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Washington's e-Tax Muddle
By Howard Gleckman
The latest episode of the Internet tax version of Perils of Pauline could be played out by Aug. 3, when the workweek ends. With Congress about to leave town on a month-long break, and with the Internet tax moratorium due to expire just six weeks after the lawmakers return, pols are yet again attempting to get something done on the contentious issue.
If they fail this week, odds will sharply increase that Congress will extend the freeze on Internet-access taxes, but most likely for only a year or less. Such a step would be less of a victory for the high-tech industry than a reflection of Congress' inability to tackle the issue this year.
Lawmakers are not giving up quite yet. For the third time since May, Congress looks like it may be on the verge of actually doing something on e-taxes. In the first two episodes, key Senators marched to the brink of a bipartisan deals before the proposed solutions fell apart in legislative disarray.
This time, both the House and Senate are trying to take steps to settle the issue. But, as if anyone needed more clues as to how nasty the e-tax debate is, the two chambers seem to be moving in opposite directions.
The House Judiciary Committee -- if it actually meets this week -- is likely to vote to extend the current freeze on Internet-access taxes for another five years. Continuing that ban also would have the more far-reaching result of effectively blocking states from requiring e-tailers to collect sales taxes for purchases made online. The Supreme Court has ruled that, without congressional approval, a state cannot impose such an obligation on out-of-state businesses.
Across Capitol Hill, pressure is growing to clear the way for such tax collection. There, key members of the Senate Commerce Committee, including Chairman Fritz Hollings (D-S.C.), top Republican John McCain (Ariz.), and Senator Byron Dorgan (D-N.D.) are still trying to ready a bill that would pave the way for states to require both online and mail-order businesses to collect sales taxes.
Their measure would allow states to impose such a requirement on retailers once 20 or 25 states agree to dramatically simplify their sales-tax regimes. If they can finally nail down their deal, there is a slim chance that the Senate Commerce Committee could approve the measure this week.
Can they pull off an agreement this time after failing so often in the past? Perhaps. One reason may be that they could be preparing to cut loose Senator Ron Wyden (D-Ore.), who has been a key backer of the tech industry in the ongoing talks.
Until now, protax strategists have been willing to compromise on some key elements of a deal in order to get Wyden's support. For instance, they were willing to swallow the requirement that each state permit only a single sales-tax rate within its borders. But sources say McCain, Hollings, and Dorgan are losing patience with Wyden and may now try to push a bill without him. Wyden still hopes to work out an agreement, an aide says.
Of course, even if the Senate Commerce and House Judiciary panels can complete their work on e-taxes, Congress has a lot more work to do before the moratorium ends on Oct. 20. Other committees, including the powerful Senate Finance Committee, must still be heard from. The bills will have to go to the House and Senate floors. And, toughest of all, some agreement will have to be reached between the two chambers.
All that will be hard to do in such a short time. If Congress can't at least get started by the end of this week, it could prove impossible. If that's the case, don't be surprised to see a mini-extension of the Internet tax moratorium and a replay of the whole debate yet again in 2002.
Gleckman covers the political and economic scene from his perch in BusinessWeek's Washington bureau, and he pens BW Online's Washington Watch column
Edited by Beth Belton


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Cosmetic Surgery, from Blast Wounds to Brow Lifts (3/24/09)
Roger Friedenthal, Chairman, Department of Plastic Surgery, CPMC
Plastic and reconstructive surgery began in World War I to treat blast wounds. Since the mid 20th century, the field has grown to treat traumatic injuries, birth defects, hand surgery and modern cosmetic surgery. The field continues to evolve, and non-surgical liposuction with the use of focused ultrasound is currently in clinical trials. Come hear how this fascinating field of medicine has evolved and what the future will bring.
This program was recorded in front of a live audience at the Commonwealth Club of California on March 24, 2009.


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This is a discussion on New from West Central Georgia within the New Members Introduce Yourself forums, part of the Welcome To DefensiveCarry.com category; Looking forward to the forum. Interested in all things 1911 and concealed carry related....
Looking forward to the forum. Interested in all things 1911 and concealed carry related.
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July 11, 2013
OKLAHOMA CITY --Lauren Gibson hit a two-run homer and scored three runs and Raven Chavanne had a single and a run as the two Tennessee legends led Team USA past Canada, 7-0, on Thursday in the General Tire World Cup of Softball VIII at ASA Hall of Fame Stadium.
Gibson hit a two-run blast in the top of the sixth and finished 2-for-3 with two RBIs and three runs. Chavanne was 1-for-3 with a run and a stolen base.
Chavanne and Gibson both started the game, batting second and third, respectively.
Gibson enjoyed a hot start, hitting a one-out single through the left side in her first at-bat in the first inning. With Lauren Chamberlain at-bat, Gibson stole second base. She scored Team USA's second run when Valerie Arioto hit a two-RBI single.
In the second inning, Chavanne recorded her first hit with the U.S. National Team, legging out an infield single before stealing second. Gibson was hit by a pitch on an 0-2 count in the next at-bat, giving the U.S. two Lady Vols on base with two outs. Both advanced on a wild pitch and Chavanne later scored on an error at short. Gibson extended Team USA's lead to 4-0 on a double steal attempt in the following at-bat.
In the top of the sixth, the U.S. had two outs and Taylor Hoagland on first base when Gibson stepped in. She let out her customary yell as she swung her bat at a 0-2 pitch, drilling a two-run blast over the wall in center field. With the homer, Team USA enjoyed the 7-0 advantage.
The U.S. National Team will face Australia on Friday at 8 p.m. ET on ESPN.


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Region: Central Africa
Capital: Kigali
Population (2012): 11,689,696
Surface area: 26,338 sq km
Currency: Rwandan franc
GDP per capita (2011): US $ 583
Economy – Overview:
Rwanda is a rural country with about 90% of the population engaged in (mainly subsistence) agriculture and some mineral and agro-processing. Tourism is now Rwanda's primary foreign exchange earner and in 2008, minerals overtook coffee and tea as Rwanda's primary export. Minerals exports declined 40% in 2009-10 due to the global economic downturn.
Rwanda has made substantial progress in stabilizing and rehabilitating its economy to pre-1994 levels. GDP has rebounded with an average annual growth of 7-8% since 2003 and inflation has been reduced to single digits. Nonetheless, a significant percent of the population still live below the official poverty line. Despite Rwanda's fertile ecosystem, food production often does not keep pace with demand, requiring food imports. Agricultural production has increased significantly over the last three years and last year Rwanda was self sufficient in food production. Africa's most densely populated country is trying to overcome the limitations of its small, landlocked economy by leveraging regional trade. Rwanda joined the East African Community and is aligning its budget, trade, and immigration policies with its regional partners. The government has embraced an expansionary fiscal policy to reduce poverty by improving education, infrastructure, and foreign and domestic investment and pursuing market-oriented reforms. Energy shortages, instability in neighbouring states, and lack of adequate transportation linkages to other countries continue to handicap private sector growth. The Rwandan government is seeking to become regional leader in information and communication technologies. In 2010, Rwanda neared completion of the first modern Special Economic Zone (SEZ) in Kigali. The SEZ seeks to attract investment in all sectors, but specifically in agribusiness, information and communications technologies, trade and logistics, mining, and construction. The global downturn hurt export demand and tourism, but economic growth is recovering, driven in large part by the services sector, and inflation has been contained. On the back of this growth, government is gradually ending its fiscal stimulus policy while protecting aid to the poor.
Human Development Index ranking (2012): 167 out of 186
Net Official Development Assistance (ODA) (2011): US $ 1,262 million
Top Three Donors of gross ODA: United States, IDA, EU Institutions.
FDI inflows (2012): $ 160 million
Total External Debt (2011): US $ 1.1 million
External debt stock (% of GNI) (2011): 17.5
Merchandise exports (2011): US$ 464 million
Terms of trade index (2012): 304
Major export commodities: Tin ores and concentrates, Coffee, Tea
Cost to export per container (2013): US $ 3,245
HIPC Position (2013): Post Completion Point
United Nations membership date: 18 September 1962
New York Mission:
Permanent Mission of the Rwandese Republic to the United Nations,
124 East 39th Street, New York, N.Y. 10016
Telephone: 212-679-9010 / 9023 / 9024
Fax: 212-679-9133
United Nations Statistics Division
OECD Creditor reporting System Database
UNCTADStat database
UNDP (2013) Human Development Report
World Bank (2013) HIPC at a Glance
World Bank World Development Indicators
World Bank (2013) Doing Business 2013
Updated July 2013


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I grew up with Witch Stick, we practically covered our faces with it in school, it was the truth. Witch now runs with a huge range of skincare products and the BB is the latest. In short, it kinda rocks. It's paler than other BB cream's I've tried, which is nice because it doesn't have a massive effect on your foundation. The thing I like most about this product though, and the reason I'm recommending it today, is the mattifying power it holds. Seriously, it's an all dayer people. You apply it, you think 'Hmm, nice matte base, I will enjoy that for about an hour until it wears off', but nope, it just keeps going and going! On the days I use it, I go without a powder topping and blotting papier requirements are rare, if any are needed at all. NUTS. Obviously due to the colour it might not be ideal for everyone, but if you have a pale to mid range skintone, and you like the usual features of a BB, then I can't recommend this enough. Hit up Twitter and try to win one at least!
J - Which Witch?


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International Journal of Vascular Medicine
Volume 2012 (2012), Article ID 985025, 8 pages
The Effects of Walking or Walking-with-Poles Training on Tissue Oxygenation in Patients with Peripheral Arterial Disease
1Department of Veterans Affairs, Center for Management of Complex Chronic Care, Edward Hines Jr., VA Hospital, Hines, IL 60141, USA
2Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA
3Department of Veterans Affairs, Research & Development, Edward Hines Jr., VA Hospital, Hines, IL 60141, USA
4Cooperative Studies Program, Department of Veterans Affairs, Edward Hines Jr., VA Hospital, Hines, IL 60141, USA
Received 3 July 2012; Revised 27 August 2012; Accepted 28 August 2012
Academic Editor: Erich Minar
Copyright © 2012 Eileen G. Collins et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This randomized trial proposed to determine if there were differences in calf muscle StO2 parameters in patients before and after 12 weeks of a traditional walking or walking-with-poles exercise program. Data were collected on 85 patients who were randomized to a traditional walking program () or walking-with-poles program () of exercise training. Patients walked for 3 times weekly for 12 weeks. Seventy-one patients completed both the baseline and the 12-week follow-up progressive treadmill tests ( traditional walking and walking-with-poles). Using the near-infrared spectroscopy measures, StO2 was measured prior to, during, and after exercise. At baseline, calf muscle oxygenation decreased from % prior to the treadmill test to % at peak exercise. The time elapsed prior to reaching nadir StO2 values increased more in the traditional walking group when compared to the walking-with-poles group. Likewise, absolute walking time increased more in the traditional walking group than in the walking-with-poles group. Tissue oxygenation decline during treadmill testing was less for patients assigned to a 12-week traditional walking program when compared to those assigned to a 12-week walking-with-poles program. In conclusion, the 12-week traditional walking program was superior to walking-with-poles in improving tissue deoxygenation in patients with PAD.
1. Introduction
Walking ability is impaired in patients with peripheral arterial disease (PAD) due to decreased blood flow to the skeletal muscle tissue used during walking. It has been demonstrated that walking distance is associated with the degree of impairment in the affected leg as measured by the ankle-brachial index (ABI) and the time to onset of claudication pain [1–6]. Likewise, it has been shown that walking exercise in patients with PAD prolongs the onset of claudication pain thus allowing the patient to walk longer but does not change the ABI [7–9].
Recently, several investigators have used near-infrared spectroscopy (NIRS) to dynamically study the effect of walking on oxygen desaturation of the gastrocnemius muscle of the impaired leg during exercise [2, 10–14]. Investigators noted a marked decline in skeletal muscle tissue oxygenation (StO2) during walking exercise [2, 10–14]. Gardner et al. also identified that the rate of decline in calf muscle StO2 was significantly associated with initial claudication time and absolute claudication time in patients with PAD [2]. Three of the above studies examined the changes in tissue oxygenation, using NIRS, in patients with PAD before and after an exercise training program [12–14]. Figoni et al. [12] used a pretest-post-test design and reported greater exercise duration and lower mean exercise StO2 in 15 patients after a 3-month treadmill and calf exercise training program. Manfredini et al. [13] studied 55 patients with PAD who were given the option to participate in a structured or unstructured home exercise program for weeks. At the end of the study, those patients in the structured exercise program had an increased oxyhemoglobin area under the curve when compared to baseline; similar changes were not identified in the unstructured exercise group. Lastly, Tew et al. [11] studied calf-tissue oxygenation and treadmill walking response time after randomization to 12 weeks of arm-crank ergometry or a control group in 57 patients with intermittent claudication. Investigators identified that walking distance and time to nadir StO2 increased in those assigned to arm-cranking and there were no changes in the control group. No studies however compared leg muscle responses after a traditional walking program compared to a walking-with-poles program of rehabilitation in patients with claudication.
The purpose of this study was to determine if there were differences in calf muscle StO2 parameters before and after 12 weeks of a traditional walking program versus a walking-with-poles exercise program. We reasoned that by using the poles to offload the legs, patients would have less claudication pain and be able to walk longer distance thus achieving a greater training effect. We hypothesized that the calf muscle tissue deoxygenation would be less in both groups after 12 weeks of exercise training than at baseline and that the decrease would be greater in those patients assigned to the walking-with-poles group. These data represent a subanalysis of data from a larger clinical trial comparing traditional walking to walking with poles [14].
2. Methods
2.1. Subjects
Patients with PAD were screened and recruited to participate in a randomized clinical trial designed to compare the effects of a traditional walking training program versus walking-with-poles exercise training program. A total of 2296 patients were screened for eligibility, 146 enrolled in the study [14]. Patients were recruited using radio and newspaper advertising, posted fliers, and letters of invitation sent to patients at the university and VA hospitals. For the purposes of this analysis, we included only those participants with an ABI of ≤0.90 ( patients). Of those 91 patients, 3 did not have StO2 analyses on their baseline progressive treadmill test due to equipment malfunction and 3 had questionable data resulting in a final sample of 85 patients. Of those 85 patients, 45 were assigned to the walking-with-poles group and 40 patients were assigned to the traditional walking group.
2.2. Research Design
The major study was a randomized clinical trial to examine the effects of a traditional walking program compared to walking with poles on walking endurance and perceived physical function in patients with PAD. This subanalysis provides an in-depth examination of StO2 responses to exercise training. Our primary outcome focused on changes the patients realized walking on the constant work rate treadmill test whereas this analysis used data from the progressive treadmill test. At two minutes on the constant work rate test, the speed and incline increased to 85% of the patient's workload on the progressive treadmill test resulting in a sudden decline in StO2. Due to the gentle nature of the progressive treadmill protocol used, we were able to detect more subtle changes in StO2 and onset of claudication pain.
The intervention consisted of traditional walking or walking with poles three times weekly. Patients were randomized using computer-generated permuted blocks and group assignment was managed by the study statistician. The training programs for both groups were identical except that one group exercised with poles and the other group did not. Patients assigned to the walking-with-poles group received training on the use of the poles prior to beginning the exercise program. Additionally, patients were coached on proper poling mechanics during the training period if needed. The training program incorporated interval training whereby exercise consisted mostly of low-to-moderate intensity training at the start of the program and progressed to moderate-to-high intensity. Exercise intensity was determined by heart rate associated with a percentage of oxygen uptake obtained during the metabolic exercise treadmill tests. Exercise duration and intensity was adjusted every three weeks. During the first weeks, patients walked for 30 minutes (20% light intensity, 60% moderate intensity, and 20% hard intensity). By weeks 10–12, patients walked for 55 minutes (10% light intensity, 45% moderate intensity, and 45% hard intensity). Light intensity was defined as 25–44% peak VO2, moderate intensity was 45–59% peak VO2, and hard intensity was 60–84% VO2 peak. The program was designed so that patients walked on the treadmill two days/week and outdoors or in the hospital corridors one day/week. The exercise interval was adjusted based on the patient's pain tolerance. For example, some patients could only walk for one to two minutes at the higher intensities. In order for them to achieve 20% total time at the harder intensities, multiple short intervals were completed. Exercise intervals were gradually lengthened and rest times between intervals were gradually decreased.
2.3. Measurements
Demographic information, height, weight, comorbid conditions, and medication history were obtained from the patient and reviewed in the patient medical record. A physical exam was completed prior to participation in the study.
2.3.1. Ankle-Brachial Index
The ABI was measured in the more severely affected leg at baseline and 12 weeks after training. The dorsalis pedis or posterior tibial arteries were used for measurement. The location of the signal was recorded and used consistently throughout the study for that individual subject. After the patient rested comfortably in a supine position for 15 minutes, Doppler ultrasound was used to measure the systolic pressure in the right and left arms and in the ankle of the most severely affected leg. The arm with the highest systolic pressure was used to calculate the ABI [15].
2.3.2. Symptom-Limited Treadmill Test Protocol
Patients were tested using a gentle treadmill protocol that was developed for patients with PAD [6, 16]. Increases in percent grade occurred every 30 seconds, and, after the first 6 minutes, speed increased every 3 minutes. Validity and reliability of the treadmill protocol has been previously reported [17]. Electrocardiogram and StO2 of the gastrocnemius muscle were monitored continuously throughout the test. Initial claudication time was defined as the time during the treadmill test when the subject experienced pain in the affected leg. The absolute walking time was defined as the time walked by the patient on the progressive treadmill test.
2.3.3. Metabolic Values
Peak oxygen uptake was measured using the MedGraphics CPX/D System (Medical Graphics Corp, St. Paul, MN, USA). The metabolic cart was calibrated using a 3 L syringe prior to each test and the analyzers were calibrated using references gasses and room air. Patients breathed through a mouthpiece and their nose was clipped with a standard nose clip. Oxygen uptake was averaged over 30 s and the highest value at peak exercise was recorded.
2.3.4. Near-Infrared Spectroscopy Measures (NIRS)
Skeletal muscle tissue oxygenation was measured prior to, during, and after exercise using the NIRS spectrometer (InSpectra 325, Hutchinson Technology, Inc., Hutchinson, MN, USA). A 25 mm probe attached to an optical cable was used to noninvasively measure the percentage of hemoglobin oxygen saturation of the tissue beneath the near-infrared light. The InSpectra machine was calibrated prior to each test according to known high and low reference standards [18]. The NIRS probe was attached to the medial section of the gastrocnemius muscle of the patient's most severely affected leg. Calf circumference measurements were taken to assure consistent placement of the probe. The probe was placed into a specially designed adhesive housing unit to reduce ambient light. The probe was then secured to the leg to avoid excessive motion and possible tripping. The StO2 measures were recorded every 3.5 seconds using the InSpectra software. The StO2 values used in this analysis were the StO2 value recorded after 2 minutes of standing prior to exercise (StO2 rest), time walked when the patient reached the nadir StO2 value (time to nadir StO2 value), StO2 value at peak exercise (StO2 peak), and absolute and relative drop in StO2 (absolute drop in StO2 = rest StO2 − minimal StO2 value, relative drop in StO2 = [rest StO2 − nadir StO2 value]/rest StO2).
2.3.5. Ratings of Perceived Pain
Ratings of perceived leg pain were obtained every minute using the Borg ratio scale [19]. Patients were instructed to notify the staff at the onset of leg pain. The initial claudication time is the time that patients either notified the staff of the onset of pain or the time they first reported pain when asked every minute.
2.4. Statistical Analysis
Measures of central tendency were completed to describe the sample. The two groups were compared at baseline using the t-test for independent samples and Mann Whitney U test. Data that were not normally distributed were log transformed. Regression analyses were used to compute the initial decline in slopes for StO2 values (StO2 value regressed over time). Pearson r correlations were completed to examine relationships between the variables. Paired t-tests were used to describe changes in measures from baseline to post-12 weeks of training. Independent t-tests were used to examine differences between groups. Intent-to-treat analyses using the baseline value carried forward were completed for the comparisons between groups. The criterion for significance was .
3. Results
The sample consisted of primarily older (age = years) men. The ABI was . Over one-third of the patients were current smokers, half were diabetic, and the majority of patients received treatment for hypertension and dyslipidemia (Table 1). Patients were generally unfit with a peak oxygen uptake of . The walking-with-poles group was older than the traditional walking group. No other differences in baseline demographic characteristics were identified.
At baseline, calf muscle oxygenation decreased from % prior to the treadmill test to % at peak exercise (71% relative decline from rest to peak exercise). Patients walked minutes before experiencing claudication pain and minutes when the StO2 reached its nadir value. There was no difference between the time elapsed when the StO2 reached its nadir value and pain onset (). Although all patients reported claudication pain, exercise was not limited by claudication pain for all patients. Therefore, we examined the onset of claudication pain and time to nadir StO2 for those whose exercise was limited by claudication pain only (). Patients walked minutes before experiencing claudication pain and minutes when the StO2 reached its nadir value. There was no difference between the time elapsed when the StO2 reached its nadir value and pain onset (). After exercise, the time for the StO2 to return to half of its resting value was min and minutes to return to resting values. The initial claudication time and absolute walking time were not associated with the StO2 values at rest (Table 2) but were moderately related to the time elapsed prior to reaching the nadir StO2 value (r = .42, ; r = .58, , resp.). There was also a small to moderate relationship between onset of claudication pain and the exercise slope decline in StO2 (r = .28, ). Relationships were similar between initial claudication time and absolute walking time and the time elapsed prior to reaching the nadir StO2 values when the analysis was restricted to those whose exercise was limited by claudication (, and r = .47, ).
Data comparing groups after exercise training were analyzed using intent-to-treat analysis for all patients. The change in time elapsed prior to reaching nadir StO2 values between baseline and 12 weeks was related to the change in absolute walking time between baseline and 12 weeks (r = .65, ) and initial claudication time at 12 weeks (r = .33, ). Analysis of covariance was completed to compare the groups with age as the covariate since there was a difference in age at baseline (Table 3). The change in the time elapsed prior to reaching nadir StO2 values () and absolute walking time () were greater in the traditional walking group when compared to the walking-with-poles group. There was, however, no difference in the change in initial claudication time between the two groups ().
When the analyses were restricted to those who completed the exercise training only (), the change in time elapsed prior to reaching nadir StO2 values between baseline and 12 weeks was related to the change in absolute walking time between baseline and 12 weeks (r = .57, ) and initial claudication time at 12 weeks (r = .32, ). Data from a sample patient are depicted in Figure 1. Recovery time was unchanged when baseline and 12-week values were compared (baseline = min, 12 wk = min, ). After 12 weeks of exercise training, within-group changes in initial claudication time, absolute claudication time and time elapsed prior to reaching nadir StO2 values increased (Table 4.) The time elapsed prior to reaching nadir StO2 values increased more in the traditional walking group when compared to the walking-with-poles group (walking group = minutes, walking-with-poles group = minutes, ). Similarly, absolute walking time increased more in the traditional walking group than in the walking-with-poles group (walking group = minutes, walking-with-poles group = minutes, ). There was no difference between the two groups in initial claudication time (walking group = minutes, walking-with-poles group = minutes, ). Since there was a significant difference in age between the two groups, age was entered as a covariate yet it did not contribute significantly to the model. No differences in recovery time were noted between the traditional walking and walking-with-poles groups at the 12-week follow-up time period (traditional walking recovery time = min, walking with poles = min, ). No significant differences were identified in peak oxygen consumption or ABI within or between the two groups from baseline to 12 weeks using intent-to-treat analysis or restricting the analysis to those who completed the training only.
4. Discussion
There are three major findings of this study: (1) the time elapsed before reaching nadir StO2 values is associated with initial claudication time and absolute walking time, (2) there was no difference in the time associated with the nadir of StO2 and the onset of claudication pain, and (3) the time to nadir StO2 of the gastrocnemius muscle was greater after 12 weeks of exercise training in the traditional walking group when compared to the walking with poles group.
As Bauer notes, during higher work rates and apparent blood flow limitation, muscle oxygen desaturation becomes more rapid in PAD subjects [19]. Thus, one would expect that oxygen desaturation would be associated with onset of claudication and walking duration. Our findings reflect these assumptions and were similar to those reported by Gardner et al. [2], that is, shorter time to reach nadir StO2 values were associated with shorter initial claudication time and total walking duration. Second, in Gardner's study, relationships between initial claudication time (), absolute walking time () and measured time to minimal exercise StO2 were similar to our relationships between initial claudication time (), absolute walking time () and measured distance to nadir StO2. These findings suggest that our sample patients were similar to patients in other studies [2, 19].
Exercise-associated decline in StO2 of the gastrocnemius muscle was less after 12 weeks of exercise training when compared to baseline. Wang and colleagues recently demonstrated in 17 subjects with PAD who completed a 24-week walking program that an increase in the number of capillaries in contact with type IIx and IIa calf muscle fibers was related to an improved pain-free walking time ( and , ) [8]. Investigators hypothesized that the ratio of capillaries to muscle fibers affects oxygen supply thus delaying the mismatch between supply and demand [8]. Figoni et al. [12] and Manfredini et al. [13] both report greater exercise StO2 area under the curve postexercise training when compared to preexercise training. In our study, an increase in the time to nadir StO2 values was associated with delayed initial claudication time and improved absolute walking time. Our findings provide further evidence that walking exercise improves tissue muscle oxygenation in patients with PAD. Likewise, our findings support the possibility that the onset of claudication and walking duration are linked by the decline in tissue oxygenation. The onset of claudication and the time elapsed prior to reaching the nadir StO2 values were nearly identical. Thus, the patient's perception of pain is a good indicator of StO2 in the calf muscle.
Exercise-induced decline in gastrocnemius muscle StO2 was less in patients assigned to the traditional walking program than in patients assigned to the walking-with-poles exercise training program. We had originally hypothesized that a walking training program with poles for patients would be advantageous because the poles would "offload" the legs during periods of claudication allowing additional walking exercise. Indeed, Oakley et al. [20] investigated the immediate effects of walking with Nordic poles on 20 patients with PAD and found that claudication distance increased from 77 m without the poles to 130 m with the poles () and the level of claudication pain also decreased (). Our group has also previously reported that patients had decreased calf pain when walking with poles. Oakley et al. [20] compared muscle histology of 36 patients randomly assigned to 12 weeks of treadmill training, strength training or control. After the 12 weeks, only the treadmill group had histological changes in the muscle. The increase in muscle ischemia with treadmill training was associated with a marked increase in muscle damage. Hiatt suggests that skeletal muscle dysfunction and associated muscle metabolic state can be ameliorated with treadmill exercise training. Tew et al. [11] provides evidence that even when the exercising muscle is not the calf muscle, tissue oxygenation can improve. Our evidence is equivocal. Clearly, the patients assigned to the traditional walking group experienced a prolonged exercise time before experiencing claudication pain, prolonged their absolute walking time and increased the amount of time exercising until reaching nadir values. In the walking-with-poles group, there were no changes over time when an intent-to-treat approach was used. However, when the analysis was restricted to those who completed the training program only, there was a difference in absolute walking time and a trend toward increasing time to initial claudication pain onset as well as nadir StO2. The explanation for these findings may be that leg metabolic changes in the calf muscle occurred to a greater extent in those assigned to the walking-with-poles group or we may not have had enough statistical power to detect changes that were present.
Another explanation for this finding may be that the intensity of our training program was based on oxygen uptake associated with heart rate response to exercise. With the addition of the upper body to the exercise regime for patients assigned to the walking-with-poles group, exercise intensity was augmented using the upper body. Thus, the work accomplished by the leg muscles may have been less even though overall exercise intensity was consistent between the two groups of patients. Both groups trained on the treadmill and outdoors. Patients assigned to the walking with poles group were unable to use the handrails on the treadmill for balance; added anxiety may have increased the cardiovascular response thus keeping the overall work accomplished lower in some patients.
Our study had several limitations that may limit the generalizability of the findings. First, although age was not a contributing factor to the differences between the groups, the walking-with-poles group was older than the traditional walking group. We cannot exclude that the differences in exercise tolerance and willingness to push limits may differ between someone who is 67 years old (mean age for walking group) and someone who is 72 years old (mean age for walking-with-poles group). This five-year age difference may have influenced our outcomes in ways that we did not measure. Next, the sample was primarily men and thus cannot be generalized to women. Additionally, in order to include only those with compressible vessels, we excluded 17 patients who were initially randomized to our study. Although this limited the variability, it also reduced power in our statistical testing. Lastly, although all of our patients experienced claudication pain, not all patients stopped exercise due to claudication pain. Including patients that did not stop exercise due to claudication pain may have affected the study results.
Additional studies examining different walking intensities in patients with peripheral arterial disease should be tested. Further, it may be that use of walking poles early in the rehabilitative effort may augment traditional walking training later by assisting patients to train longer early on. Further research in this area is warranted.
5. Conclusion
In summary, we conclude that there is a significant decline in StO2 in the gastrocnemius muscle during walking exercise in patients with peripheral arterial disease reflecting muscle tissue ischemia. Contrary to our hypothesis, after 12 weeks of exercise training, absolute walking time and time to reach nadir muscle tissue oxygenation were prolonged in the patients assigned to the traditional walking program more than those assigned to a walking-with-poles exercise training program reflecting greater tissue perfusion and enhancement of arteriovenous oxygen extraction. The precise mechanism for these differences remains unknown but these findings may provide some insight to tissue adaptations to exercise stimulus and may therefore be useful to PAD rehabilitation programs.
|Ankle-brachial index
|Absolute walking time
|Initial claudication time
|Near-infrared spectroscopy
|Peripheral arterial disease
|Skeletal muscle tissue oxygenation.
Authors' Contribution
E. G. Collins and D. Reda are responsible for the concept and design. E. G. Collins. C. McBurney, J. Butlur, C. Jelinek, and S. O'Connell are responsible for the acquisition of data. E. G. Collins supervised the study. The drafting of paper was carried out by E. G. Collins, C. McBurney, J. Butlur, C. Jelinek, S. O'Connell,C. Fritschi, and D. Reda. The critical revision of the paper for important intellectual content (principal investigation) the principal investigator E. G. Collins obtained funding. E. G. Collins and D. Reda are responsible for administrative, technical, or material support.
Conflict of Interests
The authors have declared that no competing interests exist.
This study was approved by the Institutional Review Boards at the University of Illinois at Chicago and the Edward Hines Jr., VA Hospital. Written informed consent was obtained prior to enrolling patients in the study.
This material was based on work supported by a Grant from the National Institute of Nursing Research (RO1 NR008877-01) and a Research Career Scientist Award (E. G. Collins), Rehabilitation Research & Development, Department of Veterans Affairs. The authors acknowledge the editorial assistance of Mary Reidy.
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Archive for August, 2011
They Jimmy Dore Show Aug. 25th, 2011
The Jimmy Dore Show Aug 25,2011
- The Conservative Bible Project: Rewriting the Bible to get rid of the LIberal bias.
- Bill Donohue is angry at the Atheists and can't wait for god to get them.
- Abstinence only spokesman Rep. David Souter , apologizes for cheating on his wife with another abstinence advocate.
- "Tuesdays with Moron": Moron takes Therese to a movie
- David Feldman gets in a few hilarious jabs at the anti-medicine christians.
Comedy & Everything Else ep#155 Bill Burr
Comedy and Everything Else Episode 155 Bill Burr
Bill Burr tells us what's wrong with EVERYTHING!
- How much money is Enough!?
- Two things they should teach every kid in high school
- What's wrong with Capitalism?
- Bill watches Americans eating McDonalds in an airport, and it aint pretty.
- We find out: just what is the least sympathetic disease out there?
The Jimmy Dore Show Aug. 18, 2011
The Jimmy Dore Show Aug 18,2011
This week: Best of "Oh My God"!
Jimmy is on vacation, but he loves you so much that he still took time to put together this special "best of" the "Oh My God" segment for you.
Comedy & Everything Else ep #154 with Rory Scoval and Paul Morrisey
Comedy and Everything Else Episode 154
- Rory Scoval tells us what its like to perform your act one Conan, while another comedian performs at the same time. Sounds crazy, but its just funny.
- Is it wrong to call a woman a "vagina"?
- When do you stop responding to jerks on Facebook?
- Phone calls from Barack Obama and Texas Gov. Rick Perry
ABC 7 almost reports the news.
Yet another fine example of journalism at its best. Here is local abc 7 news on the night of the debt ceiling deal, they spend :30 seconds on it so they could make time for ……. well, get ready.
CNN: Aren't the poor really to blame for this economy?
Here is another example of the kind of journalistic standards they have over at CNN. The question Carol Cambell asks her audience is enough to make your head fly off, which is why Cornell West has that thing on his neck, to keep his head attached during CNN interviews.


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MuzArt LLC presents Lundi Gras Love 3: An Evening with Blair Dottin-Haley
Johnny Brasco of MuzArt, LLC
Monday, March 3, 2014 at 8:00 PM - Tuesday, March 4, 2014 at 12:00 AM (CST)
Who's Going
San Francisco, California
London, United Kingdom
Florence, Italy
Event Details
For the 3rd consecutive year, Johnny Brasco of MuzArt, LLC and Blair Dottin-Haley team up to bring you Lundi Gras Love 3: An Evening with Blair Dottin-Haley. Due to the overwhelming success of the previous 2 years, we have had to find a bigger venue to comfortably fit everyone. Our new home will now be Cafe Istanbul, which is located @ 2372 St. Claude Ave.
Lundi Gras Love 3 will be hosted by New Orleans own comedian Tony Fredrick (Monster's Ball, Treme) [Facebook: @CreoleComicTwitter: @creoleactor] and opening will be 3 year Lundi Gras Love Vet Kevin Stylez [Facebook: @KevinStylez, Twitter: @KevStylez]. We will also have a few very special guests so this is an event you DO NOT want to miss.
Special Christmas Advanced tickets will be available for $10 from Dec 25 - Jan 1. Advanced tickets will be available for $15 from Jan 1 - Feb 28. Group tickets will be available for $60 for 5 Jan 1 - Feb 28). Admission will be $20 the day of the event, so hurry and get your advanced tickets NOW.
There is a parking lot in the back on N. Rampart and lots of street parking.
For more information, Email: email@example.com
When & Where
Cafe Istanbul
2372 Saint Claude Avenue
New Orleans,
Monday, March 3, 2014 at 8:00 PM - Tuesday, March 4, 2014 at 12:00 AM (CST)
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text:
Click any word in a definition or example to find the entry for that word
a person who is mononymous uses only one name
a name consisting of one word only
'"Get Over Yourself, Rog!" So jeers Nige, the mononymous blogger …, who flatly declares that the court case was "all about money".'Atlantic Wire 14th March 2010
'It is a select band. Madonna, Maradona, Pele, Sting and even, possibly, Jordan. People who wear their fame with such confidence that they have dispensed with the B-list concerns of having more than one name. They are the mononym brigade …'The Observer 29th January 2006
Bono the rock star, Pelé the footballer, Molière the playwright, Plato the Greek philosopher and Twiggy the model – they might have very different roles in cultural history, but they all share one obvious characteristic: they are mononymous.
though it's difficult to really understand why, there is something rather groovy and instantly memorable about a single name
A person who is mononymous only uses one name, and it's a practice familiar to all of us from the entertainment world. Though it's difficult to really understand why, there is something rather groovy and instantly memorable about a single name, hence its popularity as a means of aiding recognition and nurturing fame.
In order to be successful, however, a mononym (single word name) has to be unique – you don't tend to see mononymous celebrities called run-of-the-mill names like Jane or Bill. People who had the good fortune to be given a more unusual name from birth might choose to use it – compare Cher, born Cherilyn Sarkisian and Prince, born Prince Rogers Nelson. Original surnames sometimes become mononyms too (e.g. Liberace, Morrissey).Those who by contrast started life with something more ordinary tend to go for a new invention, often leading us to speculate about what their 'real name' really is. The model Twiggy for example, was born Lesley Hornby, and rock star Bono entered the world as Paul Hewson.
Sometimes, the way in which mononymous individuals arrived at their names is an interesting little anecdote in itself. Pop star Moby for instance, is so called because he is a distant relative of Herman Melville, author of the famous novel Moby Dick. Bono is actually based on the Latin expression bonavox, meaning 'beautiful voice', given to the singer as a nickname during the 1970s. Bonavox was in fact the name of a hearing aid shop that Bono and his friends passed regularly, the joke being that Bono sang so loudly it was as if he was trying to make deaf people hear him!
However in today's online culture, being mononymous is not the preserve of the rich and famous. Whether it's setting up an account on eBay® or posting a comment on a blog, many of us are often required to adopt a mononym (think for example Zack1, Cooldude and Edinburghlass). Somewhat bizarrely, it seems that in order to remain anonymous, we often have to become mononymous!
The word mononymous is an adjectival derivation of mononym, which has two main components: prefix mono–, deriving from Greek monos, (meaning 'alone'), and suffix –onym, from Greek onuma, meaning 'name' (compare pseudonym and aptronym, etc). There is also some evidence for a derived noun mononymity, meaning something like: 'the state of only using one name'.
Though the concept of being mononymous goes right back to early civilization, use of the term itself is comparatively new, and is still not well documented in published dictionaries.
A lexical variant, mononomial, appears in the Shorter Oxford English Dictionary and dates back to 1844.
Read last week's BuzzWord. Hacktivist.
This article was first published on 11th May 2010.
Open Dictionary
Dunning-Kruger effect
the phenomenon by which an incompetent person is too incompetent to understand his own incompetenceadd a word
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