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- Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD more...
Practice Essentials
Anemia is strictly defined as a decrease in red blood cell (RBC) mass. The function of the RBC is to deliver oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs. This is accomplished by using hemoglobin (Hb), a tetramer protein composed of heme and globin. In anemia, a decrease in the number of RBCs transporting oxygen and carbon dioxide impairs the body's ability for gas exchange.[1] The decrease may result from blood loss, increased destruction of RBCs (hemolysis), or decreased production of RBCs.
Anemia, like a fever, is a sign that requires investigation to determine the underlying etiology. Often, practicing physicians overlook mild anemia. This is similar to failing to seek the etiology of a fever. The purpose of this article is to provide a method of determining the etiology of an anemia. (See the image below.) (See Etiology, Presentation, and Workup.)
Methods for measuring RBC mass are time consuming and expensive and usually require transfusion of radiolabeled erythrocytes. Thus, in practice, anemia is usually discovered and quantified by measurement of the RBC count, Hb concentration, and hematocrit (Hct). These values should be interpreted cautiously, because they are concentrations affected by changes in plasma volume. For example, dehydration elevates these values, and increased plasma volume in pregnancy can diminish them without affecting the RBC mass. (See Workup.)
The most serious complications of severe anemia arise from tissue hypoxia. Shock, hypotension, or coronary and pulmonary insufficiency can occur. This is more common in older individuals with underlying pulmonary and cardiovascular disease. (See Pathophysiology.)
Erythrocyte life cycle
Erythroid precursors develop in bone marrow at rates usually determined by the requirement for sufficient circulating Hb to oxygenate tissues adequately. Erythroid precursors differentiate sequentially from stem cells to progenitor cells to erythroblasts to normoblasts in a process requiring growth factors and cytokines.[2] This process of differentiation requires several days. Normally, erythroid precursors are released into circulation as reticulocytes.
Reticulocytes are so called because of the reticular meshwork of rRNA they harbor. They remain in the circulation for approximately 1 day before they mature into erythrocytes, after the digestion of RNA by reticuloendothelial cells. The mature erythrocyte remains in circulation for about 120 days before being engulfed and destroyed by phagocytic cells of the reticuloendothelial system.
Erythrocytes are highly deformable and increase their diameter from 7 µm to 13 µm when they traverse capillaries with a 3-µm diameter. They possess a negative charge on their surface, which may serve to discourage phagocytosis. Because erythrocytes have no nucleus, they lack a Krebs cycle and rely on glycolysis via the Embden-Meyerhof and pentose pathways for energy. Many enzymes required by the aerobic and anaerobic glycolytic pathways decrease within the cell as it ages. In addition, the aging cell has a decrease in potassium concentration and an increase in sodium concentration. These factors contribute to the demise of the erythrocyte at the end of its 120-day lifespan.
Response to anemia
The physiologic response to anemia varies according to acuity and the type of insult. Gradual onset may allow for compensatory mechanisms to take place. With anemia due to acute blood loss, a reduction in oxygen-carrying capacity occurs along with a decrease in intravascular volume, with resultant hypoxia and hypovolemia. Hypovolemia leads to hypotension, which is detected by stretch receptors in the carotid bulb, aortic arch, heart, and lungs. These receptors transmit impulses along afferent fibers of the vagus and glossopharyngeal nerves to the medulla oblongata, cerebral cortex, and pituitary gland.
In the medulla, sympathetic outflow is enhanced, while parasympathetic activity is diminished. Increased sympathetic outflow leads to norepinephrine release from sympathetic nerve endings and discharge of epinephrine and norepinephrine from the adrenal medulla. Sympathetic connection to the hypothalamic nuclei increases antidiuretic hormone (ADH) secretion from the pituitary gland.[3] ADH increases free water reabsorption in the distal collecting tubules. In response to decreased renal perfusion, juxtaglomerular cells in the afferent arterioles release renin into the renal circulation, leading to increased angiotensin I, which is converted by angiotensin-converting enzyme (ACE) to angiotensin II.
Angiotensin II has a potent pressor effect on arteriolar smooth muscle. Angiotensin II also stimulates the zona glomerulosa of the adrenal cortex to produce aldosterone. Aldosterone increases sodium reabsorption from the proximal tubules of the kidney, thus increasing intravascular volume. The primary effect of the sympathetic nervous system is to maintain perfusion to the tissues by increasing systemic vascular resistance (SVR). The augmented venous tone increases the preload and, hence, the end-diastolic volume, which increases stroke volume. Therefore, stroke volume, heart rate, and SVR all are maximized by the sympathetic nervous system. Oxygen delivery is enhanced by the increased blood flow.
In states of hypovolemic hypoxia, the increased venous tone due to sympathetic discharge is thought to dominate the vasodilator effects of hypoxia. Counterregulatory hormones (eg, glucagon, epinephrine, cortisol) are thought to shift intracellular water to the intravascular space, perhaps because of the resultant hyperglycemia. This contribution to the intravascular volume has not been clearly elucidated.
Basically, only three causes of anemia exist: blood loss, increased destruction of RBCs (hemolysis), and decreased production of RBCs. Each of these causes includes a number of disorders that require specific and appropriate therapy. Genetic etiologies include the following:
Enzyme abnormalities of the glycolytic pathways
Defects of the RBC cytoskeleton
Congenital dyserythropoietic anemia
Rh null disease
Hereditary xerocytosis
Fanconi anemia
Nutritional etiologies include the following:
Iron deficiency
Vitamin B-12 deficiency
Folate deficiency
Starvation and generalized malnutrition
Physical etiologies include the following:
Prosthetic valves and surfaces
Chronic disease and malignant etiologies include the following:
Renal disease
Hepatic disease
Chronic infections
Collagen vascular diseases
Infectious etiologies include the following:
Viral - Hepatitis, infectious mononucleosis, cytomegalovirus
Bacterial - Clostridia, gram-negative sepsis
Protozoal - Malaria, leishmaniasis, toxoplasmosis
Thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome may be a cause of anemia. Hereditary spherocytosis either may present as a severe hemolytic anemia or may be asymptomatic with compensated hemolysis. Similarly, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency may manifest as chronic hemolytic anemia or exist without anemia until the patient receives an oxidant medication. Immunologic etiologies for anemia may include antibody-mediated abnormalities. In the emergency department (ED), acute hemorrhage is by far the most common etiology for anemia.
Drugs or chemicals commonly cause the aplastic and hypoplastic group of disorders. Certain types of these causative agents are dose related and others are idiosyncratic. Any human exposed to a sufficient dose of inorganic arsenic, benzene, radiation, or the usual chemotherapeutic agents used for treatment of neoplastic diseases develops bone marrow depression with pancytopenia.
Conversely, among the idiosyncratic agents, only an occasional human exposed to these drugs has an untoward reaction resulting in suppression of one or more of the formed elements of bone marrow (1:100 to 1:millions). With certain types of these drugs, pancytopenia is more common, whereas with others, suppression of one cell line is usually observed. Thus, chloramphenicol may produce pancytopenia, whereas granulocytopenia is more frequently observed with toxicity to sulfonamides or antithyroid drugs.
Current evidence suggests that susceptibility to idiosyncratic reactions involves certain genetic polymorphisms involving cellular detoxifying enzymes. As a result, exogenous toxins that would normally be converted to nontoxic compounds are instead metabolized into reactive compounds that modify cellular proteins, which can be recognized by the immune system and trigger autoimmunity.[4]
The idiosyncratic causes of bone marrow suppression include multiple drugs in each of the categories that can be prefixed with anti- (eg, antibiotics, antimicrobials, anticonvulsants, antihistamines). The other idiosyncratic causes of known etiology are viral hepatitis and paroxysmal nocturnal hemoglobinuria. In approximately one half of patients presenting with aplastic anemia, a definite etiology cannot be established, and the anemia must be regarded as idiopathic.
Rare causes of anemia due to a hypoplastic bone marrow include familial disorders and the acquired pure red cell aplasias. The latter are characterized by a virtual absence of erythroid precursors in the bone marrow, with normal numbers of granulocytic precursors and megakaryocytes. Rare causes of diminished erythrocyte production with hyperplastic bone marrow include hereditary orotic aminoaciduria and erythremic myelosis.
A study of 2688 patients undergoing cardiac surgery in the United Kingdom from 2008-2009 found that 1463 (54.4%) met the World Health Organization definition for anemia. This prevalence was much greater than previously reported, although the reason for this association is unclear.[5]
Occurrence in the United States
The prevalence of anemia in population studies of healthy, nonpregnant people depends on the Hb concentration chosen for the lower limit of normal values. The World Health Organization (WHO) chose 12.5 g/dL for both adult males and females. In the United States, limits of 13.5 g/dL for men and 12.5 g/dL for women are probably more realistic. Using these values, approximately 4% of men and 8% of women have values lower than those cited. A significantly greater prevalence is observed in patient populations. Less information is available regarding studies using RBC or Hct.
International occurrence
The prevalence of anemia in Canada and northern Europe is believed to be similar to that in the United States. In underprivileged countries, limited studies of purportedly healthy subjects show the prevalence of anemia to be 2-5 times greater than that in the United States. Although geographic diseases, such as sickle cell anemia, thalassemia, malaria, hookworm, and chronic infections, are responsible for a portion of the increase, nutritional factors with iron deficiency and, to a lesser extent, folic acid deficiency play major roles in the increased prevalence of anemia. Populations with little meat in the diet have a high incidence of iron deficiency anemia, because heme iron is better absorbed from food than inorganic iron.
Sickle cell disease is common in regions of Africa, India, Saudi Arabia, and the Mediterranean basin. The thalassemias are the most common genetic blood diseases and are found in Southeast Asia and in areas where sickle cell disease is common.
Race-related demographics
Certain races and ethnic groups have an increased prevalence of genetic factors associated with certain anemias. Diseases such as the hemoglobinopathies, thalassemia, and G-6-PD deficiency have different morbidity and mortality in different populations due to differences in the genetic abnormality producing the disorder. For example, G-6-PD deficiency and thalassemia have less morbidity in African Americans than in Sicilians because of differences in the genetic fault. Conversely, sickle cell anemia has greater morbidity and mortality in African Americans than in Saudi Arabians.
Race is a factor in nutritional anemias and anemia associated with untreated chronic illnesses to the extent that socioeconomic advantages are distributed along racial lines in a given area;[6] socioeconomic advantages that positively affect diet and the availability of health care lead to a decreased prevalence of these types of anemia.[7, 8, 9] For instance, iron deficiency anemia is much more prevalent in the populations of developing nations, who tend to have little meat in their diets, than it is in populations of the United States and northern Europe.
Similarly, anemia of chronic disorders is commonplace in populations with a high incidence of chronic infectious disease (eg, malaria, tuberculosis, acquired immunodeficiency syndrome [AIDS]), and this is at least in part worsened by the socioeconomic status of these populations and their limited access to adequate health care.
Sex-related demographics
Overall, anemia is twice as prevalent in females as in males. This difference is significantly greater during the childbearing years due to pregnancies and menses.
Approximately 65% of body iron is incorporated into circulating Hb. One gram of Hb contains 3.46 mg of iron (1 mL of blood with an Hb concentration of 15 g/dL = 0.5 mg of iron). Each healthy pregnancy depletes the mother of approximately 500 mg of iron. While a man must absorb about 1 mg of iron to maintain equilibrium, a premenopausal woman must absorb an average of 2 mg daily. Further, because women eat less food than men, they must be more than twice as efficient as men in the absorption of iron to avoid iron deficiency.
Women have a markedly lower incidence of X-linked anemias, such as G-6-PD deficiency and sex-linked sideroblastic anemias, than men do. In addition, in the younger age groups, males have a higher incidence of acute anemia from traumatic causes.
Age-related demographics
Previously, severe, genetically acquired anemias (eg, sickle cell disease, thalassemia, Fanconi syndrome) were more commonly found in children because they did not survive to adulthood. However, with improvement in medical care and breakthroughs in transfusion and iron chelation therapy, in addition to fetal hemoglobin modifiers, the life expectancy of persons with these diseases has been significantly prolonged.[10]
Acute anemia has a bimodal frequency distribution, affecting mostly young adults and persons in their late fifties. Causes among young adults include trauma, menstrual and ectopic bleeding, and problems of acute hemolysis. During their childbearing years, women are more likely to become iron deficient.
In people aged 50-65 years, acute anemia is usually the result of acute blood loss in addition to a chronic anemic state. This is the case in uterine and GI bleeding.
Neoplasia increases in prevalence with each decade of life and can produce anemia from bleeding, from the invasion of bone marrow with tumor, or from the development of anemia associated with chronic disorders. The use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and warfarin also increases with age and can produce GI bleeding.
Usually, the prognosis depends on the underlying cause of the anemia. However, the severity of the anemia, its etiology, and the rapidity with which it develops can each play a significant role in the prognosis. Similarly, the age of the patient and the existence of other comorbid conditions influence outcome.
Sickle cell anemia
Patients who are homozygous (Hgb SS) have the worst prognosis, because they tend to have more frequent crises. Patients who are heterozygous (Hgb AS) have sickle cell traits, and they have crises only under extreme conditions.
Patients who are homozygous for beta thalassemia (Cooley anemia or thalassemia major) have a worse prognosis than do patients with any of the other thalassemias (thalassemia intermedia and thalassemia minor). These few years have witnessed groundbreaking advancements in the treatment of thalassemias, especially with iron chelation therapies, allowing thalassemia patients to live well into adulthood.[10] Patients who are heterozygous for beta thalassemia have mild microcytic anemia that is not clinically significant.
Aplastic anemia
Chances of survival are poorer for patients with idiosyncratic aplasia caused by chloramphenicol and viral hepatitis and better when paroxysmal nocturnal hemoglobinuria or insecticide toxicity are the probable etiology. The prognosis for idiopathic aplasia lies between these 2 extremes, with an untreated mortality rate of approximately 60-70% within 2 years after diagnosis.
The 2-year fatality rate for severe aplastic anemia is 70% without bone marrow transplantation or a response to immunosuppressive therapy.
Among patients with a hyperplastic bone marrow and decreased production of RBCs, one group has an excellent prognosis, and the other is unresponsive, refractory to therapy, and has a relatively poor prognosis. The former includes patients with disorders of relative bone marrow failure due to nutritional deficiency, in whom identification of the etiology and treatment with vitamin B-12, folic acid, or iron leads to a correction of anemia once the appropriate etiology is established. Drugs acting as an antifolic antagonist or inhibitor of DNA synthesis can produce similar effects.
The second group includes patients with an idiopathic hyperplasia that may respond partially to pyridoxine therapy in pharmacologic doses but more frequently does not. These patients have ringed sideroblasts in the bone marrow, indicating an inappropriate use of iron in the mitochondria for heme synthesis.
Certain patients with marrow hyperplasia (see the image below) may have refractory anemia for years, but some of the group eventually develop acute myelogenous leukemia.
Hemolytic-uremic syndrome
Hemolytic-uremic syndrome carries a significant morbidity and mortality if untreated. As many as 40% of those affected die, and as many as 80% develop renal insufficiency.
Patient Education
Inform patients of the etiology of their anemia, the significance of their medical condition, and the therapeutic options available for treatment.
If no effective specific treatment of the underlying disease exists, educate patients who require periodic transfusions about the symptoms that herald the need for transfusion. Likewise, they should be aware of the potential complications of transfusion.
For patient education information, see Anemia.
Veng-Pedersen P, Chapel S, Schmidt RL, Al-Huniti NH, Cook RT, Widness JA. An integrated pharmacodynamic analysis of erythropoietin, reticulocyte, and hemoglobin responses in acute anemia. Pharm Res. 2002 Nov. 19(11):1630-5. [Medline].
Liang R, Ghaffari S. Advances in understanding the mechanisms of erythropoiesis in homeostasis and disease. Br J Haematol. 2016 Jul 21. [Medline].
Adamson JW, Longo DL. Anemia and polycythemia. Harrison's Principles of Internal Medicine. 15th ed. New York, New York: McGraw-Hill; 2001. Vol 1.: 348-354.
Babushok DV, Li Y, Roth JJ, Perdigones N, Cockroft JD, Biegel JA, et al. Common polymorphic deletion of glutathione S-transferase theta predisposes to acquired aplastic anemia: Independent cohort and meta-analysis of 609 patients. Am J Hematol. 2013 Oct. 88 (10):862-7. [Medline]. [Full Text].
Hung M, Besser M, Sharples LD, Nair SK, Klein AA. The prevalence and association with transfusion, intensive care unit stay and mortality of pre-operative anaemia in a cohort of cardiac surgery patients. Anaesthesia. 2011 Sep. 66(9):812-8. [Medline].
Servilla KS, Singh AK, Hunt WC, et al. Anemia management and association of race with mortality and hospitalization in a large not-for-profit dialysis organization. Am J Kidney Dis. 2009 Sep. 54(3):498-510. [Medline].
Adebisi OY, Strayhorn G. Anemia in pregnancy and race in the United States: blacks at risk. Fam Med. 2005 Oct. 37(9):655-62. [Medline].
Silva DG, Priore SE, Franceschini Sdo C. Risk factors for anemia in infants assisted by public health services: the importance of feeding practices and iron supplementation. J Pediatr (Rio J). 2007 Mar-Apr. 83(2):149-56. [Medline].
Oliveira MA, Osorio MM, Raposo MC. Socioeconomic and dietary risk factors for anemia in children aged 6 to 59 months. J Pediatr (Rio J). 2007 Jan-Feb Epub 2007 Jan 12. 83(1):39-46. [Medline].
Borgna-Pignatti C, Rugolotto S, De Stefano P, et al. Survival and complications in patients with thalassemia major treated with transfusion and deferoxamine. Haematologica. 2004 Oct. 89(10):1187-93. [Medline].
Kuku I, Kaya E, Yologlu S, Gokdeniz R, Baydin A. Platelet counts in adults with iron deficiency anemia. Platelets. 2009 Aug 3. 1-5. [Medline].
Stamatoyannopoulos G, Majerus PW, Perimutter RM. The Molecular Basis of Blood Diseases. Philadelphia, Pa: WB Saunders Co; 2000.
Dhar R, Zazulia AR, Videen TO, et al. Red blood cell transfusion increases cerebral oxygen delivery in anemic patients with subarachnoid hemorrhage. Stroke. 2009 Sep. 40(9):3039-44. [Medline]. [Full Text].
DeLoughery TG. Microcytic anemia. N Engl J Med. 2014 Oct 2. 371(14):1324-31. [Medline].
Mozaffari-Khosravi H, Noori-Shadkam M, Fatehi F, Naghiaee Y. Once weekly low-dose iron supplementation effectively improved iron status in adolescent girls. Biol Trace Elem Res. 2009 Aug 4. epub ahead of print. [Medline].
[Guideline] Killick SB, Bown N, Cavenagh J, Dokal I, Foukaneli T, Hill A, et al. Guidelines for the diagnosis and management of adult aplastic anaemia. Br J Haematol. 2016 Jan. 172 (2):187-207. [Medline]. [Full Text].
[Guideline] Barone A, Lucarelli A, Onofrillo D, Verzegnassi F, Bonanomi S, et al. Diagnosis and management of acquired aplastic anemia in childhood. Guidelines from the Marrow Failure Study Group of the Pediatric Haemato-Oncology Italian Association (AIEOP). Blood Cells Mol Dis. 2015 Jun. 55 (1):40-7. [Medline].
|Serum Iron
|Total Iron-Binding Capacity (TIBC)
|Bone Marrow Iron
|Iron deficiency
|Responsive to iron therapy
|Chronic inflammation
|Unresponsive to iron therapy
|Thalassemia major
|Reticulocytosis and indirect bilirubinemia
|Thalassemia minor
|Elevation of fetal hemoglobin and Hb A2, target cells, and poikilocytosis
|Lead poisoning
|Basophilic stippling of RBCs
|Ring sideroblasts in marrow
|Hemoglobin electrophoresis
|↓ = decreased; ↑ = increased; 0 = absent; +'s indicate the amount of stainable iron in bone marrow specimens, on a scale of 0-4; N = normal.
|Megaloblastic bone marrow
|Deficiency of vitamin B-12
|Deficiency of folic acid
|Drugs affecting deoxyribonucleic acid (DNA) synthesis
|Inherited disorders of DNA synthesis
|Nonmegaloblastic bone marrow
|Liver disease
|Hypothyroidism and hypopituitarism
|Accelerated erythropoiesis (reticulocytes)
|Hypoplastic and aplastic anemia
|Infiltrated bone marrow
|Larger than normal (>8.5 µm diameter). See Table 2.
|Smaller than normal (< 7 µm diameter). See Table 1.
|Less hemoglobin in cell. Enlarged area of central pallor. See Table 1.
|Loss of central pallor, stains more densely, often microcytic. Hereditary spherocytosis and certain acquired hemolytic anemias
|Target cell
|Hypochromic with central "target" of hemoglobin. Liver disease, thalassemia, hemoglobin D, and postsplenectomy
|Hypochromic cell with a normal diameter and decreased MCV. Thalassemia
|Oval to cigar shaped. Hereditary elliptocytosis, certain anemias (particularly vitamin B-12 and folate deficiency)
|Fragmented helmet- or triangular-shaped RBCs. Microangiopathic anemia, artificial heart valves, uremia, and malignant hypertension
|Slitlike area of central pallor in erythrocyte. Liver disease, acute alcoholism, malignancies, hereditary stomatocytosis, and artifact
|Tear-shaped RBCs
|Drop-shaped erythrocyte, often microcytic. Myelofibrosis and infiltration of marrow with tumor. Thalassemia
|Five to 10 spicules of various lengths and at irregular intervals on surface of RBCs
|Evenly distributed spicules on surface of RBCs, usually 10-30. Uremia, peptic ulcer, gastric carcinoma, pyruvic kinase deficiency, and preparative artifact
|Sickle cell
|Elongated cell with pointed ends. Hemoglobin S and certain types of hemoglobin C and l
|Intracorpuscular defect
|Hereditary spherocytosis
Hereditary elliptocytosis
Congenital dyserythropoietic anemias
Hereditary RBC enzymatic deficiencies
Rarer hereditary abnormalities
|Vitamin B-12 and folic acid deficiency
Paroxysmal nocturnal hemoglobinuria
Severe iron deficiency
|Extracorpuscular defect
|Physical agents: Burns, cold exposure
Traumatic: Prosthetic heart valves, march hemoglobinuria, disseminated intravascular coagulation (DIC), graft rejection
Chemicals: Drugs and venoms
Infectious agents: Malaria, toxoplasmosis, mononucleosis, hepatitis, primary atypical pneumonia, clostridial infections, bartonellosis, leishmaniasis
Hepatic and renal disease
Collagen vascular disease
Malignancies: Particularly hematologic neoplasia
Transfusion of incompatible blood
Hemolytic disease of the newborn
Cold hemagglutinin
Autoimmune hemolytic anemia Thrombotic thrombocytopenic purpura (TTP) and hemolytic-uremic syndrome (HUS)


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Hotel Indigo Madrid - Gran Via, Madrid
- Free WiFi
Main amenities
- 89 guestrooms
- Restaurant and bar/lounge
- Rooftop terrace
- Breakfast available
- Seasonal outdoor pool
- Self parking
- Business center
- Childcare
- Multilingual staff
- Tour/ticket assistance
- Porter/bellhop
What's around
- In Gran Via
- Plaza Mayor (0.4 mi / 0.7 km)
- Plaza de Espana (0.3 mi / 0.5 km)
- Puerta del Sol (0.4 mi / 0.6 km)
- Royal Palace (0.5 mi / 0.8 km)
- Almudena Cathedral (0.6 mi / 0.9 km)
Hotel Indigo Madrid - Gran Via, Madrid
Hotel Info: 866-539-8117from $116
- Room, 1 Queen Bed, Non Smoking
- Executive Room, 1 King Bed, Non Smoking
- Room, 1 King Bed, Non Smoking
- Superior Room, 1 King Bed, Non Smoking
- Room, 1 Bedroom, Non Smoking
- Superior Room, 1 Queen Bed, Non Smoking
- Superior Room, Non Smoking
- Suite, Non Smoking, City View
- Superior Room, 1 Single Bed, Non Smoking
- Standard Room, Non Smoking
- Deluxe Room
- Room, 1 King Bed, Accessible, Non Smoking
Also popular with travelers from the USA
At a glance
Key facts
Hotel size
- This hotel has 89 rooms
- This hotel is arranged over 14 floors
- Check-in time starts at 2 PM
- Check-out time is noon
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
Travelling with others
- Pets not allowed
- Free WiFi and wired Internet access in public areas
- Free WiFi and wired Internet access in rooms
- Self parking *
Nearby Four Star Madrid hotels
In the hotel
- Supervised childcare/activities
- Full breakfast daily (surcharge)
- Restaurant
- Bar/lounge
- Outdoor seasonal pool
- Business center
- Tours/ticket assistance
- Multilingual staff
- Porter/bellhop
- Rooftop terrace
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Minibar
- Coffee/tea maker
- Bathrobes
- Iron/ironing board
- Private bathroom
- Rainfall showerhead
- Hair dryer
- 40-inch LCD TV
- Satellite TV channels
- Desk
- Free newspaper
- Free WiFi
Top Madrid hotels
Recently reviewed hotels in Madrid
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Special features
DiningAndrea Tumbarello - This restaurant specializes in Mediterranean cuisine and serves lunch and dinner.
Hotel Indigo Madrid - Gran Via, Madrid's small print
Also known as
- Hotel Indigo Hotel Madrid Gran Via
- Hotel Indigo Madrid Gran Via
Cash transactions at this property cannot exceed EUR 2500, due to national regulations. For further details, please contact the property using information in the booking confirmation.
Optional extras
Self parking costs EUR 25 per night
Full breakfast is offered for an extra charge of EUR 16 per person (approximately)
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
Recent reviews
Excellent 4.4 /5 from 170 reviews
There was no natural light in the room at all. There was a window that opened on a very narrow air shaft. When I tried to change, they explained that all standard rooms were like that, and that an upgrade was not available (5 hours later amended to an upgrade "might" be available).The bath was small but with a walk-in shower complete with a grab bar and good traction - a very positive experience.The breakfast was adequate but of 5 hotels we stayed at over 3 weeks in Spain it ranked a distant 5th.The coffee service was ridiculous. You had to feed little containers into the machine and push the button to get coffee and it took three rounds to get a nearly full cup. The staff was friendly and helpful, but it felt like they were sabotaged by management. Little things like blocking the European Cup games from the in room TV and pulling tables and chairs away from the (very tiny) pool area in the afternoon of an 85 degree day to prep for a private function that evening. Take a snack if you're going to use the elevators. They were the slowest I've ever been in - and two small cars to serve 12 floors of guest rooms.
We only stated one night. Staff friendly hotel safety was great. Food was good but limited. Lights in room were annoying to control. Room was perfumed with a strong scent. Took sometime to get use to. Left window open to diminish scent which wax nice but just was too strong would stay again
A very nice hotel just a block from a busy street and a big plaza. We walked from the hotel to all the major parts in Madrid, and were able to see everything. Only issue we had with the hotel was that the room was a little smaller, but well appointed. Also they had switched over to the hotel heater, so we couldn't turn on the AC, so our room was pretty hot. Overall a very nice stay.
I needed help calling the airline to clarify an issue and the staff was so friendly and helpful. The team that supported the rooftop bar was also pleasant and that made my stay even better than expected.
Just about perfect place to stay. The only thing that might bother some people is that there is a late night club close enough to the hotel that you'll wake up hearing thud-thud-thud dance beats in the middle of the night. I was on the 4th floor, so might not be a problem higher up. I always travel with earplugs and they covered it up fine for me.
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Synonyms of consonance in English:
1 a constitution in consonance with the customs of the people
agreement, accord, harmony, unison;
compatibility, congruity, congruence
formal concord
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The 15th-century style Venetian palazzo known as the Isabella Stewart Gardner Museum is most famous for its historic art and contemporary collection – or infamous, perhaps, for its 1990 heist – but there are many beautiful sculptures, manuscripts and pieces of furniture that are also on display. Named after an American woman who loved the arts, the museum added a new wing in 2012 behind the main building that hosts live musical performances, prominent exhibits, concerts at Calderwood Hall and even two artists-in-resident apartments. The indoor courtyard, which has a spectacular year-round garden of flowering jade trees, summer blues hydrangeas and midwinter tropics flowers, is made even more beautiful when decorated for the holidays.


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Armband Water Bottle As an avid runner, I've often found myself wishing I had an armband water bottle. When you're in the middle of the woods in high temperatures, it's not only miserable to be thirsty but dangerous as well. But, one, for obvious reasons, doesn't want to be lugging around bulky gear that will interfere with performance. Product was received for review purposes. I am so … [Read more...]
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Tervis Water Bottle I love water bottles. I have a ton of them, and I consider a good water bottle an essential everyday item that I must always have with me. That being said, I was really excited to try the Tervis Water Bottle and even more excited when I learned that they had collegiate designs. Of course, I had to get a University of Kentucky design to showcase my love for my school (and our … [Read more...]
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Script and Scribble Custom People Water Bottle I have a fun and truly unique product to share with you! Script and Scribble is now making Custom People Water Bottles that you can personalize, having the character on the bottle look like your little one! Script and Scribble is a nationally distributed catalog and website that sells exclusive personalized stationery and gifts for friends and … [Read more...]
Swiggies Wrist Water Bottle Review
Swiggies - The Wrist Water Bottle Every morning I wake up, bright and early, at 5 a.m. and head to the gym before work or class. And every morning, while I'm at the gym, I face the dilemma of whether or not I should take my water bottle with me. Obviously, it's great to have with me, but I am too busy trying to get perfect glutes to want to carry that thing around with me. So more often than not, … [Read more...]


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... is what I heard from the most of the cases? do augmentin needs to be taken for a otitis media in stead?
Otitis Media - is it true that if you treat an otitis only with amoxicilin, it recurents? couse this
- Posted:
- 27 Oct 2009 by lexas
- Topics:
- augmentin, otitis media
Answers (1)
13 Nov 2009
I don't think so. It may happen in some cases but not all. Provided the patient is on a decent course of the antibiotic (amoxicillin) and the infection is totally cleared it should not reoccur.
Further Information
- Augmentin Information for Consumers
- Augmentin Information for Healthcare Professionals (includes dosage details)
- Side Effects of Augmentin (detailed)
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What are the risks involved w/6.5 mo. old male taking Augmentin?
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Took augmentin without realizing it was expired will it make me sick or is the potency just reduced?
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Is Augmentin 875 known to raise Blood sugar in diabetics??
My blood sugar soared to 300 about 3hrs after takinbg the first does for an ear infection. Is this a known problem for this drug?
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Medical Herbalism: The Science and Practice of Herbal Medicine
Inner Traditions / Bear & Co, Oct 24, 2003 - Health & Fitness - 672 pages
A foundational textbook on the scientific principles of therapeutic herbalism and their application in medicine
• A complete handbook for the medical practitioner
• Includes the most up-to-date information on preparations, dosage, and contraindications
• By the author of The Complete Illustrated Holistic Herbal
Medical Herbalism contains comprehensive information concerning the identification and use of medicinal plants by chemical structure and physiological effect, the art and science of making herbal medicine, the limitations and potential of viewing herbs chemically, and the challenge to current research paradigms posed by complex plant medicines. It also includes information on toxicology and contraindications, the issues involved in determining dosage and formulation types for an individual, guides to the different measurement systems and conversion tables, and the pros and cons of both industrial and traditional techniques.
With additional sections devoted to the principles of green medicine, the history of Western Herbalism, the variety of other medical modalities using medicinal plants, an extensive resource directory, and a discussion of treatments organized by body system, Medical Herbalism is the comprehensive textbook all students and practitioners of clinical herbalism need to develop their healing practices.
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Treatment Approaches by Body System
Selected Examples of Binomial Meanings
Herbs by Latin and Common Names
Pharmacy Terms
Weight and Measure Conversions
Herbal Information Sources
Taxonomy Hierarchy
About the Author
Other editions - View all
Medical Herbalism: The Science and Practice of Herbal Medicine
David Hoffmann
No preview available - 2003
Common terms and phrases
Achillea millefolium acid ACTION HERBS activity alkaloids Allium sativum anti-inflammatory antimicrobial Antispasmodic Artemisia astringent bitter blood body body's Calendula cancer cardiac cardiovascular cause cells chemical chronic Cimicifuga racemosa clinical compounds constituents Crataegus cup of boiling demulcent dietary digestive disease diuretic dose dried herb drug drunk three Echinacea effects enzyme essential oil expectorant extract flavonoids Galium aparine Genus glycosides graveolens healing heart hepatic herbal medicine herbalist holistic hormone Hydrastis canadensis Hypericum perforatum Ibid immune indicated infection inflammation infusion inhibit Inula helenium irritation kidney Leonurus cardiaca liver Matricaria recutita membranes Mentha piperita metabolism ml of tincture ml three molecules muscle Nervine occur pain patient Phytotherapy plants Preparations and Dosage Prescription problems proteins relaxing remedies respiratory root Safety Considerations saponins Scutellaria lateriflora skin specific stimulating substance symptoms teaspoons therapeutic Tilia platyphyllos Tincture dosage tion tissue tonic toxic treatment ulcers Valeriana officinalis Viburnum opulus volatile oil vulgaris


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Is Grad School For Me?
Posted by Deborah.Walker on Monday March 28, 2011
Nyack College/ATS president, Dr. Michael G. Scales, will be the speaker at a special campus event, "Why Grad School?" Join Dr. Scales on Friday, April 8 at 6:30 p.m. on the Manhattan campus at 93 Worth St., New York, NY, 10th floor, Room 1015 for dinner and musical entertainment.
RSVP deadline is April 4. Names of the first 150 people to respond will be entered into an iPad raffle! Number must be reached and must be present to win.
Click here to register online!
Recent Posts
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- Nyack College Golf Class Return to Historic Saint Andrew's
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- Nyack Counseling Professor and Students to be Published
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- Days Away from Nyack's Historic Archaeological Dig
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- Honoring the Life of Dr. Thomas P. Bailey, Sr.
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Garden Center Association Of Greater Kansas City
Rating: 0 stars 0 0 review 26
5230 Mercer Kansas City MO 64112 USA
To promote and encourage among citizens of the Metropolitan Kansa City area an interest in horticulture and related gardening activities in order to educate all ages how to develop, appreciate and sustain a community that is environmentally sound, a desirable place to live, and an attractive tourist destination thereby responsibly helping Kansas City to develop and prosper.
- 1 day environmental camp in Loose Park created for low income urban children - Guided exploration of trees in Loose Park learning about their usefulness, beauty and differences - Guided orienteering activities - Craft activities - Week of June 23-27 in 2008 (1st full Tree Camp Session) - Last full week of June in 2009 - Hours 10:00 a.m. to 3:30 p.m. - Suitable for children ages 4-12 - 80% plus campers are from low income homes in Kansas City, MO - Campers come from the Parks and Recreation Dept's Summer Youth Programs - 150 campers in 2008 - 150 campers in 2009 - Counselor's are professional educators - Master Gardeners and volunteers help counselors - Student Service credit available - Two Field Explorers Guide booklets created by the Garden Center Tree Camp Committee to be used for the camp and also to be available in the Garden Center Building for visitors to Loose Park.
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Oakland, Berkeley, And East Bay News, Events, Restaurants, Music, & Arts
Ever first Monday after Oakland Art Mur Mur, and every 2nd to the last Monday nights at Radio Bar is now "Techno Awakening" w/ DJ Paulo Nicolas presented by Kruz'N Geisha Music Line-Up Productions Company
(Underground Lounge has been closed!!!!).
Awesome!! Can't wait!!
Address correction: The Alley is located at 2309 Encinal Ave. Alameda, CA, 94501
This show is actually on the 14th! If you could please amend that?
It would be a blessing to receive this much-needed help and even the more, to be able to participate in this study; it would reveal important information toward the treatment of PTSD in veterans with conditions such as my husbands.
I believe that it should be a requirement that all city officials and police chiefs throughout California should see this display so that they can have the unbiased truth about this plant and how politics have steered public opinion on this issue,,,,,,,,,,,,,,,,,,
Where is this???


text:
Why You Can't Trust Brokerage Research - Further Proof 3 commentsAug 29, 2012 9:51 PM | about stocks: JOSB
Brokerage analysts are always looking for an edge to show they offer 'value-added' information. If you're not paying strict attention you might think they did. Here's yet another example of how the cheating occurs.
Sterne, Agee & Leach made a bold call early Wednesday morning. They predicted Jos. A. Bank's (NASDAQ:JOSB) earnings would rise and they loved the shares at the current $41.63 price. As Will Shakespeare's Hamlet once said, "Ay, there's the rub."
As it turned out, JOSB had already reported, and Reuters had broadcast JOSB's much better than expected earnings and same store sales. Their shares were up 13.5% already in premarket trading.
JOSB had a gap opening at $48.00 - up $6.37 or + 15.3% from Tuesday's close. Nobody could buy the stock today at anywhere close to the price where Sterne, Agee & Leach will take credit for putting on their recommendation.
Anyone silly enough to act on Sterne, Agee & Leach's research blurb by buying at the open was down 1.17% by 4 pm.
Why did Barrons.com contribute its good name to this deception?
The day's range was $47.29 - $49.48 with the intra-day low coming with just minutes to go. The chart speaks for itself.
Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours.Stocks: JOSBBack To Paul Price's Instablog HomePage »
Instablogs are blogs which are instantly set up and networked within the Seeking Alpha community. Instablog posts are not selected, edited or screened by Seeking Alpha editors, in contrast to contributors' articles.Comments (3)Track new comments
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Paul, it looks like you misread the Stern release. To me it clearly says: "FOLLOWING a strong second quarter report, we are raising our estimate..." (emphasis mine)
The point was not that they hadn't seen the report. It was that they were recommending it at a price that was nowhere close to being available.
I agree with the principle of not trusting others research. however in this case "Following a strong second-quarter report, we are raising our estimates and target price on Jos. A. Bank Clothiers to $60 from $57 based upon 13 times forward."... So they were already bullish on it prior as well....
http://bit.ly/15IjYDB Sep 20, 2013
nly Apr 6, 2012
NLY Mar 22, 2012
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Skip to comments.Afghan Who Had (Buddha) Statues Destroyed Killed
Posted on 01/26/2007 5:57:36 AM PST by lunarbicep
A NATO airstrike destroyed a Taliban command post in southern Afghanistan, killing a suspected senior militant leader, the alliance said Friday. Separately, an assailant gunned down an Afghan lawmaker who, under the former Taliban regime, oversaw the destruction of two Buddha statues carved into a cliff.
Maulavi Mohammed Islam Mohammadi, who was the Taliban's governor of Bamiyan province when the fifth-century Buddha statues were blown up with dynamite and artillery in March 2001, was killed on his way to Friday prayers in Kabul, said Zulmai Khan, Kabul's deputy police chief.
Mohammadi was elected in 2005 to represent the northern province of Samangan in Afghanistan's parliament.
After he was elected, Mohammadi said he should not be held responsible for the destruction of the statues, which the Taliban considered to be idolatrous and anti-Muslim.
``It was foreigners like Chechens and Arabs with the Taliban who made the decision. They were crazy people,'' Mohammadi told The Associated Press at the time. ``Even though I was governor, I had no power.''
International outcry followed the destruction of the giant Buddhas, which were chiseled into a cliff and famed for their size and location along the ancient Silk Road linking Europe and Central Asia. Archaeologists in Bamiyan have been painstakingly collecting the stone remains of the two statues - and are considering rebuilding them.
(Excerpt) Read more at guardian.co.uk ...
I remember reading about that in the spring of 01 before 9-11 and thinking: those Taliban people are crazy...
Well, I guess it really isn't 'instant' - it did take a few years.
And I'm not sure if Buddha people do the 'karma' thing or not, now that I think of it.
Still, it's great news!
Boy, gonna be a long Friday now that I morphed into this guy....
Don't messwith the Buddha...he'll get you.
With a name like that, I'll bet he's swarthy.
Good news!
Good, that was a despicable act.
Buddha 1, Mohammad 0
Don't pull on supermans cape , don't spit in the wind....don't blow the bhuddah off the wall or it will be your end...lol
Buddha sends his love. President Bush sends his greetings.
Mark and Danny in the Greek Hotel
Bold as badgers on a one-take Mission
Got their equipment from a dwarf outside
On the trail of any suspect wisdom
Pond-Life beneath a Southern sky
(They make their move then they head off to the border)
They don't care as long as you can pay -
Whatever - whatever they say
We're on the road and we're gunning for the Buddha
We know his name and he mustn't get away
We're on the road and we're gunning for the Buddha
It would take one shot - to blow him away...
Now's the time to have some big ideas
Now's the time to make some firm decisions
We saw the Buddha in a bar down south
Talking politics and nuclear fission
We see him and he's all washed up -
Moving on into the body of a beetle
Getting ready for a long long crawl
He ain't nothing - he ain't nothing at all...
We're on the road and we're gunning for the Buddha
We know his name and he mustn't get away
We're on the road and we're gunning for the Buddha
It would take one shot - to blow him away...
Death and Money make their point once more
In the shape of Philosophical assassins
Mark and Danny take the bus uptown
Deadly angels for reality and passion
Have the courage of the here and now
Don't take nothing from these ½-baked buddhas
When you think you got it paid in full
You got nothing - you got nothing at all...
We're on the road and we're gunning for the Buddha
We know his name and he mustn't get away
We're on the road and we're gunning for the Buddha
It would take one shot...
I'm tempted to believe Mohammadi. The Afghans had been living with the statues for centuries; the impetus to destroy them probably came from Kandahar. Mullah Omar and his foreign friends were crazy people, even by Southwest Asian standards. If Prince Turki and his alim couldn't convince Omar to leave the statues alone, no Afghan official could, either.
Even the name for the Hindu Kush mountains means "Hindu Slayers."
They do.
Bush? The article doesn't say Bush killed him. Gunning down elected legislators in democratizing countries doesn't seem like his style.
That is a good song and a good band. Whatever happened to them?
I didn't say Bush killed him either. I only said he sent his greetings.
I'm not really feeling the joy. According to the guy himself, he was just a paper pusher who had few options under the ruling Taliban --- a group he publicly stated were crazy. Since then, he got involved in the nascent democracy we're trying to create in Afghanistan and was lawfully elected to office.
Now he's a victim of political violence.
Just how is terrorists gunning down officials in the democratically-elected Afghan government a good thing? I was kind of hoping Afghanistan wouldn't go down Iraq's path.
LOL! I'm Hank Kimball this morning too! Love that guy.
.....I'm tempted to believe Mohammadi.....
He is telling the truth about the crazies but ..... who let them in? He did.
I'm not exactly sure...Big Night Music was actually one of the last vinyl records I ever bought before overhauling my collection to CD's back in the 80's. I think I still have it around somewhere:-)
Technically, wouldn't it be 1-1?
Well, this is game two.
I understand that. But it's the same excuse that Germans used after World War II. I was just following orders.
Awwwwwww geeeee that's too bad...
Don't tell Jack Bauer you don't know the answer to hs question.....
Don't waste his time when he says that he is running out of it....
Garde la Foi, mes amis! Nous nous sommes les sauveurs de la République! Maintenant et Toujours!
(Keep the Faith, my friends! We are the saviors of the Republic! Now and Forever!)
LonePalm, le Républicain du verre cassé (The Broken Glass Republican)
Poetic justice.
This is great news in the WAR ON TERROR.
All we hear is bad news and news that runs down our country and demoralizes our troops.
Finally, this story comes out today that shows the enemies of freedom for what they are, and reinforces why we are fighting this war. We need some good news from time to time.
It's also BREAKING NEWS.
So why did the Admin. Moderator take it down and put it under "misc" effectively ending the thread?
I had referenced the wrong quote. This is what I had meant to reference. It states that the official OVERSAW the destruction. You can infer that because he is now an elected official it gives him grace from his prior OVERSEEING of the destruction of the statues, and that he is miraculously a good guy now. I choose not to infer it. I wonder what else he "oversaw" under the former Taliban regime. Did he "oversee" the destruction of people as well as things?
Thank you for finding that video
"The mohaMADans need to get it thru their brainwashed heads that Afghanistan was not theirs, no matter how much they try to erase the proud Buddhist history."
You're gunna get a kick out of this:
(comments) muslims say Australia and America all belongs to them!
The song (a live version) is on You Tube, but the sound quality is not good.
Cool...Thank you!
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


text:
We are experiencing an exceedingly hard to track down issue where we are seeing ClassCastExceptions sometimes when trying to iterate over a list of unmarshalled objects. The important bit is sometimes, after a reboot the particular code works fine. This seems to point in the direction of concurrency/timing/race condition. I can confirm that neither the JAXBContext, nor the marshallers and unmarshallers are being used concurrently. We've gone as far as serializing access to them through locking.
However, since we run on an OSGi platform where individual bundles are getting initialized asynchronously through Spring DM it can be that 2 different bundles are creating their JAXBContext at the same time.
In any case I would appreciate any pointers towards an explanation for what could cause these intermittent ClassCastExceptions. The intermittent is important since they indicate that the code itself is normally working fine but that some external factor seems to influence the behaviour.
Here's a specific example of the exception (note I removed the company specific stuff):
Caused by: java.lang.ClassCastException: com.sun.org.apache.xerces.internal.dom.ElementNSImpl cannot be cast to com.foobar.TunnelType
at com.foobar.NetMonitorImpl.getVpnStatus(NetMonitorImpl.java:180)
That method at line 180 is a for() construct looping over a Collection of TunnelType objects inside of an unmarshalled object (said unmarshalling works fine BTW).
Given that the actual object unmarshalling went fine, is it even physically possible for JAXB to leave ElementNSImpl objects inside of nested collections?
Runtime environment:
- OSGi
- Spring DM
- The JAXBContext is initialised with the ClassLoader of the bundle containing the classes to be marshalled/unmarshalled


text:
Index of content:
Volume 119, Issue 4, April 2006
Dependence of phonation threshold pressure on vocal tract acoustics and vocal fold tissue mechanics119(2006); http://dx.doi.org/10.1121/1.2173516View Description Hide Description
Analytical and computer simulation studies have shown that the acoustic impedance of the vocal tract as well as the viscoelastic properties of vocal foldtissues are critical for determining the dynamics and the energy transfer mechanism of vocal fold oscillation. In the present study, a linear, small-amplitude oscillation theory was revised by taking into account the propagation of a mucosal wave and the inertive reactance (inertance) of the supraglottal vocal tract as the major energy transfer mechanisms for flow-induced self-oscillation of the vocal fold. Specifically, analytical results predicted that phonation threshold pressure increases with the viscous shear properties of the vocal fold, but decreases with vocal tract inertance. This theory was empirically tested using a physical model of the larynx, where biological materials (fat, hyaluronic acid, and fibronectin) were implanted into the vocal fold cover to investigate the effect of vocal foldtissueviscoelasticity on . A uniform-tube supraglottal vocal tract was also introduced to examine the effect of vocal tract inertance on . Results showed that decreased with the inertive impedance of the vocal tract and increased with the viscous shear modulus or dynamic viscosity of the vocal fold cover, consistent with theoretical predictions. These findings supported the potential biomechanical benefits of hyaluronic acid as a surgical bioimplant for repairing voice disorders involving the superficial layer of the lamina propria, such as scarring, sulcus vocalis, atrophy, and Reinke's edema.
Vocal responses to unanticipated perturbations in voice loudness feedback: An automatic mechanism for stabilizing voice amplitude119(2006); http://dx.doi.org/10.1121/1.2173513View Description Hide Description
The present study tested whether subjects respond to unanticipated short perturbations in voiceloudness feedback with compensatory responses in voice amplitude. The role of stimulus magnitude ( vs SPL), stimulus direction (up vs down), and the ongoing voice amplitude level (normal vs soft) were compared across compensations. Subjects responded to perturbations in voiceloudness feedback with a compensatory change in voice amplitude 76% of the time. Mean latency of amplitude compensation was . Mean response magnitudes were smallest for stimulus perturbations and greatest for conditions . However, expressed as gain, responses for perturbations were largest and almost approached 1.0. Response magnitudes were larger for the soft voice amplitude condition compared to the normal voice amplitude condition. A mathematical model of the audio-vocal system captured the main features of the compensations. Previous research has demonstrated that subjects can respond to an unanticipated perturbation in voice pitch feedback with an automatic compensatory response in voice fundamental frequency. Data from the present study suggest that voiceloudness feedback can be used in a similar manner to monitor and stabilize voice amplitude around a desired loudness level.
Electropalatographic, acoustic, and perceptual data on adaptation to a palatal perturbation119(2006); http://dx.doi.org/10.1121/1.2173520View Description Hide Description
Exploring the compensatory responses of the speech production system to perturbation has provided valuable insights into speech motor control. The present experiment was conducted to examine compensation for one such perturbation—a palatal perturbation in the production of the fricative /s/. Subjects wore a specially designed electropalatographic (EPG) appliance with a buildup of acrylic over the alveolar ridge as well as a normal EPG palate. In this way, compensatory tongue positioning could be assessed during a period of target specific and intense practice and compared to nonperturbed conditions. Electropalatographic, acoustic, and perceptual analyses of productions of /asa/ elicited from nine speakers over the course of a one-hour practice period were conducted. Acoustic and perceptual results confirmed earlier findings, which showed improvement in production with a thick artificial palate in place over the practice period; the EPG data showed overall increased maximum contact as well as increased medial and posterior contact for speakers with the thick palate in place, but little change over time. Negative aftereffects were observed in the productions with the thin palate, indicating recalibration of sensorimotor processes in the face of the oral-articulatory perturbation. Findings are discussed with regard to the nature of adaptive articulatory skills.
On phonetic convergence during conversational interaction119(2006); http://dx.doi.org/10.1121/1.2178720View Description Hide Description
Following research that found imitation in single-word shadowing, this study examines the degree to which interacting talkers increase similarity in phonetic repertoire during conversational interaction. Between-talker repetitions of the same lexical items produced in a conversational task were examined for phonetic convergence by asking a separate set of listeners to detect similarity in pronunciation across items in a perceptual task. In general, a listener judged a repeated item spoken by one talker in the task to be more similar to a sample production spoken by the talker's partner than corresponding pre- and postinteraction utterances. Both the role of a participant in the task and the sex of the pair of talkers affected the degree of convergence. These results suggest that talkers in conversational settings are susceptible to phonetic convergence, which can mark nonlinguistic functions in social discourse and can form the basis for phenomena such as accent change and dialect formation.


text:
Topic: European Tour
Rory McIlroy Battles a Robot in Chipper Ad for Golf's European Tour
Who'll get taken to the cleaners?
By David Gianatasio on Jul. 1, 2013 - 6:56 AM EDT
This ad for golf's European Tour pits Northern Irish phenom Rory McIlroy against a wise-cracking golf-ball-hitting robot named Jeff in a contest to see who can chip the most balls…


text:
2x2 Games
2x2 Games is a 4-strong indie dev team that is not afraid of treading new ground. On a mission to find that perfect balance between fun and historical accuracy in wargames, they just might be onto something.
Games > Searching for "" - Sorted by newest first. Only 2x2 Games.3 matches
Unity of Command


text:
Nothing pisses me off more than having to drop down to MySQL level and toggle settings but that's what I've finally had to do on this blog. 90 spam comments an hour is more than even I'm willing to kill off and the new comment policy wasn't covering the older posts. Faced with the task […]
Temporary Lockdown – Updated
Category: Blog Stuff | Leave a Comment
Sunday Links
Category: Reading | Leave a Comment
Let's lead off with Glenn Beck's ten kinds of awesome remix of Reagan's speech on socialized medicine. Go listen and then pass it on. Remember Retired Lt. Gen. Russel Honore of Katrina fame? He's one ofthe few people who stepped up and restored order when everyone else lost their minds. So it goes in Shreveport […]
Change to comment functionality
Category: Blog Stuff | Leave a Comment
I'm currently getting spammed all to hell and back so – I have to go to a registration style comment system. If you want to comment, please register. This site does not track stats, it does not keep an email list for any reason.
The Guilt Bill
Category: General Badness, Obama | 2 Comments
President Obama's writers have been working overtime perfecting tomorrow's eulogy of HR3200 otherwise known as the KennedyCare Death Panel Bill. While it's true Obama was officially on vacation it's no accident that he chose his vacation spot as close to the only person who could feasibly save HR 3200 – alive or — preferably — […]
In other news
Category: General Badness | Leave a Comment
Carlos Miller, who is a flaming liberal, but I like him anyway because he's all about the camera and the online media and seldom shoves Obama in my face, has a post about the Miami Herald going after blogger RandomPixels for copyright infringement. This could get interesting. Left and Right bloggers can all agree on […]
Today's Quote
Category: Reading | Leave a Comment
And may I just add – Holy $hit. Brutal Truth. Without some type of faith, people can remain in a state of ravenous hunger, as needy and frightened as a little lost child. They're looking for something, but all the roads are blocked off. The only door leading to safety has been shut in their […]
The Gauntlet
Category: Politics | Leave a Comment
Claire McCaskill has thrown down the gauntlet. If you don't like how she has represented the district then vote her out of office. She double dog dares you. She said this as she was lying through her teeth about Republicans because the trick to getting elected these days is to lie like a rug, something […]


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You are the only person in charge of you, and if you want something (better health, a more fulfilling job or a more nourishing relationship), you need to take action. Let go of these five habits in order to be the healthiest version of yourself.
When drinking alcohol, just as with eating, at times you may overindulge despite your best intentions. And if you do, it's quite likely you'll end up with a hangover, which will make you crave unhealthy foods to soothe it. This spells a disaster for your waistline and your...
Exercises that feature single-leg work are beneficial, particularly because they mimic how we move in day-to-day life and while playing sports. These six exercises featuring the TRX Suspension Trainer enable you to work unilaterally and create enough instability to...


text: ETF sponsors, of course, are only responding to demand. (I wonder if the old study still holds true, that most active managers underperform the indices.) Rules and Choices There is no need to compare the arguments for grabbing income right now vs. acting in a way that pays income, and probably a lot more income, periodically over time. There are good, rational reasons to argue for each. Rather, we have to consider whether we want so many golden eggs right now that we are willing to run the risk that we'll kill the goose when we jam her full of amphetamines. There is a limit to the immediate capacity of almost everything. This is why even the freest of markets need regulations. We need to be free to make choices in the world of finance, and that means we need functioning and at least occasionally discriminate markets. No markets, no way to choose. Markets require capital, and capital requires a level playing field. The last 12 months have shown us what happens when capital decides it's not worth it to be in the markets. Money market levels are at all-time highs, as capital is pulled to the sidelines. The Securities and Exchange Commission eliminated the plus-tick rule because people and organizations with an interest in seeing it gone asked them to, and while there were others who disagreed, the SEC chose to get rid of it. Before doing so, the agency's Office of Economic Analysis studied the issue over a period of about 18 months, beginning in May 2005. (Interestingly, although the pilot period was extended until August 2007, the SEC did not wait until the pilot was complete before eliminating the rule.) Prev 1 of 5 Next


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Funeral service for Mrs. Elena W. Robinson, 86, of 558 Calvary Church Road, in Bishopville will be held Saturday, January 12, 2013, 1:00 p.m. at Elizabeth baptist Church in Bishopville with burial in the church cemetery. Mrs. Robinson died Tuesday, January 8, 2013. Collins Funeral Home is in charge of the arrangements.
Mr. Oziah Leland Boykin, Jr., 55, of 1461-A Halley Rd., Passed on Sunday, January 6, 2013. Funeral arrangements are incomplete and will be announced at a later date by Haile's Funeral Home.
Services for Alice Goude Moore, 85, of Camden, S.C. were held on Tuesday, Jan. 8 at 1:00 p.m. at 145 Innsbrooke Blvd. Murfreesboro, Tenn. The Rev. Dan Moore and the Rev. Don Goude officiated. Burial was at Roselawn Memorial Gardens in Murfreesboro, Tenn. under the direction of Murfreesboro Funeral Home.
Mr. Michael Arnez Richards Sr., 56 of Conyers, GA, formerly of 617 Gate St, Camden, SC passed on Thursday, January 3, 2013. Funeral service will be held Thursday, January 10, 2013, 1:00 PM, at Camden First United Methodist Church, Camden, SC. Burial will follow at Good Hope-Wesley Chapel United Methodist Church Cemetery Camden, SC.
Nathaniel Bumblee Wilson of 610 York Street, Camden, passed on Friday, Dec. 28, 2012 at his residence. Funeral service will be held Thursday, Jan. 10, 2013, 112 a.m., at New Life Temple, Lugoff, S.C. Burial at Restoration Cemetery, Bethune, S.C.
Funeral services to celebrate the life of Robert James "Jimmy" Wardlaw III, 77, of Camden, will be held at 2:00 PM Thursday, January 10, 2013 at New Hope Church with burial to follow in Liberty Hill Presbyterian Church Cemetery. Rev. Lyn Hill and Rev. Richard Cameron will officiate. The family will receive friends Wednesday January 9, 2013 from 7:00 til 9:00 PM at Kornegay Funeral Home, Camden Chapel. Memorials may be made in Mr. Wardlaw's memory to New Hope Church, 9025 Liberty Hill Road, Camden, SC 29020.
A memorial service paying tribute and honoring the life of Walter Cannaday, 83, of Camden, will be held at 2:00 PM, Saturday, January 12, 2013 at Kornegay Funeral Home, Camden Chapel, 1112 Fair Street, Camden, SC. Walter passed peacefully from this life on December 26th in Houston, Texas at the home of his daughter. In lieu of flowers, the Cannady family wishes any memorials be made to the Wounded Warrior Project, P.O. Box 758515, Topeka, KS 66675
Mrs. Catherine Hilton Dantzler, 87, formerly of Holly Hill, died Friday, Jan. 4, 2012 at KershawHealth in Camden.
Elizabeth "Betty" Hatfield Deas, 80, widow of L.W. "Dock" Deas, died Saturday, January 5, 2013 at Tuomey Regional Medical Center.
Funeral services for Linda Sanders Gantt, 68, were held Sunday at 3:00 p.m. at Trinity Baptist Church, Lugoff. The Rev. Dr. Charles Everett officiated. The family received friends Saturday from 6 to 8 p.m. at Powers Funeral Home. In lieu of flowers, memorials may be made to the American Cancer Society. Mrs. Gantt died Friday, January 04, 2013.
Funeral service for Anita S. Jeffords, 81, will be announced by Powers Funeral Home.
The Lord welcomed into His arms Martha Dawkins Owens, infant daughter of Gray and Ashley Moore Owens, on Thursday, January 3, 2013.
Mr. Michael Arnez Richards Sr., 56, of Conyers, GA, formerly of 617 Gate Street, Camden, S.C., passed on Jan. 3, 2013.
Mr. Charles Eugene Stokes, 61, of 1881 Red Hill Church Road, Cassatt, S.C., passed on Jan. 2, 2013.
The Lord welcomed into His arms Martha Dawkins Owens, infant daughter of Gray and Ashley Moore Owens, on Thursday, January 3, 2013. She was deeply loved by all her family and is now in glory with the Lord.
Page 147 of 246
Our dear beloved Mother, Suzanne Harris Lee was born November 23, 1930 to Elizabeth Singleton Harris and Joseph Harvin Harris. She transitioned from this life ...
Mrs. Catherine B. Thomas, 93, of 1445-A Ft. Jackson Road, Lugoff, South Carolina, passed on Sunday, July 17, 2016. Funeral services will be conducted at ...
CAMDEN - A funeral service to celebrate the life of Dr. Alfred B. "Fred" Boykin, Jr. of Columbia, SC was held Monday, July 18, 2016 at ...
LUGOFF – Memorial services for Ernest Lee Davis, Sr., 86, will be held Wednesday at 6:00 p.m., with a visitation 1 hr prior at ...
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Q&A on Scrum for Managers
Rini van Solingen and Rob van Lanen wrote Scrum for Managers, a book providing answers for organizations that want to or are adopting Scrum. An interview on what managers can do to give teams enough space to self-organize, the possible ROI of implementing Scrum and how to measure ROI, defining teams and anchoring Scrum in the organizational structure and systems, and much more.
Q&A on Kanban Change Leadership
In the book Kanban Change Leadership Klaus Leopold and Sigi Kaltenecker explore how Kanban can be deployed to get change done in organizations and to build a culture of continuous improvement. An interview on doing change in small steps, solving problems, using WIP limits, priorities and classes of service in Kanban, using the Theory of Constraints with Kanban, and getting results with Kanban.
Q&A on "The Coaching Booster"
An interview with Shirly Ronen-Harel and Jens R. Woinowski, authors of "The Coaching Booster", about why they based their book on lean and agile methods, why change needs to become an ingrained habit, how you can establish a rhythm of action, the value that a coachee can get from coaching, combining retrospectives with agile coaching, and what people can do to develop their coaching skills.
Keeping Development 'On Track' with Use-Case Slices at Dutch Railways
How the Dutch Railways made the transition from large use cases completely written before development to Use Case 2.0 and why this helps them to deliver apps faster and with the right business value. 1
Increasing your Agility: An interview with Dave Thomas
While the "Agile" industry is busy debasing the meaning of the word, the underlying values are still strong. Dave Thomas suggests to stop using the word agile and switch to agility.
Q&A with Ron Jeffries on The Nature of Software Development.
The book "the nature of software development" intents to help people to organize their thoughts about value and find ways to deliver value in software development.
How a Flow Manager Helps Teams Deliver, Fast and Smoothly
With talented developers, quality advocates and user-experience designers, teams know how to deliver valuable software. But as we improve service delivery using kanban, who manages flow?
Using Experiments and Data to Innovate and Build Products Customers Actually Use
An interview with Jan Bosch about getting benefits from increasing delivery speed, steps after adopting Agile and DevOps, using experiments to innovate, and practices for experimentation.
Q&A with Sandro Mancuso about The Software Craftsman
The book The Software Craftsman contains stories, examples and practical advice for software developers and other project professionals to achieve technical excellence and customer satisfaction. 1
Using Storytelling in Organizational Change
Telling stories can inspire people to make change happen in organizations. By co-writing the company's future story you can embrace current strengths to explore future opportunities.
Inviting over Imposing Agile
We are at a crossroads in the agile-adoption narrative. Agile started spreading "bottom-up", then shifted from teams to executives and recently to consultancy for large enterprises. What will be next?
Visual Portfolio Management: Collaboratively Aligning Your Company
The three-horizons model explains how companies can work on the right things to ensure sustainable growth. Visual portfolio management can integrate the different types of work into a coherent system. 2


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Liberal, Kansas is good for your bottom line.
Our central location, highways and railroad access are only three of many advantages. Real estate is available; the workforce is diverse; and operating costs are reasonable.
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Costs of doing business in Liberal, Kansas.
Forms and documents for doing business in Liberal, Kansas.
Seward County Community College / Area Technical School is 33rd in The Washington Monthly's America's 50 Best Community Colleges!


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Mayborn School of Journalism
Flag Football
Produced by Alex Scott
Monica Perez Garcés had big plans for her life in the United States before she was forced to move back to her hometown of Tenancingo, Mexico. She had been living in Minnesota for four years, and had been accepted to an American university. Unable to afford the price of college in the U.S., Monica returned to Mexico to continue her education.
Upon returning home, Monica brought back with her new experiences and a new obsession: American football. She became the founding recruiter for an unprecedented all-female flag football league in Tenancingo. For most of the women in the league the sport is entirely new, practices consist of fundamentals of football rules and strategy, basic skills and practicing plays. Monica says her love of football is a little piece of America that she brought back with her, and she is happy it has been met with such enthusiasm.


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IMDb > Judge Max Hunter (Character)
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Judge Max Hunter (Character)
from "The Defenders" (2010)
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- "The Defenders"
- Nevada v. Hunter (2011) TV episode, Played by Dan Aykroyd
- Nevada v. Doug the Mule (2011) TV episode, Played by Dan Aykroyd
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var express = require('express');
var app = express();
app.use(express.cookieParser('keyboard 123'));
app.get('/', function(req, res){
app.post('/login', function(req, res){
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<form id="myform" action="/login" method="post" enctype="application/x-www-form-urlencoded">
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I am trying to understand and use express node js . Here I have a form which does post. My understanding is that : the first time there is no cookie(session) available. so, when we get a request : req.session.user will be empty. so when we send 200 OK. this req.session.user cookie wil be created and stored in the local browser.? and subsequently in all the req this req.session object will be send is that correct?
Issue now is : I always get req.body.username as undefined. I have the same user name defined in the login page. I have tried console.log(req.body) and it is always undefined. if I have no session, the body part works.
can you clarify me if I am understanding is correct and what is the issue in this code. I am having really issues understandging the concept of session and how to use it in express frame work


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Past Bethel College News (Page 5)
Concert Choir to make spring tour to Kansas, Nebraska and Colorado
The Concert Choir will travel to venues in northeastern Kansas, Nebraska, Colorado and western Kansas before returning for the home concert Easter Sunday evening, March 27, at 7 p.m. in Mem Hall. Read more
Bethel announces hiring of new men's soccer coach
Mario Felix, who comes to Bethel from Denver and, before that, MidAmerica Nazarene University in Olathe, will be the new head men's soccer coach. Read more
Mennonite college presidents publish open letter
The presidents of Mennonite Church USA's five colleges and one seminary have released an open letter to all MC USA members and congregations. Read more
Bethel will send its entire forensics squad to national tournament
All eight members of the Bethel forensics squad will be traveling to AFA-NIET at the University of Florida April 2-4, and the public is invited to a nationals preview Tues., March 29, 7 p.m. in Krehbiel Auditorium. Read more
Mojo's to host an evening of Bethel jazz
Bethel Jazz Ensemble II and Jazz Combos I and II will play at Mojo's Monday, March 14, starting at 7 p.m. Read more
Mika Patron to give senior piano recital
Mika Patron's senior piano recital will be Sat., March 12, at 3 p.m. in the Ad Building chapel and includes works by Debussy, Hindemith and Schumann, Bizet duets with Olivia Gehring and a Bach prelude and fugue on the organ. Read more
Goossen to present recent research on John Howard Yoder sexual abuse
Rachel Waltner Goossen, a professor of history at Washburn University, will give the next Friends of the MLA talk Tuesday, March 8 at 7 p.m. in the auditorium of Kauffman Museum. Read more
Nature-based paintings now on display in Regier Gallery
"Organic Abstraction," work by Wichita artist Charles Baughman, is in the Regier Art Gallery through March 18, with the artist reception Thursday, March 17, 6-8 p.m. outside the gallery. Read more
Bethel places high at tournament, qualifies more events to forensics nationals
Clinton Unruh qualified his first event, Impromptu Speaking, to AFA-NIET while Jacob Miller qualified his fourth and fifth, at the Battle for the Capital swing tournament in Lincoln, Nebraska, Feb. 27-28. Read more
A dark story ends with reconciliation in spring opera
The spring opera is Christoph Willibald Gluck's Iphigenia in Tauris, Friday, March 11, at 7:30 p.m. and Sunday, March 13, at 3 p.m. in Krehbiel Auditorium, with alumni Monica Schmidt singing Iphigenia and Andrew Voth singing Thoas. Read more
Jill Siebert to give senior voice recital
Jill Siebert's senior recital will be Sunday, March 6, at 4 p.m. in the Ad Building chapel, featuring work by Handel, Schubert, Mozart, Reynaldo Hahn, Roger Quilter and William Finn. Read more
Junior nursing majors observe lamplighting
Twenty-five of the 28 members of the nursing class of 2017 participated in the annual lamplighting service Feb. 20 in Krehbiel Auditorium. Read more


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Darragh Kenny takes third in Sweden
Offaly's Darragh Kenny scored Ireland's second five-star podium finish of the weekend, in the €200,000 Longines Grand Prix at Falsterbo in Sweden on Sunday.
Offaly's Darragh Kenny scored Ireland's second five-star podium finish of the weekend, in the €200,000 Longines Grand Prix at Falsterbo in Sweden on Sunday.
Kildare succeeded in scoring more than in their last two Leinster championship outings combined tonight at St Conleth's Park as they powered past Offaly in the final quarter of their qualifier fixture in Newbridge, securing their place in Monday morning's qualifier draw.
Former Offaly star Michael Duignan has tipped Clare and Cork to advance to the All-Ireland quarter-finals from Saturday's qualifier double-header at Semple Stadium.
Dublin withstood a spirited first-half effort from Offaly in the Leinster under-21 HC final at O'Connor Park in Tullamore tonight before piling on the scores in the second half to secure their sixth hurling title at this grade.
Read how it all unfolded across a busy day of championship action as Donegal got the better of Monaghan in their Ulster SFC semi-final replay and Cork were among the winners in the hurling qualifiers as they edged out Dublin.
The GAA avoided another major embarrassment this afternoon as Wexford booked their place in the next round of All-Ireland SHC qualifiers.
Tomás Mulcahy and Eddie Brennan on the problem for some counties where their best players don't want to play and the need for more meaningful hurling games throughout the year.
There were wins for Offaly, Cork, Limerick and Tipperary in the Liberty Insurance Senior Camogie Championship on Saturday.
Offaly overcame a dismal start at O'Connor Park this afternoon as they came from five points down to record a comfortable 0-17 to 1-07 win over London in the first round of the All-Ireland SFC qualifiers.
There will be a repeat of the All-Ireland final in a fortnight after Galway advanced to a Leinster final meeting with champions Kilkenny.
Shane Lowry's bid to become US Open champion ended in disappointment. Read back on a dramatic final day.
Offaly's Shane Lowry is just two shots off the lead after carding a opening round 68 at the weather-delayed US Open at Oakmont.
Westmeath survived a powerful Offaly comeback in the second-half to reach the Leinster SFC semi-final after an enthralling battle at Cusack Park ended in a 0-13 to 0-12 win for the home side.
Bernard Flynn is expecting a fascinating battle in Cusack Park on Sunday when the footballers of Offaly and Westmeath battle it out for a place in the Leinster SFC semi-final.
Waterford booked their place in a Munster final, Monghan crushed Down's challenge in Ulster while there were big wins in the Leinster SHC for Galway and Offaly
Galway have advanced to a Leinster semi-final meeting with Offaly after encountering little resistance in Mullingar.
Offaly easily avenged last year's eight-point defeat to Laois at this stage of the Leinster Championship when a devastating second half performance swept aside their midland rivals and powered them to a 3-22 to 2-14 victory.
Kilkenny's poor record at Under-21 level continued as Eddie Brennan's side came unstuck in a dramatic defeat to Westmeath, while there were also wins for Carlow and Offaly in the Leinster U21 Hurling Championship.
Two second-half goals from Joe Bergin were crucial to the Offaly cause in O'Connor Park as the Faithful County recorded a 3-19 to 0-20 win over Kerry in the Leinster SHC round-robin series.
Offaly manager Eamonn Kelly has admitted his side needed to be at their very best to overcome Kerry and secure a place in the quarter-finals of the Leinster SHC.


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Episode #382 of the Autoblog podcast is here, and this week, Dan Roth, Steven Ewing and Brandon Turkus talk about the 2014 Indianapolis 500, the addition of a Jeep Cherokee to our long-term fleet, Cadillac dropping plans for a three-row crossover, and 2015 Ford Mustang pricing. We start with what's in the garage and finish up with some of your questions, and for those of you who hung with us live on our UStream channel, thanks for taking the time. Check out the new rundown below with times for t
Autoblog Podcast 382
- Volvo shoots for self-drivers by 2021
- Jeep spends $1 billion on factories
- Find Parts & Accessories for your vehicle!
- Obama rolls out new EV plan
- Infiniti dealers ranked best, Tesla worst
- Compare Volvo XC90 and Lincoln MKX


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