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The effectiveness of resistance exercise for strength improvement among aging persons is inconsistent across investigations, and there is a lack of research synthesis for multiple strength outcomes.
The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. A meta-analysis was conducted to determine the effect of resistance exercise (RE) for multiple strength outcomes in aging adults. Randomized controlled trials and randomized or non-randomized studies among adults ≥ 50 years, were included. Data were pooled using random effect models. Outcomes for 4 common strength tests were analyzed for main effects. Heterogeneity between studies was assessed using the Cochran Q and I2 statistics, and publication bias was evaluated through physical inspection of funnel plots as well as formal rank-correlation statistics. A linear mixed model regression was incorporated to examine differences between outcomes, as well as potential study-level predictor variables.
Forty-seven studies were included, representing 1079 participants. A positive effect for each of the strength outcomes was determined however there was heterogeneity between studies. Regression revealed that higher intensity training was associated with greater improvement. Strength increases ranged from 9.8 – 31.6 kg, and percent changes were 29 ± 2, 24 ± 2, 33 ± 3, and 25 ± 2, respectively for leg press, chest press, knee extension, and lat pull.
RE is effective for improving strength among older adults, particularly with higher intensity training. Findings therefore suggest that RE may be considered a viable strategy to prevent generalized muscular weakness associated with ageing.
Muscular weakness plays a principal role in the pathogenesis of frailty and functional impairment that occurs with aging, and contributes to numerous disease processes. Maximal strength capacity reaches a peak sometime around the second or third decade of life, and by the fifth decade, begins a gradual decline (Larsson, et al., 1979, Lindle, et al., 1997, Metter, et al., 1997, Narici, et al., 1991, Vandervoort, et al., 1986). This deterioration, which is typically attributed to diminished levels of activity or disuse/immobilization due to disease, has been documented primarily through cross-sectional research, and appears to increase in severity after the age of 65 (Baumgartner, et al., 1998). Although losses of strength are rarely tracked longitudinally (Aniansson, et al., 1986, Bassey, et al., 1993, Frontera, et al., 2000, Kallman, et al., 1990), existing epidemiological studies report a significantly higher prevalence across each decade of late adult life. Sarcopenia and muscular weakness are not considered to be "disease" states, but rather conditions which translate to acute functional deficit and disability, as well as related comorbidity and mortality (Ruiz, et al., 2008). Moreover, increased longevity has led to a higher frequency of sarcopenia, and respective escalating health care expenditures for complications associated with declines in functional health and loss of independence (96).
Numerous investigations have identified a disparate decline of strength and muscle mass, indicating that these age-related debilities are to some extent, independent (Klitgaard, et al., 1990, Lynch, et al., 1999, Young, et al., 1985). However, since strength and muscle mass do not decrease concurrently, strength may be a superior indicator of muscular dysfunction (Doherty, 2003, Klein, et al., 2001). Indeed, longitudinal data suggest that muscle strength is a robust predictor of functional decline that may occur during aging (Pendergast, et al., 1993, Rantanen, et al., 1999, Rantanen, et al., 1999), and is an important physiological attribute for maintenance of mobility and movement efficiency. Since strength capacity appears to also be indicative of disability (Janssen, et al., 2002, Visser, et al., 2002), resistance exercise (RE) may serve as an effective mode of exercise to directly improve functional capacity. There is strong evidence to suggest that muscle weakness is a treatable cause of disability, and that aging persons with early-onset deterioration are probably the most likely to benefit from strategic interventions (Evans, 1996, Frontera, et al., 1988, Hakkinen, et al., 1995, Hurley, et al., 1995). Specifically, RE is considered to be a safe and effective method for increasing strength and lean muscle tissue in young (Hubal, et al., 2005, Lowndes, et al.) and older adults (Fiatarone, et al., 1990, Frontera, et al., 1988, Hakkinen, et al., 1998, Hakkinen, et al., 2001, Reeves, et al., 2004, Vincent, et al., 2002, Welle, et al., 1995). Even after short bouts of resistance training protocols, aging subjects may experience improvements in protein synthesis rate and neuromuscular adaptation that are comparable to that of younger cohorts, despite a much lower pre-exercise rate (Holviala, et al., 2006, Newton, et al., 2002, Roth, et al., 2001, Yarasheski, et al., 1993). These findings imply that disuse may actually be the underlying reason for muscle atrophy and weakness, rather than aging, per se.
The effectiveness of RE for strength improvement among aging persons is inconsistent across investigations. While much research has examined strength increases accompanying single-cohort interventions, most have examined only one or two training programs, providing only a glimpse of the overall dose-response relationship. Debate concerning the appropriateness of RE among older individuals has been cultivated by questions of the general efficacy and safety for this population. There are very few published accounts that examine the overall benefit of RE for strength in aging persons while considering a continuum of dosage schemes, treatment durations, and/or age ranges on longitudinal strength adaptation. As a result, it is difficult to evaluate the treatment effects coinciding with these factors. Further, although the existing body of evidence regarding the utility of resistance exercise for strength improvements among older adults has recently been deemed to be supported by the highest category of evidence (i.e. "Evidence Category A.") (Chodzko-Zajko, et al., 2009), a systematic review to assess treatment effects across multiple strength measures, and potential moderating variables more generalizable to RE prescription, is yet to be completed. To date, the most comprehensive reviews related to this topic have either limited the analysis of strength to a single measure (i.e. knee extension) (Latham, et al., 2003, Latham, et al., 2004, Liu, et al., 2009), or have compared multimodal exercise regiments for general changes in overall functional capacity (Baker, et al., 2007), not specific to strength outcomes. Therefore the purposes of this review and meta-analyses were to examine the effects of resistance exercise among older adults for multiple upper- and lower-body strength outcomes, and across multiple dosing schemes.
This meta-analysis was conducted in accordance with the recommendations and criteria as outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.
All resistance exercise interventions that included the primary outcome related to muscular strength were included in the original article acquisition. Any randomized controlled trials (RCTs) or quasi-randomized clinical trials meeting the subsequent specifications were included. Randomized or non-randomized treatment studies (non-RCTs) that examined intervention treatments using stratified young versus older participants, or aged men versus women were also eligible for inclusion in the analyses. The type of participants included older men and women, residents in institutions or hospitals, or senior-citizen communities. Trials were included if the mean age of participants was ≥ 50 years, but excluded if participants aged < 50 years were enrolled. The physical health of participants ranged from fit and healthy to frail or disabled older people, and/or people with identified diseases or health problems. Similar to previous reviews (Latham, et al., 2003, Latham, et al., 2004), inclusion of participants with a range in age and health complications was critical to increase external validity and generalizability of results.
Trials that had at least one group of participants who received RE as a treatment were considered for inclusion. Training could have taken place in group exercise programs (e.g. in commercial health clubs, etc.), individual personal training arrangements, and/or senior community-based settings. For these analyses, RE was defined as a strength training regimen that included specific exercises for the whole body. Training protocols were classified in accordance with the American College of Sport Medicine Position Stand on Progression Models in Resistance Training for Healthy Adults (Kraemer, et al., 2002). Study inclusion for functional improvements was limited to four discrete measurements of maximal strength capacity, including one-repetition maximum (1RM) tests for machine leg press, chest press, knee extension, and lat pull (i.e. lat pulldown and/or lat row). These tests were selected due to documented reliability for assessments, as well as reported prevalence in the literature. Other methods of assessing muscular fitness (e.g. power, endurance, etc.), functional deficit or performance were not included in the analysis.
Computerised searches of MEDLINE, EMBASE, PubMed, Web of Science, SPORTDiscus™, Evidence Based Medicine Reviews Multifile (EBMR) databases, and Digital Dissertations (accessed May, June, and July 2009) from their inception to July, 2009 were undertaken. Hand-searching of key journals, reference lists and other sources was also undertaken. Studies published in foreign language journals were not included. Abstracts and citations from annual scientific conferences relating to exercise science or gerontology were not examined due to paucity of requisite data. The preliminary search yielded over 5,000 relevant abstracts and citations. Full texts of over 400 articles were obtained and examined by the primary reviewer (MP).
A specific coding tool was developed from previous quantitative reviews, as well as suggestions from meta-analysis experts, to record information pertaining to the study source, participants, experimental characteristics, and outcomes. Although all eligible studies in this investigation shared a common directive to examine the effectiveness of RE for older adults, several studies examined different hypotheses (e.g. younger versus older (Roth, et al., 2001)). Only data from the older participants were coded for analysis. For all interventions included in this meta-analysis, each treatment group was considered a one-group pretest-posttest intervention. Therefore coding of strength change was only carried out for groups receiving the RE treatment, and all data reported from controls were disregarded. If data were not adequately reported for the purpose of quantitative pooling, the author of correspondence was contacted for additional information. If the authors could not be contacted or if the information was no longer available, the trial was excluded from analyses.
Inter-reviewer disagreements were resolved by consensus. The agreement rate prior to amending any such discrepancies was assessed using the kappa statistic (Donner, et al., 1996), and determined to be 0.93. In the case of inadequate information contained in the manuscript, the lead reviewer (MP) sought clarification from study authors. To assess for evidence of publication bias, Begg's funnel plots were examined (Begg, et al., 1989). This process included the visual inspection of scatterplots for each measure against its standard error. This process is necessary to account for the "file drawer problem," which is the potential effect that published studies are inherently biased due to a greater likelihood of significant results, whereas non-significant results are more likely to not be submitted for publication and be placed in a file drawer. The use of published studies could represent an inflated account of the effect between treatment and outcome, and thus it is necessary to test for bias. As a subsequent check of publication bias, the test of Egger et al. (Egger, et al., 1997) was incorporated. This linear regression method quantifies the bias captured by the funnel plot, and more specifically, the standardized effect is regressed on precision (i.e. inverse of standard error) (Borenstein, et al., 2009). This is a formal statistic that is intended to assess the same assumption as the funnel plot, and may be used as a "cross-check" to the physical inspection of the data.
Heterogeneity between studies was assessed using the Cochran Q statistic (Cochran, 1954). This test is appropriate in larger meta-analyses and uses the sum of squared deviations of the study-specific estimates derived from the pooled estimate, and weights the contribution of each study. P values were obtained by comparing the Q statistic with a χ2 distribution and k-1 degrees of freedom, in which k represents the number of studies included. Heterogeneity refers to the existence of variation between studies, on the main effects being evaluated. Since heterogeneity is to a certain extent, inevitable in meta-analytic research, there is ample debate regarding the utility of assigning statistical significance to this computation. Thus we also incorporated the I2 statistic, using the following equation:
With this method I2 ranges from 0% - 100% and values greater than 50% are used to indicate meaningful heterogeneity.
Treatment effects for muscular strength capacity were calculated for each study following the extraction/coding of change scores and standard deviations. Specifically, the standard deviation (SD) of change was needed to calculate the effect size, and for many of the studies this value was not reported. Rather, the majority of studies obtained for this analysis included the SDs for the baseline and postintervention strength outcomes, or in many cases the standard errors of the mean. In the event that the study reported exact P values for the change in strength outcome, the SD of change was computed. However, for those studies which did not report exact P values, the SD of change was calculated using the baseline and post-intervention SDs, as well as the within-participant bivariate correlation of strength measures using the following equation:
For every article included, authors were contacted in an effort to retrieve raw data for the calculation of the within-participant baseline and postintervention strength correlations, or the specific and respective r (correlation) values. For those studies in which authors could not be reached, r was imputed using the mean of the correlations available for 15 of the included articles. This resulted in using a within-participant correlation of r = 0.95 for the ones that were missing. This allowed for the computation of effect sizes for all cohorts included in the metaanalysis, as recommended by Follmann et al (Follmann, et al., 1992).
The analysis of pooled data was conducted with a fixed and random-effects model. A fixed effects model is used with the assumption that sampling error is random, and is the primary cause of variation in the summary effect. Conversely, a random effects model is incorporated when the underlying assumption is that the effect across studies is randomly situated about a central value (Borenstein, et al., 2009). For each of the four strength measures, forest plots were generated to illustrate the study-specific effect sizes, and the respective 95% confidence intervals (CI). Combining estimates then allowed for the assessment of a pooled effect, as has been previously described (Richardson, et al., 2008), in which the reciprocal of the sum of two variances were accounted for, including: (1) the estimated variance associated with the study, and (2) the estimated component of variance due to variation between studies. In each study, the effect size for the intervention was calculated by the difference between the means of the post-test and pre-test at the end of the intervention. The study specific weights were derived as the inverse of the square of the respective standard errors.
In order to compare the pre-post change between types of strength outcomes, the data were analyzed under a linear mixed models framework, in which the outcomes were calculated as mean percent change in strength. The study-level independent variables used in the regression model were strength measure type, indicator for study design, gender, age-group, length of training, average intensity (4 subgroups), and average training volume (4 subgroups). An interaction between strength measure types was also included in the model to assess any differential age effect across measure types. A random study effect accounted for the clustering within study. Further, each study was weighted by the inverse of the square of the study-specific standard error corresponding to the outcome. The standard deviation (standard error multiplied by ) for percentage error was approximated by the following equation:
Specifically, CV denotes the coefficient of variation equaling the ratio of standard deviation and mean at the respective time points, and R is the ratio of the post and pre strength measures. For post-hoc comparisons of strength measures, Bonferroni adjustments were used to protect against an inflated Type 1 error. All statistical analyses were performed using STATA 10.0 (StataCorp LP, College Station, Texas), MINITAB 14.0 (Minitab Inc, State College, Pennsylvania), and SAS 9.2 (SAS Institute Inc., Cary, NC).
The flow of article search and selection, from "potentially relevant" to final inclusion is depicted in Figure 1.
Of the 5011 references screened, 47 studies with 72 cohorts were deemed eligible according to the exclusion criteria (Table 1). Of the included articles, the publication dates ranged from 1990 to 2008. 55.3% of the studies included random assignment of treatment conditions as well as control groups (RCT) (Ades, et al., 1996, Ades, et al., 2005, Ades, et al., 2003, Bemben, et al., 2000, Beniamini, et al., 1999, Binder, et al., 2005, Brochu, et al., 2002, Castaneda, et al., 2001, de Vos, et al., 2005, Fatouros, et al., 2006, Fatouros, et al., 2005, Figueroa, et al., 2003, Greiwe, et al., 2001, Haykowsky, et al., 2000, Haykowsky, et al., 2005, Henwood, et al., 2006, Igwebuike, et al., 2008, Kalapotharakos, et al., 2005, Miszko, et al., 2003, Panton, et al., 2001, Pu, et al., 2001, Reeves, et al., 2004, Sharman, et al., 2001, Stewart, et al., 2005, Sward, 2001, Tsutsumi, 1997). The remaining studies were classified as randomized or non-randomized treatment studies (non-RCTs), of which three studies (Izquierdo, et al., 2003, Izquierdo, et al., 2001, Kraemer, et al., 1999) assessed young or middle-aged men versus older men, one study (Holviala, et al., 2006) assessed young or middle-aged women versus older women, one study (Ibanez, et al., 2005) assessed the effects in a single sample (i.e. just older men or older women), five studies (Ballor, et al., 1996, Bautmans, et al., 2005, Campbell, et al., 1994, Hartman, et al., 2007, Reynolds, et al., 2007) assessed the effects of combined older men and women, five studies (Hurlbut, et al., 2002, Lemmer, et al., 2001, Lemmer, et al., 2007, Roth, et al., 2001, Welle, et al., 1995) assessed four groups, including young/middle-aged women, young/middle-aged men, older women, and older men, and six studies (Bottaro, et al., 2007, Candow, et al., 2006, Galvao, et al., 2005, Haub, et al., 2002, Humphries, et al., 2000, Tarnopolsky, et al., 2007) were classified as other (e.g. comparing more than one RE treatment dosage, etc.).
Data on 1079 subjects were included in the analysis. The age range for subjects was between 50 and 92, with the mean age of the subjects in the majority of studies falling between 60 and 75 (mean = 67.4 ± 6.3 years). A large percentage of the assigned cohorts consisted of male and female combined groups (25 cohorts) (Ballor, et al., 1996, Bautmans, et al., 2005, Beniamini, et al., 1999, Campbell, et al., 1994, Castaneda, et al., 2001, de Vos, et al., 2005, Galvao and Taaffe, 2005, Greiwe, et al., 2001, Hartman, et al., 2007, Henwood and Taaffe, 2006, Kalapotharakos, et al., 2005, Lemmer, et al., 2007, Miszko, et al., 2003, Panton, et al., 2001, Reeves, et al., 2004, Reynolds, et al., 2007, Stewart, et al., 2005, Sward, 2001, Tsutsumi, 1997), with the remaining evenly distributed in male (25 cohorts) (Ades, et al., 1996, Binder, et al., 2005, Bottaro, et al., 2007, Candow, et al., 2006, Fatouros, et al., 2006, Fatouros, et al., 2005, Haub, et al., 2002, Haykowsky, et al., 2000, Hurlbut, et al., 2002, Ibanez, et al., 2005, Izquierdo, et al., 2003, Izquierdo, et al., 2001, Kraemer, et al., 1999, Lemmer, et al., 2001, Roth, et al., 2001, Sharman, et al., 2001, Tarnopolsky, et al., 2007, Welle, et al., 1995) and/or female (22 cohorts) (Ades, et al., 1996, Ades, et al., 2005, Ades, et al., 2003, Bemben, et al., 2000, Binder, et al., 2005, Brochu, et al., 2002, Figueroa, et al., 2003, Haykowsky, et al., 2005, Holviala, et al., 2006, Humphries, et al., 2000, Hurlbut, et al., 2002, Igwebuike, et al., 2008, Lemmer, et al., 2001, Pu, et al., 2001, Roth, et al., 2001, Sharman, et al., 2001, Tarnopolsky, et al., 2007) only cohorts.
Length of training ranged from 6 to 52 weeks (mean duration = 17.6 ± 8.6 weeks), frequency from 1 to 3 times per week (mean = 2.7 ± 0.5 days/week), and intensity from 40% to 85% of 1 repetition maximum (mean = 70 % ± 12.7 1RM). The number of sets per exercise session ranged from 1-6 sets for each individual muscle (mean = 2.5 ± 1.0 sets), while the number of exercises performed ranged from 5-16 (mean = 8.3 ± 2.1 resistance exercises). The within-group number of repetitions performed for each set ranged between 2 and 20 (mean = 10 ± 2.6 repetitions), while the rest period between sets ranged from 60 to 360 seconds (mean = 110 ± 25 seconds). Compliance, defined as the percentage of exercise sessions attended, ranged from 85 to 100%.
Each strength measure was independently assessed through meta-analytic procedure, and is presented sequentially. Many trials reported more than a single outcome (Table 1). Due to the significant heterogeneity of the data based on Cochran's Q and I2, a random-effects model was incorporated for each type of strength measure.
The pooled estimate of mean strength change from baseline to postintervention, combining data from 51 treatment cohorts (32 studies) (Bautmans, et al., 2005, Bemben, et al., 2000, Beniamini, et al., 1999, Binder, et al., 2005, Bottaro, et al., 2007, Candow, et al., 2006, Castaneda, et al., 2001, de Vos, et al., 2005, Fatouros, et al., 2006, Figueroa, et al., 2003, Galvao and Taaffe, 2005, Greiwe, et al., 2001, Haub, et al., 2002, Haykowsky, et al., 2000, Haykowsky, et al., 2005, Henwood and Taaffe, 2006, Holviala, et al., 2006, Humphries, et al., 2000, Ibanez, et al., 2005, Igwebuike, et al., 2008, Izquierdo, et al., 2003, Izquierdo, et al., 2001, Kraemer, et al., 1999, Lemmer, et al., 2001, Lemmer, et al., 2007, Miszko, et al., 2003, Pu, et al., 2001, Reeves, et al., 2003, Reynolds, et al., 2007, Sharman, et al., 2001, Stewart, et al., 2005, Tarnopolsky, et al., 2007), was 31.63 kg (95% CI, 27.59 kg to 35.67 kg) (p < 0.001). A forest plot of the main effects for leg press, as well as CIs for all 51 cohorts, is provided in Figure 2.
When analyzed separately, sub-group analyses for the main effect revealed non-significant differences between randomized-controlled trials (RCTs) (pooled estimate = 34.38 kg; 95% CI, 27.74 kg to 41.02 kg) and randomized or non-randomized treatment studies (non-RCTs) (pooled estimate = 28.99 kg; 95% CI, 23.47 kg to 34.52 kg), despite significant increases in strength from pre- to post-intervention, for cohorts in both designs (p < 0.001).
The pooled estimate of mean strength change from baseline to postintervention, combining data from 55 treatment cohorts (36 studies), (Ades, et al., 1996, Ades, et al., 2005, Ades, et al., 2003, Ballor, et al., 1996, Bautmans, et al., 2005, Beniamini, et al., 1999, Bottaro, et al., 2007, Brochu, et al., 2002, Campbell, et al., 1994, Candow, et al., 2006, Castaneda, et al., 2001, de Vos, et al., 2005, Fatouros, et al., 2006, Galvao and Taaffe, 2005, Greiwe, et al., 2001, Hartman, et al., 2007, Haub, et al., 2002, Haykowsky, et al., 2000, Haykowsky, et al., 2005, Henwood and Taaffe, 2006, Humphries, et al., 2000, Hurlbut, et al., 2002, Ibanez, et al., 2005, Igwebuike, et al., 2008, Izquierdo, et al., 2001, Kalapotharakos, et al., 2005, Lemmer, et al., 2001, Lemmer, et al., 2007, Miszko, et al., 2003, Panton, et al., 2001, Pu, et al., 2001, Reynolds, et al., 2007, Roth, et al., 2001, Stewart, et al., 2005, Tarnopolsky, et al., 2007, Tsutsumi, 1997) was 9.83 kg (95% CI, 8.42 kg to 11.24 kg) (p < 0.001). A forest plot of the main effects for chest press, as well as CIs for all 55 cohorts, is provided in Figure 3.
Sub-group analyses revealed non-significant differences between RCTs (pooled estimate = 9.97 kg; 95% CI, 7.57 kg to 12.38 kg) and non-RCTs (pooled estimate = 9.68 kg; 95% CI, 7.79 kg to 11.58 kg), despite significant increases in strength from pre- to post-intervention, for cohorts in both designs (p < 0.001).
The pooled estimate of mean strength change from baseline to postintervention, combining data from 43 treatment cohorts (28 studies) (Ades, et al., 1996, Ades, et al., 2005, Ades, et al., 2003, Ballor, et al., 1996, Bemben, et al., 2000, Beniamini, et al., 1999, Binder, et al., 2005, Brochu, et al., 2002, Campbell, et al., 1994, Castaneda, et al., 2001, de Vos, et al., 2005, Fatouros, et al., 2005, Galvao and Taaffe, 2005, Greiwe, et al., 2001, Haub, et al., 2002, Haykowsky, et al., 2005, Henwood and Taaffe, 2006, Kalapotharakos, et al., 2005, Lemmer, et al., 2001, Lemmer, et al., 2007, Panton, et al., 2001, Pu, et al., 2001, Reeves, et al., 2003, Stewart, et al., 2005, Sward, 2001, Tarnopolsky, et al., 2007, Tsutsumi, 1997, Welle, et al., 1995), was 12.08 kg (95% CI, 10.44 kg to 13.72 kg) (p < 0.001). A forest plot of the main effects for knee extension, as well as CIs for all 43 cohorts, is provided in Figure 4.
Sub-group analyses revealed non-significant differences between RCTs (pooled estimate = 12.73 kg; 95% CI, 10.38 kg to 15.08 kg) and non-RCTs (pooled estimate = 9.83 kg; 95% CI, 7.93 kg to 11.73 kg), despite significant increases in strength from pre- to post-intervention, for cohorts in both designs (p < 0.001).
The pooled estimate of mean strength change from baseline to postintervention, combining data from 38 treatment cohorts (19 studies) (Bemben, et al., 2000, Beniamini, et al., 1999, Binder, et al., 2005, Campbell, et al., 1994, Castaneda, et al., 2001, de Vos, et al., 2005, Fatouros, et al., 2005, Figueroa, et al., 2003, Galvao and Taaffe, 2005, Greiwe, et al., 2001, Haub, et al., 2002, Haykowsky, et al., 2005, Henwood and Taaffe, 2006, Hurlbut, et al., 2002, Kalapotharakos, et al., 2005, Lemmer, et al., 2001, Lemmer, et al., 2007, Stewart, et al., 2005, Welle, et al., 1995), was 10.63 kg (95% CI, 8.59 kg to 12.67 kg) (p < 0.001). A forest plot of the main effects for lat pull, as well as CIs for all 38 cohorts, is provided in Figure 5.
Sub-group analyses revealed non-significant differences between RCTs (pooled estimate = 10.97 kg; 95% CI, 8.21 kg to 13.73 kg) and non-RCTs (pooled estimate = 9.7 kg; 95% CI, 7.26 kg to 12.14 kg), despite significant increases in strength from pre- to post-intervention, for cohorts in both designs (p < 0.001).
Examination of the Begg's funnel plots for leg press, chest press, and lat pull demonstrated considerable symmetry, suggesting that there was no significant publication bias. Results from the Egger's test further confirmed no evidence of publication bias (p = 0.12 – 0.74), for each of these main outcomes. Conversely, for knee extension, inspection of the funnel plots (Figure 6) as well as results from the Egger's test (p < 0.001) suggested positive evidence of publication bias. In the plot, the pair representing actual strength change and its standard error for each study is represented by circles. A horizontal line at the height equaling the variance-weighted, meta-analytic effect estimate is drawn with the two walls of the cone representing the confidence interval limits (estimate +/- 1.96* standard error), about each study-specific effect. Asymmetry on the right of the graph (i.e. where studies with high standard error are plotted) may indicate evidence of publication bias.
Significant differences were obtained in percent changes of strength across measure types. The mean ± standard error of percent changes in strength were 29 ± 2, 24 ± 2, 33 ± 3, and 25 ± 2 respectively, for leg press, chest press, knee extension, and lat pull. In post-hoc comparisons, the percent change in knee extension turned out to be significantly greater than either chest press (Bonferroni adjusted p-value = 0.003) or lat pull (Bonferroni adjusted p-value = 0.007). The only between-study predictor that had a significant association with percent strength change was training intensity. The average percent change in strength for an incremental increase in intensity subgroup was found to be 5.3% (standard error = 0.9, p < 0.001).
The primary results of this investigation suggest a robust, significant association between resistance exercise and upper and lower body strength improvement among older individuals. From a public health perspective, these findings confirm the value of full-body RE for the prevention or treatment of age-related declines in muscle function, which may in turn serve as a safeguard against disablement. In particular, we observed significant main effects for lower-body (i.e. leg press = 31.63 kg (29%); knee extension = 12.08 kg (33%)) and upper-body (i.e. chest press = 9.83 kg (24%); lat pull = 10.63 kg (25%)) strength capacity, following RE interventions. These findings bear clinical significance, considering the exaggerated strength decline that occurs among sedentary individuals after the age of 50 years (Borges, et al., 1989, Larsson, et al., 1979, Lindle, et al., 1997, Metter, et al., 1997, Narici, et al., 1991, Vandervoort and McComas, 1986), as well as the subsequent contribution of strength deficit to disability and movement impairment (Pendergast, et al., 1993, Rantanen, et al., 1999, Rantanen, et al., 1999).
Previous meta-analyses conducted on this population have restricted the examination of muscle function following "progressive resistance training (PRT)" to changes in knee extensor strength capacity, for the purpose of reducing the risk of "clinical heterogeneity" (Latham, et al., 2003, Latham, et al., 2004, Liu and Latham, 2009). This criterion is rational, given the high frequency with which knee extension strength is reported in the literature, as well as the relevance of lower-limb strength to locomotion, activities of daily living, and risk of slip-and-fall accidents (Pijnappels, et al., 2008). Moreover, due to the large cross-sectional area of the quadriceps, the degree of strength decline and muscle atrophy during aging appears to exceed that of the upper-body (Doherty, 2003), and thus an intervention model for positive effects on lower-limb strength provides salient inference for enhancement of overall functional capacity. However, the aforementioned analyses yielded significant statistical heterogeneity in the strength data that could not be attributed to differences in the study quality, participant characteristics or the exercise program variables (Latham, et al., 2003, Latham, et al., 2004).
In order to improve external validity and clinical generalizability associated with prescription of RE in older adults, the current analysis separated and examined the four most frequently tested strength outcomes (i.e. leg press, chest press, knee extension, and lat pull), and subjected each measure to individual meta-analytic synthesis and post-hoc analysis. These measures were chosen due to the high frequency of reporting in the literature, and ultimately because the aggregate represents a superior indicator of whole body functionality. To our knowledge, this is the first meta-analysis to synthesize data from full-body resistance training programs conducted on older men and women, and to report the main effects from multiple strength outcomes.
Similar to previous reviews (Latham, et al., 2003, Latham, et al., 2004, Liu and Latham, 2009), we found significant heterogeneity in the data for each outcome estimate, and thus a random effects model was necessary to analyze pooled effect sizes. Based on the linear mixed model regression and sub-group analyses, this heterogeneity could not be explained by differences in age, indicator for study design, length of training, or resistance training volume. Although there was variability in the individual study characteristics, nearly every resistance exercise protocol conformed to the American College of Sports Medicine (ACSM) recommendations for resistance exercise in older adults (ACSM, 1998). Further, according to the mixed model regression, strength improvement across all four outcomes shared a significant, positive relationship with resistance training intensity, suggesting that higher intensity RE programs are superior for strength improvement. In particular, training intensity ranged from approximately 40-90% of 1RM. Based on the a priori designation of low intensity (< 60% 1RM), low/moderate intensity (60-69% 1RM), moderate/high intensity (70-79% 1RM), and high intensity (≥ 80% 1RM), the mean change in relative strength (i.e. percent from pre to postintervention) for an incremental increase in intensity subgroup was nearly 5.5%. This is similar to previous reviews (Latham, et al., 2003, Latham, et al., 2004) in which subgroup analysis demonstrated that higher intensity training was associated with greater strength improvement among older populations, as compared to low and moderate intensity training.
The results from the linear mixed model on RE prescription variables did not identify any significant relationships between intervention duration or training volume, and subsequent strength effects. This is contrary to data from independent studies which have demonstrated the superiority of higher dosage RE for strength adaptation, longitudinally (Galvao and Taaffe, 2005). For the current analysis it is conceivable that the overall lack of substantial variability in training regimens across program models (Table 1) may have convoluted these results. Specifically, without a sufficient number of cohorts to stratify into trichotomous categories for each of the variables (e.g. high-, medium-, and low-volume), it is not feasible to effectively pool data to estimate individual main effects.
Current published RE recommendations are considerably different for young and middle-aged healthy adults (ACSM, 2009, Kraemer, et al., 2002), as compared to those for elderly populations (ACSM, 1998, Chodzko-Zajko, et al., 2009, Nelson, et al., 2007). The majority of published intervention studies and subsequent recommendations for younger adults have incorporated suggestions of periodization to promote enhanced adaptation of strength, whereas no such recommendations have been endorsed for the aging population. Since most of the studies in the current analysis followed the basic recommendations by the ACSM (ACSM, 1998, ACSM, 1998), the only requisite "progression" in training prescription was that of the absolute training load (i.e. "Progressive Resistance Training (PRT)"). However, merely increasing training load over time may not be sufficient beyond a certain point, as this represents an inevitable reliance on the same relative intensity (i.e. per maximal strength capacity). It is therefore conceivable that current findings misrepresent the true relationship between training volume dosages, and respective strength adaptation-potential of aging men and women. Although results from the current study confirm that resistance exercise is very effective for increasing strength capacity in this population, further research is warranted that examines interventions with hierarchical resistance exercise prescription models, and variable volume dosage schemes among healthy older adults.
Previous comparisons between young and/or middle-aged men and women and healthy elderly samples have yielded conflicting results (Hakkinen, et al., 1998, Holviala, et al., 2006, Lemmer, et al., 2000). Several investigations have demonstrated similar strength improvements (Hakkinen, et al., 1998, Holviala, et al., 2006, Newton, et al., 2002), whereas others suggest greater strength adaptation among younger cohorts (Lemmer, et al., 2000, Macaluso, et al., 2000). For the current review, regression analyses failed to identify an association between gender or age and strength main effects, and thus imply that the potential adaptive-response is significant for both men and women, across each decade of late adult life. Although significant strength adaptation is possible in the "oldest old" (Kryger, et al., 2007), it may be expected that the benefits of early strength acquisition will translate to superior preservation of functional movement capacity and instrumental activities of daily living, prevention of disability, and maintenance of independence and autonomy. In fact, as has recently been suggested, a reasonable degree of variation in muscular atrophy and weakness between older individuals may in part be attributable to the peak attained earlier in life (Sayer, et al., 2008). However, as a cautionary statement it should be noted that the vast majority of these current data were derived from healthy older adults, < 80 years old. Certainly more research is needed to ascertain the influence of RE for specific disease outcomes, and across a broader spectrum of age categories.
Strict inclusion criteria related to study design for meta-analysis has been widely debated. Systematic reviews generally employ only randomized controlled trials due to the removal of increased risk of bias in nonrandomized samples. However, there have been several recent reviews that have demonstrated no differences in effect sizes between randomized and nonrandomized trials (Benson, et al., 2000, Concato, et al., 2000), and there is ample debate regarding the value of this quality index for meta-analysis study inclusion (Balk, et al., 2002). With regard to assessing indicators of study "quality," no acceptable scale currently exists for examining the quality of exercise intervention research. Moreover, the Cochrane Collaboration has recently updated guidelines for systematic reviews, and has recommended against the use of quality scales due to an overall lack supporting evidence and validity (Higgins, et al., 2009). Therefore, sub-analysis for overall study quality was not carried out for the current investigation, although previous reviews have reported the overall lack of quality among the majority of resistance training literature for older adults (Latham, et al., 2004).
Although meta-analyses usually solicit articles from large databases there is typically a limitation with regard to research design quality. In the present study, only 25 out of 47 studies incorporated randomized controlled designs (RCTs). The remaining studies were classed as non-RCTs that often did not have a control group or involved placing subjects into groups by convenience, availability, or age/gender stratification. Sub-group analyses demonstrated no significant differences for the main effect between RCTs and non-RCTs, and in all cases, the main effects for non-RCTs were actually slightly less than that demonstrated among RCT designs. Certainly, the body of knowledge pertaining to the effects of RE on muscular strength among older adults would be enhanced if there were more investigations with a true experimental design. Moreover the acceptance of RE as a viable preventive or treatment option should elicit larger available samples from which to recruit, and thus reduce the risk of low-powered studies.
As with all meta-analysis, general limitations include the comparison of aggregate outcomes that do not necessarily assess the exact same construct (i.e. "comparing apples and oranges"), the process of search and retrieval for eligible articles, and the potential influence of publication bias (Rosenthal, 1991). For this study, every attempt was made to examine outcomes of similar construct. However, whereas previous reviews have restricted the analyses of strength effects to knee extension (Latham, et al., 2003, Latham, et al., 2004, Liu and Latham, 2009), we pooled data across various strength measures, in an effort to enhance external validity. Cooper et al. (Cooper, et al., 1994), also reported a "retrieval bias" in which criteria for soliciting articles is potentially inadequate. For example, in this analysis, retrieval bias may have been an issue due to the selection and retrieval of articles published only in the English language. Despite that over 5000 abstracts were reviewed, the selection of articles for inclusion could have potentially resulted in more publications if this criterion was not established. Publication bias has also been a longstanding concern with meta-analysis and systematic reviews. In essence, the use of published data may represent an inflated account of the effect between treatment and outcome. To this end, many reviewers have evaluated publication bias through the visual examination of funnel plots. Although a common practice, the use of funnel plots has received some degree of criticism (Tang, et al., 2000). At present there is not a uniform consensus on how these plots should he constructed for examining exercise intervention literature, and thus asymmetrical funnel plots should be interpreted cautiously. For the current analyses, the only evidence of publication bias determined through these tests was for the main effects of knee extension strength.
Ultimately, this meta-analysis cannot infer a causal-effect for disability or functional deficit, per se. Since age-related muscular weakness is a collection of interrelated deteriorations that coincide with chronological aging, the improvement of strength capacity through RE is a viable preventive strategy to complement other medical and lifestyle interventions. Muscle weakness is associated with specific functional deficits, disease comorbidity, and escalating health care expenditures, and thus more studies are needed to directly examine treatment options for these significant consequences. The investigation of resistance exercise for aging populations is a relatively contemporary focus of research scholarship that bridges multiple fields of study, and one that has potential to significantly impact quality of life for elderly individuals, as well as for overall public health enhancement.
Resistance exercise is an effective modality for aging men and women, and may elicit significant improvements in muscular strength capacity. The current analysis is supportive of previous findings to suggest a positive association between intensity of resistance exercise and degree of strength improvement. As strength decline is highly related with subsequent functional deficit and disease comorbidity, it is conceivable that improvements in this parameter would help to maintain independence, health, and overall well-being. At present, approximately only 27% of the U.S. population engages in leisure time resistance exercise activity (CDC, 2009). Participation rates are dramatically less for individuals over the age of 50, and are likely to be as low as 10% of adults > 75 years (CDC, 2009). Evidence from the current investigation confirms the efficacy of higher intensity RE as a robust prevention or treatment strategy for age-related losses of muscle function, and thus, increased public health efforts to facilitate the provision of this health behavior are certainly warranted.
This research is supported by the NIH, NICHD, NCMRR Grant #5-T32-HD007422. The authors thank Dr. Brent Alvar and Dr. Pamela Swan for their support and feedback during the conception of this project. No financial disclosures were reported by the authors of this paper.
Disclosure of Funding: No financial disclosures are reported by the authors of this paper.
Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's Canada Institute for Scientific and Technical Information in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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I am trying to remove the last bullet/item from a bulleted list in Word with VBA.
It is possible to get the empty items with the following code, but I don't know how to delete this items:
For Each List In ActiveDocument.ListParagraphs
If Len(List.Range.Text = 2) Then
'Delete this list Item
End If
This is an example of the list:
- Item 1
- Item 2
- Item 3
I already tried to select the Item via Range.Text.Select, but that did not work.
Any suggestions are welcome, thank you in advance.
The problem is to delete the entire list item, including the list bullet.
list.Range.Delete does not work and it looks like that the macro is even crashing.
The message box appears only a single time, even if there are multiple occurrences in the Document, if I remove
list.Range.Delete the box appears a single time for every empty item.
Dim list As Paragraph
For Each list In ActiveDocument.ListParagraphs
MsgBox Len(list.Range.Text)
If Len(list.Range.Text) = 2 Then
MsgBox "DELETE"
End If


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Environmental Issues: Global Warming
Global Warming Main Page
All Documents in Global Warming Tagged Massachussetts v EPA
- Global Warming on Trial
NRDC and a coalition of states take the case for curbing global pollution to the Supreme Court.
- NRDC and a coalition of states took the case for curbing global pollution to the Supreme Court.
For additional policy documents, see the NRDC Document Bank.
For older publications available only in print, click here.
Get Updates and Alerts
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Watch the Video »
Our new video shows the effects of global warming in the world today.
NRDC Gets Top Ratings from the Charity Watchdogs
- Charity Navigator awards NRDC its 4-star top rating.
- Worth magazine named NRDC one of America's 100 best charities.
- NRDC meets the highest standards of the Wise Giving Alliance of the Better Business Bureau.
Switchboard Blogs
- How does China's climate pledge stack up?
- posted by Barbara Finamore, 7/1/15
- South Korea Announces Climate Target in Advance of Paris Climate Agreement
- posted by Jake Schmidt, 6/30/15
- New York State's Fracking Ban is Official
- posted by Kate Sinding, 6/29/15


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How Netflix Helps You Decide What to Watch
Two of the streaming service's engineers reveal how it makes recommendations and the extent to which a title's placement on the home page affects whether you'll check it out.
How does Netflix introduce you to movies and TV shows you might be interested in?
An interview with two of the company's engineers responsible for the streaming service's recommendation algorithms provides insight.
Netflix uses a more complicated system that user ratings to tell you what you might want to watch, Carlos Gomez-Uribe, vp product innovation and personalization algorithms, and engineering director Xavier Amatriain tell Wired.
PHOTOS: From 'Arrested Development' to 'House of Cards,' Exclusive Portraits of Netflix's Stars
With instant streaming, as opposed to Netflix's DVD-by-mail service, subscribers don't provide as many recommendations, Amatriain explains, because if they don't like something, they'll just stop watching.
Netflix knows what you watched, searched for, rated and even scrolled past, and they know when and where, including on which device, you saw it. That data is factored into several algorithms to determine what you might want to see next, the engineers explain.
However, Netflix is still working on providing recommendations based on context (the time of day, day of the week, device you're using and location).
They also still recommend two- and three-star movies, knowing that people don't always want to watch artistic masterpieces.
STORY: Netflix Not Cannibalizing Traditional TV Viewing (Study)
"People rate movies like Schindler's List high, as opposed to one of the silly comedies I watch, like Hot Tub Time Machine," Gomez-Uribe says. "If you give users recommendations that are all four- or five-star videos, that doesn't mean they'll actually want to watch that video on a Wednesday night after a long day at work. Viewing behavior is the most important data we have."
Gomez-Uribe also revealed that the closer to the first spot on a row a title is, and the higher up on the page it is, the more likely it is people will watch it.
Never miss a story. Stay up-to-date with THR's Daily Headlines.
Must Reads
Hollywood Insiders Descend on Havana
CBS Entertainment Chief and "Loudmouthed Feminist" Nina Tassler Reveals the Strategy Behind 'Supergirl' Gamble
Paul Rudd and Marvel's Kevin Feige Reveal 'Ant-Man's' Saga, from Director Shuffle to Screenplay Surgery to Studio's "Phase Three" Plans
Comic-Con 2015: THR's Full Guide to Parties in San Diego
HBO's Real-Life Game of Thrones: The Fight to Stay Rich, on Top and Score Bill Simmons
Taraji P. Henson, Viola Davis and Drama Actress A-List Tackle Race, Sexism, Aging in Hollywood
Lena Dunham, Amy Schumer and Comedy Actress A-List in Raunchy, R-Rated Roundtable
Bob Odenkirk, David Oyelowo and Drama Actor A-List on Oscar Snubs, Bad Scripts and Getting Ignored by Robert Redford


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July 4, 2015 by Jacob Camenker
The NFL All-Pro Team is often one of the more intriguing honors that players are awarded each year, and you won't believe who may be on the team this year. Read More
July 4, 2015 by Mike Carlson
With the addition of a few new pieces this offseason, as well as a several breakout stars on the horizon, Denver Broncos fans have a lot to be excited about going into the 2015 NFL season. Read More
July 4, 2015 by Evan Massey
The Green Bay Packers are expected to be a legitimate Super Bowl contender during the 2015 season. Which five players are dark horse candidates to make the Packers' 53-man roster? Read More
July 2, 2015 by Cameron DaSilva
The Dallas Cowboys have a few sleepers to make the 53-man roster, specifically on offense. Read More
July 2, 2015 by Matt Turner
There's a lot to be excited about regarding the New York Giants as they look to rebound from their awful 2014 season. Here are the top 10 reasons why fans should be pumped. Read More
July 2, 2015 by Brian Kalchik
We know who the top 10 players are on the top 100 players of 2015 list, but where should each of them be ranked? Read More
Before heading into the 2015 season, here are five positive takeaways for the Houston Texans from 2014. Read More
Aside from J.J. Watt, who are the most irreplaceable players on the Houston Texans? Read More
July 2, 2015 by Chad Troyan
As the 2015 NFL season draws near, some big-name rookies may need to get used to the sidelines. Here are 15 rookies who will ride the bench in 2015. Read More
July 1, 2015 by Alex Alarcon
The St. Louis Rams are hoping to fill some crucial roles in training camp. However some players are going to have to battle to win their position. Read More
July 1, 2015 by James Forsythe
Here are 10 San Francisco 49ers whose stock is rising or falling as they head into 2015 training camp. Read More
July 1, 2015 by Evan Massey
As the 2015 NFL season continues to draw closer, there are 10 reasons why Green Bay Packers fans should be excited. Read More
June 7, 2015 by Brad Berreman
Philadelphia Eagles OG Evan Mathis looks likely to be traded. Here are five teams that should have interest in him. Read More
May 24, 2015 by Jesus Flores
Here are five rumors surrounding the Dallas Cowboys that you might want to pay attention to during the 2015 OTAs Read More
May 21, 2015 by Kelly Anderson
Here is a quick look at who will win and who will lose certain position battles as the start of training camp quickly approaches for the Dallas Cowboys. Read More
April 29, 2015 by Nick Sardina
The most intriguing story in the 2015 NFL Draft surrounds quarterback Marcus Mariota. Find out if the Tennessee Titans take him at No. 2, or if a team will trade up to land the Oregon star. Read More
April 28, 2015 by Jason Fletcher
The New York Jets are fielding calls for Muhammad Wilkerson. These five teams could have the most interest. Read More
April 27, 2015 by Bryan Zarpentine
Rumors are swirling about the Philadelphia Eagles in the days leading up to the 2015 NFL Draft. Read More
April 25, 2015 by Chris Ross
There are plenty of rumors surrounding the New Orleans Saints as the 2015 NFL Draft comes closer. Here are the five Saints draft rumors you need to know. Read More
With the draft right around the corner, all sorts of rumors are flying about teams in the NFL. Here are five Buffalo Bills rumors you need to know. Read More
April 25, 2015 by Bryan Zarpentine
There are endless rumors circulating about the Cleveland Browns less than a week before the 2015 NFL Draft. Read More
April 23, 2015 by Bryan Zarpentine
Here are five last-minute rumors involving the Denver Broncos heading into the 2015 NFL Draft. Read More
April 22, 2015 by Shawn Spencer
There are so many false NFL Draft rumors out there right now, including many started by NFL teams. However, these 10 actually make a lot of sense. Read More
April 22, 2015 by Bryan Zarpentine
These five teams may use their first-round pick in the 2015 NFL Draft on offensive lineman Brandon Scherff. Read More


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The Shortlist
The Shortlist for Aug. 24
Tom Cruise To Pay Katie Holmes $400,000 a Year in Child Support
That's a lot of kid-sized high heels. The details of Tom Cruise and Katie Holmes' divorce settlement were leaked to TMZ this week, and it looks like Tom will be funneling a whole lot of cash for the care of the former couple's 6-year-old daughter, Suri. The actor's alimony payments will reportedly be $400,000 a year. He'll also cover medical and dental bills, insurance, education costs and more until Suri turns 18. Though it sounds like a pile of cash, Tom actually dodged a bullet by not having to give Katie a lump sum payout, according to TMZ. "Tom is very happy and relieved that he is moving forward," an insider tells E!. "His priority is being a good father and this settlement will make sure that continues." (ContactMusic)
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Westminster Jobs
Looking for jobs in Westminster? Snagajob has great opportunities with the area's leading companies. And applying for Westminster jobs has never been easier. Look at the job listings below, click on a job title that interests you and hit the "apply now" button. Part-time jobs, teen jobs, student jobs and summer jobs are now just a click away. Start your job search now.
Westminster, CO Job Openings
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Narrow your search
The Mars Curiosity rover is trying a new, easygoing drilling technique, and early results indicate acidic water conditions way back in the planet's history.
Forget water wings. The Kingii flotation device hangs out on your wrist, waiting to save you when you go under the water and need a lift back to the surface.
Fed up with wobbly beach umbrellas that take flight at the slightest breeze? The DrillBeach might be just the thing for you.
Lunar Mission One wants to bury a time capsule deep below the surface of the bottom of the moon, and it's asking the public to foot the bill. So far, humanity seems willing to chip in.
The Rosetta mission's successful comet landing turns bittersweet as the Philae lander ekes out as much science as possible before losing power and slipping into sleep.
Averse to Lego's partnership with Shell, the environmental group posts a slick flick online that will make children's stomachs feel queasy.
Take a peek at the possible future of flight on Mars with the Prandtl-m, a prototype aircraft scheduled for testing on Earth.
As Greece teeters on the edge of default, an Indiegogo campaign to crowdfund a bailout is starting to look like more than just an online stunt.
Wait. Actually, we have no idea who Tom Holland is. But we're going to find out a little more about him on today's show, and discuss whether we think he can carry Spidey into a new movie trilogy.
Can enormous heat deep in the earth be harnessed to provide energy for us on the surface?


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Pat Carlson (Patricia Arlone Krinhop) will celebrate her 80th birthday on March 17 with a dinner in Abilene with family and close friends. Pat was born on March 17, 1933. She had been married to her husband Duane for 52 years. The couple has two sons, Mark and wife Laurie and Mike and wife Susan; and four granddaughters, Shanna, Alexandra, Nicole and Jordan.
Wilma Fraser of Larned will celebrate her 100th birthday with a reception from 2 to 5 p.m. on March 9 at Glory Be, 7th and Broadway, in Larned. Hosts for the event will be her daughters, Janet Spomer and Judy Flamer. Friends, relatives, former students and community members are invited to attend.
Connie Peacock will celebrate her 90th birthday with a party for friends and relatives from 2 to 4 p.m. on Feb. 17 at River Bend Assisted Living Facility, 3820 Broadway, Great Bend. Hosts for the event will be her children, Claudia of Carmel Valley, Calif., Robert of Salt Lake City, Utah, and Sheldon of Great Bend.
Harold Schenk of Great Bend will celebrate his 95th birthday with a reception from 2 to 4 p.m. on Feb. 17 at the Senior enter, 2005 Kansas Ave. in Great Bend. Hosts for the even will be his wife, Jean Schenk and daughters Rhonda Schenk Pitts of Stockton and Roxanne Schenk Rich of Great Bend. No gifts are requested.
Wilbur Bell will celebrate his 90th birthday on Feb. 15 with his daughters, Connie Kerns and husband Kenneth L., of Great Bend and Jana Lilly and husband Henry of Wichita, and his grandchildren and great-grandchildren.
Doris Kisner will celebrate her 95th birthday on Jan. 30 with a card shower.
Les Stewart will celebrate his 80th birthday on Jan. 31 with his family, wife Mary Lou; daughters, Lisa Richardson, Mona Schaffer, Julie Lipari and Cindy Damm and their families, seven granddaughters and one grandson.
Frances Urban will celebrate her 90th birthday on Jan. 30 with family.
Tina Weber will celebrate her 80th birthday on Feb. 2 with a card shower.
Lucinda "Cindy" Rugan celebrated her 70th birthday on Jan. 19 with a card shower.
Kenneth H. (Bud) Pekarek will celebrate his 90th birthday with a reception from 1 to 6 p.m. on Jan. 19 at the Great Bend Best Western Angus Inn Courtyard. Friends and relatives are invited.
Eugene Hallett will celebrate his 80th birthday on Jan. 6.
Isabelle A. Befort will celebrate her 95th birthday on Jan. 8 with a card shower. Born in 1918 and raised on a farm near
Margie Cooper (Granny) will celebrate her 85th birthday on Dec. 20 with a card shower. Cards may be sent to her at 20 Dellwood Ln. Canyon TX 79015.
Page 11 of 22
Norma Gatterman will celebrate her 90th birthday on July 6, with a card shower.
Elma Laughlin Lepej will celebrate her 99th birthday on June 30, with a card shower. Elma and her twin brother, Elmer Laughlin, were born on June 30, 1916, on a farm near Alexander. They attended school in LaCrosse. On April 17, 1943, she married Joe Lepej. Elma has been a resident of Great Bend since 1965. She has two daughters, Patti Smith and husband George of Great Bend and Jo Kay Lepej of Topeka;
Bernie Schneider Linenberger will celebrate her 90th birthday in June with a card shower.
Dale Burroughs of Ellinwood will celebrate his 80th birthday with an Open House from 2 to 4 p.m. on June 27, at the upstairs room of The Lone Wolf Restaurant, 108 East 1st Street, in Ellinwood. The event will be hosted by his children and their spouses David and Pam Burroughs of Wichita and Dana and Jerry Pfanenstiel of Scott City. He has five grandchildren and nine great-grandchildren.
Alfred "Al" Steinert will celebrate his 90th birthday on June 20, with a card shower.
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You will enjoy:
Massage for each stage of pregnancy, connecting mother and baby through the power of touch. Performed on the unique Elemis beanbag for safety, comfort and relaxation. This inspirational therapy relieves back tension, swollen hands and feet. It also eases the mind and lifts the spirit. Recommended: 1 treatment every 2-3 weeks.
Hotel Spa
Online bookings let you pick date/time for your visit.
If you purchase an eVoucher you will need to book with the venue directly.
Our old Wahanda Gift Vouchers can still be redeemed at over 3,000 locations. Use them to pay as you would with cash. Please note, the Wahanda Gift Voucher's successor – the Wahanda Gift Card – can only be used for online purchases.


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On Sunday 10 June the Guardian streamed Janácek's Cunning Little Vixen direct from Glyndebourne. Did you miss it live? You can watch a video of the stunning and detailed new production here until 22 June.
"These days having a mobile presence is a must, and InstantEncore delivers powerful apps that are incredibly easy to manage."


text: CVU131 - The Felix Culpa by DYNASTY PODCASTS published on 2011/12/09 00:35:52 +0000 This week on the ChicagoVerseUniteD audio podcast: Marky Hladish, Tristan Hammond, Joel Coan, and Dustin Currier of The Felix Culpa! In an interview recorded at the group's practice space, the members of The Felix Culpa open up about why their performance this Friday, December 9th at Metro is the band's final show. The group also reflects on the highlights of their career, the challenges facing artists today, and whether additional Felix Culpa music will ever surface. Comment by Alejandro Rioja great sounds, go and check me also! 2011/12/09 00:58:00 +0000


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Click here to visit Northeast Georgia Marketplace, which includes classifieds from Dawson Community News, The Times of Gainesville and other regional papers.
Click here to place your ad for Dawson Community News with our sister paper, The Times, or call 770-535-1199 to speak with a representative..
The Class AA No. 7 ranked Dawson County Lady Tigers soccer team had a grand weekend playing in the Tournament of Champions in Jekyll Island.
Coach Jed Lacey's team went 2-1 and defeated Richmond Academy, 4-0, Cedar Shoals, 4-0, before losing the last game to a very skillful team in Strong Rock Christian Academy, 2-0.
The Dawson County High School girls' golf team picked up two big wins last week on the links.
The Lady Tigers defeated Jackson County, 100-106, on March 12 at Chestatee Golf Club and Pickens County, 95-121, on March 15 at Crystal Falls Golf Club.
The Dawson County boys soccer team traveled to Jekyll Island last weekend to play in the Tournament of Champions event.
The Tigers came away with a 2-1 record after beating Lee County, 2-0 and Coffee County, 2-0, before losing the last game on Saturday to Houston, Tenn., by a 1-0 score.
Coach Van Samples' Dawson County boys' golf team had a rough week.
The Tigers lost two matches. One to Jackson County, 198-169, on March 12 and the second at the hands of Pickens County, 189-180, on March 15.
The Dawson County High School Tigers varsity baseball team dropped an 8-4 decision to visiting Union County last Tuesday.
Dawson bounced back on Thursday to sweep a doubleheader from the Panthers in Blairsville, 8-2 and 5-4.
The Lady Tigers picked up a sixth place finish at the East Jackson Eagle Invitational March 3.
The team racked up 27.6 points.
The Dawson County High School girls tennis team defeated East Hall, 3-2, in a Region 8-AA match last Thursday in Dawsonville.
Due to the length of the match it had to be moved to Rock Creek Park to finish. The tennis courts at the high school are not equipped with lights.
Dawson County escaped with an exciting 2-1 win over Fannin County at home last week. The win for the Class AA No. 9-ranked Lady Tigers was big and gave the team an upper hand in region play.
The team's ranking is the first in school history for the girls' soccer program.
The Dawson County High School boys track team participated at The Eagle Invitational hosted by East Jackson Comprehensive High School on March 3.
Ten teams competed in the event, with the Tigers accumulating 20 points.
In the first Region 8-AA match of the season, the Dawson County boy's soccer team demolished Fannin County 8-0 last Tuesday at Tigers Stadium.
Dawson County jumped out to a huge 3-0 lead before halftime with goals by Josh Lund, Sam Wentworth and freshman Brandon Lund.
The Dawson County High School varsity baseball team defeated visiting Habersham Central 3-0 last week.
Jeffrey Partington started on the mound and pitched five great innings during the March 8 game.
The Dawson County High School Varsity basketball team's historic season will be celebrated locally next week.
The Dawsonville City Council plans to honor the team with a dinner at the Ga. Racing Hall of Fame at 5:30 Tuesday.
The Dawson County High School boys tennis team defeated Gilmer County, 3-2, in its first match of the season last week in Dawsonville.
Winning Feb. 27 singles matches were Spencer Roper, Luke Branson and Riley Westbrook in convincing fashion.
The Dawson County junior varsity baseball team defeated Pickens County 2-1 last week to pick up its first win of the season.
Dawson was able to hold on to the Feb. 28 win with good pitching and solid defense.
Head coach Jed Lacey's varsity girls soccer team is red hot.
The Lady Tigers trounced Lumpkin County, 7-0, last Tuesday at Tigers Stadium. The team is also state ranked, at No. 9 in Class AA, for the first time in program history.
Page 41 of 80
Dawson County High School Lady Tiger senior golfer Madison Caldwell claimed the Class AAA state championship as the low medalist Monday at Horseshoe Bend Country Club in Roswell.
The Dawson County boys track team ran at the Class AAA track meet last week at Memorial Stadium in Jefferson.
Student athletes and coaches are celebrating Dawson County High's latest victory after the school was awarded the Region 7-AAA All-Sports Trophy last week.
Another Dawson County High School senior has received a scholarship for his athletic prowess.
The Dawson County High School Lady Tigers' track team competed at the Girls State Class AAA Championship last week in Albany. The event is run at Hugh Mills Stadium.
The Dawson County High School varsity Lady Tigers' soccer team's season came to an end at The Westminster School Friday night in an Elite Eight game.
Dawsonville's Chase Elliott is hoping to have the fifth Hendrick Motorsports car competing in the Sprint All-Star race next weekend.
Dawson County High School junior golfer Madison Caldwell was selected Most Valuable Player for Region 7-AAA.
The Dawson County High School varsity Tiger soccer team traveled about 1,000-miles last week on the team's quest for a state championship.
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Feature length animated motion picture brimming with action and adventure!
weebl and bob
It's the everyday happenings of weebl and sometimes weebl's friend bob!
Hardcore bunny killing action.
It's a different idea for the series, but still good.
nice game
i had the swine flu last year and this kinda makes me feel good trying to cure it
Addictive and Intelligent
Brilliant, Just like the rest of the series. I love the entire Pandemic Series and this and Pandemic 2 are incredible. I like the idea of having to be the government rather then the disease, and the amount of control you have is brilliant. 10/10
The best Flash RTS game... and Creator.
I am always amazed at the consistent amount of research that has been pumped into each and every one of your games (at least the ones I know of). All the games I have played by you have been directly associated with global disease, but the accuracy of your information, again, is staggering. However, even more amazing is the clever setup of playing the games; it seems complex to the average new player, but in short order the player adapts and quickly overcomes their hesitance of the array of controls and tabs.
My favorite game by you used to be Pandemic II. Now it is this; not only have you incorporated true elements of the H1N1 influenza, but it involves politics, hospitals, economy, and above all, media and overall panic. This deserves more than a 10/10, but it is all they will allow. So a 10/10, and a 5/5 for the next three weeks.
Realistic Media
Leave it up to the media to collapse the infrastructure of America... You know what, I hope that the panic they caused comes around full circle and kills every one of the rating-loving bastards...


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Rally for Super Bowl champ Ray Rice in New Rochelle
Ray Rice, the Baltimore Ravens running back who helped take the team to the Super Bowl and win in February, was congratulated and applauded in his hometown of New Rochelle on Saturday. Hundreds of fans turned out to hear the former New Rochelle High School player speak. (March 2, 2013) Videojournalist: Xavier Mascareñ
Vinny the Dentist, Long Island's 80-year-old boxer Reebok unveils UFC Fight Kit Meet 'The Matz' sandwich Police investigate homicide in Central Islip Chris Christie: "Telling It Like It Is" Willy Wonka-themed prom at Vandermeulen High School Jones Beach bandshell hosts Latin music and dance lessons Midsummer Night celebration in Old Westbury State BBQ competition comes to North Fork Cops: Motorcyclist killed in crash on Sunrise Highway 8 ducklings rescued from storm drain Long Island bodybuilders celebrate their fitness


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Olympic fashion photo-packed story about Olympic metals: Going for Gold, Silver Lining, Bronze Beauty Monday July 16, 2012 in studio. Photos are for both SA Life and Houston Chronicle features section.
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Professional PHP Developer and Web Scraper
Turkey - Last active: 17 days ago - Tests: 8 - Portfolio: 33
Top-notch web scraping expert using PHP/cURL, having scraped hundreds of sites with billions records. Always deliver perfect quality with quick turnaround. Craigslist, Yipit, Crunchbase, Twitter and Instagram are just a few examples. My major expertise is web crawling / data minning, I am also interesting in solving complex challenges, difficult problem solving, and learning to enhance my programming skills with PHP programming language. I prefer to work for short-time but difficult projects. So I can give my experiences to the task effective. I have a degree in Computer System & Engineering and have 15 years experience coding. I have been working in the hosting industry (Hostgator, GoDaddy, Bluehost) for more than 10 years and highly experienced using hosting software such as WHM / CPanel / Plesk / Virtuozzo / Webmin / Virtualmin. (Installation and Management) Technical background; I began programming on C64s with QBasic language in the 1990s. Following graduation, I developed various programs with Borland Delphi for computing hardware faculty from 2000s, and I am still programming for the automotive industry (OBD/OBD2). I professionally created various web development projects with PHP and Perl languages since 2002. I began working with FreeBSD in 2002 and Linux in 2004 and I have been working as an hostadmin for various servers like Debian and Ubuntu operating systems since 2005. I have founded to BACOMputer, which my first company on 2005, and I am still working as a project manager for my own company. I began working with clients through oDesk since 2009, and I have successfully completed many contracts between 2010 - 2015. The subjects of my recently works; ° Web scrapping / mail scrapping with PHP/cURL. My PHP codes also can be run as standalone programs on the linux shell and/or with crontab. ° PHP-MySQL works / Admin Panels. ° Delphi or PHP based text file conversion programs. ° Hosting services and transfers. ° OpenVPN authentication systems (PAM / Google Authenticator / MySQL / LDAP / Radius) ° Creating Wordpress plugins and themes. HTML to Wordpress. * OPEN-WRT Linux distributions. ° Malware code cleaning on the sites and servers. (I have developed my own tools for finding malicious codes and infected files as quickly and efficiently) ° Decompiling/Tracing Flash applications/games. ° Radio, Audio stream program installations and configurations. Shoutcast, Icecast and Flashcast solutions. ° Software installation on Linux. Ftp servers, Apache, Nginx, PHP and MySQL installations/configurations. ° jQuery and resolving jQuery issues and conflicts. ° JWplayer, Flowplayer video player installations and delayed messages/auto redirecting projects ° Lightbox, Greybox, Laytbox and other jQuery (auto) popup/popunder solutions. Locked pages with javascript alerts. ° .htaccess works (Mass redirections, SEO based links, permalinks)
- Web scraping
- Data scraping
- WordPress
- twitter bootstrap
- MySQL Administration
- jQuery
- JavaScript
- Delphi
- Linux System Administration
- CPanel
- SHOUTcast
- IRC Server Administration
Brainbench certified JSE/JEE dev, DB dev, Sys-Arch
Ukraine - Last active: 7 days ago - Tests: 2 - Portfolio: 11
Would you like to find a powerful Java-dev? If so, please read further... 1. Intentions I'm working as a free-lancer more than 2 years already, and worked > 12 years in scientific and software engineering areas. I'm here because I'm looking worldwide for interesting work related to software development using the following technologies (some or all): - Java 5/6/7 (JSE, Swing, CORBA, Web Services, etc.) - JEE5/6 (EJB3, JSF, Hibernate, etc.) - GWT, Spring, Struts, etc. - And other JSE/JEE-related frameworks - GlassFish, Tomcat, JBoss, Jetty, etc. - JME (CLDC 1.1, MIDP 2.0) and Android - Maven, Ant, etc. - Oracle, MySQL, PostgreSQL and other DBMS - Some sub-tasks could be related to C/C++ with STL (but NOT the whole project!) - UML and/or Agile Modeling - Well-organized Agile processes - Etc. It would be nice to be involved into software concepts and architecture development. Also it would be nice to have possibilities for applying my initiative and creativity. I'm ready to work as a free-lancer for the beginning up to 40+ hours per week), and you may hire me as a full-time employee as well. I'm ready to move mostly to any country or city. In such case I'm ready to start as a developer (or senior developer), but with possibility to grow up to TL, and further up to SA or PM (of course, starting from TL or SA would be nice). 2. Education - University Master Degree in the area of Informatics and Computer Systems 3. General Skills I have a wide working and scientific experience with dozens of technologies (> 14 years). The most deep experience I have with the following techs: - JSE5/6 and J2SE (Java Core, Multithreading, AWT, Java2D, Swing, CORBA, WebServices, Networking, etc.) - since 1998 - JEE5 (EJB3, Hibernate3, JSF, CometD, Jetty, Tomcat, JBoss, GlassFish) - about of 5 years - J2ME (CLDC 1.1, MIDP 2.0, WMA) - about a year - Other Java techs (Jakarta Commons, Log4J, Velocity, Maven, Ant, etc.) - many years - Android development (support about 0.5 years) - C/C++ and STL - since 1995 (STL from 2001) - Oracle 9i/10g, MySQL, PostgreSQL, InterBase - since 2000 - OOA/OOD/OOP and UML Modeling - since 1995 (UML from 2001) Large experience with the following platforms and tools: - Windows - since 1995 - Linux/UNIX - since 1997 - MS Office (incl. Visio and Project) and Star/OpenOffice - since 1997 - IntelliJ IDEA, NetBeans, Eclipse - since 2001 - C++Builder and Delphi - since 2000 - PL/SQL Developer - since 2005 - Enterprise Architect and other UML tools (Rational Rose, Poseidon, etc.) - since 2001 Git, SVN and CVS - since 2001 Management Skills - since 2004 (worked on TL and PM positions) Architect Skills - since 2000 (designing concepts, business models and architectures for quite complex scientific, B2C and B2B applications) Language Skills: - Russian - native - English - fluent, working language since 2001, ~1000 pages of docs written - German - intermediate (quite fluent, but non-perfect) - Ukrainian - can understand in 100%, cannot speak/write fluently 4. Contacts - You can contact me via oDesk. Usually online (GMT): - 10:00am - 5:00pm - 7:00pm - 10:00pm
- Comet
- JavaScript
- ArchiCAD
- MySQL Administration
- PostgreSQL Administration
- .NET Framework
- Pascal
- NetBeans
- Eclipse
- IntelliJ IDEA
- Apache Subversion (SVN)
- Git
- Apache Maven
- InterBase
- Delphi
- Linux System Administration
- Unix System Administration
- OpenOffice
- Standard Template Library (STL)
- GlassFish
- JBoss
- Log4j
- Richfaces
- Facelets
- JavaServer Faces (JSF)
- Hibernate
- Swing
- Java
Architect, Backend Engineer (Scala, Java, Hadoop)
Brazil - Last active: 10 days ago - Tests: 12 - Portfolio: 1
Over the past 15 years I've worked with projects ranging from Startups to Fortune 100s. From C++ to Scala, past assignments involved: - Protocol Design in C++/Delphi - Java API Publishing - Maven Plugin Development - Distributed Systems using RESTful backends - Scala / Akka Design - Jenkins Plugins Writing On a daily basis, I spend between Systems Architecture, Build Planning, for Hadoop and Restful Backends, specially under Amazon Web Services. Oh, I'm also a Cloudera Certified Administrator and Developer. Favorite platforms include Scala, Python and General Java. See my full profile for more descriptions and feel free to browse my github and bitbucket profiles at the addresses below: http://github.com/ingenieux http://bitbucket.org/aldrinleal Favourite customers involve pragmatic teams, with contant online presence, and direct involvement with the end customer, and a problem involving legacy and the next generation Feel free to discuss our next project - I'm always looking for the next challenge!
- Hadoop
- Java
- Amazon Web Services
- Spring Framework
- Apache Maven
- Hibernate
- Amazon EC2
- Amazon S3
- Amazon Relational Database Service
- Apache Camel
- Apache Hive
- Puppet Administration
- xml web services
- JUnit
- Cryptography
- twitter api
- API Development
- API Documentation
- NoSQL
- Test Driven Development
- OAuth
- Java Servlets Development
- Agile software developmennt
- Automated Testing
- Database testing
- Load testing
- Apache Thrift
- Mercurial
- Multithreaded Programming
- Software Debugging
- Reverse engineering
- Data Science
- "Extract, Transform and Load (ETL)"
- Web Crawling
- Google App Engine
- Google Apps
- Google App Engine API
- Google Apps API
BizTalk, EDI, XSLT, XSL, XML, CSV, C#
Hong Kong - Last active: 2 days ago - Tests: 1
I have worked in BizTalk over 6 years, and got BizTalk 2010 Certification on October 11,2011. It is really like a nice trip to work in BizTalk from differenct verion 2006, R2, 2009 and 2010. Glad to see that BizTalk being stronger and stronger. As a developer, I'm fluent in developing Schema, Mapping, Orchestration, Pipeline, Adapter. As an administrator, I'm experienced in the BizTalk maintainance, such as Performance Optimization, Access Control, Managing BizTalk Application, Backup and Restore BizTalk Server, Purge and Archive BizTalk database, Application deployment. ------------------------------------------------------------------------------------- Fluent in BizTalk 2006/2009/2010; Fluent in ANSI X12, EDIFACT, Rosettanet, XML, XSL, Schema; ---------------------------------------- Case Experience: 1. BizTalk integration with Dynamics AX 4.0, 2009, 2012. CRM, SAP, and all kinds of BizTalk development, administration; 2. Transform Excel to XML, CSV format; 3. Using xslt/xsl to transform XML to any format; 4. .NET, SQL Server development; You will find the right person from me in BizTalk, EDI, XSL, XML, Schema, C#.
Back-end and front-end dev and photographer
Ukraine - Last active: 2 days ago - Tests: 2 - Portfolio: 1
I specialize on Ruby on Rails and front-end development. In spite of the fact I have got a degree in International Journalism and Translation, I worked as QA and IT Sales for total of 3 years (from 2008) and then moved to web development from Jan, 2012. I have performed both back-end tasks (from basic CRUD to making simple APIs or server scripts) and front-end (building static websites from scratch or developing views with twitter-bootstrap). I believe the experience is formed with the quality of the projects, you have delivered, and not with the years of sitting in front of the laptop. Specialties: ruby 1.9.2+, Ruby on Rails 3.0+, linux and MacOS X environment, unix-shell, Git, SQL (SQLite, MySQL, PostrgeSQL), HTML, Haml, CSS, Sass, Less, twitter-bootstrap, javascript, jQuery Here is link to my github profile: https://github.com/amseledka I do photographs and various design tasks in my spare time, as well as help my friends with Russian-Ukrainian-English translations. My flickr profile: http://www.flickr.com/photos/37859578@N06/
Java, Web and Google Maps Engineer
United States - Last active: 1 month ago - Tests: 2 - Portfolio: 5
Experienced professional with 6 years of experience of Java/J2EE web projects. I have a good knowledge of Google products and APIs as well (Google Maps, KML/KMZ). I also have a strong testing background (JUnit, JMock, Cobertura, Concordion, Selenium, Webdriver...) and developed a couple of testing frameworks based on these technologies. Specialties include: Java, J2EE, JEE, KML, KMZ, Google, Maps API, Javascript, AJAX, XML, SAX, DOM, JAXB
- Java
- Google Maps API
- Selenium
- JUnit
- JavaScript
- MySQL Administration
- Google AdSense
- Google Docs
- Google Map Maker
- Digital Mapping
- jQuery
Groups: Application Developers Alliance
Responsive Front-End Web Developer (HTML5, CSS3, jQuery, PHP)
United States - Last active: 15 days ago - Tests: 7
Expert Web Developer, 15+yrs Marketing+Sales, 5+yrs REALTOR
United States - Last active: 18 days ago - Tests: 7 - Portfolio: 20
- Lead generation
- Internet Marketing
- Email Marketing
- Affiliate Marketing
- Real Estate IDX
- Web design
- Website Development
- ebook Writing
- psd to html
- WordPress
- eBook Design
- Photo Manipulation
- Content Management
- aWeber
- getresponse
- Adobe Photoshop
- Photo Editing
- Spreadsheets
- jQuery
- JavaScript
- MySQL Administration
- JQuery Mobile
- Adobe Dreamweaver
- Amazon S3
- Google search
- Humor Writing
- Content Writing
- Copywriting
- Video production
- Video editing
- Mind Mapping
- Facebook Marketing
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft OneNote
- Google AdWords
- AutoHotKey
- phpMyAdmin
- Marketing strategy
- Startup Consulting
- Brand Consulting
- Video Streaming
- Video Conversion
Groups: LoginRadius
Senior Salesforce Developer
Vietnam - Last active: 18 days ago - Tests: 4 - Portfolio: 3
I have two years experience as a salesforce developer and I have 8 years experience in software development . I have developed a wide range of products from Web to Desktop bases. I have also involved in project management process from initial state to end. My responsibility at work: _Creating and managing complex workflow rules,trigger, data validations, and object customizations _Create and maintain system interface diagrams, functional designs, and technical specifications _Developing integration processes using SF Web Services API, and other integration tools _Designing and creating client-specific solutions on the Force.com platform using Apex and VisualForce _Work closely with business partners to realize the full capabilities of Salesforce.com CRM.
Lifetime Internet Guru
United States - Last active: 4 days ago - Portfolio: 5
Well before the World Wide Web was a common phrase as it is today, before most people even owned a home computer I was programming code in a variety of languages for a variety of network related projects back when you had to put the handset of a telephone on a 300 baud modem. Trillions of lines of code under my belt and a mind that functions like a computer processing unit I not only understand today's most popular programming languages, I know how the languages themselves came to be. I am an expert who has owned, operated or worked with thousands of technology based businesses over the past 25 years. More than a programmer, I am a valuable consultant to any business wishing to build or improve any online enterprise. My work is relatively fast, accurate, functional and most importantly well constructed based on your exact needs. I do all of my own work but will bring in experts if necessary to accomplish the goals of your organization. I am an American living in Pennsylvania.
- WordPress
- Business Development
- Entrepreneurship
- Network Administration
- Google AdSense
- English
- Content Writing
- Java
- JavaScript
- jQuery
- Linux System Administration
- Perl
- twitter api
- Management Skills
- Business Analysis
- Analytics
- SQL Programming
- Social Media Marketing
- Internet Security
- Facebook Marketing
- Ecommerce Platform Development
- Computer Graphics
- Electrical engineering
- Virtual Assistant
- Application Programming
- Web design


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All hotels in Middletown, Rhode Island, United States of America
1 room, 2 adults
425 E Main Rd, Middletown, RI, 02842, United States of America, 0203 027 9779
Ramada Middletown, Newport
Lowest price£79
available on 05/07/2015
Best Price Guarantee
Family hotel in Middletown with restaurant, bar/lounge
- Free WiFi in lobby and free parking
Main amenities
- 131 guestrooms
- Restaurant and bar/lounge
- Breakfast available
- Fitness center
- 24-hour business center
- Area shuttle
- Air conditioning
- Garden
- Front desk safe
- ATM/banking services
- Laundry service
- Conference space
What's around
- Naval War College Museum (2.5 mi / 4.1 km)
- Touro Synagogue (2.8 mi / 4.5 km)
- Newport Vineyards (1 mi / 1.7 km)
- Whitehall Museum House (1.5 mi / 2.5 km)
- Newport Grand Slots (1.9 mi / 3 km)
A good hotel, helpful staff, large rooms, good breakfast. The shuttle down town was an…
The was a very strange smell in the reception of the hotel which carried on down the…
TripAdvisor Traveller Rating: 2.5
From 521 reviews
Enter dates to check prices
Hotel Info: 020 3027 9803from £79
- Standard Room, 1 Queen Bed
- Standard Room, 2 Queen Beds
- Double Room, 2 Double Beds, Accessible
- Standard Room
- Upgraded, Standard Room, 1 King Bed
- Suite, 1 King Bed, Non Smoking
- Double Room, 2 Double Beds
- Standard Room, 1 King Bed
- Executive Room, 1 King Bed, Non Smoking
Recommended hotels
At a glance
Key facts
Hotel size
- This hotel has 131 rooms
- This hotel is arranged over 3 floors
- Check-in time starts at 3 PM
- Check-out time is 11 AM
- Express check-in/out
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Pets not allowed
- Free WiFi in public areas
- Free extended parking
- Accessible parking
- Area shuttle *
Nearby Two Star Newport hotels
In the hotel
Food and drink
- Breakfast (surcharge)
- Restaurant
- Bar/lounge
- Coffee shop/café
- Room service (during limited hours)
Things to do
- Fitness facilities
Working away
- 24-hour business center
- Number of meeting rooms - 2
- Conference space
- Meeting rooms
- Dry cleaning/laundry service
- Free newspapers in lobby
- Wedding services
- ATM/banking
- Safe-deposit box at front desk
- Designated smoking areas
- Garden
- Disabled parking
- Accessible path of travel
- Braille or raised signage
- Accessibility equipment for the deaf
- Accessible bathroom
In the room
Home comforts
- Climate control
- Air conditioning
- Coffee/tea maker
- Iron/ironing board
Freshen up
- Hair dryer
Be entertained
- Flat-screen TV
- Premium TV channels
Stay connected
- Free local calls
Food and drink
- Refrigerator
- Microwave (on request)
Top Newport hotels
Recently reviewed hotels in Newport
- Marshall Slocum InnFrom
- Hyatt Regency NewportFrom
"Breakfast and restaurant service are excellent! Especially omelette and waffles..amazing! Rooms are really comfortable but a little bit noisy...we were at the ground floor and we…"Apr 10, 2015
- La Farge Perry HouseFrom
"This hotel should be kept secret as once you have stayed you will want to keep the experience to yourself. The relaxed and friendly welcome remained throughout our stay, allowing…"Jan 4, 2015
- Hampton Inn & Suites Providence DowntownFrom
"Great hotel. Nice and close to the centre, and also to the Dorrance (where we were attending our son's wedding!). Good sized room. Good breakfast."Dec 20, 2014
Nearby hotels
Special features
DiningPortofino Bar and Grille - This restaurant serves breakfast, lunch, and dinner. Guests can enjoy drinks at the bar. A children's menu is available.
Ramada Middletown, Newport's small print
Optional extras
Rollaway beds are available for USD 10 per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.


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Tory Burch Finally Got Around to Countersuing Chris Burch
No need to rush things.By Charlotte Cowles
No need to rush things.By Charlotte Cowles
Not that he really had one to begin with, but still.By Charlotte Cowles
Fashion's new favorite decade.By Veronica Misako Gledhill
Skip basic black for a color that's as timeless.By Diana Tsui
Loop, tie, and wrap them to transform your look.By Veronica Misako Gledhill
Okay, okay, it's actually pretty cool.By Charlotte Cowles
Did he break his Google glasses?By Alex Rees
Plus, the critic's thoughts on DKNY and Daisuke Obana.By Lynn Yaeger
Looks from Victoria Beckham, Derek Lam, and Thakoon. And Google glasses, of course!By Amy Larocca and Rebecca Ramsey
Basically, they're iPhones you can wear on your face.By Charlotte Cowles
He and his wife were at the designer's office today.By Charlotte Cowles
Plus, Kate Bosworth is "talking about doing" her own fashion line.
"Everyone here better be a Democrat."By Charlotte Cowles
Donna Karan, DVF, Siriano discuss first lady style.By Jamie Miles, Jenni Avins and Jennifer Vineyard
Celebrating the style of New York fashion's matriarch.
European princess embraces American warmonger.By Maureen O'Connor
Plus, let Naomi Campbell be your Russian tour guide.
A man by the name of Joel Horowitz.By Hilary Moss
"Happens all the time," says Clinton's chief of staff.By Kat Stoeffel
See them all in our comprehensive slideshow.By Ally Betker