile rather than polyurethane, so it's pliable and warms with the body. And it has some advantages over the male condom. It covers more of the outside skin of the vulva, reducing skin-to-skin STD transmission risk. And Reis says it can even increase a woman's pleasure, because the outer ring can rub up against the clitoris during sex.
The biggest drawback, according to Reis: women don't know how to use it. But in a project in Atlanta, Planned Parenthood held trainings to teach 600 women how to use the method, and gave them goodie bags with three female condoms to take home. Then they surveyed those 600 women, plus 350 who hadn't done the training. 85.5 percent of the women who did the training said they'd consider using a female condom, compared with 57.3 percent of women who hadn't. And 51.3 percent of training participants said they'd rather use a female condom than a male one (just 18.1 percent of non-participants said the same).
So a little information can make a big difference. For instructions on how to use a female condom, plus an animated video, check out Planned Parenthood's site.


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Because of the limited actual photos, I was not able to see the stitching on the jacket. The pants were perfect. The extra stitching on the jacket was removed for $25 by a taylor (who said when she saw the jacket, "this looks cheap.") At any rate, the jacket is top notch now and I'm still about $300 less than if I had bought at a large department store.
Great suit! I have 4 of his suits and all were bought on overstock. They are as described. I went to a retailer and tried it on and bought at overstock.
This is an excellent suit for the money. Fits me very well.
The suit itself is decent for the price, but the lapel stitching is very pronounced. I dislike the lapel stitching enought that I intend to return the suit.
This is nice lower end suit. I did return the item for two reasons. The shoulders are quite "boxey", and I prefer more natural shoulder shape. Also, the breast pocket is faux! No place to put a pocket square. If you are looking for an affordable, reasonable suit- but with prominent shoulder profile and a faux breast pocket- this is nice for the money.
Beautiful suit! This was my second Joseph Aboud suit purchased and I'm extremely happy with the quality. Thanks O!
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** Most Oversize orders are delivered within 1-4 weeks. Some orders may take 6 weeks to be delivered.


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On Fri, Jun 10, 2011 at 03:30:21PM +0100, Ralf Baechle wrote: > Aside of the usual motivation for constification, this function has a > history of being abused a hook for interrupt and other fixups so I turned > this function const ages ago in the MIPS code but it should be done > treewide. > > Due to function pointer passing in varous places a few other functions > had to be constified as well. > > Signed-off-by: Ralf Baechle <email@example.com> Acked-by: Paul Mundt <email@example.com> |
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Mozzarella-Stuffed Tomatoes
Recipe courtesy Edison Mays
- Party Starters
- 6 vine-ripened tomatoes
- 1 cup finely grated mozzarella cheese
- 1/2 cup unseasoned bread crumbs
- 1 tablespoon flat-leaf parsley leaves, minced
- 2 cloves garlic, minced
- 1/4 teaspoon oregano
- 1/4 cup extra-virgin olive oil
- Fine sea salt and fresh ground black pepper
Preheat oven to 375 degrees F.
Cut the tops off the tomatoes and, using a spoon, hollow out the middle. In a medium bowl, combine the mozzarella, bread crumbs, parsley, garlic, oregano, and olive oil. Season to taste with salt and pepper. Place the stuffing in the tomatoes, taking care not to pack them too tight. Place on a baking sheet and transfer to the oven. Roast for 30 minutes.
Recipe courtesy Edison Mays
Cooking Tips
More Recipes and Ideas
Roasted Tomato, Arugula and Mozzarella Salad
Recipe courtesy of Patrick and Gina Neely
Stuffed Tomatoes
Recipe courtesy of Alex Guarnaschelli


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Our Bureau
Mumbai, July 18
THE Council of Scientific & Industrial Research (CSIR) has empanelled Lintas IMAG for its endeavour to disseminate its messages to the masses. With this deal, Lintas IMAG is now the largest and most comprehensive Integrated Marketing Action Group in the country.
The empanelment was awarded after a multi-agency pitch, involving several agencies.
"We are happy to have been empanelled by the Council of Scientific & Industrial Research and are eagerly devising comprehensive communication plans for science dissemination. Mr Debashis Das and Mr Dinesh Malhotra have been entrusted the responsibility of providing an integrated marketing solution to CSIR. We are truly happy that the integrated marketing offering of Lintas IMAG, is being so well received by the clients," said Mr Ashish Bhasin, Director IMAG, Lintas India.


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Home |
Antique Japanese Imari Covered Dish "Syokurou" browse these categories for related items... All Items: Archives: Regional Art: Asian: Japanese: Pre 1920: item # 1166586 Please refer to our stock # T-I823 when inquiring. RYOUTAN 19 Nikaido, Kamakura City Kanagawa Pref. 248-0002 JAPAN tel:+81-467-24-7035 Guest Book |
Sold, Thank you! A beautiful antique Imari porcelain covered dish painted with red, gold and coral pink Phoenix surrounded with peonies. The bottom section of the dish contains geometric blue-and-white patterns and camellia flowers. Interior has a beautiful design too, butterfly and flowers. The condition is in excellent. Date: Meiji period, 19th century. Measurements about : 24cm(9.44")Diameter, 14cm(5.51")Tall. |


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03.01.2012 - Norway: Lessons from a $500 bln investment fund |
For some inkling of where investment theory is headed, take a look at the debates and forums being hosted by the Norwegian Government Pension Fund. Fund officials are in the midst of an inquiry into why their fund, which invests proceeds from Norways vast petroleum exploits, performed so poorly in 2009 and how it should re-orient itself. Unlike, say, a hedge fund, Norways pension fund conducts a big portion of its business in the public eye, which means you can get a heck of an education simply by tuning in to the presentations given by the bevy of academics the Norwegian government has brought in to look at the performance...............................................Full Article: Source |


text: The worlds largest billfish fishing tournament starts next week in Ocean City, MD. Book a room with us and join the thousands of people that will watch the exciting weigh ins at this years tournament August 4th – 8th. Hundreds of boats and 1000's of anglers compete in the White Marlin Open each year.


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Your bum hole.
One morning Phil "McCrackin" Rollason rose from his bed to find he had a leakage out of his Rusty Sheriffs Badge. Upon investigation he had found out that Kevin Ryan had spent the night at his flat!!!
by Manwell hung
November 28, 2003
7 more definitions
Top Definition
Arsehole, ring, sphincter, anus
Show us your Rusty Sheriff's Badge ya dirty bitch!!
by D
November 10, 2003
To use it's correct scientific name: 'The A-hole'.
Of course this is due to their startling similarity in appearance.
Of course this is due to their startling similarity in appearance.
"See you in fifteen minutes Ed, I'm off to the toilet to release a few 'Chocolate hostages' from the Rusty Sheriff's Badge.
by T-time
June 02, 2005
your anal opening
my mate is queer he likes to feel a penis up his rusty sherrifs badge
by sheep
January 17, 2004


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Skip to content. | Skip to navigation
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The Draft Comprehensive Plan establishes the overarching restoration goals and describes the criteria by which the Council will evaluate projects. The public has been invited to provide feedback during a series of meetings across the region and through an on-line public comment process. Public meetings have been held in each of the Gulf States and a final meeting will be held June 17, 2013 in St. Petersburg, FL. The deadline for submitting comments is June 24, 2013.The plan does not include the Ten Year Funding Strategy, nor does it include a project priority list because the trial between the Department of Justice and BP is on-going. The Council is also waiting for the Department of Treasury to issue guidelines regarding how the funds may be spent. View the plan >>The Partnership for Gulf Coast Land Conservation will submit comments in consultation with its 30 member organizations. Individual land trusts are encouraged to submit comments as well. Submit a comment >>
The Alliance will offer two $500 scholarships to each land trust member of the Partnership for Gulf Coast Land Conservation (PGCLC) from the state and local level with with five or fewer FTE staff to attend the 2013 National Land Conservation Rally (Sept 17-19) in New Orleans. Study the Rally website and follow instructions for scholarship application. We encourage your land trust to come to the conference with a large delegation of staff and board members. If you are able, we encourage you to register for one of the intensive seminars offered on Tuesday the 17, such as the seminar on Conservation Financing/bridge loans. Note also there will be a special topic seminar about Gulf Restoration and Resiliency efforts on Thursday the 19. Visit the Rally webpage >>View the Rally Schedule At a Glance >>View Rally scholarship information >>
The Partnership for Gulf Coast Land Conservation will have its annual meeting the day prior to Rally – on Monday September 16 from 10:00am to 5:00pm. The meeting will take place at the same New Orleans Sheraton hotel/conference center where Rally will be held. reception will follow the day's activities. A detailed agenda will be available by the end of July.
The National Fish and Wildlife Fund has set up the Gulf Environmental Benefit Fund (GEBF) to administer more than $2 billion in fines from the oil spill. The GEBF Fund received $158 million in April 2013. The fine money will be used to support projects that remedy harm to natural resources (habitats, species) where there has been injury to, or destruction of, loss of, or loss of use of those resources resulting from the oil spill.
Alabama: Alabama Department of Conservation and Natural ResourcesFlorida: Florida Fish & Wildlife Conservation Commission & Florida Department of Environmental ProtectionLouisiana: Louisiana Coastal Protection and Restoration AuthorityMississippi: Mississippi Department of Environmental QualityTexas: Texas Parks and Wildlife Department, Texas Commission on Environmental Quality and Texas General Land Office
Read more >>
The Farm Bill (S. 954) was passed by the Senate this week and contains important victories for land trusts. Despite billions in cuts overall, the Senate bill makes no cuts to the levels provided in last year's bill for the new Agricultural Land Easement program (ALE). Thanks to the persistence of Senator Michael Bennet (D-CO), Colorado land trusts and the Alliance, we're one step closer to a final Farm Bill that will allow some landowners to donate more of the easement value as match in the newly created ALE program, helping land trusts to conserve more land in more places.The House bill (H.R. 1947) may be taken up the week of June 17. View Farm Bill updates >>
Eric Eckl of Water Words that Work will be leading this workshop and will be teaching us how to overcome language and cultural barriers to effectively communicate our environmental messages. This FREE workshop will be offered at two dates: On July 16 at 5 Rivers in Spanish Fort, AL and on July 24 at USM's Gulf Coast campus in Long Beach, MS. To register, sign up online or via email.
The general membership meeting of the Gulf of Mexico Alliance is referred to as the 'All Hands' meeting. The event will be held June 25 - 27 at the Tampa Bay Grand Hyatt in Tampa, Florida. One of the highlights of the event will be the announcement of the recipients of this year's Gulf Guardian Awards. The public is invited to attend. Read more >>
Julia WeaverPartnership for Gulf Coast Land ConservationOcean Springs, firstname.lastname@example.com
The Partnership for Gulf Coast Land Conservation is organized under the auspices of the Land Trust Alliance which provides administrative and fiscal support.
July 21, 2014 | The Watauga Democrat | Boone, NC
May 22, 2014 | Public News Service | West Jefferson, NC
May 17, 2014 | al.com | Fairhope, AL
Family and Fund Conserve 132-Acre Buffalo Ridge Farm
NC- A family's love of farming and funding from the Triangle Land Conservancy's Our Water, Our Land campaign and Johnston County collaboratively conserved the Moore's 132-acre family farm — Buffalo Ridge Farm.
1660 L St. NW, Suite 1100, Washington, DC 20036 firstname.lastname@example.com ©Copyright 2015 Land Trust Alliance
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Anchorage Weather
Troopers: Man fatally shoots self during struggle
Alaska State Troopers say a 24-year-old Homer man fatally shot himself after he grabbed a trooper's gun during a struggle following a domestic violence call.
Aaron Michael Rael-Catholic died at the scene Wednesday night. Troopers got a call from a woman reporting her ex-boyfriend was assaulting her at her home at East End Road near Homer. Troopers say the woman left in her car, followed by Rael-Catholic in another car, which he used to ram into her vehicle. According to troopers, the responding officer used pepper spray and a stun gun as he tried to arrest Rael-Catholic. Troopers say the two ended up wrestling on the ground, and that's when Rael-Catholic grabbed the officer's gun. The trooper is on administrative leave. His name will not be released for 72 hours. |


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Kuhns Bros. Lumber Co., established in 1962, is a third generation family owned saw mill located in central Pennsylvania in the heart of the Appalachian Forests. We are committed to providing our customers with the finest quality forest products available while managing your woodlands to meet your timber harvesting objectives. Are you looking for Timber Management, Hardwood/Softwood Logs & Lumber, Mulch, Firewood, Fence Products or Drying Agent for the Natural Gas Industry?
We have it all at Kuhns Bros. Lumber Co.
Serving our customers with
Integrity… Honesty… Outstanding Service
for over 50 years.
Integrity… Honesty… Outstanding Service
for over 50 years.


text:
Las Vegas--How can we keep an aging, changing workforce safe and able to work? That was the question posed at this morning's Combined Sections Meeting session "Workforce Trends and Their Impact on PT Practice." Nicole Matoushak, PT, MPT, CEES, CEAS, and Michelle Despres, PT, CEAS II discussed the physiological struggles faced by the aging workforce--in this case, 55 years and older.
It's no secret the U.S. workforce is getting older. By 2030, it's estimated 19% of the population will be 65 or older. 80% of 50-year-olds plan to work after retirement. So, keeping this population injury-free will be a growing responsibility of physical therapists. Yet it is easier said than done.
The most common injury for an aging workforce is falls. The most common result of those falls are fractures, which take longer to heal with age. There is a slower recovery as people age. For the 55 or greater population, there is an average of 12 lost work days per incident. Compare that to the 25-34-year-olds, where the average lost work time is 6 days. Those injured, aging workers are being treated by PTs for longer than the recommendation duration of care for specific injuries.
Many factors go into this increased falls risk. Strength is 25-30% lower at age 60; flexibility is 18-20% lower at 65. Reaction speed and manual dexterity reduce with age.
Physical therapists might be unaware that common medications prescribed to the elderly population can have unfortunate physiological side effects. Fatigue, weakness, increased muscle mass, increased injuries, and delayed healing time have all been documented
"Sacropenia," from the Greek, meaning "poverty of flesh," refers to loss of muscle size and strength," and it is a major contributor to age-related injuries. By the time someone is 80, they've lost 1/2 their muscle mass.
Fortunately, that loss can be minimized through strength training programs. Physical therapists need to look beyond the current injury they are treating and examine the patient's total health. "We have great opportunity as PT professionals to work on the wellness aspect," said Matoushak."
The bright lights of the strip won't be the only thing shining at this conference. After 2 days of in-depth pre-conference lectures, things kick off in the evening of Monday, February 3 with the annual recognition ceremony for clinical specialists. APTA President Paul Rockar will welcome the crowd. A reception, one of several throughout the conference, will follow, so PTs can start the week by letting their hair down.
Whether your focus is neurology, geriatrics, sports medicine, or one of the 18 other APTA specialty sections represented, CSM has something for everyone. Physical therapists from the Cleveland Clinic will discuss "The Implementation of a Multidisciplinary Concussion Care Path," sharing how their facility standardized treatment approaches. Mike Studer, PT, MHS, NCS, CEEAA and Robert Winningham, Ph.D will present a lecture sure to be of interest to PTs working in long-term care, "Motivating Apathetic and Depressed Clients." A panel of sports medicine specialists will present "Rehabilitation Considerations for the Female Athlete," offering evidence-based background for the special considerations needed for this population.
One key event every year is the Cerasoli Lecture. This year, Leslie Portney, PT, DPT, PhD, FAPTA will present "Choosing a Disruptive Path Toward Tomorrow." The lecture honors a physical therapist who has made significant contributions to physical therapy education. Portney, of the MGH Institute of Health Professions, will discuss how general issues affecting all of higher education specifically impact physical therapy programs.
Each Combined Sections Meeting is also home to the Linda Crane Lecture, honoring outstanding contributions to the practice of physical therapy. Dianne Jewell, PT, DPT, PhD, CCS of Arcadia University will talk about "More than a 'White Hat.' Delivering the Substance of Physical Therapy's Value Proposition." Jewell will ask how physical therapists can stay relevant in our changing healthcare landscape.
And of course, the exhibit hall is a major part of the conference. Approximately 500 exhibitors will be presenting their products and services, so be sure to carve out some time to walk through. ADVANCE will be in booth 631, so stop by to renew your magazine subscription, pick up the latest issue and purchase one-of-a-kind PT gear from the ADVANCE Healthcare Shop. You might even run into staffers Jon Bassett and Danielle Bullen.
Yes, the ADVANCE for Physical Therapy editorial staff will be on site at Vegas. We'll blog about sessions, take photos, and update social media. Be sure to return to the ADVANCE Perspective blog the week of the conference and to follow us on Facebook and Twitter to get the latest news from the Venetian and Sands Expo Center.
Looking forward to seeing you in "Sin City!"
Related Content
Thousands of PTs and PTAs to descend upon Entertainment Capital of the World.
In this season of giving thanks, ADVANCE has so much to be grateful for. Besides the rewarding response we continue to receive for our dedicated print reporting on the rehabilitation profession, our efforts to expand web and social media coverage have engaged record numbers of readers and fans.
Just as the rehab profession is constantly evolving and reacting to new developments, so too is the journalism profession. We at ADVANCE take pride in our ability to push the cutting edge, offering our community of rehab professionals vital information about the profession you love, while providing opportunities to share your thoughts on these developments through our various interactive platforms.
In our year-end print issue coming out this week, we're happy to recognize Coury & Buehler Physical Therapy in Southern California as the recipient of our 12th Annual ADVANCE Practice of the Year Award! On our website this month, keep an eye out for Top 10 lists of the most popular blogs and app reviews from 2013 -- which continue to build followers as two of the most popular departments ever offered by ADVANCE.
Finally, we want to thank you. Without our tens of thousands of dedicated print readers, hundreds of thousands of web fans and talented contributors too numerous to name, none of this would be possible. We rely on you for interviews and freelance contributions, guest editorials and reader comments. Your feedback and participation are what enable ADVANCE to keep our fingers on the pulse of the rehab profession. Your passion for that profession inspires us every day. So to all of our readers and fans across the country and around the world, cheers to a great 2013 and here's hoping for an even better 2014!
Our 2012 Practice of the Year winner stays true to its founding principles.
In Michigan, efforts are heating up. Senate Bill 690 was introduced on Nov. 14 by Sen. John Moolenaar (Midland) and lobbying is now underway in the state legislature to "remove any unnecessary barriers to safe and cost-effective physical therapy services," according to the Michigan Physical Therapy Association.
MPTA has assembled a Direct Consumer Access Portal with tips and tools for contacting state legislators, including a pre-loaded message to send to representatives that the sender can edit as they like. With just a couple of clicks, physical therapists, patients, family members and friends can demonstrate their support of the bill.
View the tool as well as background information on the issue at the MPTA website.
Opponents of direct access for physical therapists frequently cite the issue of patient risk as a reason to deny it. Yet according to the APTA, no state that has enacted a direct consumer access law has ever repealed it.
Three days before the legislation was introduced, ADVANCE published an in-depth examination of the question of direct access and patient risk. Check it out here.
And please encourage your friends, co-workers and family members in the Wolverine State to show their support of SB690. Let's get the number of holdouts down to one. You're next, Oklahoma.
I did it. On Sept. 15, I attempted and completed my first-ever 13.1-mile race -- the Philadelphia Rock 'n' Roll Half-Marathon. Although I've been running since I was 13, this particular accomplishment meant a lot to me because my ability to run has been hampered for about 15 years by recurring iliotibial (IT) band tendonitis in my right knee.
I wrote a guest blog post for Philly.com last week about the origins of my injury and how I've tried to manage it. In a nutshell, for most of the past 15 years my efforts to combat the inflammation have consisted of rest, ice, protective knee straps, Ibuprofen, not running on consecutive days and generally limiting myself to about 3 miles when I did run. That was all well and good if the only races I ever wanted to run were 5Ks. But over the past couple years, I became determined to push my limits and stop letting my knee hold me back.
So after doing some research, I incorporated two new key elements into my training. The first was a shortened stride, because I read that keeping it more underneath my center of gravity would decrease stress on my knee and help soften stride impact. The second was regularly using a foam roller to loosen up my hamstrings, quads and IT bands.
Armed with these supplemental tactics, I've been gradually increasing my training mileage and race distances since the spring of 2012. I capped off last year's running season in November with an 8.4-mile loop race along the Schuylkill River in Philadelphia, the first time I had run that far since high school. Then I challenged myself early this running season by taking on a 10-mile race in ADVANCE's hometown, King of Prussia, PA. But all the while, I knew my ultimate goal was to complete a half-marathon -- and that judgment day finally arrived this week.
So how did it go? Well, I can truly say it was the most physically grueling challenge I've ever faced. But not because of my knee, which held up great. The course was beautiful and the weather perfect (about 60 degrees with clear skies). Music bands and cheer squads along the way definitely helped keep me going.
My goal was to not only finish the half-marathon, but also run it at 8-minute-mile pace. I actually impressed myself with how consistent a pace I was able to keep -- almost exactly 8 minutes a mile for each of the first 11 miles. At that point, I found myself staring at 2 miles to go and about 30 seconds overall ahead of goal pace. Mentally I felt very good about the position I had put myself in. Physically, I felt like every muscle in my legs was about to seize up. "Just hold on!" I told myself. "You can do it. You don't have to run any faster -- just maintain." Easier said than done, but I willed myself forward.
By the 13-mile mark, I knew I had lost some seconds and it would come down to the wire whether I reached my time goal or not. So I steeled myself to give every last bit of energy I had for the final 0.1 miles, which turned out to be... uphill. My legs felt like lead weights but I forced them to surge ahead and actually started passing other competitors in the straightaway. As the end loomed, I coaxed one last burst of speed out of my spent body and shot through the finish line. Struggling to walk on wobbly legs in the post-race area, I felt overwhelming relief and satisfaction from having passed such a daunting test.
But did I reach my time goal? I wasn't sure -- and actually thought I might have missed it by a few seconds. Later that day, I pulled out my smartphone and went to the race website in search of posted results. To run at exactly 8-minute-mile pace or better, I needed to finish with a time of 1 hour, 44 minutes and 52 seconds. So I inputted my name, took a deep breath and hoped for the best. My time? 1:44:51! Incredibly, over the course of 13.1094 miles, I had beaten my goal by a single, solitary second. It was an amazing cap to what I already felt was a terrific accomplishment.
Who knows if I'll ever run another half-marathon again? But finishing this one, especially considering the challenges I had to overcome to even reach the starting line, has to rank as one of the greatest moments of my life.
ADVANCE staffer Rebecca Mayer Knutsen checks an item off her bucket list.
On Aug. 1, Rep. Jackie Speier (D-CA) introduced the "Promoting Integrity in Medicare Act," according to a press release from the American Physical Therapy Association (APTA), Alexandria, VA. This measure seeks to remove physical therapy and other healthcare services from the in-office ancillary services (IOAS) exception from the federal Stark laws, also commonly known as self-referral. If enacted, it would effectively eliminate financial incentives from the physician-referral process. The APTA and its partners in the Alliance for Integrity in Medicare, or AIM Coalition, strongly support this move to exclude these services from the IOAS exception.
The self-referral law generally prohibits physicians from referring Medicare patients to entities in which they have a financial interest. It seeks to ensure medical decisions are made in the best interest of the patient on the basis of quality, diagnostic capability, turnaround time, and cost without consideration of any financial gain that could be realized by the referring physician. Originally intended for same-day services such as X-rays and blood draws, the IOAS exception allows physicians to bill the Medicare program for procedures that are meant to be integral to the physician's services and offered for patient convenience.
"Unfortunately, using the exception in a manner not originally intended provides physicians with incentive to refer patients for services that may not always be necessary or typically provided on the same day of an office visit," the press release continued. "This not only increases utilization of services but also Medicare costs. Physical therapy services clearly do not meet the intent of the exception and self-referral by physicians has the potential to increase costs. Physicians and physical therapists have a longstanding professional relationship that serves patients well without the need for adverse financial ties or relationships."
The argument over physician-owned physical therapy services (POPTS) has raged in the profession for years now. This latest development is certainly a boost to the cause of those who oppose POPTS. On which side of the issue do you stand? What do you believe the future holds for POPTS?
A perspective on the POPTS legislative battle from one therapist in the thick of it.
Last week's PT 2013 conference in Salt Lake City offered what has become an annual institution -- the 44th Mary McMillan Lecture. Promoting the theme "The Next Evolution," this presentation featured honorary speaker Roger Nelson, PT, PhD, FAPTA. Currently vice president of expert clinical benchmarks at MedRisk Inc., based in King of Prussia, PA, Nelson is also professor emeritus at Lebanon Valley College in Annville, PA, and a former professor at Thomas Jefferson University in Philadelphia. Overall, Nelson has served the profession of physical therapy and APTA for more than 45 years, including 25 years as a commissioned officer in the U.S. Public Health Service.
ADVANCE sat down with Nelson after the presentation for a short interview about the message he sought to convey as McMillan lecturer.
"I saw it as a daunting challenge, and I wanted to offer a message that would resonate with attendees," he said. "So I emphasized how we as a profession need to evolve, in terms of research, education and practice. That includes identifying the value of physical therapy, emphasizing the role of data collection and analysis, while also understanding the importance of cost efficiency. Practices must act as businesses."
So did he believe that the presentation went well?
"Yes, and that was very important to me. I spent the past 14 months preparing and I tried to offer a cogent set of points that combined to present a vision for the future. In general, I think we need to ensure that PT isn't known as a 'commodity.' For example, in conversation people will say they have an appointment with their doctor or their dentist. But they usually don't say they have an appointment with their physical therapist. Instead they say a 'physical therapy appointment.' We need to develop the concept that we're a profession, not a commodity. Although progress has been slow in that aspect, I think we're making headway."
SALT LAKE CITY -- For the first time ever, the APTA has brought its Annual Conference and Exposition to Utah, and ADVANCE is here to cover all the action. Coincidentally, this is also my first trip to Utah, and specifically Salt Lake City. For those wondering what the place is like, here's a quick rundown. The scenery is beautiful -- Salt Lake City sits in a valley surrounded by towering mountains. It's also hot. Real hot. The temperature is expected to reach triple digits all four days of the conference. But as they say, it's a dry heat -- and noticeably different from the muggy mid-Atlantic summers I'm used to. Finally, there's a very laid-back vibe to the whole town -- with friendly residents and quiet streets.
Last night's opening ceremonies though were certainly not laid-back. The APTA made a concerted effort to deviate from its traditional format of a succession of podium speakers comprising a lengthy lead-in to the keynote speaker. This year's ceremonies, modeled after the increasingly popular TED (Technology, Entertainment, Design) Talks, featured APTA board members and Utah chapter representatives addressing the audience in quick bursts from the front of the stage. This presentation combined with short pre-taped segments to put an emphasis on fun and entertainment. Keynote speaker Dave Barry then took the stage and drew many laughs throughout his irreverent 45-minute presentation. A well-known humor columnist and author, his work has been syndicated in more than 500 newspapers in the United States and abroad. Barry began by joking how little he actually knew about physical therapy.
"In fact," he said, "you might even get a couple CE credits deducted because you attended this speech."
The Miami-based humorist related tales about the hazards posed by hurricane season in Florida (which "lasts from June until about the following June") as well as the dangers presented by having so many retirees living in the area. He also touched on his own status as an aging Baby Boomer and later brought the house down with his thoughts on the difficulties men and women face in relating to each other. Tongue planted firmly in check, he concluded, "So those are my thoughts on the challenges facing physical therapists in the 21st century," and left the stage to a rousing ovation.
It was a great start to what all attendees hope will be a fun and informative conference. Are you in town for PT 2013 too? Feel free to leave some comments below about your thoughts on the conference so far.
With temperatures soaring well into the triple digits this week (and a potential to break the all-time record high this weekend), NATA President Jim Thornton, MA, ATC, PES, kicked off the 64th Annual Meeting and Clinical Symposia of the National Athletic Trainers' Association (NATA) the morning of June 25 by moderating a press event to release the association's new Best Practice Guidelines for preventing sudden death in secondary school athletes.
Announcing "significantly record-breaking" conference attendance numbers upward of 15,000 -- which shattered previous numbers in St. Louis and New Orleans the last two years -- Thornton reported that the new guidelines will be published in the July issue of Athletic Training, the association's professional journal.
"This is the most important moment for me professionally," said task force chair Doug Casa, PhD, ATC, FACSM, FNATA, chief operating officer of the Korey Stringer Institute (KSI) and director of athletic training education at the University of Connecticut. The recommendations serve as a roadmap for policy consideration regarding the safety of secondary school athletes. They address the leading causes of sudden death in this population -- head and neck injuries, exertional heat stroke, sudden cardiac arrest and exertional sickling.
LaQuan Phillips, a local football player who sustained a spinal contusion during a 2008 game and who became partially paralyzed from the injury, was on hand to help introduce the new guidelines. Phillips, who was injured as a senior linebacker for Green Valley (Las Vegas) High School, credits the school district's athletic trainer Jeremy Haas for saving his life, keeping him calm during the event and preventing further damage. Phillips underwent surgery and nine months of rehabilitation, and walked at his own graduation the following June.
"That was a very humbling, very gratifying moment," Phillips told the audience.
The full guidelines can be viewed here.
The NATA conference is taking place this week at the Mandalay Bay Convention Center in Las Vegas the week of June 24-27. Stay tuned to updates and comprehensive coverage from ADVANCE!
Two weeks from today, the APTA's annual conference & exposition will kick off, making its first-ever appearance in the state of Utah. From June 26-29, PT 2013 is scheduled to convene in beautiful Salt Lake City. The exclusive ADVANCE preview article detailing city attractions and conference highlights can be found here.
According to Curtis Jolley, PT, MOMT, president of the Utah Physical Therapy Association, "The conference will come at a beautiful time of year here. There could still be a little snow on top of the mountains. It's only about a half-hour drive from downtown to famous ski resorts like Park City and Snowbird. For any attendees who come from parts of the country that don't really have mountains, I definitely recommend going up there to see how pretty it is."
Salt Lake City has much to offer beyond the natural scenery as well.
"There are all kinds of wonderful restaurants downtown, including a section called Trolley Square, which is a gathering of shops and places to eat," Jolley added. "A huge new indoor/outdoor mall called City Creek Center also just opened. There's been a great resurgence in the downtown area over the past few years, including enhanced mass transit. A light rail line now runs from the airport straight downtown, so conference attendees who fly in can just take the train to within a block or so of the convention center. We're excited to showcase Utah along with its physical therapy profession and we encourage people to come here and enjoy our state,"
Will you be attending the conference? Have you ever been to Salt Lake City before? What are you most looking forward to about it?
NATA returns to the Silver State to host its 64th Annual Meeting.
The American Physical Therapy Association (APTA), Alexandria, VA, announced in an April 30 press release that Indiana Gov. Mike Pence has signed HB 1034, granting Hoosiers direct access to evaluation and treatment by a physical therapist without a physician referral. Ensuring a patient's choice of which healthcare professional to see and when has been a longtime goal of the APTA and its state chapters.
Passage of this bill signifies a landmark moment for the profession in that all 50 states and the District of Columbia now allow patients to be evaluated by a physical therapist without a referral. With enactment of HB 1034, 48 states and DC also allow some level of treatment by a PT without a referral. The new law takes effect July 1.
"We are thrilled that Indiana has become the latest state to offer patients the choice of direct access to physical therapist services. Ensuring patient access is a cornerstone of APTA's vision and mission," said APTA President Paul A. Rockar Jr., PT, DPT, MS. "I congratulate our colleagues in the Indiana Chapter for their resilience and dedication in enacting this vital legislation after many years of tough battle. I also want to thank Rep. David Frizzell for authoring the bill and Sen. Patricia Miller for sponsoring the bill in the Senate."
The bill, which was promoted by the Indiana Chapter of APTA, permits patients to be evaluated and treated by a physical therapist for 24 calendar days without a referral from a physician or other provider. However, referrals will continue to be required for spinal manipulation and sharp debridement. After 24 days, the PT must obtain a referral from another, authorized provider to continue treatment. Prior to passage of the new law, a referral was required for all physical therapist services, both evaluation and treatment.
As APTA celebrates this legislative success in Indiana, it will continue to work toward improved patient access across the country. While all states now allow patients to be evaluated by a physical therapist without a referral, there are still significant restrictions in many states that continue to impede patient access to physical therapist services. Only 17 states currently enjoy unrestricted patient direct access.
"We'd like to see unrestricted patient access to physical therapists in all 50 states," Rockar said. "Unrestricted patient access is considered the 'gold standard' for patient care as it does not include arbitrary restrictions, such as time or visit limits."
What do you think about this milestone and the APTA's mission to pursue unrestricted direct access in every state? How has direct access impacted your practice?
APTA helps practice owners stand out from the competition.
Michael Tabasko, PT, MSPT, OCS, has been active with HVO since 2006 and has volunteered in Vietnam, Peru and Bhutan. He is currently practicing at Capitol Orthopaedics & Rehabilitation in Rockville, MD.
In "Why We Volunteer," published this month in ADVANCE, Michael wrote: "My assignment through Health Volunteers Overseas (HVO) in Thimphu, Bhutan, focused on teaching physiotherapy technician students, as well as educating and consulting with my local counterparts. We met some wonderful people along the way too, but I wanted to know that my donated time was successful, that it was worth something tangible.
"We're told the value lies in acknowledging your privileged position in this world by helping a less-privileged one. It's supposed to make you feel good--better, in fact, than if you'd been compensated to do it. Whether it's a weekend helping out in a rough neighborhood or an overseas commitment, at some point all volunteers question how much their presence has actually mattered... Maybe specific outcomes have very little to do with the individual's impact, and the real result is the experience itself, a simple interaction and greater understanding amongst cultures."
I was also recently contacted by Chandi Edmonds, DPT, who presented to a group on training she did in Port au Prince, Haiti several months ago. As a volunteer with Project Medishare, Edmonds trained local physical therapy techs to work with patients, many still suffering with injuries from the 2010 earthquake. Edmonds reported that the nation's only critical care hospital is inadequately staffed and supplied. The facility is small and treatment areas and patients are exposed to sometimes harsh elements.
In her two weeks there, Edmonds witnessed the indomitable spirit of the proud Haitian people, as well as the abject need that resulted in children dying. Chandi plans to continue promoting awareness of Project MediShare and the vast need in Haiti.
Therapy Volunteers Needed in Haiti
And more recently, this request from Donna Hutchinson, PT, co-founder of Global Therapy Group: "We are a 501c3 non-profit, all volunteer organization providing therapy services in the Port au Prince area. We are in need of PT, OT, and ST volunteers for 2013 and wondered if you might assist us in getting the word out?
"Global Therapy Group is seeking physical therapy, occupational therapy and speech therapy volunteers at our clinic in Port au Prince, Haiti, for rotations of two weeks or longer. Global Therapy Group was created in 2010 to bring sustainable rehabilitation services, therapy education, and employment opportunities to Haiti following the earthquake. Our clinic is staffed with a Haitian clinic manager, a Haitian rehab tech, and PT, OT and ST volunteers from around the world. Our patient population includes children and adults, orthopedics, cerebrovascular accidents, developmental disabilities, trauma and injuries. We arrange for guest housing, transportation and all in-country support."
If you are interested, contact Donna at firstname.lastname@example.com or visit http://www.globaltherapygroup.org/ for more information. Photos courtesy of Chandi Edmonds, DPT.
The American Physical Therapy Association, Alexandria, VA, put out a press release yesterday detailing the role that therapy professionals and students played in helping victims of the tragic bombing at the Boston Marathon. The release stated:
"A team of 70 members of APTA's Massachusetts Chapter, stationed at the Boston Marathon finish line on April 15 when tragedy struck, stepped in despite a chaotic scene to help injured people. These volunteers, led by Dave Nolan, PT, DPT, OSC, consisted of physical therapists and physical therapist students from Northern University, Simmons College, and Boston University. Nolan said, 'All are physically OK but are certainly dealing with tremendous emotional challenges right now. I am proud of how each member reacted in the face of catastrophe to provide exceptional care for the critically injured.'
Massachusetts Chapter President George Coggeshall, PT, DPT, reported that no APTA members who were runners, spectators, or volunteers were hurt in the blast; however, there are members whose family and loved ones were among the more than 170 injured people. Coggeshall expressed sincere thanks to those who aided the victims and everyone who reached out to the Massachusetts Chapter. 'Thank you for your many emails and calls expressing your concerns, caring, compassion and love,' Coggeshall said. 'We will do our best to follow the footsteps of those chapters who have survived adversity and tragedy.'
If you are interested in helping people affected by this tragic event, Massachusetts Governor Deval Patrick and Boston Mayor Tom Menino have announced the formation of The One Fund Boston."
How have you been impacted by this shocking attack at one of America's greatest community events? Do you have any suggestions about other ways that PT professionals can help?
Karen reflects on the tragic events in Boston and how such terrorist acts can impact the PT profession.
Last month, my mom, who is 67, had surgery on a torn meniscus in her right knee. She's not even sure how she tore her meniscus, and it was a very light tear; could have been something as simple as planting her foot wrong or her foot coming lose from her shoe, causing the twist. I wouldn't consider her particularly "active;" she has a full-time desk job but does walk for about 20 minutes a day at lunch when weather permits.
Before her surgery, I did some investigating on whether surgery was necessary, and what she could expect to be able to do once her treatment was complete. I asked her if her doctor had suggested physical therapy as an option, rather than the surgery. She was told the surgery, done in an outpatient office, was very non-invasive and with some rest and proper pampering of her knee, she'd be fine in a few weeks. And she now is, having recently returned to work. Other than the exercises she was told to do every day after she got home, she was told post-op physical therapy would not be needed.
It turned out that her surgeon removed some arthritic cartilage too, so perhaps the surgical intervention was the best option, in her case. But it did make me wonder if physical therapy was even put forth as a viable alternative to having the surgery. Perhaps the doctor took a look at the tear and decided surgery would be minimal enough to go right to the source. And when my mother first experienced the tear, she was in a great deal of pain; at the outset the combination of the tear and arthritis formed in the knee made walking near to impossible.
New research from Brigham and Women's Hospital (BWH), suggests that physical therapy may prove just as effective as surgery for some patients. These findings were presented this month at the annual meeting of the American Academy of Orthopedic Surgeons and simultaneously published online in the New England Journal of Medicine.
Researchers at seven major universities and orthopedic surgery centers around the U.S. assigned 351 people with arthritis and meniscus tears to get either surgery or physical therapy. The therapy was nine sessions on average plus exercises to do at home, which experts say is key to success.
After six months, both groups had similar rates of functional improvement. Pain scores also were similar.
Thirty percent of patients assigned to physical therapy wound up having surgery before the six months was up, often because they felt therapy wasn't helping them. Yet they ended up the same as those who got surgery right away, as well as the rest of the physical therapy group who stuck with it and averted an operation. The research was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health.
Should my mom have been encouraged to opt for physical therapy rather than the surgery? It might have saved her time off from work, but would it have prolonged her pain when walking? Can patients assume doctors do consider PT as an option, but decide on a patient-by-patient basis who needs surgery and who can heal just as well without it? I'd be interested to know what readers think.