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Atlantic Cove
No availability found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this hotel rated in the past?
- Suites
- Wireless internet connection in room (free)
- Refrigerator in room
- Beach
- Outdoor pool
- Non-smoking hotel
Photos of Atlantic Cove
Travelers also recommend:
TripAdvisor Reviews Atlantic Cove Ormond Beach
Travel Blogs from Ormond Beach
Time Away
Since I started school in July of last year, and Zach has been working 40+ hours a week outside, we felt a vacation was needed! Since I go to a trimester program college, I don't get very much time offfrom school, but my spring break was coming up, and we really wanted to get out of town for the weekend, so we planned a spontenous beach trip a few days before it was time to ...
Home sweet home
Welcome home, everyone! I've posted the rest of my photos on Snapfish. Go to www.snapfish.com and sign in. The email is firstname.lastname@example.com and the password is France2015. Copy any photo you like and feel free to share your own photos. I really enjoyed making memories with each of you :) Dr. ...
And we are off.....again
... early, figuring that is a sure-fire way to get our luggage lost, so we decided to go to the movies. There was a theater 1 mile from where we were so we saw "Kingsman", humorous and passed the time, but not an Academy Award Winner for sure!
Started South again. We arrived at the Miami International Airport about 7pm. It took us about 1 hour to drop the rental car off, check in at American Airlines (remind us never to ...
Crazy change in plans
... her voice on the phone. We then decided it would be in everyone's best interest if we returned to Tony and Denise's place for another day. We had to quickly contact the reservation department at 5 Magnolia Drive to see if our bed was still available...phew..luckily our bed was still available! How funny the way some things work out. This unplanned trip to see my sister suddenly turned in to a 2 day visit and has kept us out of Aunt ...
Best birthday ever
... the speedway for organizing a race weekend on my birthday!
Day one motoring from Niagara to Wytheville was uneventful, and we checked into our Charleston hotel by 3 Tuesday. We did the usual strolling the town, sea food at Hyman's, and a stroll troll through the market. Wednesday we finished the market stroll and jumped in the car to visit Fort Moultrie, which guarded the port for over 200 years. It was very interesting to see how ...


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Fridays and Saturdays - May 15, 16, 22, 23, 29, 30 at 8:00pm
Sundays - May 17, 24 at 2:00pm
Red Herring
A Comedy by Michael Hollinger
Directed by Elliott Simmons
Replete with farcical spy antics and ill-fitting shoes, something smells fishy in this comedic noir fable. It's 1952. The H-bomb is looming, Commie spies are afoot, Joseph McCarthy's daughter is in the wings, and a hard-boiled detective has to find out who dumped the dead guy in the Harbor – or lose out on her honeymoon in Havana. A sharp look at love and tying and untying "the knot."
Friday and Saturday, June 12, 13 at 8:00pm
Sunday, June 14 at 2:00pm
One Act Festival
Featuring new directorial talent to the T&C stage
Enjoy several one-act plays in one entertaining show.
Fridays and Saturdays - July 10, 11, 17,18, 24, 25 at 8:00pm
Saturdays and Sundays - July 11, 12, 18,19, 25 at 2:00pm
The Wizard Of Oz
A Family Musical by John Kane. Music by Harold Arlen. Lyrics by E.Y. Harburg
Directed by Reeva Kazman
The Wizard of Oz tells the beloved tale of Dorothy and her friends and their magical trip to the Land of Oz. This is the heartwarming story that we all know and love. Dorothy is is transported to Oz and her adventures begin as she travels with her three new friends: Scarecrow, Tin Man, and Lion, who all have wishes of their own. This fabulous version, first produced by the Royal Shakespeare Company, includes many of the original songs from the famous MGM musical.
Fridays and Saturdays - August 14, 15, 21,22, 28 and 29 at 8:00pm
Sundays - August 16, 23 at 2:00pm
Good People
A Dramedy by David Lindsay-Abaire
Directed by Nancy Ridgeway
Welcome to Southie, a Boston neighborhood where a night on the town means a few rounds of bingo, and where Margie Walsh has just been let go from yet another job. Facing eviction and scrambling to catch a break, Margie thinks an old fling who has made it out of Southie might be her ticket to a fresh new start. But is this apparently self-made man secure enough to face his humble beginnings? Margie is about to risk what little she has left to find out. The scrappy characters have tremendous appeal, and the moral dilemma they grapple with holds special significance in today's harsh economic climate.
Fridays and Saturdays - September 18,19, 25, 26, October 2, 3 at 8:00pm
Sundays - September 20, 27 at 2:00pm
Caught In The Net
A Comedy by Ray Cooney
Directed by Keith Soester
A sequel to Run For Your Wife finds the two-timing taxi driver John Smith keeping his two families in different parts of London, both happy and blissfully unaware of each other. That all changes when the girl from one family and the boy from the other meet on the internet and are anxious to meet in person since they both have the same last name and a taxi-driving dad! Keeping them apart plunges John into trouble of his own making. John enlists the aid of his pal, the not-so-bright Stanley Gardner, who brings along his father. The result is confusion, lying and all sorts of craziness.
Fridays and Saturdays, October 9, 10, 16, 17 at 8:00pm
Sunday, October 11 at 2:00pm
Tales For Nightmares
Directed by Alana Caraccio and Jesse Roy
Tickets: $15
T&C entertains you with some favorite, well-known, spooky, and mysterious, short stories.
Fridays and Saturdays - November 6, 7, 13, 14, 20, 21 at 8:00pm
Saturdays and Sundays - November 7, 8,14, 15, 21 at 2:00pm
Miracle on 34th Street
A Family Play from the novel by Valentine Davies
Based on the 20th Century Fox Film
Directed by Jesse Roy
Kris Kringle, an old man in a retirement home, gets a job working as Santa for Macy's. Kris unleashes waves of good will with Macy's customers and the commercial world of New York City by referring parents to other stores to find exactly the toy their child has asked for. Seen as deluded and dangerous by Macy's vocational counselor, Kris ends up in a courtroom competency hearing. Especially at stake is one little girl's belief in Santa.
Fridays and Saturdays - April 10, 11, 17, 18, 24, 25 at 8:00pm
Sundays - April 12, 19 at 2:00pm
The Drowsy Chaperone
A Musical by Bob Martin & Don McKellar
Music & Lyrics by Lisa Lambert & Greg Morrison
Directed by Keith Soester
A musical theatre fan known simply as "Man in Chair", tells of his obsession with a musical comedy from the 1920's called The Drowsy Chaperone. As he listens to an LP of the show, characters magically come to life inside his apartment, telling the tale of a pampered Broadway starlet who wants to give up show business and get married. Her producer must stop the wedding because if she quits show business, he'll lose his job. Add a pair of gangsters doubling as pastry chefs, and you get a delightful dose of madcap musical comedy.
The Drowsy Chaperone
A Musical by Martin, McKellar, Lambert & Morrison
Directed by Keith Soester
Order Tickets
The Wizard Of Oz
A Musical by Kane,
Arlen & Harburg
Directed by Reeva Kazman
Caught In The Net
A Comedy by Ray Cooney
Directed by Keith Soester
Order Tickets
Miracle on 34th Street
Based on the novel by V. Davies
& the 20th Century Fox Film
Directed by Jesse Roy
From left to right: Jeff Kahn, Bruce Hendreson, Cindy Wallace Henderson, Emily French, her daughter Katie French (holding gift basket), and T&C President Sharon Rill-Soester.
Congratulations to the winners of T&C's 2014 Grand Prize Raffle!
Grand Prize Winner: $400 Gift Card from Hagey Tours - plus a check for $100 for dinner - to see a Broadway show of their choice: Jeff Kahn of Doylestown
First Prize Winner: T&C Basket from Doylestown Merchants ($300 value): Emily French of Springtown
2nd Prize Winner: T&C Seat Dedication plaque: Cindy Wallace Henderson of Doylestown
Raffle tickets are sold throughout the season during T&C performances. All of the money collected from the raffles goes towards T&C's Theater Improvement Fund.
Street address: 4158 York Road, Buckingham, PA
Mailing address: P.O. Box 323, Doylestown, PA 18901
Call 215-348-7566 for general information,
or you can Join our Mailing List.
Send website suggestions or corrections to Jesse Roy

subset: commoncrawl


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Technical Papers and Presentations
Effective Thermal Conductivity of Composite: Numerical and Experimental Study
M. Karkri
Université Paris-Est, CERTES, Créteil Cedex, France
In this paper, thermal properties of composites are investigated numerically and experimentally. In the numerical study, finite-elements method in COMSOL is used to modelize heat transfer and to calculate the Effective Thermal Conductivity (ETC) of the composite for three elementary cells, such as simple cubic (SC), body centered cubic (BCC) and face centered cubic (FCC). The effect of the filler ...
Transient Finite Element Analysis of a SPICE-coupled Transformer with COMSOL Multiphysics
T. Bödrich[1], H. Neubert[1], and R. Disselnkötter[2]
[1]Technische Universität Dresden, Germany
[2]ABB AG, Forschungszentrum Deutschland, Ladenburg, Germany
The operation of transformers is characterised by strong dynamic interactions between the magnetic system and the electric circuits that are connected to the primary and econdary windings. Transient finite element modelling (FEM) of the transformer with coupling to SPICE circuit models containing the electrical sources and loads is a powerful means for analysis and design. This paper describes ...
From CT Scan to Plantar Pressure Map Distribution of a 3D Anatomic Human Foot
S. Gerbino, and P. Franciosa
University of Molise, School of Engineering, Via Duca degli Abruzzi, Termoli, Italy
Understanding the stress-strain behavior of human foot tissues and pressure map distributions at the plantar interface is of interest into biomechanical investigations. In particular, monitoring plantar pressure maps is crucial to establishing the perceived human comfort of shoe insoles. A 3D anatomical detailed FE human foot model was created, starting from CT (Computer Tomography) scans of a ...
Finite Element Analysis of Cables Heating Due to PoE/PoE+
S. Francois[1], and P. Namy[2]
[1]Nexans Research Center, Lyon cedex, France
[2]SIMTEC, Grenoble, France
Power over Ethernet (PoE/PoE+) is a technology allowing to transmit data and power over the same data cable. The major concern for this technology is the degradation of data transmission performances due to the temperature increase in the cable. To have a better quantitative and qualitative knowledge of the temperature field in the cables, Nexans has developed a 2D finite element thermal model ...
Modelling and Analysis of Acoustic Emissions and Structural Vibration in a Wind Turbine
B. Marmo, and B. Carruthers
Reactec Ltd., Edinburgh, United Kingdom
The onshore wind turbine industry must overcome many technical, commercial, and environmental difficulties. A significant element for planning consent is operational noise. Acoustic limits are strictly enforced and can lead to near-neighbour complaints as well as contractual disputes. Reactec have diagnosed, analysed and solved a problematic tonal resonance for a major wind turbine generator ...
Deformation Behavior Of A Liquid Droplet Impacting A Solid Surface
S. Oukach[1], M. Elganaoui[1], B. Pateyron[1], and H. Hamdi[2]
[1]Laboratoire des Sciences des Procèdes Céramiques et de Traitements de Surface SPCTS, Limoges, France
[2]Laboratoire de Mécanique des Fluides et Energétique LMFE, Marrakech, Morocco
The quality of coatings obtained by means of thermal spraying depends strongly on the mechanism of the interaction between the molten droplets and the surface to be covered. The aim of the present study is to simulate the impact of a droplet onto a substrate, in order to have a good understanding of the dynamics of droplets impact. In this study, the process of droplet spreading is described; the ...
2D Axial-Symmetric Model For Fluid Flow And Heat Transfer In The Melting And Resolidification Of A Vertical Cylinder
S. Morville[1], M. Carin[1], M. Muller[2], M. Gharbi[2], P. Peyre[2], D. Carron[1], P. Le Masson[1], and R. Fabro[2]
[1]Laboratoire LIMATB, Université de Bretagne Sud, Lorient , France
[2]Laboratoire PIMM, Arts et Métiers ParisTech, Paris, France
Laser direct deposition is a process, different from molding or machining, which allows the producing of fully densified and operational components. This technique involves injecting metal powder through a coaxial nozzle into a melt pool obtained by a moving laser beam. The final object is obtained by superimposing the layers created by the process. The roughness of the functional part is ...
Modelling Flow through Fractures in Porous Media
E. Holzbecher[1], W.L. Wah[1], and M-S. Litz[2]
[1]Georg-August Universität Göttingen, Germany
[2]Freie Universität Berlin, Germany
There are various alternative options concerning modeling fluid flow within fractures in porous media. We give a general overview, with remarks concerning the modeling using COMSOL Multiphysics. Moreover we define and study two test cases for intercomparison. Finally for one of the testcases some results of an extensive sensitivity study is presented.
Prediction of Transformer Load Noise
M. Kavasoglu[1], R. Haettel[1], and C.H. Ploetner[2]
[1]ABB Corporate Research, Västerås, Sweden
[2]ABB Transformers, Varennes, Canada
Transformers, as any other industrial products, have to comply with various requirements on noise levels. Three main sources of noise can be identified in transformers: no-load noise or core noise generated by magnetostriction in the core steel laminations, load noise produced by electromagnetic forces in the windings and noise due to auxiliary equipment such as fans and pumps used in the cooling ...
Using COMSOL Multiphysics in Eddy Current Non Destructive Testing Context
L. Santandrea, and Y. Le Bihan
Laboratoire de Génie Electrique de Paris, Gif-sur-Yvette, France
Eddy current testing (ECT) is widely used to check the integrity of electrically conducting parts and notably to detect flaws. It is based on the interaction between a probe and the part under testing. The finite element method (FEM) is well fitted to the modelling of these kinds of problems because of its large flexibility which allows to deal with complex probe and part configurations. In this ...


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Do you know an exceptional student who is making a difference at ECU? Reward their efforts by nominating them for a 2015 Vice-Chancellor's Student Award.
A symposium at Perth Zoo supported by CREATEC is addressing the relevance of big data to aspects of social and cultural life.
A team from ECU Sports will ride a stationary bike for 30 hours to raise money for the charity Youth Focus and staff are invited to ride alongside them.
ECU's flags will fly at half-mast today in memory of the 147 students killed at Garissa University College earlier this month.
This not-to-be-missed event will feature a procession through the Joondalup Campus and formal welcoming of Professor Steve Chapman to ECU. Registrations are now open.
ECU recently joined with the Center for Medical Simulation's Harvard Medical School and The Department of Health to deliver the instructor training course 'Simulation as a Teaching Tool'.
IT Services is pleased to announce two new services which are now available for use on computers, tablets and phones.
Mounting evidence that the current centre of Christian faith is neither in North America nor in Europe, but in Africa, Latin America, Asia and the Pacific is the focus of a new book.
Phillip Draber, Director of ECU's Risk and Assurance Services Centre, has been appointed to a role with the global body responsible for the internal audit profession, recognising ECU's commitment to good governance.
ECU students have got the message about using active transport to travel to ECU's metropolitan campuses, with more than half taking the bus, train, cycling or walking. But staff are increasingly relying on the car.
ECU staff received practical strategies this week about how to create a healthy workplace culture.
The New Year is now well and truly underway and it is a great pleasure to be able to welcome back staff and students to what will be an exciting year in the evolution of ECU.
Purchasing new printers or the replacement of existing printers has now been suspended until ECU's new printer supplier comes on board.
Some staff from the Student Services Centre (SSC) have relocated into Ngoolark (Building 34) on the Joondalup Campus. Student Central (enrolment queries, cashier etc), however, will remain in B18 until mid-March.
Please take note where the teams have relocated in order to accurately advise students and staff.


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Osprey Rev 12 Pack
The Osprey Rev 12 Pack is a running pack for long distance trail running or endurance racing. The Rev 12 is small in size but big on hydration, as included inside is a 2.5L Hydraulics™ LT Reservoir to take care of your thirst. The 12 liter pack wraps around your body with the BioStretch™ Body wrap harness and Bodybelt. It even features two sternum straps for extra stability. The harness allows the pack to move with you, and the backpanel is a reverse spacer mesh for breathable support. The harness is also equipped with a DigiFlip™ media pocket, mesh pockets for an extra water bottle and energy snacks, and zippered pockets on the belt for whatever else you may need by your side. Stuff your lunch, an extra layer or shell jacket and whatever else you may need into the main section to get you through your trail run and head out.
FEATURES of the Osprey Rev 12 Pack
- Hydration compartment with reservoir
- Hydraulics LT Reservoir included
- Reflective graphics
- Stabilization wings
- Stash pocket 6 Front panel bungee compression and storage
- Drop down DigiFlip media pocket with mesh front pocket
- Dual stretch mesh harness pockets
- Stretch mesh side pockets
- Shoulder harness pocket with zippered expansion water bottle sleeve
- Zippered stretch mesh bodybelt pockets
- Breathable mesh wrap with soft, irritation-free contact surface
- Chest strap buckle with built-in magnet for quick bite-valve attachment
- Adjustable and removable dual chest straps for additional stability
- Front harness gear and food organization pockets
- Breathable mesh wrap with soft, irritation-free contact surface
- Mesh-covered, perforated foam construction
- Modified straight ErgoPull hipbelt closure
- Zippered stretch mesh bodybelt pockets
SPECIFICATIONS of the Osprey Rev 12 Pack
- 70D x 70D three line ripstop nylon
- 70D x 160D dobby
- Reservoir Weight: 6 oz / 0.17 kg
- Dimension: (H x W x D): 16 x 9 x 7" / 40 x 23 x 18 cm
- Volume: 610 cubic inches / 10 liter
- Volume: 732 cubic inches / 12 liter
This product can only be shipped within the United States. Please don't hate us.
Ships FREE When will I get it?


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Cranberry Salad Supreme
22 Oct 2009
This Cranberry Salad Supreme is a delicious assortment of fruits cheese, cream and nuts ! Try this irresistible extravagance for your next dessert. Feel free to share your views about this Cranberry Salad Supreme with me !
|Raspberry gelatin
|3 Ounce
|Boiling water
|1 Cup (16 tbs)
|Whole cranberry sauce
|16 Ounce (1 Can)
|Lemon jello
|3 Ounce (1 Package)
|Cream cheese
|3 Ounce, softened (1 Package)
|Mayonnaise/Salad dressing
|1⁄3 Cup (5.33 tbs)
|Canned crushed pineapple
|8 1⁄2 Ounce (1 Can)
|Whipping cream
|1⁄2 Cup (8 tbs)
|Miniature marshmallows
|1 Cup (16 tbs)
|Chopped nuts
|2 Tablespoon
Dissolve raspberry Jello in 1 cup boiling water.
Stir in cranberry sauce; turn into a 9x9x2 baking dish and chill until partially set.
Dissolve lemon Jello in 1 cup boiling water.
Beat together the cream cheese and mayonnaise.
Gradually add lemon Jello, stir in undrained pineapple and chill until partially set.
Whip cream.
Fold into lemon mixture.
Fold marshmallows in.
Spread over top of cranberry layer and top with nuts.
Chill until set.
Recipe Summary
Difficulty Level:Easy
Course:Dessert, Fruit Dessert
Rate It
0 Comments
Cranberry Salad Supreme Recipe


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David Grega (1984 - 2012) was an important figure in Pagan mass media and he was only twenty-seven. He passed recently due to heart failure. He was part of the Pagan Centered Podcast and the Texas branch of the Pagan Newswire Collective.Peter Dybing, charity coordinator and Pagan blogger, wrote his concerns about the state of our community's health. "One of the most valued principles within the Wicca community is that all bodies are sacred and beautiful. This is so engrained in our culture t … [Read more...]
A Tragedy Creates Potential for a National Pagan Discussion on Health
July 18, 2012 by Tara "Masery" Miller Leave a Comment
Community Linkage
March 17, 2011 by Tara "Masery" Miller Leave a Comment
Pagan Fundraiser for Japan Disaster Relief Through Doctors Without BordersAt the time of this post, almost $16,000 of the $30,00 goal has been raised in just four days."Pagans from all over the country have donated and stepped forward to endorse the project. We received donations from individuals as well as organizations. To all those who stepped forward THANK YOU. We still have been unable to generate significant numbers of small donations. It continues to be the goal of this project to … [Read more...]


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TV Critic Tim Goodman shares his thoughts on how to choose good content when it comes to watching TV with your kids.
Tags: children kids media parenting PBS preschool television
Related Video
The Parent Show | Watching kids watch TV: How to...(May 23, 2011) Learn techniques you can use to judge the shows your kids are watching.
PBS Presents | Be more Can't Live Without | PBS(Aug 8, 2011) An excited and enthusiastic mom shares how much her son loves learning from PBS KIDS!
The Parent Show | Favorite Movie Dad Countdown...(Jun 20, 2011) For all the great dads out there, here's a montage of all our favorite TV and movie dads!
The Parent Show | Talking to kids in the...(May 26, 2011) Tornadoes, tsunamis, terrorists: Strategies to help your kids cope with scary news.
The Parent Show | Neil deGrasse Tyson's tough...(May 6, 2011) Neil deGrasse Tyson challenges Blue's Clues' creator on the logic of verbal spice shakers.
The Parent Show | How do you raise a...(May 3, 2011) Common mistakes parents make that discourage kids from thinking scientifically.
The Parent Show | Meet the Woman Behind PBS KIDS...(Sep 13, 2011) Meet Linda Simensky, VP of Children's Programming at PBS KIDS!
PBS Presents | Be more Elisa's Story | PBS(Aug 8, 2011) "What if TV made all children feel like they belong?"
The Parent Show | How to Strengthen Your Child's...(Aug 5, 2011) Mixing crafts and reading makes literacy more fun.


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News from WTOP
News from the AP
Mike Causey
Shows & Panels
Shows & Panels
- Agency of the Month
- Business of Government Hour
- The CFO Agenda: Delivering value from financial transparency and audit efforts in the public and private sector
- Cloud-Driven Data Insights in Government
- CXO Surveys
- Disaster Resilience for America
- Federal News Countdown
- Government Perspectives on Mobility and the Cloud
- Reducing Risk in the Cloud
- Reimagining the Next Generation of Government
Shows & Panels
- AFCEA Answers
- American Readiness: Renewable Power and Efficiency Technologies
- Ask the CIO
- The Business Case for Cloud Computing in Government
- Cloud-Driven Data Insights in Government
- Connecting the Dots: Digital Authentication in Government
- Data-Centric Approaches to Government in the Cloud
- Delivering the Digital Government Mission
- Federal Executive Forum
- Federal News Radio's National Cyber Security Awareness Month Special Panel Discussion
- Federal Tech Talk
- The Future of Government Data Centers
- Government Perspectives on Mobility and the Cloud
- Industrialized, Interoperable and Insight-driven Federal Health Panel
- Innovation and Tech Superiority through Acquisition Reform
- Mitigating Insider Threats in Virtual & Cloud Environments
- Moving Agency Applications to the Cloud with PaaS
- Reducing Risk in the Cloud
- Security in the Age of Targeted Attacks
- Air Traffic Management Transformation Report
- The Business of Cloud
- Cloud First Report
- Data Driven Cloud Series
- Disaster Resilience for America
- General Dynamics IT Enterprise Center
- Gov Cloud Minute
- Government in Technology Series
- Homeland Security Cybersecurity Market Report
- The Intersection: Where Technology Meets Transformation
- Modern Mission Critical Series
- National Cybersecurity Awareness Month
- The New IP for Federal IT
- The Social Platform Solution for the Department of Veterans Affairs
- Technology Insights
- The Cyber Security Report
- The Next Generation Cyber Security Experts
Shows & Panels
- Cloud-Driven Data Insights in Government
- Disaster Resilience for America
- F-35 Lightning II Program
- Government Perspectives on Mobility and the Cloud
- On DoD
- Pentagon Solutions
- Reducing Risk in the Cloud
- Reimagining the Next Generation of Government
- Transforming Business Operations at the Defense Department
Sponsored By:
Federal Drive
Monday - Friday, 6-9 a.m.
Host Tom Temin brings you the latest news affecting the federal community each weekday morning, featuring interviews with top government executives and contractors. Listen live from 6 to 9 a.m. or download archived interviews below.
Thursday morning federal headlines - May 17, 2012
Thursday - 5/17/2012, 8:37am EDT
The Morning Federal Newscast is a daily compilation of the stories you hear Federal Drive hosts Tom Temin and Emily Kopp discuss throughout the show each day.r
- The Office of Personnel Management is expanding its relationship with General Dynamics Information Technology. GDIT has been awarded two IT Blanket Purchase Agreements that have a combined potential value of $500 million with a one-year base and four one-year options. They will provide a range of support services that include network engineering, telework and help-desk support. This builds on a 27-year relationship OPM has with GDIT. (GDIT)
- The end is is sight for the Air Force to complete the transition to a résumé based system. The final phase is expected in late July. The USA staffing web-based system, automates civilian employee recruitment, assessment, referral and notification processes. Requiring a résumé means the hiring managers receive more information on the job-seeker rather than the jobs he's filled. Air Force officials hope that comparing résumés instead of job briefs will help them fill vacant positions, with stronger candidates, faster. (Air Force)
- Two diverse issues cleared a Senate committee. The Senate Homeland Security and Governmental Affairs committee approved a bill extending federal benefits to same-sex domestic partners. Four members voted against the measure, three Republicans and one Democrat. The committee also approved a bill called Keeping Politics out of Federal Contracting. The bill was launched to stop a White House order for federal contractors to disclose their political contributions. Only Sen. Jon Tester (D-Mont.) opposed. Both bills now head to the full Senate. (Federal News Radio)
- Post Traumatic Stress Disorder is a growing problem for the military. Now the Army has launched a review of how it evaluates soldiers who might have PTSD. The review followed complaints that some diagnoses were overturned to save money. The reversals occurred at the Madigan Army Medical Center in Washington. The psychiatric unit there may have overturned diagnoses based on the cost of caring for those with PTSD. The Army said it would review PTSD diagnoses at all of its medical facilities going back to 2001. (Federal News Radio)
- Joe Jordan is a step closer to becoming the next White House procurement chief. The Senate Homeland Security and Governmental Affairs Committee approved his nomination, which now goes to the full Senate. Only Sen. Ron Johnson (R-Wisc.) voted against Jordon. Ranking committee member Susan Collins (R-Maine) noted what she said was Jordan's relative lack of experience in federal procurement. If confirmed, Jordan would succeed Dan Gordon at the Office of Federal Procurement Policy. Gordon left the government for academia. Lesley Field is the acting OFPP administrator. (Federal News Radio)
- The Postal Service rolled out details today on a revised plan for mail-processing facilities. It had slated 250 cites for closure. In a letter to the American Postal Workers Union, the agency said it would begin consolidating plants this summer. It also planned to roll back overnight delivery and offer employee buyouts. It said it was working out the details with its unions. Under pressure from lawmakers, the Postal Service backed away from a plan to close 3,700 post offices, but these plants operated out of the public's eye and did not get as much attention on Capitol Hill. (APWU)
- A big annual General Services Administration
conference has a more modest look this year. Visitors estimated attendance at the annual GSA Expo was down 80 percent from last year. The event is going on now in San Antonio. A GSA spokesman said about 5,000 people were at the show, 2,500 of whom are government employees, including 357 from GSA itself. Procurement consultant Larry Allen is a regular attendee. He said in past years, the Expo drew nearly 10,000 people. Many federal agencies are curtailing travel in the wake of revelations about a costly GSA conference in Las Vegas. (Federal News Radio)
- The White House cybersecurity coordinator is stepping down. Howard Schmidt will leave his job at the end of the month. Schmidt joined the Obama administration 2-1/2 years ago. He helped craft cybersecurity legislation, but Congress has been unable to agree on a comprehensive cyber bill among several competing bills. Schmidt said he wants to spend more time teaching cybersecurity. He'll be succeeded by Michael Daniel, now chief of the Office of Management and Budget's intelligence branch. (Federal News Radio)


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The Java PrintStream class includes two methods that perform formatted output: printf() and format(). These methods are equivalent, and they are similar to the printf() function in the C programming language. Here are some examples on how to format output in Java with printf().
Formatting Integers
The following examples show how to format an integer normally, with leading zeroes and with commas.
System.out.printf("%d%n", 12345); //12345
System.out.printf("%08d%n", 12345); //00012345
System.out.printf("%,8d%n", 12345); // 12,345
Formatting Floats
These examples show how to format a float value. Some statements show how to specify the number of decimal places. The last example shows how to left-justify the number.
System.out.printf("%f%n", Math.PI); //3.141593
System.out.printf("%.3f%n", Math.PI); //3.142
System.out.printf("%8.3f%n", Math.PI); // 3.142
System.out.printf("%-8.3f%n", Math.PI); //3.142
Formatting Dates
These examples show how to format dates and times in Java. Only some of the formatting parameters are shown below. There are many more to choose from.
Calendar cal = Calendar.getInstance();
System.out.printf("%tB %te, %tY%n", cal, cal, cal); //September 28, 2013
System.out.printf("%tl:%tM %tp%n", cal, cal, cal); //2:41 pm
System.out.printf("%tD%n", cal); //09/28/13
These are just some of the ways to format output in Java using the printf() method. For more information on formatted output in Java, see the Java PrintStream reference.
For more articles, please subscribe, add or follow me here.


text:
Myths & Facts Online
The 1973 War
By Mitchell G. Bard
was responsible for the 1973 war.
"Israel was responsible for the 1973 war."
On October 6, 1973 — Yom Kippur, the holiest day in the Jewish calendar — Egypt and Syria opened a coordinated surprise attack against Israel. The equivalent of the total forces of NATO in Europe was mobilized on Israel's borders.1 On the Golan Heights, approximately 180 Israeli tanks faced an onslaught of 1,400 Syrian tanks. Along the Suez Canal, fewer than 500 Israeli defenders were attacked by 80,000 Egyptians.
Thrown onto the defensive during the first two days of fighting, Israel mobilized its reserves and eventually repulsed the invaders and carried the war deep into Syria and Egypt. The Arab states were swiftly resupplied by sea and air from the Soviet Union, which rejected United States efforts to work toward an immediate ceasefire. As a result, the United States belatedly began its own airlift to Israel. Two weeks later, Egypt was saved from a disastrous defeat by the UN Security Council, which had failed to act while the tide was in the Arabs' favor.
The Soviet Union showed no interest in initiating peacemaking efforts while it looked like the Arabs might win. The same was true for UN Secretary-General Kurt Waldheim.
On October 22, the Security Council adopted Resolution 338 calling for "all parties to the present fighting to cease all firing and terminate all military activity immediately." The vote came on the day that Israeli forces cut off and isolated the Egyptian Third Army and were in a position to destroy it.2
Despite the Israel Defense Forces' ultimate success on the battlefield, the war was considered a diplomatic and military failure. A total of 2,688 Israeli soldiers were killed.
"Egyptian President Anwar Sadat had agreed to U.S. peace proposals and did not seek war."
In 1971, Egyptian President Anwar Sadat raised the possibility of signing an agreement with Israel, provided that all the occupieddisputed territories were returned by the Israelis. No progress toward peace was made, however, so, the following year, Sadat said war was inevitable and he was prepared to sacrifice one million soldiers in the showdown with Israel.3 His threat did not materialize that year.
Throughout 1972, and for much of 1973, Sadat threatened war unless the United States forced Israel to accept his interpretation of Resolution 242 — total Israeli withdrawal from territories taken in 1967.
Simultaneously, the Egyptian leader carried on a diplomatic offensive among European and African states to win support for his cause. He appealed to the Soviets to bring pressure on the United States and to provide Egypt with more offensive weapons to cross the Suez Canal. The Soviet Union was more interested in maintaining the appearance of détente with the United States than in confrontation in the Middle East; therefore, it rejected Sadat's demands. Sadat's response was to abruptly expel approximately 20,000 Soviet advisers from Egypt.
In an April 1973 interview, Sadat again warned he would renew the war with Israel.4 But it was the same threat he had made in 1971 and 1972, and most observers remained skeptical.
The United States agreed with Israel's view that Egypt should engage in direct negotiations. The U.S.-sponsored truce was three-years-old and Secretary of State Henry Kissinger had opened a new dialogue for peace at the UN. Almost everyone was confident the prospect of a new war was remote.
Sadat reacted acidly to Kissinger's initiative:
"Egypt and Syria were the only Arab states involved in the 1973 war."
At least nine Arab states, including four non-Middle Eastern nations, actively aided the Egyptian-Syrian war effort.
A few months before the Yom Kippur War, Iraq transferred a squadron of Hunter jets to Egypt. During the war, an Iraqi division of some 18,000 men and several hundred tanks was deployed in the central Golan and participated in the October 16 attack against Israeli positions.7 Iraqi MiGs began operating over the Golan Heights as early as October 8, the third day of the war.
Besides serving as financial underwriters, Saudi Arabia and Kuwait committed men to battle. A Saudi brigade of approximately 3,000 troops was dispatched to Syria, where it participated in fighting along the approaches to Damascus. Also, violating Paris's ban on the transfer of French-made weapons, Libya sent Mirage fighters to Egypt (from 1971-1973, Libyan President Muammar Qaddafi gave Cairo more than $1 billion in aid to rearm Egypt and to pay the Soviets for weapons delivered).8
Other North African countries responded to Arab and Soviet calls to aid the frontline states. Algeria sent three aircraft squadrons of fighters and bombers, an armored brigade and 150 tanks. Approximately 1,000-2,000 Tunisian soldiers were positioned in the Nile Delta. The Sudan stationed 3,500 troops in southern Egypt, and Morocco sent three brigades to the front lines, including 2,500 men to Syria.
Lebanese radar units were used by Syrian air defense forces. Lebanon also allowed Palestinian terrorists to shell Israeli civilian settlements from its territory. Palestinians fought on the Southern Front with the Egyptians and Kuwaitis.9
Theleast enthusiastic participant in the October fighting was probably Jordan's King Hussein, who apparently had been kept uninformed of Egyptian and Syrian war plans. But Hussein did send two of his best units — the 40th and 60th Armored Brigades — to Syria. This force took positions in the southern sector, defending the main Amman-Damascus route and attacking Israeli positions along the Kuneitra-Sassa road on October 16. Three Jordanian artillery batteries also participated in the assault, carried out by nearly 100 tanks.10
1Chaim Herzog, The Arab-Israeli Wars, (NY: Random
House, 1984), p. 230.
Maps: The Pedagogic Center, The Department for Jewish Zionist Education, The Jewish Agency for Israel, (c) 1997, 1998, 1999, 2000, Director: Dr. Motti Friedman, Webmaster: Esther Carciente.
See also: History
of Israel
To order the paperback edition, click HERE.


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Hi there! My name is Kate, a.k.a. Katybear. I have been cosplaying since 2011. My first convention was Con-Nichiwa in Tucson, AZ where I debuted my Cammy costume. I'm still pretty new to all this, but it's my passion. Please enjoy my pictures and please like my fanpage if you have facebook! Thank you! ^_^
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Heartbreak on his birthday for Mickelson in Open
This one would have been almost as good, except there would be cake instead of a green jacket. All Mickelson had to do was play even par coming in to win and, though that's a tough order in any Open, he had the easy 121-yard 13th hole that he would almost surely birdie as insurance against any bogeys down the stretch.
But he hit a pitching wedge instead of a gap wedge to the hole, flying the green and leaving himself with a pitch from the rough he had no way of getting close to the hole. He made bogey, then compounded his error on No. 15 by quitting on a gap wedge and leaving it so short he had to chip from the front of the green for another bogey.
This from a guy who had studied Merion so carefully that he carried five wedges in his bag and not one driver.
"Thirteen and 15 were the two bad shots of the day that I'll look back on where I let it go," Mickelson said.
What made it hurt even more was that Merion was Mickelson's kind of course, a place where he could work the ball both ways and use his short game magic to trump the field. He knew it from the time he first played it, and became even more convinced of it the more he studied his notes and course pictures in the days ahead of the Open.
He opened with a 67 on little sleep and had a one-shot lead going into the final round. Everything was going according to plan - you could almost see the newspaper headlines of "PHIL-a-del-phia" - but anyone who has ever seen Mickelson play knows that even his best plans sometimes have a way of unraveling with little warning.
"This could have been the big - a really big turnaround for me on how I look at the U.S. Open and the tournament that I'd like to win after having so many good opportunities," Mickelson said. "Playing very well here and really loving the golf course, this week was my best opportunity I felt, heading in, certainly the final round, the way I was playing and the position I was in."
There was still a chance at the end, though it wasn't a good one. With no driver, Mickelson had to hit his 3-wood on the 511-yard finishing hole immortalized by Hogan's 1-iron and he put it in the left rough with no chance of reaching the green.
The crowd serenaded him with choruses of "Happy Birthday" as he came to the green needing to hole a pitch shot to force a playoff, but there would be no happiness this time.
"This one's probably the toughest for me because, at 43 and coming so close five times, it would have changed the way I look at this tournament altogether and the way I would have looked at my record," Mickelson said.
"Except I just keep feeling heartbreak."
A word he kept repeating. A feeling he knows all too well.
Tim Dahlberg is a national sports columnist for The Associated Press. Write to him at tdahlberg(at)ap.org or http://twitter/timdahlberg
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The Right to Self-determination Under International Law
"Selfistans," Secession, and the Rule of the Great Powers
Series: Routledge Research in International Law
This book proposes a novel theory of self-determination; the Rule of the Great Powers. This book argues that traditional legal norms on self-determination have failed to explain and account for recent results of secessionist self-determination struggles. While secessionist groups like the East...
Published November 5th 2012 by Routledge


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A simple, classic BBQ technique that yields a moist, flavorful chicken with a subtle flavor of mustard.
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The effects of exercise-based rehabilitation on balance and gait for stroke patients: a systematic review.
This review evaluated the effects of balance and/or gait exercise interventions for stroke survivors and summarized the available evidence on these exercise interventions. A search for studies published between January 2001 and January 2010 was performed using the keywords stroke, walking or balance, and physical activity or exercise. Seventeen randomized clinical trials were identified. The findings suggest that initiating early rehabilitation during acute to subacute stroke recovery can improve balance and walking capacity. The findings also demonstrate that at least 1 hour, three to five times per week, of balance training and 30 minutes, three to five times per week, of gait-oriented exercise are effective to improve balance and walking. This review confirms that balance and walking capacity are improved with specific exercise modalities. A combination of balance, gait, and aerobic exercises would be ideal.
Stroke is a leading cause of long-term functional disability in the United States. Among stroke survivors, about 15%-30% are permanently disabled and 20% still require institutional care at 3 months after onset, indicating dependence on others to perform their daily activities, because of impaired arm and hand function and impaired walking ability (Lloyd-Jones et al., 2010). These impairments can lead to reduced activity and sedentary lifestyles. Therefore, rehabilitation is essential for stroke survivors to optimally recover mobility and functional abilities so that they can live independently, participate in the community, and experience fewer secondary complications.
Restoration of independent gait and balance is a main aim of rehabilitation for patients living with stroke, because it is associated with independent mobility and reduced fall risk (Lamb, Ferrucci, Volapto, Fried, & Guralnik, 2003). Physical activity and exercise have been established to be beneficial to stroke patients in terms of improvement in walking ability and balance (Gordon et al., 2004). Many studies have reported that various exercise programs, such as gait-oriented training (van de Port, Wood-Dauphinee, Lindeman, & Kwakkel, 2007), aerobic treadmill training (Hesse, 2008; Hesse, Werner, von Frankenberg, & Bardeleben, 2003), intensive mobility training (Eng & Tang, 2007), and physiotherapeutic interventions (Hammer, Nilsagard, & Wallquist, 2008), are beneficial in improving walking and balance ability for stroke survivors.
However, there is limited information regarding specific exercise types and prescriptions for stroke survivors in different phases of recovery. It is necessary to establish such exercise recommendations and support them with scientific evidence, because these factors may dramatically affect rehabilitation outcomes. Therefore, the purpose of this review was to evaluate the effects of exercise interventions focused on balance and/or gait and to summarize the available evidence on exercise interventions to optimize mobility outcomes for stroke survivors.
Literature Search
A search was conducted for studies, including systematic reviews and meta-analyses, and recent studies published between 2001 and January 2010. Databases searched were MEDLINE, PubMed, and CINAHL. The following keywords were used: stroke, gait or balance, and physical activity or exercise.
Selection Criteria
The search was limited to randomized controlled trials (RCTs) published in the English language involving adults living with stroke. The following inclusion criteria were applied: (a) participants living with stroke who were 18 years and older and (b) one of the outcomes focused on balance or gait functions, such as walking distance or walking speed. The exclusion criteria were as follows: (a) studies using robotic devices or virtual reality therapy or (b) clinical observation or case study. The methodological quality was rated using the Physiotherapy Evidence Database (PEDro) Scale (see Table 1). The PEDro Scale uses 11 items to assess the characteristics of RCTs for comparison in systematic reviews. PEDro scores of 6 points or higher were classified as high quality, and scores of 5 points or lower were of lower quality, with a cutoff at 4 points for acceptable quality (Maher, Sherrington, Herbert, Moseley, & Elkins, 2003).
All titles were screened for relevant studies, and abstracts were chosen from the relevant titles. Abstracts were then reviewed for concurrence with inclusion criteria. From the remaining abstracts, full text articles were reviewed, and during the review, those that did not meet the inclusion criteria were excluded as well.
Over 353 titles were retrieved from the database sources, and 56 abstracts were identified for possible inclusion. During screening of titles, studies were excluded for the following reasons: nonrandomized design, no control group, inappropriate patient population, inappropriate intervention, and inappropriate outcome. On examination of the abstracts, 39 studies were excluded for the reasons stated above. Seventeen studies were reviewed, which provided information on a 1,105 stroke survivors.
Study Characteristics and Quality
Sample sizes of the studies reviewed varied widely from 14 to 136 patients (median, 60 patients), and most participants in the trials were 60 years and older (range, 27-87 years), with at least minimal gait impairment resulting from stroke. The time between stroke onset and the start of the intervention ranged from less than 10 days to over 1 year. With the time point of 1 and 6 months poststroke serving as the cutoff points between these categories, the recovery phase was divided into acute (within 1 month), subacute (less than 6 months), and chronic (6 months or more). Details of the methodological quality are presented in Table 1, and PEDro scores ranged from 4 to 8 points.
Ten studies used RCTs to examine the effects of exercise programs on balance in patients with stroke. These studies were performed in the chronic phase of stroke recovery (n = 7), subacute phase (n = 2), and acute phase (n = 1). Most of the trials (17--8) assessed balance using the Berg Balance Scale (BBS), which is composed of 14 tasks that assess balance in older adults. Scores range from 0 to 56: scores of 0 to 20 indicate balance impairment, 21 to 40, acceptable balance, and 41 to 56, good balance (Berg, Wood-Dauphinee, & Williams, 1995). An increase of 7.7 BBS points is required to reveal a genuine change in function for a participant (Conradsson et al., 2007). The variety of exercise programs that post-stroke individuals underwent was handled by dividing the exercise programs into three categories: aerobic, comprehensive, and multisensory exercise.
Aerobic Exercises to Improve Balance
Au-Yeung, Hui-Chan, and Tang (2009) recruited 136 chronic stroke patients with manifestation of hemiplegia. The patients in the experimental group (n = 62) participated in tai chi exercise, 1 hour of group practice and 3 hours of self-practice per week. The control group (n = 74) received general exercise training with similar duration and schedules to the experimental group. After the training, the tai chi exercise group showed greater shifting center of gravity movements than the control group when leaning forward, backward, and toward the unaffected and affected side at the end of the 12-week program. The benefits were still present after an additional 6 weeks. Neither the experimental group nor the control group had significant improvements in functional mobility assessed with the Timed Up and Go test (-1.9 and -2.2 seconds, respectively). The results indicated that tai chi exercise improved standing balance control but did not affect walking speed or ability to turn around.
Barbeau and Visintin (2003) conducted a 6-week locomotor training in subacute patients with hemiparesis. One hundred stroke survivors were randomly assigned to either locomotor training with body weight support (BWS; n = 50) or locomotor training with full-weight bearing (non-BWS; n = 50) by block randomization within strata identified based on initial level of ambulatory status. Participants in both groups exercised four times per week for 6 weeks. The stratified subjects with severely impaired pretraining scores in the BWS showed significant improvement in balance, walking speed, and walking endurance over those in the control group (p < .05). After stratification by age to 20-65 and 65-85 years, older people (65-85 years) in the BWS group showed significantly greater improvement in balance and motor recovery. The results indicate that the improvement in balance produced by gait-oriented exercise accompanied walking capacity.
Yen, Wang, Liao, Huang, and Yang (2008) randomly allocated 14 chronic stroke patients to an experimental group that received 4 weeks of BWS treadmill training after 4 weeks of general physical therapy (n = 7) and a control group that received physical therapy only (n = 7). The treadmill training was provided in a 30-minute session, three times per week. After training, both groups improved balance, as assessed by BBS, but there was no significant difference between the groups (+2.1 and +1.0, respectively). Considering the baseline balance scores for the samples, the participants in the experimental group and the control group had already good balance, with mean scores of 50.57 and 50.29, respectively. In addition, the study was likely underpowered because of the small sample size. To examine the effect of treadmill training on balance, further research is needed--another repeat study in the population with balance impairments.
In a pilot study, Noh, Lim, Shin, and Paik (2008) evaluated the effects of 8 weeks of aquatic therapy in 25 chronic stroke patients with hemiparesis. The training lasted 1 hour, three times per week. Conventional therapy, including extremity strengthening and gait training, was provided to control group (n = 12) with the same frequency and duration. The aquatic exercise group (n = 13) had an increase of 7.6 BBS points compared with the 2.2-points increase in the control group (p < .05). In addition, significant improvement in forward and backward weight bearing abilities of the affected limbs and knee flexor strength were observed in the aquatic exercise group. The result, 7.6 increases in BBS scores within 2 months, indicates that aquatic therapy has a genuine effect to improve balance in chronic stroke patients. However, the pilot study results have limited generalizability because of small sample sizes.
These findings from the above four RCTs provide evidence that aerobic exercise positively affects balance in subacute to chronic stroke patients with hemiparesis. The findings also suggest that improved balance in stroke survivors can be attained with exercise performed at least 20 minutes to 1 hour, three to four times a week, for 6-12 weeks.
Comprehensive Exercises to Improve Balance
Duncan et al. (2003) randomized 44 and 48 subacute stroke patients to experiment and control groups, respectively. The experiment group received a structured, progressive, physiologically based, therapist-supervised home exercise program, and the control group received conventional care. The participants received 90 minutes of exercise, 36 sessions, for 12-14 weeks. A significant improvement in BBS from 42.85 to 47.2 (+4.36 points) was observed after the 12-week exercise program compared with the improvement in BBS of 1.70 points (43.1-44.8) in the control group. Secondary stroke occurred in three participants (4%) who were all in the experimental group, but none of these occurred during the treatment sessions and all three returned home. The findings demonstrate that this kind of "one-on-one" comprehensive home-based exercise program improves balance in subacute stroke survivors.
Langhammer, Stanghelle, and Lindmark (2009) conducted an intensive exercise program with components of endurance, strength, and balance for the experimental group (n = 35). The control group (n = 40) did self-initiated exercise and did not receive encouragement from the researchers. The exercise program was initiated at an average of 16-22 days after stroke and took place 40-60 minutes, two to three times a week for 40 weeks. Both groups received 1 hour of general physiotherapy for 20 sessions. The groups had an average gain of 12.4 (26.0-38.4) and 15.8 (32.9-48.7) points in BBS, meaning that the first year of exercise brought the participants from acceptable to good balance. However, the results showed no difference between the groups at 3-, 6-, and 12- month follow up. Interestingly, an improvement was noted up to 6 months and was followed by a slight decline over the last 6 months of the study in the experimental group, but continuous improvement was noted in the control group. The findings suggest that early rehabilitation after stroke is effective in balance restoration, and simple, self-initiated exercise in the first year poststroke is as effective as intensive exercise if accessible exercises are available.
Pang, Eng, Dawson, McKay, and Harris (2005) studied 63 chronic stroke patients who were 50 years and older. The experimental group (n = 32) participated for 1 hour, three times per week, for 19 weeks of fitness and mobility exercise. The control group (n = 31) participated in a seated upper extremity program. The control group had similar improvements in balance to the experimental group (+2.0 and +1.9, respectively). There was no significant difference in the BBS between the two groups. This finding may be due to involved trunk stability and reaching function improvements through upper extremity training impact on balance. However, this small increase in BBS may come from a time effect for 19 weeks rather than genuine exercise effects.
The findings from the above three RCTs provide evidence that early initiation of exercise after stroke is effective in improving balance in stroke survivors, and there is evidence of longer-term benefits of the regular exercise in stroke survivors.
Multisensory Training to Improve Balance
Bayouk, Boucher, and Leroux (2006) studied 16 chronic patients with hemiparesis resulting from stroke. A task-oriented exercise program was provided to both groups (n = 8, respectively). The experimental group received additional multisensory training for 1 hour, two times a week, for 8 weeks. Center of pressure variability and total excursion on a pressure sensing floor mat were used to evaluate static and dynamic balance. There was no significant difference in balance between the two groups. This study showed that the intervention combining task-oriented exercise and multisensory training tended to improve balance, which was assessed by the center of pressure displacement scores, but the combined program did not lead to greater improvement in balance for hemiparetic subjects. Small sample size might have made it difficult to detect a statistical significance in postural weight bearing.
Marigold et al. (2005) compared the effects of 10-week agility exercise to stretching or weight-shifting exercise in chronic stroke patients who were 50 years and older. The experimental group received training in agility exercise in multisensory approach program for 1 hour, three times per week. Both the experimental group (n = 30) and the control group (n = 31) showed improvements in balance (+4.4 and +3.3, respectively), as measured by the BBS, but there was no significant difference between the groups. A significant improvement in step reaction time was found in agility exercise group than in stretching or weight-bearing group. The results illustrate that the agility exercise would be beneficial in reducing falls in chronic stroke patients who have altered motor coordination.
Yelnik et al. (2008) randomized 68 patients who had experienced a recent stroke but had reached the chronic recovery period (average of 7 months post-event). The experimental group (n = 33) patients received multisensorial training, and the control group (n = 35) received neurodevelopmental theory-based treatment for 1 hour, 5 days a week, for 4 weeks. Multisensorial training focused attention on the amount of exercise, such as duration and intensity, rather than the quality of the movement. Both the experimental group and the control group showed improvements on balance measured by BBS (+4.0 and +6.0, respectively), but there was no significant difference between the two groups. The results indicate that the superiority of the multisensorial approach training is not evident in this group of chronic stroke patients, and additional research may consider an approach more focused on quality of movement rather than amount of movement in multisensorial training.
The findings from the three RCTs showed similar trends. Both the experimental and the control groups improved balance, but there was no significant difference between the two groups. The three RCTs indicated that multisensorial interventions do not seem to be effective in improving balance in stroke survivors. On the basis of the literature reviewed regarding interventions targeting balance restoration, initiating early rehabilitation after stroke is important in acute stroke survivors. Moreover, well-structured home-based exercise is beneficial to restore additional balance in subacute stroke survivors at home after discharge from acute rehabilitation. Aerobic exercise also has shown to be beneficial to maintain and improve balance in chronic survivors.
Walking Ability
Ten studies evaluated the effects of an exercise program focused on walking speed or walking distance in participants in the acute to chronic stroke phases. These studies were conducted in the acute phase of stroke recovery (n = 2), subacute phase (n = 3), and chronic phase (n = 5). Most of the interventions were aimed at improving walking speed and were performed in the community. The prevailing type of exercise to improve walking ability was treadmill walking. Walking speed (m/s) was generally assessed using the timed 10-meter walk test (10MWT) or 6-minute walk test (6MWT), and walking distance was assessed using the 6MWT.
Using a classification of gait velocity validated for stroke survivors (Schmid et al., 2007), the participants' ambulation level in the following studies was stratified to household ambulation (<0.4 m/s), limited community ambulation (0.4-0.8 m/s), and full-community ambulation (>0.8 m/s). Among the 739 participants in the 11 trials, most patients had limited community ambulation (n = 607, 82.1%), 9.2% of the patients (n = 68) had household ambulation, and the remaining 8.6% had full-community ambulation. All participants had slower speed compared with the average healthy older adult's walking speed, which is 1.28 m/s (Laufer, Dickstein, Chefez, & Marcovitz, 2001). Their initial walking speed before their interventions ranged from 0.18 to 0.92 m/s and changed from 0.33 to 1.04. In this review, the exercise types were categorized as task-oriented exercise, intensive exercise, and dual-task exercise.
Gait-Oriented Exercise
Eight studies assessed walking speed and/or walking distance of stroke survivors from acute to chronic phase after they took part in treadmill walking. Various combinations of the treadmill walking training have been studied.
Treadmill walking with BWS versus general physical therapy. Yen et al. (2008) investigated the effects of additional gait training with 4-week treadmill training after a 4-week general physical therapy in chronic survivors averaging 2 years poststroke. Of 14 chronic stroke subjects with limited community ambulation, seven were randomized to the experimental group, which received a 4-week treadmill training (30 minutes, 3 times per week) with BWS after general physical therapy, and the remaining seven were randomized to the control group, which received only general physical therapy. After the intervention, both the experimental and the control groups improved walking speed (+23.58 and +8.35 cm/s, respectively), but the change in scores of walking speed was much higher in the experimental group, improving from 68.66 (+32.8) to 92.24 (+32.34) cm/s in walking speed, compared with the control group, which improved from 78.44 ([+ or -] 43.49) to 86.79 ([+ or -] 43.00) cm/s (p = .004). The results indicate that treadmill training combined with a conventional rehabilitation program provides additional benefit in improvement in walking speed in chronic stroke.
Treadmill walking with BWS versus overground walking. Two RCTs compared treadmill walking exercise with BWS to overground walking in acute and subacute stroke individuals.
Franceschini et al. (2009) randomized 92 patients who were within 60 days poststroke and had limited community ambulation to an experimental group (n = 52) and a control group (n = 45). The experimental group (n = 52) received a 20-minute BWS treadmill training plus a 40-minute overground walking training, 5 days per week, for 4 weeks, whereas the control group (n = 45) received a 60-minute overground walking training with the same frequency and duration. Both the experimental and control groups showed meaningful improvements in walking speed (+0.3 and +0.4 m/s, respectively) and distance (+67 and +70 m, respectively), but no significant differences were found between the groups. These results demonstrate that an early rehabilitation program contributed improvements in walking capacity, resulting in transitions from limited community ambulation to full-community ambulation. However, the modality of treadmill training, adding 20 minutes of treadmill training with BWS to the overground walking, was not superior to 1 hour overground walking modality.
Peurala et al. (2009) randomized 43 acute stroke patients with household ambulation ability to body weight supported treadmill training on a gait trainer (n = 22) and overground walking exercise (n = 21). The two exercise groups exercised a maximum of 1 hour to achieve 20 minutes of actual walking, 5 days a week, for 3 weeks in combination with physiotherapy. Both the treadmill and overground walking exercise groups improved walking speed (+0.42 m/s, +0.45 m/s, respectively) and walking distance (+124.8 meters, + 150.7 meters, respectively) but there was no significant change between the two groups. These results indicate that the early intensive walking is beneficial to improve walking ability, resulting in transition from household ambulation to limited community ambulation. The treadmill training with BWS and the overground walking were equally effective in improving walking ability.
The results of both studies suggest that stroke patients should participate in early rehabilitation to regain walking ability.
Treadmill walking with BWS versus without BWS. Barbeau and Visintin (2003) studied 100 subacute stroke patients with household ambulation. The patients were block-randomized to the experimental group (n = 50) and the control group (n = 50) by baseline ambulation speed. The experimental group received a 6-week treadmill training (4 times per week) with BWS, and the control group received the same schedule of treadmill training with full-weight bearing. After the training, the experimental group had significantly greater improvement in walking speed and walking distance, with more impaired subjects showing the most improvement in overground walking speed (p < .05). These results demonstrate that treadmill training with BWS leads to improved overground walking ability in subacute stroke survivors with severe walking deficits.
Treadmill walking without BWS versus overground walking. The following three RCTs evaluated treadmill walking without BWS compared with overground walking exercise.
Langhammer and Stanghelle (2010) compared treadmill training without BWS with overground walking in chronic stroke survivors with full-community ambulation. Both the experimental (n = 21) and the control (n = 18) groups performed 30 minutes, 5 days a week, for about 2.5 weeks, while they attended a private rehabilitation center. Participants in both groups received general physical therapy. After the treadmill training, the experimental group had a 0.2 m/s increase in walking speed measured by the 10MWT, a 0.1 m/s increase by the 6MWT, and a 31-m improved walking distance by the 6MWT, compared to the control group with overground walking training (+0.1 m/s, +0.1 m/s, and +24.1 m, respectively). The findings showed that treadmill walking improves spatial and temporal gait characteristics in stroke patients more effectively than walking outdoors.
Laufer et al. (2001) randomized 25 stroke survivors within 90 days from stroke with household ambulation to the experimental group (n = 13) and the control group (n = 12). Eight nondisabled, age-matched participants were recruited to provide for normal values. The experimental group received treadmill training without BWS and the control group received floor walking training for 3 weeks. In addition, both groups received Bobath approach physical therapy five times a week during the 3 weeks. Both groups started to exercise on the treadmill 4 minutes per day during the first week and increased to 2-minute increments every week for 3 weeks. Compared with the healthy subjects with same age, all the participants had slower walking speed and shorter stride length. Both the experimental and the control groups showed greater improvements in walking speed (+0.27 and +0.15m/s, respectively), but the changes were not significantly different. However, combining treadmill training with conventional physical therapy lead to clinically meaningful improvement in transitions from household ambulation (0.20 m/s) to limited community ambulation (0.47 m/s) compared with the overground walking with physical therapy (0.18-0.33 m/s).
Macko et al. (2005) randomized 61 chronic stroke survivors with limited community ambulation to the experimental group (n = 32), which received a treadmill aerobic training intervention program, and the control group (n = 29), which received a reference exercise program composed of stretching plus low-intensity walking exercise. Both the groups performed exercises for 40 minutes per session, three times per week, for 6 months. The experimental and control groups showed significant improvement in the 30-feet usual walking speed (+0.11 and +0.09 m/s, respectively) and fast walking speed (+0.13 and +0.10 m/s). However, there was no significant difference in walking speed between the two groups. Significant improvement in walking distance measured by the 6MWT (+160 feet = 49 m) was observed in the experimental group compared with the control group (+20 feet = 6 m and +6 points, respectively). The result demonstrates that, in chronic stroke survivors, the treadmill training with longer training sessions translated to improved overground walking distance but not improved walking speed.
The results showed that both exercises were effective in improving walking ability, but there was conflicting evidence about which modality of exercise was more effective.
Structured speed-dependent treadmill walking versus physiotherapeutic gait therapy. Pohl, Mehrholz, Ritschel, and Ruckriem, (2002) compared the effects of a 4-week structured speed-dependent treadmill training (STT) to limited progressive treadmill training (LTT) and to conventional gait training (CGT) in subacute stroke patients with limited community ambulation. The 60 participants were randomly assigned to one of the three groups by block randomization on the basis of the initial 10MWT. The STT group (n = 20) received 12 sessions, 30 minutes each, of treadmill training that increased walking speed of 10% if the participants could hold the current speed for 10 seconds. If they could not maintain the speed, then the speed was reduced by 10% in the next phase. This increase and decrease continued in the entire sessions. The LTT group (n = 20) received 12 (30-minute) sessions of a treadmill training that increased by no more than 5% of the maximum initial walking speed each week (20% over 4 weeks). The CGT (n = 20) group received 12 sessions, 45 minutes, of a physiotherapeutic gait therapy based on the principles of the proprioceptive neuromuscular facilitation and Bobath concepts. In addition, all the groups received eight sessions (45 minutes) of conventional physiotherapy.
After a 4-week training period, the STT group improved more significantly in walking speed (+1.02 m/s) than the LTT (+0.56 m/s) or CGT (+0.31 m/s) groups in the 10MWT, the fastest comfortable overground walking speed. In addition, there was a significant difference between the LTT and CGT groups. All of the three groups improved walking speed from limited community ambulation to full-community ambulation. The findings reveal that speed-dependent training modality gives greater results in walking speed; treadmill training with and without significant speed increases is also more beneficial in improving walking speed than CGT. Therefore, combining STT with physiotherapy is an efficient exercise regimen for improving walking speed in subacute stroke recovery with limited community ambulation.
These findings from the above eight RCTs provide evidence that combining treadmill exercise with conventional therapy in acute and subacute stroke recovery can produce better clinical improvements in transitions from household through limited community to full-community ambulation. In addition, repetitive and speed-dependent training provides additional walking capacity. Exercise prescription can be applied differently based on participants' ambulatory ability; however, the findings suggest a regimen of at least 20-30 minutes, 3-5 days a week, for 3-4 weeks.
Intensive Exercise to Improve Walking Ability
Duncan et al. (2003) assessed the effects of home-based exercise on subacute stroke patients with household ambulation. The experimental group (n = 44) in 90-minute sessions of intensive home-based exercise for 3 months. The components of the intervention program were range of motion and flexibility, strengthening, balance, upper extremity functional use, and endurance. The control group (n = 48) received
usual care with physical therapy or occupational therapy prescribed by their physicians and also received home visits by research staff every 2 weeks for health education, vital signs, and a test of oxygen saturation. After the training, the experimental group achieved greater gains in the 6-minute walking speed (+0.18 m/s) and walking distance (+61.61 m) compared with the control group (+0.11 m/s and +33.59 m, respectively). These results indicate that natural recovery continues in the subacute phase, and the home-based intensive exercise program could be a beneficial and cost-effective strategy to improve additional walking functions for stroke survivors discharged after acute rehabilitation.
Dual-Task Exercise to Improve Walking Ability
The concept of dual-task exercise involves the performance of two tasks at the same time and is helpful in reflecting the broader dimensions in community ambulation (Lord & Rochester, 2005). Yang, Wang, Chen, and Kao (2007) conducted a 4-week dual-task-based ball exercise study in chronic stroke survivors with full-community ambulation. The experimental group (n = 13) participated in 30 minutes of ball exercise program, three times a week, for 4 weeks. During the ball exercise, participants walked while manipulating either one or two balls (i.e., holding one or two balls in their hands). The control group (n = 12) did not receive any matched attention rehabilitation training. In this study, walking speed was measured under the single-task condition (walking) and under the dual-task condition (walking carrying a tray with glasses). The experimental group showed significant improvement in walking speed under the single-task and dual-task conditions (+29.73 and +31.08 cm/s, respectively) compared with the control group ( - 12.84 and + 12.93 cm/s, respectively). The posttest walking speed in the experimental group was 115.35 cm/s, which is enough to function as healthy senior pedestrians (1.28 m/s; Laufer et al., 2001).
On the basis of a review of the above literature, gait-oriented exercise is effective in improving walking capacity for stroke survivors in acute to chronic recovery. In addition, initiating early rehabilitation from the acute to subacute phase can produce walking transitions from household to full-community ambulation. Dual-task exercise can be a novel strategy for chronic survivors with full-community ambulation to optimize their ambulatory function.
In this review, aerobic exercise is shown to improve balance in chronic stroke survivors. This finding refutes the results of previous systematic reviews that balance or gait-oriented trainings have a nonsignificant effect (Yeasell, Foley, Bhogal, & Speechley, 2003; van de Port et al., 2007). In addition, this review extends the body of literature on balance and falls in stroke survivors. Aerobic exercise is beneficial to improving chronic survivors' balance and, presumably, their level of activity.
Among eight RCTs that assessed balance by BBS, six reported that both the experimental and control groups showed improvements in balance, but there was no significant difference between the groups. This may be explained, in part, by the small sample sizes. Another possible explanation is the ceiling effect of measures used as participants in seven RCTs already had good balance (BBS scores of 40 or higher).
In one RCT, before the intervention, subjects were impaired in the "acceptable range" (i.e., BBS scores of 21-40, a level of balance that put them at risk for falls). The remaining RCTs examined participants who had substantively higher BBS scores, possibly precluding clinically significant improvements in balance. Further studies need to be conducted for populations with more significant balance impairment to assess the true value of the interventions tested.
There is evidence that timing plays a role in improving balance in rehabilitation. Exercise performed in the acute recovery period showed greater improvements in balance by 12-15 points in BBS within the first year of stroke compared with a BBS increase of 2-7 points in subacute or chronic recovery. This finding supports that early intervention is critical to optimize rehabilitation (Duncan et al., 2005).
Gait-oriented walking exercise has been proven to improve walking capacity for stroke survivors who are in different phases of recovery and who have variable ambulatory ability. This finding is similar to previous review results (van de Port et al., 2007). Structured STT may be beneficial in improving walking speed and distance. In addition, stroke survivors who initiated early rehabilitation with gait-oriented exercise produced greater improvements in walking ability. These findings suggest that early intervention or a specific intervention may be instrumental in upgrading walking transition from household to limited community ambulation, from limited to full-community ambulation, or from household to full-community ambulation.
This review has several potential limitations. First, it examined balance and walking only in RCTs published in the English language. Second, in most of the studies examined, participants were exposed to several treatments; therefore, identifying pure effects of the treatment exercises was difficult. Third, some studies had small sample sizes, which limit generalizability. All of the studies reviewed lacked longitudinal follow-up data. Further longitudinal studies are needed to discern whether participants maintain their improvements over time. Finally, only a few RCTs that investigated interventions for the most profoundly affected stroke survivors with household-only ambulatory ability were found. Home-based exercise could be one strategy for this population to improve walking ability (Duncan et al., 2003).
Nursing Implications
Specific recommendations regarding exercise in the poststroke population have not been published, partly because of the variability in study methodology to date, as evidenced in this review. Another confounding element is the heterogeneity of neurological deficit profiles in stroke survivors that mandate customization of specific exercise prescriptions. However, based on the articles analyzed in this review, a regimen lasting at least 6 weeks, 1 hour per session, three to five times per week, may be recommended to improve balance and a regimen of at least 4 weeks, 20-30 minutes of gait-oriented exercise, three to five times per week, for walking are recommended for improvements in balance and walking.
Nurses play a crucial role in managing the recovery trajectory of patients poststroke. Beginning in the acute phase, the focus is on stabilization of neurological status and management of comorbid illnesses. Evidence suggests that early mobilization and therapeutic exercise is linked to better functional outcomes (Indredavik, Bakke, Slordahl, Rokseth, & Haheim, 1999). During the subacute phase of recovery, when survivors are likely to receive inpatient or outpatient rehabilitation services, the emphasis of care switches to functional recovery and development of adaptive or compensatory strategies. It is during this phase that stroke survivors and therapists can most readily capitalize on spontaneous neurological and functional recovery and initiate exercise patterns translatable to home and community settings.
Nurses in these settings have a key role in observing stroke survivors carrying out activities of daily living, identifying potential safety risks, and collaborating with physicians, physical and occupational therapists, and other rehabilitation professionals to identify an appropriate and effective plan of care. Nurses also play a crucial role in educating stroke survivors and their families on the importance of developing and maintaining good exercise habits to facilitate ambulatory recovery and reduce secondary stroke risk.
Once stroke survivors are discharged from formal rehabilitation services and resume life at home, community health nurses may assist with identifying safe places for stroke survivors and family members to exercise in the home or community setting. Furthermore, nurses should provide support and motivation for survivors to continue and progress exercise regimens for permanent incorporation into a daily routine. Community-based nurses may also be instrumental in monitoring functional abilities and triggering appropriate referrals to therapists and rehabilitation professionals to enhance recovery.
Many stroke survivors are referred to extended care settings, requiring additional rehabilitation time prior to discharge to home. Nurses in these settings that understand the importance of incorporating as much exercise as possible into a daily routine can educate and direct the patient care team accordingly. Encouragement and motivation of caring staff to continually progress activity may positively influence functional recovery and return to independence.
In conclusion, current literature suggests that ideal exercise intervention for stroke survivors includes a combination of gait, balance, and aerobic activities. The regimen should be customized for individual participants and appropriate to their level of impairment. Future directions in research should include longitudinal follow-up data for exercise intervention studies to examine whether participants maintain improvements over time. Further study is also needed to examine impact of exercise interventions across the spectrum of neurological deficit profiles and whether or not home-based rehabilitation focused on balance and walking is as safe and beneficial as hospital-centered rehabilitation models. Further study is needed to test and evaluate strategies to motivate chronic stroke patients to adapt and maintain exercise behavior, because current evidence indicates that exercise behavior is helpful in recovering function and independence, reducing disability and secondary complications, and preventing secondary stroke, all of which are more likely to improve quality of life.
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Questions or comments about this article may be directed to Minjeong An, MSN RN FNP-BC, at firstname.lastname@example.com. She is a doctoral student at the University of Maryland School of Nursing, Baltimore, MD.
Marianne Shaughnessy, PhD RN CRNP, is the associate director of Education/Evaluation at the Baltimore VA Geriatric Research Education and Clinical Center (GRECC) and an associate professor at the University of Maryland School of Nursing, Baltimore, MD.
The authors declare no conflict of interest.
DOI: 10.1097/JNN.0b013e318234ea24
TABLE 1. Methodological Quality of the 17 Included Randomized Controlled Trials PEDro Criterion Number (a) Study 1 2 3 4 5 6 7 8 9 10 Au-Yeung et al. (2009) Y 1 0 1 0 0 1 0 1 1 Barbeau et al. (2003) Y 1 0 1 0 0 1 0 0 1 Bayouk et al. (2006) Y 1 0 1 0 0 0 1 0 0 Duncan et al. (2003) Y 1 1 1 0 0 1 1 1 1 Franceschini et al. (2009) Y 1 0 1 0 0 1 0 1 1 Langhammer et al. (2010) Y 1 1 1 0 0 1 1 1 1 Langhammer et al. (2009) Y 1 1 1 0 0 1 1 1 1 Laufer et al. (2001) Y 0 0 1 0 0 1 1 0 1 Macko et al. (2005) Y 1 0 1 0 0 1 0 0 1 Marigold et al. (2005) Y 1 1 1 0 0 1 0 0 1 Noh et al. (2008) Y 1 0 1 0 0 1 0 0 1 Pang et al. (2005) Y 1 1 1 0 0 1 1 1 1 Peurala et al. (2009) Y 1 1 1 0 0 0 0 0 1 Pohl et al. (2002) Y 1 0 1 0 0 1 1 0 1 Yang et al. (2007) Y 1 1 1 0 0 1 1 0 1 Yelnik et al. (2008) Y 0 0 1 0 0 1 1 1 1 Yen et al. (2008) Y 1 1 1 0 0 0 1 1 1 PEDro Criterion Number (a) Total Study 11 Score Au-Yeung et al. (2009) 1 6/10 Barbeau et al. (2003) 0 4/10 Bayouk et al. (2006) 1 4/10 Duncan et al. (2003) 1 8/10 Franceschini et al. (2009) 1 6/10 Langhammer et al. (2010) 1 8/10 Langhammer et al. (2009) 1 8/10 Laufer et al. (2001) 1 5/10 Macko et al. (2005) 1 5/10 Marigold et al. (2005) 1 6/10 Noh et al. (2008) 0 4/10 Pang et al. (2005) 1 8/10 Peurala et al. (2009) 1 5/10 Pohl et al. (2002) 1 6/10 Yang et al. (2007) 1 7/10 Yelnik et al. (2008) 1 7/10 Yen et al. (2008) 1 7/10 Note. Y = yes; 1 = eligibility criteria specified (this is not calculated for the total score); 0 = no. (a) = eligibility criteria specified; 2 = random allocation; 3 = concealed allocation; 4 = groups similar at baseline; 5 = subject blinding; 6 = therapist blinding; 7 = assessor blinding; 8 = less than 15% dropouts; 9 = intention-to-treat analysis; 10 = between-group statistical comparisons; 11 = point measures and variability data.
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