text:
BEIRUT — Gunmen killed the brother of Syria's parliament speaker in a hail of bullets as he drove to work in Damascus on Tuesday, the state news agency said, as the international envoy for Syria warned the country could become another Somalia.
Mohammed Osama Laham, the brother of Parliament Speaker Jihad Laham, became the latest victim of a wave of assassinations targeting Syrian officials, army officers and other prominent supporters of President Bashar Assad's regime. Four of the leader's top security officials were killed in a rebel bombing on the state security headquarters in Damascus in July.
Mr. Laham was gunned down in the Damascus neighborhood of Midan, the SANA state news agency said. The killing came a day after some of the most intense fighting in Damascus in months as rebels wage a civil war to unseat Mr. Assad.
The government and activists said a series of explosions Tuesday evening rocked the northwestern edge of Damascus. At least 13 people were killed and 30 wounded, according to a government official who spoke on the condition of anonymity because he was not authorized to brief the media. SANA said the three blasts occurred in the al-Wuroud district near the town of Qudsaya, causing significant destruction.
Activists said the bombs were placed in a main square near housing for the country's elite troops from the Republican Guards, which is led by Mr. Assad's brother Maher and is charged with protecting the capital.
U.N.-Arab League envoy Lakhdar Brahimi, who, like his predecessor Kofi Annan has been unable to put an end to the 19-month-old civil war, called the events in Syria a "big catastrophe." In remarks published Tuesday in the pan-Arab daily Al Hayat, he said international efforts now are focused on getting a "binding resolution by the [U.N.] Security Council" to start a political process that will lead to change.
"I don't want to go too far in pessimism, but the situation in Syria is very dangerous. The Syrian people are suffering a lot," Mr. Brahimi said.
"I believe that if the crisis is not solved in a right way, there will be the danger of Somalization. It will mean the fall of the state, rise of warlords and militias."
The east African nation of Somalia has been mired in conflict for two decades after warlords overthrew a longtime dictator in 1991 and then turned on each other. The government, backed by African Union troops, is currently battling Islamist extremist rebels linked to al Qaeda.
If the Syrian regime collapses, the country could fast shatter along multiple fault lines, leading to a protracted and bloody conflict.
The predominantly Sunni country is a patchwork of religious and ethnic groups. The regime is led by Mr. Assad's Alawite minority, an offshoot of Shiite Islam, but there are also considerable Kurdish and Christian populations in the country.
The Britain-based Syrian Observatory for Human Rights said more than 100 people were killed in violence across Syria on Tuesday, including air raids on Houla, a group of villages in the central province of Homs, that killed seven people. The group also reported air raids on the Damascus suburbs of Douma, Kfar Batna and Maadamiyeh and the northern province of Idlib.
SANA said six regime supporters were killed when 11 mortar rounds fell near a pro-government demonstration Monday night in the northern city of Aleppo.


text: I spent one week with my sister for ski vacation. location is good, close to city center and all the restaurant, bars, etc. but it is not on the main street so it is very quiet. Breakfast was tasty, fresh and everyday they brought different kinds of food and we loved it. Room was cleaned everyday and from the window... More

subset: commoncrawl


text:
Page 1
Peripheral Arterial Disease
Women With Peripheral Arterial Disease
Experience Faster Functional Decline Than
Men With Peripheral Arterial Disease
Mary M. McDermott, MD,* Luigi Ferrucci, MD, PHD,† Kiang Liu, PHD,*
Jack M. Guralnik, MD, PHD,‡ Lu Tian, SCD,§ Melina Kibbe, MD,* Yihua Liao, MS,*
Huimin Tao, MS,* Michael H. Criqui, MD, MPH?
Chicago, Illinois; Baltimore and Bethesda, Maryland; and Palo Alto and La Jolla, California
We hypothesized that women with lower extremity peripheral arterial disease (PAD) would have greater mobility
loss and faster functional decline than men with PAD.
Whether rates of mobility loss or functional decline differ between men and women with PAD is currently
Three hundred eighty men and women with PAD completed the 6-min walk, were assessed for mobility disabil-
ity, and underwent measures of 4-m walking velocity at baseline and annually for up to 4 years. Computed
tomography-assessed calf muscle characteristics were measured biannually. Outcomes included becoming un-
able to walk for 6 min continuously among participants who walked continuously for 6 min at baseline. Mobility
loss was defined as becoming unable to walk for a quarter mile or to walk up and down 1 flight of stairs without
assistance among those without baseline mobility disability. Results were adjusted for age, race, body mass in-
dex, physical activity, the ankle brachial index, comorbidities, and other confounders.
At 4 years of follow-up, women were more likely to become unable to walk for 6 min continuously (hazard ratio:
2.30, 95% confidence interval: 1.30 to 4.06, p ? 0.004), more likely to develop mobility disability (hazard ratio:
1.79, 95% confidence interval: 1.30 to 3.03, p ? 0.030), and had faster declines in walking velocity (p ? 0.022)
and the distance achieved in the 6-min walk (p ? 0.041) compared with men. Sex differences in functional de-
cline were attenuated after additional adjustment for baseline sex differences in calf muscle area.
Women with PAD have faster functional decline and greater mobility loss than men with PAD. These sex differ-
ences may be attributable to smaller baseline calf muscle area among women with PAD.
2011;57:707–14) © 2011 by the American College of Cardiology Foundation
(J Am Coll Cardiol
Lower extremity peripheral arterial disease (PAD) affects 8
million men and women in the U.S. (1). Among older
individuals, the prevalence of PAD is similar to or even
slightly higher in women as compared with men (1–3). A
previous cross-sectional study demonstrated that women
with PAD have greater functional impairment and poorer
lower extremity strength than men with PAD (4). However,
little is known about sex differences in rates of functional
decline or changes in calf muscle characteristics over time
between men and women with PAD.
In this observational, longitudinal study, we compared rates
of mobility loss, decline in 6-min walk performance, and
decline in walking velocity between men and women with
PAD at 4 years of follow-up. We also compared baseline
measures of calf muscle characteristics and leg strength and
changes in these muscle outcomes between men and women
with PAD at 4 years of follow-up. We hypothesized that
women with PAD would have greater mobility loss, faster
functional decline, and more adverse changes in calf muscle
characteristics over time compared with men with PAD. We
further hypothesized that greater mobility loss and faster
functional decline among women with PAD as compared with
From the *Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
†National Institute on Aging, Baltimore, Maryland; ‡National Institute on Aging,
National Institutes of Health, Bethesda, Maryland; §Department of Health Policy
and Research, Stanford University, Palo Alto, California; and the ?Department of
Family and Preventive Medicine, University of California at San Diego, La Jolla,
California. Supported by grants R01-HL58099, R01-HL64739, R01-HL071223,
and R01-HL076298 from the National Heart Lung and Blood Institute and by grant
RR-00048 from the National Center for Research Resources, National Institutes of
Health. Supported in part by the Intramural Research Program, National Institute on
Aging, National Institutes of Health. The authors have reported that they have no
relationships to disclose. Healther L. Gornik, MD, served as Guest Editor for this
Manuscript received May 12, 2010; revised manuscript received September 7, 2010,
accepted September 10, 2010.
Journal of the American College of Cardiology
© 2011 by the American College of Cardiology Foundation
Published by Elsevier Inc.
Vol. 57, No. 6, 2011
Page 2
men with PAD is explained by
more adverse muscle characteris-
tics among women with PAD as
compared with men with PAD.
Study overview. The Institu-
tional Review Boards of North-
western University and Catholic
Health Partners Hospital ap-
proved the protocol. Participants gave written informed con-
sent. Participants were in the WALCS (Walking and Leg
Circulation Study) II cohort, a prospective, observational study
designed to identify mechanisms of functional decline in PAD
(5,6). Participants underwent baseline measures and returned
annually for follow-up for up to 4 follow-up visits. Data
collection took place between November 6, 2002, and October
16, 2009. Every effort was made to maximize follow-up by
scheduling follow-up visits before or after their due date, if a
participant was otherwise unable to return for follow-up
Participant identification. PAD participants were 59 years
of age and older and were identified from among consecu-
tive patients diagnosed with PAD in Chicago-area nonin-
vasive vascular laboratories (5,6). A small number of PAD
participants were identified from among consecutive pa-
tients in a large general internal medicine practice at
Northwestern with a low ankle brachial index (ABI) at their
study visit. PAD was defined as ABI ?0.90 (2,5,6). Ab-
sence of PAD was defined as ABI 0.90 or more and 1.30 or
less (5,6).
Participation rates and exclusion criteria for the WALCS II
cohort have been described and are summarized briefly here
(6). Patients with dementia were excluded because of their
inability to answer questions accurately. Nursing home
residents, wheelchair-bound patients, and patients with foot
or leg amputations were excluded because they had severely
impaired functioning at baseline. Non–English-speaking
patients were excluded because investigators were not fluent
in non-English languages. Patients with recent major sur-
gery were excluded.
ABI measurement. A hand-held Doppler probe (Nicolet
Vascular Pocket Dop II, Nicolet Biomedical, Inc., Golden,
Colorado) was used to obtain systolic pressures in the right
and left brachial, dorsalis pedis, and posterior tibial arteries
(5–7). Each pressure was measured twice. The ABI was
calculated by dividing the mean of the dorsalis pedis and
posterior tibial pressures in each leg by the mean of the 4
brachial pressures (7). Zero values for the dorsalis pedis and
posterior tibial pulses were set to missing for the ABI
calculation. Average brachial pressures in the arm with
highest pressure were used when 1 brachial pressure was
higher than the opposite brachial pressure in both measure-
ment sets and the 2 brachial pressures differed by 10 mm Hg
or more in at least 1 measurement set, because in such cases,
subclavian stenosis is possible (8). The lowest leg ABI was
used in analyses.
Functional outcomes. Functional outcomes were assessed
annually and consisted of mobility loss, becoming unable to
walk for 6 min continuously without stopping, decline in
6-min walk performance of 20% or more, and average
annual declines in 6-min walk performance, usual paced
4-m walking velocity, and fastest paced 4-m walking veloc-
ity (5,9).
6-min walk. Following a standardized protocol (9), partic-
ipants walk up and down a 100-foot hallway for 6 min after
instructions to cover as much distance as possible. The test
administrator recorded whether the participant stopped
during the 6-min walk. Participants who stopped at baseline
were excluded from analyses of becoming unable to com-
plete the 6-min walk without stopping.
4-m walking velocity. Walking velocity was measured
with a 4-m walk performed at usual and fastest pace, based
on a previous study (9,10). Each walk was performed twice.
The faster walk in each pair was used in analyses (9,10).
Mobility measures. At baseline and at each follow-up visit,
participants were asked to indicate whether they could walk
a quarter mile and whether they could climb up and down
1 flight of stairs: 1) on their own; 2) with assistance; or 3)
not at all (5,10). Mobility loss was defined as becoming
unable to walk up and down one flight of stairs or to walk
a quarter mile without assistance among those without
mobility limitations at baseline (5,10). Those unable to
return for follow-up were interviewed by telephone for the
mobility outcome measure.
Calf muscle characteristics. Calf muscle measurements
were assessed with computed tomography (CT) at baseline
and at the 2- and 4-year follow-up visits using a CT scanner
(LightSpeed, General Electric Medical Systems, Waukesha,
Wisconsin) (5,6). Cross-sectional images of the calves
measuring 2.5 mm were obtained at 66.7% of the distance
from the distal to the proximal tibia (6,7). Cross-sectional
images were analyzed using BonAlyse (BonAlyse Oy, Jyvas-
kyla, Finland), a software for processing CT images that
identifies muscle tissue, fat, and bone (11). The muscle
outline was traced manually, excluding subcutaneous fat and
bone. When quantifying muscle area, the BonAlyse soft-
ware quantifies voxels within a range corresponding to
muscle density (9 to 271 mg/cm3) and excludes voxels
corresponding to fat density (?270 to 8 mg/cm3). Intra-
muscular fat is quantified by summing voxels corresponding
to fat within muscle tissue. Cadaver studies demonstrate
that these methods provide an estimate of muscle cross-
sectional area that is highly correlated with direct anatomic
measures (12). Because larger individuals require greater
muscle mass to support their frame, muscle area was
adjusted for the square of individual tibia length (5). Muscle
density measures the quantity of muscle per volume within
the voxel range corresponding to muscle (9 to 271 mg/cm3)
and is a measure of muscle quality.
and Acronyms
ABI ? ankle brachial index
BMI ? body mass index
CT ? computed
PAD ? peripheral arterial
708McDermott et al.
Sex Differences in Peripheral Arterial Disease
JACC Vol. 57, No. 6, 2011
February 8, 2011:707–14
Page 3
Isometric strength measures. Knee extension strength was
measured at baseline and annually during follow-up using a
computer-linked strength chair with a transducer placed for
knee extension (Good Strength Chair, Metitur Oy, Jyvask-
lya, Finland) (13). Data were collected electronically by
computer over 6 s. Strength measurements using the Good
Strength Chair have high test–retest reliability (Pearson prod-
uct moment correlations: 0.88 to 0.96) (14). Two trials were
performed. Maximum strength was used in analyses (13).
Comorbidities. Comorbidities assessed at baseline were
diabetes, angina, myocardial infarction, heart failure, cancer,
chronic lung disease, lower extremity arthritis, spinal steno-
sis, spinal disk disease, and stroke (15). Disease-specific
algorithms that combine data from the patient report,
medical record review, medications, laboratory values, and a
questionnaire completed by the participant's primary care
physician were used to verify and document baseline comor-
bidities other than knee and hip arthritis, based on criteria
previously developed (15). American College of Rheuma-
tology criteria were used to document presence of knee and
hip osteoarthritis (16,17).
Other measures. Height and weight were measured at
baseline. Body mass index (BMI) was calculated as weight
in kilograms per height in square meters. Cigarette smoking
history was determined with the patient report. At baseline,
participants were asked to report the number of blocks they
walked during the previous week. At each follow-up visit,
we used the patient report, a primary care physician ques-
tionnaire, and medical record review to identify lower
extremity revascularizations since the prior visit.
Statistical analyses. Analyses of covariance was used to
compare baseline clinical characteristics between men and
women with PAD, adjusting for age. A priori, a p value
?0.05 was considered statistically significant. For the out-
comes of loss of the ability to walk continuously for 6 min
without stopping, mobility loss, and a 20% or more decline
in distance achieved in the 6-min walk test, Cox regression
analyses were used to compare rates of each functional
outcome between men and women with PAD, adjusting for
confounders. We used PROC PHREG to perform these
analyses and TIES equal to DISCRETE for the discrete
time point in years. For the outcome of mobility loss,
participants with mobility limitations at baseline were ex-
cluded. For the outcome of becoming unable to walk for 6
min continuously, participants unable to walk for 6 min
without stopping at baseline were excluded. Person-time
was calculated as the number of months from the baseline
visit to the date of the most recent visit (last seen) or the
date of the visit during which each functional outcome of
interest was first reported, whichever came first. Participants
who died before experiencing an outcome measure or who
underwent lower extremity revascularization during follow-up
were censored at the date of their last visit before these events.
In these analyses, model I adjusted for age, race, ABI, BMI,
smoking, comorbidities (diabetes, angina, myocardial infarc-
tion, heart failure, cancer, chronic lung disease, knee arthritis,
hip arthritis, spinal stenosis, disk disease, and stroke), and
physical activity. To determine whether sex differences in
baseline calf muscle characteristics or knee extension
strength may explain sex differences in functional decline,
model I was repeated with additional adjustment for base-
line measures of each calf characteristic, knee extension
strength, and baseline 6-min walk performance, respectively.
We tested the proportional hazards assumption for the 3
outcome measures using martingale residuals-based methods
(18). There were no significant deviations from the propor-
tional hazards assumption.
Changes in continuous outcome measures, including
functional performance (6-min walk distance and 4-m
walking velocity), knee extension strength, and calf muscle
characteristics were compared between men and women
with PAD using a longitudinal or repeated-measures anal-
ysis of covariance and a mixed model approach. PROC
MIXED in SAS software (SAS Institute, Inc., Cary, North
Carolina) was applied for this procedure. The within-
subject correlations were modeled with a subject-specific
random effect. The primary dependent variables for each
analysis were the successive annual differences in each
outcome of interest (i.e., the difference in 6-min walk
distance between baseline and the first follow-up visit,
between the first and second follow-up visit, between the
second and third follow-up visit, and so on). Sex differences
in decline for each continuous outcome were compared
using an analysis of covariance, adjusting for baseline age,
race, BMI, smoking, physical activity, comorbidities, and
the corresponding prior year performance or muscle char-
acteristic (model I). Analyses of average annual decline in
6-min walk performance or 4-m walking velocity were
repeated with additional adjustment for each baseline calf
muscle characteristic and baseline knee extension strength,
respectively, to determine whether sex differences in functional
decline could be explained by sex differences in baseline muscle
characteristics. Analyses were performed using SAS statistical
software (version 9.2, SAS Institute, Inc.).
Four-hundred fifty-five participants in the WALCS II
cohort had a baseline ABI of less than 0.90 and completed
baseline calf muscle measures or underwent measurement of
baseline knee extension strength. Of these, 70 (15%) did not
meet inclusion criteria for any functional outcomes and 5
(1%) did not have data for at least 1 covariate measure. Of
the 75 who did not meet inclusion criteria, 32 (42.7%) were
women. Mean follow-up was 47 months (range 8 to 81
The mean age ? SD of the women was 76.0 ? 8.1 years,
and that of men was 74.2 ? 7.7 years (p ? 0.024). Table 1
shows baseline characteristics of men and women with
PAD, adjusting for age. Women with PAD included higher
prevalences of African Americans, those with knee arthritis,
JACC Vol. 57, No. 6, 2011
February 8, 2011:707–14
McDermott et al.
Sex Differences in Peripheral Arterial Disease
Page 4
and those with disc disease and lower prevalences of angina
compared with men with PAD (Table 1). Adjusting for age,
women walked fewer blocks per week and had poorer 6-min
walk performance, smaller calf muscle area, lower calf
muscle density, and poorer knee extension strength com-
pared with men (Table 1).
Table 2 compares rates of functional decline and changes
in muscle characteristics between men and women with
Age-Adjusted Baseline Characteristics of Men Versus WomenWith Peripheral Arterial Disease (n ? 380)
Table 1
With Peripheral Arterial Disease (n ? 380)
Age-Adjusted Baseline Characteristics of Men Versus Women
Baseline Characteristics
(n ? 180)
(n ? 200) p Value
African American (%)24.78.8
Ankle brachial index
Body mass index (kg/m2)
0.62 (0.01) 0.64 (0.01)0.152
27.9 (0.4) 28.3 (0.4)0.392
Current cigarette smoker (%)15.3 13.0 0.522
Cancer (%)21.6 15.60.136
Diabetes mellitus (%)29.2 33.4 0.385
Pulmonary disease (%)45.4 38.1 0.155
Angina pectoris (%)26.6 40.6 0.005
Myocardial infarction (%)23.728.60.284
Stroke (%)20.220.1 0.980
Heart failure (%)23.9 32.5 0.067
Hip arthritis (%)4.9 3.00.352
Knee arthritis (%)16.89.6 0.040
Disc disease (%)46.9 35.3 0.023
Spinal stenosis (%)18.212.1 0.099
No. of blocks walked during the past week18.4 (4.1) 39.2 (3.9)
6-min walk at baseline (ft)1,014.0 (27.9)1,222.9 (26.3)
Usual speed 4-m walking velocity (m/s)0.81 (0.01)0.91 (0.01)
Fastest speed 4-m walking velocity (m/s)
Muscle area (mm2)
1.07 (0.02)1.24 (0.02)
4676.1 (86.8)6113.0 (82.8)
Muscle percent fat (%)
Muscle density (g/cm2)
12.4 (1.0)10.9 (1.0) 0.279
32.1 (0.3)32.9 (0.3)0.042
Knee extension strength (Newtons)211.7 (7.7)321.0 (6.8)
The values in parentheses represent standard errors.
Adjusted Associations of Sex With Decline in Functional Performance and Changesin Lower Extremity Muscle Among Peripheral Arterial Disease Participants (n ? 380)
Table 2
in Lower Extremity Muscle Among Peripheral Arterial Disease Participants (n ? 380)
Adjusted Associations of Sex With Decline in Functional Performance and Changes
Women (n ? 180)Men (n ? 200)
Hazard Ratio
(95% Confidence Interval)n
Hazard Ratio or Average
Annual Change
(95% Confidence Interval)p Value
p value categorical outcomes for functional
Becoming unable to walk for 6 min
continuously during follow-up
108 2.30 (1.30 to 4.06)139 1.00 0.004
Mobility loss142 1.79 (1.06 to 3.03)186 1.00 0.030
?20% decline in 6-min walk performance
during follow-up
168 1.49 (0.99 to 2.26) 1851.00 0.058
Average annual decline in functional performance
6-min walk performance (ft/yr) 159–57.27 (–75.52 to –42.02)181 –34.25 (48.23 to –20.27)0.041
Usual paced 4-m walking velocity (m/s/yr)167 –0.036 (–0.044 to –0.028)186 –0.022 (–0.030 to –0.015)0.022
Fast-paced 4-m walking velocity (m/s/yr)164–0.043 (–0.053 to –0.033) 185–0.031 (–0.041 to –0.022)0.120
Average annual change in muscle outcomes
Calf muscle area (mm2/yr) 134 –220.1 (–292.8 to –147.5) 166–358.5 (–421.7 to –295.4) 0.015
Calf muscle percent fat (%/yr)
Calf muscle density (g/cm3/yr)
1340.80 (0.33 to 1.28) 1661.80 (1.38 to 2.22)0.003
134–0.74 (–0.99 to –0.49)166 –0.75 (–0.97 to –0.53)0.949
Knee extension isometric strength (Newtons/yr)164 –2.89 (–6.37 to –0.92) 186–10.2 (–13.2 to –7.1) 0.003
Analyses adjust for age, race, body mass index, comorbidities, physical activity, smoking, and ankle brachial index. Analyses of changes in 6-min walk distance, 4-m walking velocity, and muscle
characteristics additionally adjusted for prior year performance or the relevant calf muscle characteristic.
710McDermott et al.
Sex Differences in Peripheral Arterial Disease
JACC Vol. 57, No. 6, 2011
February 8, 2011:707–14
Page 5
PAD. Compared with men, women were more likely to
become unable to walk for 6 min continuously, had greater
mobility loss, and had greater average annual declines in
6-min walk distance and usual-paced 4-m walking velocity,
adjusting for age, race, BMI, comorbidities, physical activ-
ity, smoking, prior year performance (6-min walk and
walking velocity outcomes only), and ABI (Table 2).
Compared with men, women had less annual decline in
calf muscle area, less increase in calf muscle percent fat, and
less decline in knee extension isometric strength adjusting
for age, race, BMI, comorbidities, physical activity, smok-
ing, prior year calf muscle or strength measurement, and
ABI (Table 2).
To determine whether baseline sex differences in func-
tional performance might have influenced our findings
regarding mobility loss, becoming unable to walk for 6 min
continuously, and 20% or more decline in 6-min walk
performance, we repeated analyses for these outcomes after
additionally adjusting for baseline 6-min walk performance.
After additional adjustment for baseline 6-min walk perfor-
mance, associations of female sex with faster decline were
attenuated. Hazard ratios for mobility loss, becoming
unable to walk for 6 min continuously, and 20% or more
decline in 6-min walk distance were 1.35 (95% confi-
dence interval: 0.77 to 2.36, p ? 0.288), 1.70 (95%
confidence interval: 0.94 to 3.09, p ? 0.088), and 1.27
(95% confidence interval: 0.82 to 1.97, p ? 0.289), respec-
tively. These findings suggest that baseline sex differences in
functional performance may contribute to higher rates of
decline in these 3 outcomes among women as compared
with men with PAD.
Associations of sex with functional decline, with and
without adjustment for baseline calf muscle area, are shown
in Table 3. Data in Table 3 are limited to participants with
baseline calf muscle area data. In this subset of 369
participants, women had a higher rate of becoming unable
to walk for 6 min continuously during follow-up, a higher
rate of mobility loss, and greater decline in the usual-paced
4-m walking velocity, adjusting for age, race, BMI, comor-
bidities, physical activity, smoking, prior year performance
(for analyses of average annual declines only), and ABI
(Table 3, base model). These associations of female sex with
faster functional decline were attenuated and no longer
statistically significant after additional adjustment for base-
line calf muscle area (Table 3). Similarly, the association of
female sex with greater decline in usual-paced walking
velocity was no longer statistically significant after the base
model was adjusted additionally for calf muscle density
(?0.035 m/s/year for women vs. ?0.024 m/s/year for men,
p ? 0.052). However, remaining significant associations of
female sex with functional decline were not attenuated and
remained statistically significant after additional adjustment
of the base model for calf muscle density. Similarly, the
significant associations of female sex with faster functional
Adjusted Associations of Sex With Functional Decline in Peripheral Arterial Disease With and Without Adjustment for Baseline Calf Muscle Characteristics (n ? 369)
Table 3
With and Without Adjustment for Baseline Calf Muscle Characteristics (n ? 369)
Adjusted Associations of Sex With Functional Decline in Peripheral Arterial Disease
Women (n ? 176) Men (n ? 193)
Hazard Ratio or Annual
Average Change
(95% Confidence Interval)n
Hazard Ratio or Annual
Average Change
(95% Confidence Interval)p Value
Becoming unable to walk for 6 min
continuously during follow-up
Base model 1072.32 (1.31 to 4.11) 135 1.000.004
Base model ? baseline calf muscle area107 1.83 (0.96 to 3.49) 1351.00 0.065
Mobility loss
Base model 1381.88 (1.10 to 3.20) 180 1.000.023
Base model ? baseline calf muscle area 1381.06 (0.57 to 1.97)1801.000.846
?20% decline in 6-min walk during follow-up
Base model1641.41 (0.92 to 2.15) 1791.00 0.112
Base model ? baseline calf muscle area 1641.39 (0.86 to 2.26) 179 1.000.179
Average annual decline in 6-min walk
distance (feet)
Base model154 –54.59 (–69.88 to –9.30) 172–34.18 (–48.26 to –20.09)0.070
Base model ? baseline calf muscle area154 –50.39 (–67.11 to –33.66)172 –37.85 (–53.12 to –22.58) 0.332
Average annual decline in usual paced 4-m
walking velocity (m/s)
Base model 162–0.036 (–0.044 to –0.027)177 –0.023 (–0.031 to –0.015)0.038
Base model ? baseline calf muscle area 162–0.032 (–0.041 to –0.023)177 –0.027 (–0.035 to –0.019)0.496
Average annual decline in fast-paced 4-m
walking velocity (m/s)
Base model159–0.041 (–0.051 to –0.031)172 –0.032 (–0.041 to –0.022)0.224
Base model ? baseline calf muscle area159 –0.038 (–0.048 to –0.027) 172 –0.035 (–0.045 to –0.025) 0.771
The base model adjusts for age, race, body mass index, comorbidities, physical activity, smoking, and ankle brachial index. Analyses of declines in 6-min walk distance and 4-m walking velocity additionally
adjust for prior year performance. The base model ? baseline calf muscle adjusts for variables in the base model and adds calf muscle area.
JACC Vol. 57, No. 6, 2011
February 8, 2011:707–14
McDermott et al.


text:
updated 05/12/2011 AT 11:00 AM ET
•originally published 05/12/2011 AT 11:40 AM ET
How does a country superstar prepare for her big day? For bride-to-be Miranda Lambert, it's all about down-home pampering – and down-home delicacies.
Lambert, who will marry fellow singer and The Voice coach Blake Shelton this weekend in Texas, Tweeted her last-minute checklist, writing, "I am so excited. Got nails touched up. One last wal mart run and I should be good!"
The Tishomingo, Okla.-based star, 27, who like Shelton makes no secret of her love for hunting, also posted a photo of a package of deer meat, Tweeting: "Last thing loaded for the wedding!!! Harvested by….me!!!!!"


text:
from £67 /night help Price for guests, Nights
from £67 /night help Price for guests, Nights
Estimated nightly price based on a weekly stay. Excludes fees (if applicable). Enter your dates to see the total cost.
Apartment / 2 bedrooms / sleeps 6 Home 1670974
Availability Your dates are available
Apartment / 2 bedrooms / sleeps 6
|Key Info
Property is located near Old Town Dubrovnik. It is situated in a peaceful and quiet area with beautiful views on Island Lokrum, the sea and Dubrovnik Old Town. Many consider this to be the most beautiful part of Dubrovnik, during Dubrovnik Republic a favorite area of Dubrovnik nobles, rich in Mediterranean vegetation and with a unique view on the 11-th century Fort Lovrijenac. From here you can reach the Old Town of Dubrovnik or the sandy beach for a pleasant 10 minute walk. Nearby there is public garage, and nice walking areas, bakery, bars, supermarket, post office, bus stations, travel agencies, taxi and much more.
APARTMENT MAURO is air conditioned, has an area of 62 m2 and was built five years ago. It consists of 2 bedrooms (with double bed, plus 2 extra beds, cot available on request), fully equipped kitchen, dining room, two bathrooms (shower with hydromassage). Additional equipment includes TV, DVD and stereo. Terrace (30 m2) with barbecue can be used as often as you like, prepare food, or just relaxing. With the windows of sleeping rooms and the terrace area is amazing view on the open sea, 11-th century Fort Lovrijenac and city walls. The apartment is suitable for the accommodation of 4 to 6 people. Four people can sleep in sleeping rooms, and two in the living room on the couch, which can be converted to double bed for two
|Sleeps up to 6, 2 bedrooms
|Nearest beach
|Will consider
|Long term lets (over 1 month)
|Car not necessary
|Nearest travel links
|Nearest airport: 22
|Family friendly
|Great for children of all ages
|No pets allowed, No smoking at this property
Features and Facilities
|Sea view
|Air conditioning, TV, Wi-Fi available
|Kettle, Hair dryer
|Cooker, Microwave, Fridge, Freezer
|2 bedrooms, 2 bathrooms of which 2 Family bathrooms
|1 Sofa beds, Double beds (2), Dining seats for 4
|Linen provided, Towels provided
|Balcony or terrace, Shared garden, BBQ
|Secure parking, Not suitable for wheelchair users
The apartment Mauro is located close to Old town public garage, 10 min wallking distance from city gate. The Ivana Mazuranica street, where the apartment is located crossing Zagrebacka road, which is 50 m from Public garage, in traffic direction.
Build your perfect trip, with Holiday Lettings & TripAdvisor
Real opinions, real reviews
Genuine guest feedback from 100,000+ reviews
Quick response times
Know where you're staying within 24 hours
Safe, simple, secure
When you pay online with PayPal or by credit/debit card
Book with confidence
Pay online to be covered by Payment Protection
Guest reviewsPowered by TripAdvisor
Guest reviews no reviews
Guest reviews Powered by TripAdvisor
Help other travellers decide where to stay
This holiday home hasn't got any reviews yet. The average rating on Holiday Lettings is four out of five. This place could be newly added or perhaps it's a well kept secret. Either way, it's time to reveal all.
This advert is created and maintained by the advertiser; we can only publish adverts in good faith as we don't own, manage or inspect any of the properties. We advise you to familiarise yourself with our terms of use.
You're booking with
Miljenko L.
75% Response rate
Calendar last updated:02 Oct 2015
Based in Croatia
- English


text:
Dutch oranje support, oranje, holland, nederland, oranjeshirt, wk, ek, dutch, voetbalshirt, wk shirt, ek shirt, netherlands, supporter, holland shirt, soccer, voetbal, nederlands elftal, supporter van oranje, superior dutch, koninginnedag
This great product in black from our department Men and Dog Bandana category can be printed just for you in the size and style you like. The design Holland was created by Nowhereman78 and uploaded to Spreadshirt for you to have printed on a Dog Bandana. Next to a host of other great designs, you can find this Holland design in Spreadshirt's Football category. If you are interested in topics like Dutch or Dutch oranje support, then you'll love Holland designs by Nowhereman78. Spreadshirt also offers a huge selection of personalised T-shirts, hoodies and accessories for the category Football as well as top Ek clothing. Nowhereman78's designs have already impressed many of our customers, so we are sure that we've got right stuff for you! Spreadshirt is your shop for great designs of all kinds – whether it's Dutch, Dutch oranje support or Ek. We are sure that you will find something nice in our shop, there are many amazing personalised Football T-shirts, jumpers or accessories for you to find! Tags: Design ID: 4296308
Hi, if you like to contact me: jekanhetdakop at msn.com
Willberry Wonder Pony tee Designed by 2395767
Melting Rubiks Cube Designed by Rubiks Cube
South African Springbok 2 T-Shirts Designed by Magnaen
Royal blue Europe - European Union T-Shirts Designed by Mi-Enno
Jesus' names on cross shape Designed by Samuele83
Installing Muscles (Loading) T-Shirts Designed by macello
Mens Black Piston Shirt Designed by Hi-Artz Press
Diablo Road Runners - Foo Fighters Designed by mackenteeUK
Avengers Black & White Men T-Shirt Designed by TheAvengers
A Cure For Tourettes T-Shirts Designed by Quarantine
Man's best friend on trendy walkies. The triangular bandana shawl for dogs to stand out nicely when out for a walk.
still to fill


text:
By Matt Allibone, GoPSUsports.com Student Staff Writer
UNIVERSITY PARK, Pa - When Bryan Pearsall is asked about how far he has come during his time with the Penn State wrestling team, the senior can't help but smile.
For someone who has worked his way from a 3-23 freshman season to now being among the team's top lower weight wrestlers, the journey has been a long but rewarding one.
"It's hard to look back to when I was wondering if I'd ever get mat time and then to look at where I am now," said Pearsall. "I definitely took some bumps but I'm thankful that I stayed here."
After finishing his junior campaign on an impressive run that included a seventh place finish at the Big Ten Championships, Pearsall has carried that momentum into this season.
Not only has he brought stability to the 141 weight, he has also been a force on the mat, opening the season with an 8-2 record, while going 3-0 in dual meets.
For Pearsall, the hot start has been a welcome change from his previous seasons.
"I generally have a slow start to the season and it takes me until about Christmas to get warmed up," said Pearsall. "I came in this year with my weight lower and more focused on wrestling strong right off the bat."
Along with keeping his weight down and working on his technique, Pearsall has credited his early success to the motivation he gained after his season last year ended just short of a birth in the NCAA Championships.
While he was obviously disappointed, Pearsall believes the experience gave him the desire necessary to reach his full potential this season.
"I really felt that if I had qualified for nationals last year that I would have improved even more," said Pearsall. "It was really that disappointment that motivated me in the offseason since I knew I only had one year left."
Pearsall also has been able to find motivation and inspiration from the teammates he practices with every day.
With five returning All-Americans joining him in the lineup, he doesn't have to look far to see what it takes to wrestle at the highest level.
"I look at those guys and I know they're at the place where I want to be," said Pearsall. "I always try to pick on the things that they do so I can improve myself and get to where they're at."
While Pearsall has often tried to learn from his teammates, it is certainly not a one-way street.
Many of his most accomplished teammates not only look up to him but also find motivation from the improvements he has made over the course of his career.
"Seeing how much Bryan has progressed through the years is really inspirational to me," said junior and returning national champion Ed Ruth. "The guy works so hard and is such a grinder."
Pearsall's style of grinding has taken notice with both his teammates and his coaches, who love the way he has been able to wear down his opponents and score points late in matches.
"You like to try and score early but sometimes you have to adapt and keep wrestling hard the whole time," said Pearsall. "I usually find that if I fall behind early I can come back and score late in the third."
Although he acknowledges the vast improvements he has already made, Pearsall doesn't believe he has stopped progressing.
In fact, he doesn't believe his career as a Nittany Lion will be complete until he too can say that he is an All-American.
"Anything less than being an All-American will be a major disappointment," said Pearsall. "If I keep working hard and keep improving I feel that it's a goal I can definitely attain."
Pearsall Strives to Continue Impressive Stretch
By Matt Allibone, GoPSUsports.com Student Staff Writer
No TrackBacks
TrackBack URL: http://cstv.collegesports.com/mt5.2/mt-tb.cgi/41654
Leave a comment
- VIDEO: 2015 Preview - One-on-One with Russ Rose
- VIDEO: Training Camp Update - August 19
- Training Camp: Hamilton Primed to Build on Strong Season
- Depth Playing Key Role in Special Teams Growth
- Inside Training Camp - Equipment Staff
- VIDEO: Behind the Scenes - Green Screen Shoot
- Inside Training Camp - Lion's Den
- Training Camp: Mangiro Leading the Battle in the Trenches
- VIDEO: Training Camp Update - August 12
- Add category (5)
- All-Sports Blog (4397)
- Baseball (142)
- Coaches Caravan (51)
- Cross Country (51)
- European Tour 2012 (14)
- Fencing (6)
- Field Hockey (76)
- Football (1329)
- Men's Basketball (503)
- Men's Basketball 2013 European Tour (16)
- Men's Gymnastics (64)
- Men's Hockey (267)
- Men's Lacrosse (135)
- Men's Soccer (80)
- Men's Volleyball (112)
- PSU Road Warriors (16)
- Softball (72)
- Swimming & Diving (87)
- Track & Field (82)
- Women's Basketball (442)
- Women's Gymnastics (90)
- Women's Hockey (120)
- Women's Lacrosse (98)
- Women's Soccer (177)
- Women's Soccer Player Blog (44)
- Women's Volleyball (295)
- Wrestling (332)


text:
As your Allstate agency we can help with your insurance needs
44 Main St
East Hartford, CT, 06118
Call: (860) 528-5643
Fax: (860) 528-5652
Contact Me Contact Me
Get quality protection at a great price. Every policy comes with the support of a knowledgeable and friendly Allstate agent.
Save up to 30% on your auto insurance by taking advantage of the available discounts.Get an Auto Quote Get a quote Get an Auto Quote Get a quote
Protect your family and your biggest investment with quality home protection from Allstate.Get a Renters Quote Get a quote Get a Renters Quote Get a quote
Allstate offers many kinds of insurance. Speak with me about renters insurance, life insurance, motorcycle insurance, and more.Contact Me for Other Products Find out more Contact Me for Other Products Find out more
As a Personal Financial Representative in Manchester, I know many local families. My knowledge and understanding of the people in this community help me provide customers with an outstanding level of service. I look forward to helping families like yours protect the things that are important – your family, home, car and more. I can also help you prepare a strategy to achieve your financial goals.
I'm proud to work with a company who's been serving satisfied customers for over 80 years. Customers count on outstanding financial strength and superior claims service to help protect what they value most. Allstate delivers on their promise. In fact, their outstanding financial strength and superior claims service received an A+ (Superior) rating by A.M. Best. Quality service, strength and satisfaction – that's something I'm glad to be a part of.
I'm committed to helping you keep your financial life on track. Not only can I assist you with Allstate's broad range of financial solutions, I can offer my knowledge to help you achieve your financial goals. That includes planning for your child's education or planning your retirement.
Not everyone's life insurance needs are the same. Allstate agent Franklin Osei-Assibey in East Hartford understands that you and your family are unique. If you're interested in life insurance coverage that adapts as your lifestyle changes, then talk to me about Allstate's term life insurance policies. I can tell you about coverage features, premiums, benefits, and more. Call (860)528-5643 to schedule appointment today!
Franklin Osei-Assibey
44 Main St
East Hartford, CT, 06118
Send Me An Email


text:
Non-operative treatment of acute hip adductor longus ruptures in athletes has been described in the literature. However, very limited information concerning the recovery of this type of injury exists. This case represented a unique possibility to study the recovery of two acute adductor longus ruptures, using novel, reliable and validated assessment methods.
Case presentation
A 22-year old male soccer player (Caucasian) sustained two subsequent acute adductor longus ruptures, one in each leg. The injuries occurred 10 months apart, and were treated non-surgically in both situations. He was evaluated using hip-strength assessments, self-report and ultrasonography until complete muscle-strength recovery of the hip adductors had occurred. The player was able to participate in a full soccer training session without experiencing pain 15 weeks after the first rupture, and 12 weeks after the second rupture. Full hip adductor muscle-strength recovery was obtained 52 weeks after the first rupture and 10 weeks after the second rupture. The adductor longus injuries, as verified by initial ultrasonography (10 days post-injury), showed evidence of a complete tendon rupture in both cases, with an almost identical imaging appearance. It was only at 6 and 10 weeks ultrasonographic follow-up that the first rupture was found to include a larger anatomical area than the second rupture.
From this case we can conclude that two apparently similar hip adductor longus ruptures, verified by initial ultrasonography (10 days post-injury), can have very different hip adductor strength recovery times. Assessment of adductor strength recovery may therefore in the future be a useful and important additional measure for determining when soccer players with hip adductor longus ruptures can return safely to play.
Keywords:Hip adductor longus ruptures; Return to sport; Adductor strength; Ultrasonographic findings; HAGOS
Hip adductor longus ruptures are most commonly seen in football and ice-hockey [1,2]. Treatment of acute hip adductor longus ruptures in elite athletes includes both surgical and non-surgical approaches [3]. A case-series from 2009, including 19 American Football players, found that non-surgical treatment of proximal adductor tendon rupture results in faster return-to-play than surgical treatment in players competing in the National Football League [3]. Another advantage of non-operative treatment is that it avoids the risks associated with surgery, while still providing an equal likelihood of return-to-play [3]. However, that study did not include any assessment concerning the muscle-tendon-bone healing process or the muscle strength recovery of the adductors [3].
We have only identified one previous case-report, which has documented hip muscle strength and functional recovery after acute repair of a proximal adductor longus rupture by surgical re-fixation in two elite soccer players [1]. This study showed normalised hip adductor strength after 8 weeks and return to previous competitive level 10 weeks post-surgery. However, muscle strength was assessed by manual muscle testing which should be considered cautiously, as manual muscle testing has been shown to fail the identification of substantial muscle strength deficits [4-6]. Therefore, crucial aspects of the adductor muscle recovery process after an adductor longus rupture are largely unknown [3].
In the present case, we report on a 22-year-old male, playing soccer at a sub-elite level, who sustained two acute hip adductor longus ruptures, one in each leg, within a 10-month interval. This case represented a unique possibility to study the recovery of these ruptures, using novel, reliable and validated assessment methods [7].
Case presentation
Case description - mechanism of injury (Adductor rupture 1 and 2)
The player described the first injury (left leg) as occurring in a one-on-one attacking situation. When trying to get pass a defender, dribbling with the ball, he was pushed from the side by the defender. While being pushed, the player tried to maintain balance and ball possession by reaching for the ball with his right leg, while at the same time having all his weight shifted onto the left leg due to the push. He described the injured left hip as being in a position of abduction, extension and externally rotation, while the upper body was forced laterally towards the side of the left hip (Figure 1). He felt a sudden pop and a sharp pain, fell to the ground, and was unable to continue playing. The second injury (right leg) occurred in an almost identical situation 10 months later. The player had no history of previous injuries in the hip and groin.
Figure 1. Mechanism of injury for adductor longus rupture.
Clinical examination
Ten days after both injuries, the player presented for clinical consultation. The clinical examination was performed by a physiotherapist (KT). The examination revealed significant swelling in the proximal groin region near the pubic bone, and a large haematoma was spreading down the medial and posterior thigh for both injuries. The first rupture (Figure 2), however, was much more visible at the medial and posterior aspect of the thigh than the second rupture (Figure 3), indicating that more bleeding had occurred after the first rupture.
Figure 2. Haematoma on the posterior medial thigh 2 weeks after adductor longus rupture. Adductor longus rupture 1 (left leg).
Figure 3. Haematoma on the posterior medial thigh 2 weeks after adductor longus rupture. Adductor longus rupture 2 (right leg).
Acute and severe pain was present on palpation and isometric contraction of the adductor longus muscle-tendinous complex at the proximal insertion site. The hip joint could not be examined during the initial visits due to pain restricting the assessment of full range of motion. The hip was clinically examined 6 weeks post injury in both cases. The clinical examination of the hip joint at 6 weeks did not show any severe restriction of passive hip movement or sign of any additional intra-articular injury, and indicated that both injuries were adductor-related [8,9]. However the specific location and extent of the injury could not be determined. The player was therefore referred to diagnostic imaging. An ultrasonographic examination was performed by a radiologist (MBN) with extensive experience in ultrasound of the hip and groin [10]. The scan revealed an isolated complete adductor longus rupture in both cases, with no additional injury to the iliopsoas, rectus abdominis, conjoined tendon, inguinal canal or other relevant structures.
Clinical assessment of the recovery
Hip strength assessment
Isometric hip muscle strength assessment was performed by the examining physiotherapist (KT) using standardised and reliable strength measurements [11]. Hip muscle strength testing was continued until no difference (≤ 5%) in hip adduction strength was identified between the affected leg and the reference leg [12]. For the first injury (left leg), baseline strength measures of the contralateral side (right leg) were determined two weeks post trauma, and these data were used as a reference for normalisation of hip muscle strength [12]. For the second injury (the right leg), the aforementioned baseline strength measures for the ipsilateral side (right leg), obtained 10 months earlier, were used as the reference for hip muscle strength normalisation. Strength testing was used to monitor the loss and recovery of hip muscle strength.
Ultrasonographic examination
Ultrasonography was repeated to describe the anatomical healing over time. The following parameters were described: presence of blood/fluid; muscle/tendon injury; calcifications (myositis ossificans) and hyperemia/inflammation based on increased color Doppler activity.
Self-reported activity level
Self-reported pain-free activity level was reported at a weekly basis. The player was asked when he was able to perform the following activity pain-free, in this sequence: 1) walk, 2) jog, 3) run, 4) sprint, 5) make sudden changes in direction, 6) kick and 7) participate in a full training session (Table 1). He was only allowed to proceed to the next activity level when the preceding activity was reported as being pain-free, to ensure a safe progression and return-to-play.
Table 1. Pain-free activity level reported at a weekly basis
New and recurrent injury registration
The player was contacted by phone or e-mail on a weekly basis during the testing period. Injuries and recurrent injuries were documented, according to the FIFA consensus statement on injury definitions [13,14]. A retrospective three-year follow-up period reporting injuries and recurrent injuries was performed.
Long-term follow up
At two- (Adductor rupture 2) and three-year (Adductor rupture 1) follow-up, self-reported disability; Copenhagen Hip And Groin Outcome Score (HAGOS) [15], muscle strength [11,12], and ultrasonography were performed [10].
Both injuries were treated non-surgically, since this seems to provide early return to play with no additional risk of recurrence [3]. At the initial consultations a supervised exercise program was introduced to the player. The exercise program was based upon the exercise protocol described by Holmich et al. [16], developed for patients with longstanding adductor-related groin pain. This program was followed 3–5 times weekly. Additional strengthening exercises with an eccentric emphasis, using strength training machines, were added for hip-adductors, -abductors, -flexors and abdominal muscles. Strength training in machines was initiated after 10 weeks, starting with a relative load of 20 repetitions maximum (RM) progressing into 15, 12 and 10 RM, when these loads could be tolerated and executed pain-free. Soccer-specific exercises, including running and kicking exercises, were added subsequently when these activities were pain-free, following the predefined algorithm for activity progression (Table 1).
Return to a soccer match was not advised until all soccer-specific activities could be performed pain-free, with no aggravation of symptoms the following day(s), and when the hip adduction strength difference between the injured leg and the reference leg was <10% (± 5%) [2,11,12].
Self-reported activity level
The player was able to participate in a full pain-free soccer training session 15 weeks after the first adductor rupture, and 12 weeks after the second adductor rupture (Table 1).
Hip strength assessment
Figures 4 and 5 shows the strength recovery of hip adductors and hip flexors during the initial 52 weeks after the injuries. For the first rupture hip adduction strength was only 90% recovered 18 weeks after the injury, and normalised somewhere between 6 months and 1 year after the injury. For the second rupture hip adduction strength was normalised after 10 weeks.
Figure 4. Hip adduction strength recovery after adductor longus ruptures.
Figure 5. Hip flexion strength recovery after adductor longus ruptures.
Ultrasonographic examination
Adductor rupture 1
At 2 weeks the ultrasonographic examination showed a full adductor longus rupture at the proximal musculoskeletal junction with hematoma in the proximal 3–4 cm. After 4 weeks several calcifications in the size of approximately 4 mm were present in close relation to the insertion of the adductor longus tendon as well as within the tendon. Significant color Doppler activity representing hyperemia (inflammation) was present in a 6 cm long focal area from the insertion of the tendon. After 6 weeks the calcifications had increased in size to 5 to 22 mm per element and were still found near the insertion. Furthermore, a 3 cm long and 1 cm wide fluid-filled area had developed and color Doppler activity was still present. Fluid and color Doppler activity gradually decreased during the following 12 weeks. Ultrasonographic findings after half a year and beyond were unchanged. Calcifications were seen at the insertion and within the tendon, and the tendon was thickened from the site at insertion and 6 to 7 cm distally (Figure 6).
Figure 6. Ultrasonographic assessment and time of anatomical recovery following adductor longus ruptures 1 (AR 1) and 2 (AR 2). AR 1 (2 weeks): White arrow (Insertion), Snip of torn proximal adductor longus tendon, Haematoma, Distracted muscle. AR 2 (2 weeks): White arrow (Insertion), Distracted muscle, Fluid / Haematoma. AR 1 (6 weeks): Distracted muscle, Calcification, Fluid. AR 2 (6 weeks): Calcifications, Fluid. AR 1 (10 weeks): Distracted muscle, Calcification, Fluid. AR 2 (10 weeks): Calcifications. AR 1 (18 weeks): Calcification. AR 2 (26 weeks): Calcification.
Adductor rupture 2
At 2 weeks the ultrasonographic examination showed a full adductor longus rupture at the proximal musculoskeletal junction and focal fluid-filled areas near the insertion. After 6 weeks several calcifications were present in immediate relation to the insertion of the adductor longus tendon. The proximal 4 to 5 cm of the tendon was thickened and significant color Doppler activity representing hyperemia (inflammation) was present in this area. A 1.5 cm long and 0.5 cm wide fluid-filled area was seen. Fluid and color Doppler activity gradually decreased during the following 12 weeks, but calcifications persisted in the proximal part of the tendon and were still seen 2 years after the injury (Figure 6).
New and recurrent injury registration
No new or recurrent injuries occurred in the hip or groin region after the initial adductor ruptures in each leg.
Long-term follow up
At two-year (adductor rupture 2) and three-year follow-up (adductor rupture 1) the self-reported disability score (HAGOS) [15] showed that the ability of the player to participate in his preferred physical activity (soccer) was a little affected for both injuries (Figure 7). Hip muscle strength was still normalised at long-term follow-up. At two-year follow-up, the ultrasonographic examination revealed calcification of the tendon (second rupture) near its insertion site, extending 2.6 cm along the muscle-tendinous junction (Figure 8).
Figure 7. Hip and Groin Outcome Score (HAGOS) at 2-year and 3-year follow-up after adductor longus ruptures.
Figure 8. Ultrasonographic assessment at 2-year and 3-year follow up following adductor longus ruptures. Adductor rupture 1 (3 years): White arrow (Insertion), Small calcification in the tendon. Adductor rupture 2 (2 years): White arrow (Insertion), Calcifications (2.6 cm).
The present case-report shows that two apparently very similar adductor longus ruptures can have very different hip-adductor strength recovery times. In the present study hip adduction strength was restored after 1 year for the first rupture, and after 10 weeks for the second rupture.
Ultrasonographic findings and adductor muscle-strength recovery times
The most interesting imaging finding was that both adductor longus injuries, as verified by initial ultrasonography (10 days post-injury), had an identical imaging appearance, showing a similar complete tendon rupture. Only at 6 and 10 weeks follow-up, ultrasonography indicated that the first rupture included a larger anatomical area compared to the second rupture.
Preventing re-injury
Previous groin-injury exposes soccer players to a 5-fold increased risk of a future groin injury [14]. It has been suggested that inadequate rehabilitation may explain this phenomenon [17]. It therefore seems of great importance to optimize the rehabilitation program, improving hip adductor function and its eccentric strength capacity, since muscle injuries and recurrent muscle injuries have been related to eccentric hip muscle weakness [18-21]. In this case no recurrent adductor injuries were encountered for any of the initial adductor ruptures. There may be several explanations for the positive outcome of the rehabilitation in terms of no recurrent injuries. Firstly, the thorough monitoring of hip-adductor strength made it possible to measure when hip adductor strength was normalized, before advising return-to-play. A rehabilitation period of 12–15 weeks before return-to-play is a fairly long rehabilitation period, compared with previous studies concerning hip adductor longus ruptures [1,3]. It could be argued that a recovery period of 15 weeks would be difficult to accept by the player, the coach or the club. However, the advantage of the hand-held dynamometer measurements is that they provide precise insight into the muscle strength recovery. This gives the sports practitioner an objective impression of adductor muscle function and recovery instead of solely having to rely on subjective reports, from the player, regarding pain during sports-specific activity as a guideline for return-to-play [11,12]. In fact, for both injuries the player reported no pain during running after 35–38 days (5–6 weeks). For players and coaches this would often indicate that the player is nearly ready for "return-to-play". However, since muscle strength for the first rupture at the stage where he was running pain-free (6 weeks) was only 60% of the reference leg, we advised the player not to return to soccer-play at this point.
Long-term follow of a hip-adductor longus rupture
At the long term follow-up the player reported that the second injury from time to time would cause him minor problems during soccer play, and the HAGOS scores seemed to support this notion. Based on knowledge of injuries to the hamstring muscle-tendinous complex, as estimated by MRI, involvement of the proximal free hamstring tendon and proximity to the ischial tuberosity are associated with longer time to return to pre-injury level than injuries with no proximal tendinous involvement [22]. The long term ultrasonographic follow-up assessment in the present study seems to indicate that while being less severe in terms of bleeding and swelling, the second rupture may have occurred near the insertion point (enthesis), possibly including a few intact - but pain eliciting - insertional fibers, and/or pain eliciting scar tissue formation at the muscle-tendinous insertion point (enthesis) [23]. Both scenarios that could possibly explain the minor difference in long term self-reported disability between the two injuries [22,23].
From this case we can conclude that two apparently similar hip-adductor longus ruptures, verified by initial ultrasonography (10 days post-injury), can have very different hip-adductor strength recovery times. Assessment of hip-adductor strength recovery may therefore in the future be a useful and important additional measure for determining when soccer players with hip adductor longus ruptures can return safely to play.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors' contribution
KT drafted the manuscript. KT and PH were responsible for the study concept and design. Acquisition of data was performed by KT, JP and MBN. All authors were responsible for the interpretation of data and critically revised the manuscript. All authors read and approved the final manuscript.
Authors' information
Jesper Petersen, Michael Bachmann Nielsen and Per Hölmich are co authors.
Dimitrakopoulou A, Schilders EM, Talbot JC, Bismil Q: Acute avulsion of the fibrocartilage origin of the adductor longus in professional soccer players: a report of two cases.
Clin J Sport Med 2008, 18:167-169. PubMed Abstract | Publisher Full Text
Nicholas SJ, Tyler TF: Adductor muscle strains in sport.
Sports Med 2002, 32:339-344. PubMed Abstract | Publisher Full Text
Schlegel TF, Bushnell BD, Godfrey J, Boublik M: Success of nonoperative management of adductor longus tendon ruptures in national football league athletes.
Am J Sports Med 2009, 37:1394-1399. PubMed Abstract | Publisher Full Text
Beasley WC: Influence of method on estimates of normal knee extensor force among normal and postpolio children.
Phys Ther Rev 1956, 36:21-41. PubMed Abstract
Hayes KW, Falconer J: Reliability of hand-held dynamometry and its relationship with manual muscle testing in patients with osteoarthritis in the knee.
J Orthop Sports Phys Ther 1992, 16:145-149. PubMed Abstract
Saraniti AJ, Gleim GW, Melvin M, Nicholas JA: The relationship between subjective and objective measurements of strength.
J Orthop Sports Phys Ther 1980, 2:15-19. PubMed Abstract
Thorborg K, Hölmich P: Advancing hip and groin injury management: from eminence to evidence.
Br J Sports Med 2013.
PMID: 23407439. [Epub ahead of print]
Holmich P: Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients.
Br J Sports Med 2007, 41:247-252. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Holmich P, Holmich LR, Bjerg AM: Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study.
Br J Sports Med 2004, 38:446-451. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Brown AK, O'Connor PJ, Wakefield RJ, Roberts TE, Karim Z, Emery P: Practice, training, and assessment among experts performing musculoskeletal ultrasonography: toward the development of an international consensus of educational standards for ultrasonography for rheumatologists.
Arthritis Rheumatism - Arthritis Care Res 2004, 51:1018-1022. Publisher Full Text
Thorborg K, Petersen J, Magnusson SP, Holmich P: Clinical assessment of hip strength using a hand-held dynamometer is reliable.
Scand J Med Sci Sports 2010, 20:493-501. PubMed Abstract | Publisher Full Text
Thorborg K, Serner A, Petersen J, Madsen TM, Magnusson P, Hölmich P: Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury.
Am J Sports Med 2011, 39:121-126. PubMed Abstract | Publisher Full Text
Fuller CW, Ekstrand J, Junge A, Andersen TE, Bahr R, Dvorak J, Hagglund M, McCrory P, Meeuwisse WH: Consensus statement on injury definitions and data collection procedures in studies of football (Soccer) injuries.
Scand J Med Sci Sports 2006, 16:83-92. PubMed Abstract | Publisher Full Text
Arnason A, Sigurdsson SB, Gudmundsson A, Holme I, Engebretsen L, Bahr R: Risk factors for injuries in football.
Am J Sports Med 2004, 32:5S-16S. PubMed Abstract | Publisher Full Text
Thorborg K, Holmich P, Christensen R, Petersen J, Roos EM: The copenhagen hip and groin outcome score (hagos): development and validation according to the COSMIN checklist.
Br J Sports Med 2011, 45:478-491. PubMed Abstract | Publisher Full Text
Holmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, Krogsgaard K: Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial.
Lancet 1999, 353:439-443. PubMed Abstract | Publisher Full Text
Hagglund M, Walden M, Ekstrand J: Lower reinjury rate with a coach-controlled rehabilitation program in amateur male soccer - a randomized controlled trial.
Am J Sports Med 2007, 35:1433-1442. PubMed Abstract | Publisher Full Text
Croisier JL, Forthomme B, Namurois MH, Vanderthommen M, Crielaard JM: Hamstring muscle strain recurrence and strength performance disorders.
Am J Sports Med 2002, 30:199-203. PubMed Abstract | Publisher Full Text
Thorborg K: Why hamstring eccentrics are hamstring essentials.
Br J Sports Med 2012, 46:463-465. PubMed Abstract | Publisher Full Text
Tyler TF, Nicholas SJ, Campbell RJ, Mchugh MP: The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players.
Am J Sports Med 2001, 29:124-128. PubMed Abstract | Publisher Full Text
Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP: The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players.
Am J Sports Med 2002, 30:680-683. PubMed Abstract | Publisher Full Text
Askling CM, Tengvar M, Saartok T, Thorstensson A: Acute first-time hamstring strains during high-speed running: a longitudinal study including clinical and magnetic resonance imaging findings.
Am J Sports Med 2007, 35:197-206. PubMed Abstract | Publisher Full Text
Dimitrakopoulou A, Schilders E, Bismil Q, Talbot JC, Kazakos K: An unusual case of enthesophyte formation following an adductor longus rupture in a high-level athlete.
Knee Surg Sports Traumatol Arthrosc 2010, 18:691-3. PubMed Abstract | Publisher Full Text


text:
Limited Submissions
Some grant and fellowship programs limit the number of proposals that may be submitted by an institution. Please see below for a list of limited submission programs and the status of the associated USA limited submission competition. The list below is not exhaustive. If you want to apply for a limited submission opportunity that is not listed below please contact Kim Littlefield, Ph.D., Asst. Vice President for guidance about obtaining institutional nomination before submission. Note if you submit a proposal to a limited submission program without institutional nomination and USA's limit is exceeded, your proposal, and other proposal(s) submitted from the USA, will very likely be rejected without review. To prevent circumstances such as this the USA Office of RDL coordinates internal limited submission competitions.
2016 National Science Foundation Major Research Instrumentation (MRI) Program
The Major Research Instrumentation Program (MRI) seeks to improve the quality and expand the scope of research and research training by supporting proposals for shared instrumentation that foster the integration of research and education in research-intensive learning environments. Each MRI proposal may request support for the acquisition (Track 1) or development (Track 2) of a single research instrument for shared inter- and/or intra-organizational use, Development efforts that leverage the strengths of private sector partners to build instrument development capacity at MRI submission-eligible organizations are encouraged. The instrument is expected to be operational for regular research use by the end of the award period (up to three (3) years for an acquisition proposal; up to five (5) years for a development proposal. Institutions may submit up to three (3) applications to this program; at least one (1) application must be submitted under the Development track. The USA Limited Submissions Guidelines and Process to select the 2016 institutional applicants can be found here: 2016 MRI Limited Submission Guidelines and Process. The important milestones related to the 2016 competition and submission are:
2015 Alabama Innovation Fund (AIF)
The State of Alabama has created the Alabama Innovation Fund. This fund will support two programs - Research and Renewal. The renewal and research programs are described in detail in the attached Request for Proposal (RFP) announcement (July 14, 2015 version). Each institution may submit two (2) renewal and two (2) research proposals. The USA 2015 AIF institutional nominees are:
Dr. Mohammad Alam, Electrical and Computer Engineering (Research)
Dr. Alec Yasinsac, School of Computing (Research)
Dr. K.-T. Hsaio, Mechanical Engineering (Renewal)
Dr. Sean Powers, Marine Sciences (Renewal)
USA Office of Research and Economic Development National Endowment for the Humanities (NEH) Summer Stipends Program Nominating Process (Continuous)
USA faculty who intend to submit a NEH Summer Stipends proposal must notify Dr. Kimberly Littlefield, Asst. Vice President Research Development and Learning via email to firstname.lastname@example.com by July 31, annually. Institutions may nominate up to two (2) faculty applicants. In the event that more than two applicants present notice, an internal competition will be staged to select the institutional nominees. Applicants will be notified via email by the 1st Wednesday in August if an internal competition is necessary. In the event that an internal competition is not necessary, the institutional nominees will be announced by the 1st Wednesday in August.
The following supporting documentation will be required from an applicant if an internal competition is necessary: 1) a letter of support from the Department Chair, and 2) a one page summary of the project to be conducted including a description of the research to be conducted, the methods and work plan, a description of the applicant's competencies, skills and access and the anticipated final products and dissemination plans. Supporting documentation will be due by the 2nd Monday in August and will be reviewed and ranked by a panel of USA humanities experts. The institutional nominees will be announced by the 2nd Friday in August.
Please refer to the NEH Summer Stipends program guidelines for important, additional eligibility and nomination information.


text:
Sno-Isle Libraries and the Sno-Isle Foundation are proud to offer book discussion kits.
Each kit includes 10 copies of a single title. Resources for book discussions may be found at publishers' websites, bound into some editions of the book, or at www.bookreporter.com or www.readinggroupguides.com.
You're viewing items 1-3
Newlyweds, TheFreudenberger, Nell
Leaving her Bangladesh home to marry a New Yorker who wooed her online, Amina finds the marriage challenged by secrets and her struggles to find a place for herself in America.
Nothing DauntedWickenden, Dorothy
"A captivating book about Dorothy Wickenden's grandmother, who left her affluent East Coast life to "rough it" as a teacher in Colorado in 1916"-- Provided by publisher.
|Overdrive eBook download
|3M eBook download
Nowhere But HomePalmer, Liza
After being fired from her job, Queenie Wake returns home to North Star to cook meals for death row inmates and, hoping that the bad memories of her late mother and promiscuous sister have been forgotten, discovers that some people are harder to forget than others. Original. 30,000 first printing.


text:
Armed with just a toothbrush, a worn passport and £150 in cash, we send Jack Palfrey to investigate if it's still efficacious to travel on a whim.
From competitive pelvic thrusting to bizarre bird control, we take a look at this week's weirdest travel news in our quiz.
Lesser-known London. Modern Britain. Immigration. October's new releases tackle a diverse mixture of subjects, says Stanfords' bookworm, Dan Lewis.
Our photographer, Gavin Haines, chronicles the extraordinary life of Baltazar Ushca, who climbs Ecuador's highest mountain every week to collect ice from its glacier. Fridge-freezers have all but killed his trade, but he makes the perilous journey regardless.
Just two and a half hours from London, Bridgend County offers great surfing, award-winning beaches, dramatic landscapes and peak-to-beach cycling.
A destination steeped in history, rich in culture and filled with some amazing sights and attractions, Athens is a hugely popular holiday destination. This is a bustling city soaked in glorious sunshine, with breathtaking sights, exciting adventures, and thousands of years of heritage.
For most people, the very thought of a trip to the Caribbean tends to conjure up images of turquoise waters, powder white beaches, sizzling sunshine and lush foliage. Happily, this is all quite close to fact. Include a laid-back atmosphere, tropical breezes, sumptuous local cuisine, and a...
Do you have any Feedback about this page?
© 2015 Columbus Travel Media Ltd. All rights reserved. No part of this site may be reproduced without our written permission, click here for information on Columbus Content Solutions.


text:
Insight Editions Announces Global Time Capsule Book - A DAY IN THE WORLD
On May 15th, 2012, people from around the globe picked up their cameras to record their lives, and A Day in the World is the result. This inspiring project, the first time capsule of its kind, is an extraordinary worldwide account of an ordinary day, celebrating diversity, connections, and the human spirit with vibrant imagery.
Professionals and amateur shutterbugs alike are featured in this beautiful edition, the most comprehensive photographic documentation of daily life ever made. Based on the philosophy that everyone's life matters, contributors come from areas as varied as the earth itself: farmers, fishermen, office workers, and award-winning photojournalists. Tribal areas and urban sprawl, intimate portraits and riotous events, A Day in the World captures a global scope with the candor only a photograph can capture. Participants utilized whatever photographic means was at their disposal to document their lives, from crisp high-tech point-and-shoots to cell phones and old-fashioned cameras, creating a touchingly varied perspective. This book presents the first global photography project that incorporates top talent with the general public.
The brainchild of the movement Aday.org, this unique project celebrates the power of photography to encourage cultural understanding. An interactive site was the hub for the project, and then, an international jury selected the best one thousand images. Ultimately, A Day in the World is not only an around-the-globe ticket for the armchair traveler, it is an invaluable record of the people on our planet, sure to spark reflections on humankind for generations to come.
Expressions of Humankind: A Day in the World launched from Aday.org, a branch of the foundation Expressions of Humankind. The foundation supports scientific research and education focused on the photographic image and the written word. The aim is to inspire creative reflections on humanity, by experiencing global perspectives. The foundation's council includes Archbishop Desmond Tutu, Sir Richard Branson, singer/songwriter Robyn and a host of other luminaries and advocates for the project.
About Author
- SAG-AFTRA Convention Continues, George Heller Memorial Awards Presented
- Hugh Jackman, Lady Gaga, and More to Appear on THE TONIGHT SHOW STARRING JIMMY FALLON
- David Leitch to Direct THE COLDEST CITY
- SAG-AFTRA Announces Gabrielle Carteris Re-Elected Executive Vice President at National Convention
- VH1's Primetime Ratings For Third Quarter Surge Ahead +34% Over Prior Quarter Among Adults 18-49
- Sara Bareilles, Idris Elba, Adam Lambert, and More to Visit LATE NIGHT WITH SETH MEYERS
- KEVIN HART PRESENTS PLASTIC CUP BOYZ to be Released on Comedy Dynamics 10/13
- The First Lady Joins Public Media Effort, American Graduate Day 2015
- Review Roundup: Matt Damon Stars in Action Adventure THE MARTIAN
- Original Motion Picture Score from Acclaimed Film THE MARTIAN Out Today
- Kaley Cuoco & More Attend Opening Day of MASTERS OF LA
- Mika Kaurismaki's THE GIRL KING Available 12/8
- Sony Classical Releases THE WALK Original Motion Picture Soundtrack Today
- Documentary PINK & BLUE: COLORS OF HEREDITARY CANCER Set for Worldwide Theatrical Premiere Tonight
- Warner Bros. Celebrates Release of PAN by Asking Audiences to 'Discover Your Neverland'
- THE DAILY SHOW's Trevor Noah to Participate In Politicon
- As World Preps or Release of SPECTRE, Gillette Celebrates 'Bond Moments' in Every Man's Life
- Innovid and Netflix Win 2015 IAB MIXX Gold Award
- Director Ridley Scott Incorporates GoPro into the Making of THE MARTIAN
- Special Screening of Documentary SIR IVAN: I AM PEACEMAN to Kick Off Transgender Awareness Campaign


text:
go Gourmet
Discerning Alief residents know that the only bakery that always delivers perfect Grooms cake results is go Gourmet.
Sugar Sweet Cakes
At Sugar Sweet Cakes, we want to make sure our Graduation is everything you hoped it would be. Call us today!
Zeapod Cakery
Whether you want a Zeapod Cakery Baby Shower original cake, or you have a completely new idea in mind, we'll do it!
Kakes Xcetera
At Kakes Xcetera, we know you will love every aspect of your cake, whether it's for a Anniversary or other special occasion.
When the average cake just won't do, call Memories and check out the outstanding Custom Cake creations we can do.
Ms E Sweet Treats
Square and rectangle Baby Shower cakes can be boring. Get imaginative with a unique Ms E Sweet Treats creation for your party instead!
Sweet Dreams Custom Cakes
Need a hardcore Graduation cake? Contact Sweet Dreams Custom Cakes in Alief and they will create something amazing for the big day.
Tea Cake Factory
Never settle for a Custom Cake cake that is less than spectacular. Call Tea Cake Factory for all your celebration needs.
Bake My Day Bakery
Big box store Bar Mitzvah cakes just can't compare to the superb choices available from Bake My Day Bakery in Alief right now.
Geris Cakes
Ask Geris Cakes about our amazing Anniversary cakes and Cupcakes, and you'll understand why we're the best bakery in Alief.
Yummyville Cakes
Yummyville Cakes is the only bakery you'll need in Alief. We have awesome Birthday cakes that will make everyone smile.
She Cupcakes
She Cupcakes is always ready to try a new Birthday or special occasion cake design. We love being imaginative!
Lil Audi Cakes
Lil Audi Cakes bakers are gifted and credentialed. Visit us to see some of our amazing Baby Shower cakes as proof.
My Goodie Basket Cupcakes and Cakep...
You can always serve yummy Cheesecakes instead of cake at your Baby Shower party. Call My Goodie Basket Cupcakes and Cakepops for great choices!
Morgans Cakery
The Morgans Cakery bakers are always friendly, attentive, and committed to creating the exact Baby Shower cake you are envisioning.
Cake Sweet Cake
It's always the right time for a delectable cake, even if it isn't your Communion or other special occasion.
How Sweet It Is
How Sweet It Is always provides outstanding Custom Cake cakes, but you really need to try their scrumptious Pies as well!
For Heavens Cake
At For Heavens Cake in Alief, our only goal is to make sure you're in awe of the Anniversary cake you receive.
Sweet Delights Wedding Cakes
You can always expect spectacular Communion cake results when you work with Sweet Delights Wedding Cakes bakers! Call us today for info!
Cake Design
Beauty is in the eye of the beholder. Unless, of course, it's a stunning Wedding cake from Cake Design!


text:
Signing up could earn you gear and it helps to keep offensive content off of our site.
This American classic has served as a winter refuge for the rich and famous since its 1935 inception, when Averell Harriman decided to create a grand American ski resort at the end of his Union Pacific train line.
Mt. Bachelor and its home base of Bend, Ore., are heaven for Type A personalities: The problem is not what to do but how to do it all. The premier golf destination in the Northwest, the region boasts 25 courses.
During the summer, Mammoth is to mountain biking what Mt. Everest is to climbing: There is no equal. The Mammoth Mountain Bike Park provides more than 70 miles of singletrack through the spectacular Eastern Sierra Mountains.
Steamboat has built its reputation around the image of cowboys riding through flank-deep snow, but summer is the best time to sample the area's ranching heritage. That's when the ProRodeo is in full-swing and pickups outnumber SUVs on Main Street.
Ahhh, Aspen¿that bastion of wealth and status nestled cozily in the Elk Mountains of Colorado. This glitzy gem of a resort really turns on the charm in summer months.
Say "Deer Valley" and people automatically think fine food and white-glove service. And Deer Valley does serve up a seamless and luxurious experience.
I can see the mail already. "Dear Editor: As a recent subscriber to SKI, I was expecting to receive a magazine about skiing. Instead, this 'special' Mountain Summer issue just arrived in my mailbox.
Go big: John Elway's Summit County, Colo., ski home is up for grabs.
U.S. Alpine Ski Team athlete Caroline Lalive will miss the on-snow training at Mammoth Mountain, CA due to a broken wrist from a mountain bike accident.
March 31: Mammoth ValuePass, is on sale starting tomorrow. Mammoth is breaking all the rules byholding the price to $399 for the third straight season
Go to skiingmag.com
Go to nastar.com
Go to warrenmiller.com
Copyright © 2015 Cruz Bay Publishing, Inc. an Active Interest Media Company.


text:
I have nothing negative to say about our stay.
From arrival to departure the hotel far exceeded the star rating in every respect.We particularly commend the dining room management and staff..
lack of airconditioning in the room.NO tissues provided.
Location and breakfast
Rooms were clean and large enough. Breakfast was fairly good.
We had a 4 in the morning fire alarm go off and had to evacuate the hotel. That was due to an employee opening the fire exit at that time for a late arriving guest. That was quite unpleasant, and tiring.
Spacious rooms
Cleaning service not great.
Modern and comfortable (and air conditioned!) budget-priced hotel. Decent restaurant. Not lavish but quite suitable for a 1-2 night stay. Within easy walking distance of the cathedral.
Pay parking
Location OK
Furnishing sparse. Not by any stretch a 3* hotel. More like an average 2* motel
Here's why:
We're not the seller
At KAYAK we don't set prices, so it's not possible for us to guarantee what other companies are selling.
We aggregate tons of data for you
Our service lets you quickly and easily compare results from hundreds of travel sites at once. In this sense, KAYAK is a search engine and we don't guarantee prices we find.
Why aren't prices accurate 100% of the time?
Prices on airline seats, hotel rooms and car rentals can change frequently. Several people may also be trying to buy the same travel option simultaneously. As a result, you may find on occasion that certain prices are no longer available.
More questions or if you have a bad price to report to us
Please send us an
and someone from our team will get back to you promptly.
KAYAK is part of The Priceline Group, the world leader in online travel & related services.


text:
Lindaa is amazing. Let me first mention that she started to suck on my cock before the fellas even showed up. I was on the phone with them trying to get them all to come over and she just pulled out my cock and put it in her mouth. Awesome. Once Tony, Renato, and Leslie got there, it was pretty much a free for all. Pussy and ass licking followed by titty sucking. One after the other got a great wet blowjob. Then one started to fuck her tight pussy and smack her round bubble butt as the other went in for the anal for some double penetration action. Man what a shoot. You have to see this one to fully grasp. Enjoy it. Trust.
"Horny Models On Set"
Donna Bell
"Breast Time Ever"
"Shake Town"
Taissia Shanti
"Tour Guide"
Katarina Muti
"Pleasant Lips"
Bella Baby
"Getting In The Mood"
Mea Melone
"Deep Drilling"
Gina Gerson
"Lips Wide Open"
Tina Blade
"Dual Licking"
Gina Gerson


text:
You are using an outdated browser. Please upgrade your browser to improve your ReverbNation experience.
You ...."are why" I am #1 in METAL for San Diego Thanks for Listening - do not forget to upload my 8 songs FREE, as a FAN !!
stopping thru to show some LUV to your pg.. HIT my FOLLOW button on my pg.. I'LL do the same for you www.twitter.com/mr_slic
Thanks for all your support. R.I.S.K
Love that you support local music!! Take a listen to some of our songs, and leave us a comment telling us what you think! \m/ -Ten Ton Mojo
Heavy, eerie, epic, Nu Blakenstein songs up; Sabbathy/Evanescence on steroids www.myspace.com/blakensteinmusic
#iAM KOOP,, a #YOUTUBEpartner and I get paid BY monetizing my videos.. #iWANTMYKIDS!!! #PleaseSUBSCRIBE TO MY #YOUTUBEaccount FOR #FREE AND HELP ME GET MY CHILDREN... #PLEASE...
Hi Marlene, I wanted to thank you for watching my video and the comment you left regarding it, I truly appreciate you taking the time. Thank you so much for your support.
Thnx for being my fan. I appreciate your support.-TRUTH, KNOWLEDGE, RESPECT
Thank you very much again Marlene.Wishing you a great weekend
Hello Marlene, thank you so much for adding me to your music friends. Have a great week. ~Valenteen. X


text:
Trivia: Jurassic Fight Club
- Development Hell: Where any further episodes of the Animated Adaptation have gone.
- What Could Have Been: The host wanted to pit numerous other prehistoric beasts against each other, however the series wasn't renewed for a second season.
- Word of God: Dinosaur George answers questions about the show and palaeontology in general on his YouTube channel. His videos are a lot more informative than the show, and George himself has a very friendly, down-to-earth attitude. Don't let his antics from the TV show fool you!


text:
Pioneer staff reports
Contact Email
- Member for
- 3 years 4 months
Author Content
Cub Scout Pack 234 of West Fargo is celebrating their 30th anniversary. Originally chartered in October 1981 by the West Fargo Jaycees, the pack was led by Cubmaster Joseph Spier. Through the years there have been many volunteers who have been instrumental in keeping the scouting program at Westside Elementary going strong. Pack 234 along with the West Fargo Exchange Club, the group's current charter organization, is appreciative to the community for supporting scouting.
It's that time again. Dust off those cases, get those embouchures ready and head on over to West Fargo High School for the Summer Band 2013 season. Rehearsals will be held on Wednesday evenings in June from 7 to 8 p.m. Anyone grade 9 and above is welcome to attend. If an instrument is needed contact Sue Jordahl at WFHS at 356-2050 in advance, and it will be waiting when you arrive. The first rehearsal will be Wednesday, June 5, with the plan to play a concert or two June 26 and also be a part of West Fargo's West Fest Celebration in September.
North Dakota residents are encouraged to cast their vote for the state's Outstanding Senior Volunteer. The recognition is part of the Salute to Senior Service program, sponsored by Home Instead, Inc., the franchisor of the Home Instead Senior Care network. The program honors the contributions of adults 65 and older who give at least 15 hours a month of volunteer service to their favorite causes.
The District 22 Republicans held their annual dinner last week at the Fargo Holiday with the event featuring keynote speaker Lt. Governor Drew Wrigley and a special recognition of past district chairpersons, Cleo and Ralph Thompson. Also attending was the District 22 legislative team of Senator Gary Lee and Representatives Wes Belter and Pete Silbernagel.
The American Legion held its 1st District Meeting in Harwood on April 15 with District Commander Greg Kraiter from Harwood chairing the meeting that heard reports about Boys State, the Oratorical Contest, Baseball and other promoted programs. Bill Marcks of Buffalo received a confirmation vote to move up to District Commander for the 2013-2014 year. State Commander Dave Rice from Harwood provided a legislative update and encouraged membership recruitment and retention within the district.
Benjamin Huber, a senior at West Fargo High School, has been named the West Fargo Exchange Club Student of the Month for April. He the son of Jason and Maira Huber, West Fargo.
Gov. Jack Dalrymple and North Dakota Department of Commerce Tourism Division Director Sara Otte Coleman announced this year's recipients of the Governor's Travel and Tourism Awards in a ceremony in Grand Forks on April 17.
The Red River Valley Fair Association held their Annual Meeting on Tuesday, April 16, 2013 with agenda items including the discussion of the 2013 Red River Valley Fair, 2013 Big Iron Farm Show, plus voting in newly elected board members and officers.
Superintendent David Flowers announced Wednesday that Adam Gehlhar has been named as an Assistant Principal for Cheney Middle School and Michelle Weber has been named as the Assistant Principal for...
West Fargo Public Schools has announced that the district's second Annual New Neighbor Night Celebration is coming up tomorrow night. New Neighbor Night was established last year as a way...


text:
How to Clean Fake Plants
Fake plants are a great way to add color and texture to any interior design, bringing the serenity of nature into your home without the need for watering or maintenance. Unlike live plants, artificial plants are robust and long lasting, and modern manufacturing techniques ensure that they are realistic and elegant. However, fake plants do require some regular cleaning, or they will fade and deteriorate.
This article has been tagged as a stub.
That means it's off to a good start, but still has room to grow into a more helpful resource. Until the article reaches its full potential, it will be hidden from search results. Can you help it flourish? If you think the article offers complete and accurate instructions, feel free to remove this tag.
1Clean Fake Plants Regularly: The most important aspect of cleaning silk plants is to clean them regularly. A quick dust with a feather duster is enough to keep off the worst of the dirt, and you can incorporate this into your normal weekly cleaning routine.
2Fake Plant Cleaning Solution: A few times every year, you should spray your plants with a recommended fake plant cleaning solution. This dissolves dust particles and dries to leave a waxy, natural sheen.
3Wipe With a Damp Cloth: If your fake plant has been neglected for a while, or is particularly dirty, then you can wipe it with a damp cloth. High quality fake plants are extremely delicate, so you should try to be as gentle as possible and avoid using hot water or detergent, which can affect the glue, preservative coating, and natural dyes.
Give us 3 minutes of knowledge!
- There is a lot of conflicting information online about cleaning fake plants with salt or with the shower. These methods may work for some types of fake plants, but many high-quality silk plants are extremely delicate and easily damaged.
- Wherever possible, ask the fake plant manufacturer for advice
- If you are unsure and do not know who manufactured your artificial plant, test and cleaning methods on a small, unobtrusive part.
Article Info
Categories: Stub | Home Decorating
Thanks to all authors for creating a page that has been read 8,228 times.


text:
The Style Gallery is a great new way for you to view, love, and share outfit photos. It's meant to showcase
all the expressive, creative, and inspirational personalities of our community!
Riviera Romance Dress in Wine
Ah, love - or as the French call it 'amour'! It really does make the world go round. It's that same euphoric rush of feelings that you experience every time you look at this cabernet- and cloud-striped dress by Synergy. Crafted in soft, organic cotton and cut in a classic ...
Networking for the Weekend Dress
Your fellow event hosts are waiting to see what youll wear next - impress them with this half-sleeved dress! Black, white, and grey intersecting stripes rep the many connections youll make tonight, while a comfortable jersey knit offers a relaxed air that puts new contacts at ease. How ideal!
Dining Cars and Stripes Forever Dress
While having a snack as you zip through the countryside, you look terrific in transit when sporting this detailed dress! With strawberry and vanilla stripes, this nifty number is accented with a sheer crocheted neckline and braided belt for days spent on the train.
Clink or Swim Dress
A celebration on the sea? Youre ready to frock the boat in this striped T-shirt dress! Cheers to this nautical numbers breezy jersey knit and contrast pocket decked in navy anchors and red helms. Whats more, its relaxed, loose silhouette fits perfectly over your swimsuit!
Oceanfront Properly Dress in Black Stripes
You'll look and feel coast-appropriate in this striped dress! Featuring a crisp white surplice bodice and a textured, black-and-white striped skirt, this cotton-blend frock is as cute as it gets when it comes to casual seaside attire.
Heir Aperitif Dress
You look so elegant sipping away in this navy blue cocktail dress that you could be mistaken for royalty! Regally displaying an illusion neckline paired with a sheer-striped bodice, plus subtle pleats and panels on its skirt, this frock is next in line for stealing every partygoers attention.
Record Store Date Dress in Black
Spotting your favorite record among the stacks, you set it on the turntable and start to dance in this ModCloth-exclusive black dress! With its white Peter Pan collar, long sleeves, and exposed zipper, this sweet shift is the perfect date night ensemble. The catchy beat encourages you to grab your ...
Inlet's Get Together Dress in Pink and White
This striped dress is a breath of fresh air for your wardrobe! In bold carnation pink and pristine white, the broad stripes of this short-sleeved, princess-seamed frock put a fun spin on nautical style. This pleated A-line is bound to sail away with your heart!
Take a Ladylike-ing To Dress
You thought this white dress was lovely from the moment you laid eyes on it, but your love for it grows with every wear! Style the pink and purple vines of flowers n striped hemline of this v-neck dress every feminine way imaginable to make this most of this marvelous ...
Chesapeake Bay Way of Life Dress
Gather the girls for a weekend on the water wearing this striped maxi dress, which flaunts optimum casual-cool vibes! Detailed with a slim sash and decorative pockets, this red and ivory, jersey-knit number pairs perfectly with drinks on the deck or at your fave waterside bistro.
Making Macarons Dress
You rise confidently to the challenge at todays pastry lesson in this black and white A-line! Topped with a striped bodice, intersected by a gathered waistline, and completed with a solid skirt, this twofer is classic and sweet just like the French treat.
Aweigh Back When Dress
Your favorite childhood memories involve family vacations and colorful ensembles - bring it recall back with this pocketed maxi dress! Starring a strapless neckline, a nod-to-nautical pattern of white, aqua, and grey stripes, and a tassel-tied waist, this comfy frock is a look to remember.
Peeks and Galleries Dress
With a dress like this textured LBD, you should have your own featured spot at the art opening! The lovely lattice illusion neckline detail is repeated at the waist and hemline, and completed with a subtly striped bodice and skirt, making this beautiful bodycon deserving of a delightful debut.
Bliss, That, and the Other Thing Dress
From casual Fridays to weekend crafting hours and beyond, this knit dress is a laid-back fashion paradise! With 3/4-length sleeves, deep blue stripes, and chambray back panels that pop with polka-dots and a tie, this joyful frock inspires an upbeat attitude everywhere you go.
A Bliss Goodnight Dress
The date may be over, but your hearts still fluttering, enriched by how lovely you feel in this red gown. Made distinct with a sheer neckline, gathered bust and waist details, and striped mesh panels, this flowing knit maxi is at once elegant and exceptional, just like your night.
Bryant Park Brilliance Dress in Ivory
While strolling through the city, you encounter an outdoor orchestral performance as captivating as your colorblocked maxi! Featuring a buttoned neckline with front and back keyholes, an accordion pleated skirt, and taupe-and-coral chevron stripes, this alabaster dress calls for an encore.
Vying for Vinyl Dress
Seated at the estate auction in this boho-inspired dress, you raise your paddle in the battle for a rare record set! Patterned stripes border the sheer sleeves and hemline of this number, pairing with a tied neckline to jazz up its burgundy backdrop. What a perfect look you've found for ...
Always Amiable Dress in Merlot
Your effervescent charisma is as renowned as your chic style - which you demonstrate in this sassy A-line! Striped in black and white, this vibrant fit and flare is accentuated by a burgundy waistband and hem for a timeless look that packs a modern punch.
Remarkable fashion & decor, inspired by our community, & delivered with uncommon care.
Copyright ©2002-2015 ModCloth.com. All Rights Reserved.
Site Map
CA Notice
Privacy & Security
Terms of Use