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Get up and running at our great-value gym in Bradford which welcomes everyone and every body.
View our 2 gyms in Bradford: Gyms in Bradford
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Get up and running at our great-value gym in Bradford which welcomes everyone and every body.
View our 2 gyms in Bradford: Gyms in Bradford
Whether you're new to exercise, a gym regular or working towards the perfect physique, the UK's leading gym operator has all the tools to help you hit your fitness targets - big or small. Our gym in Idle is jam-packed with hundreds of pieces of the latest kit and has so many free fitness classes that you won't know where to start! With 24-hour access and no-contract, low-cost membership we wonder why you'd want to go anywhere else!
It's tough balancing work, home life and free time, but PureGym has made it a whole lot easier! Our gym in Idle is open 24 hours which means whether you're a night owl or an early bird you can work out whenever you like and because all of our gyms are remotely monitored you can be confident you're in safe hands.
Ever been stuck with a contract you no longer use when your circumstances change? That won't happen at PureGym because we don't have contracts, just a monthly membership which you are free to cancel whenever you like without paying a penalty. No catches - no hidden extras.
We think you'll be happy to stay with us because despite being a cheap gym we have more than 220 state-of-the-art pieces of kit to keep your body moving in the right direction. Take a spin on our brilliant indoor cycles or bring colour to your cheeks on our cross trainers, treadmills, steppers and rowers. You can also keep an eye on your progress with computerised monitors on the equipment! We also have a large free weights area and an Olympic weightlifting platform for those with muscle in mind. Take a virtual tour on the 'What's Inside' tab to see what else we have to offer.
If you prefer working out in groups or with a friend, you can choose from more than 50 free fitness classes every week. Some like it hot and if that describes you then burn off those calories in circuits, boot camp and step. For something a bit different try our combat class in which we combine martial arts with motivating music for a great all-round work-out.
Not only do we have exercise areas specifically for women at our gym, we have classes too! If you want to tone up those abs, legs, bums and tums or want to give your dancing feet some time on the gym floor in our aerobics work-out, we have women-only classes where you can improve your fitness and socialise at the same time.
Joining PureGym is easy. Simply click on the 'Join Now' link, fill in your details and we will send you a unique PIN number for you to access the gym. Once you're a member, book a free induction class online with a member of staff who will show you round and give you advice on the exercise best suited to your needs and abilities. You can always book a day pass if you prefer to try us out first. Once you're on board there are special offers and discounts from leading brands and local businesses in the members' area of the website.
Alternatively, Red Line buses 640, 641 and 654 run regularly from within E5 and also on the main roads surrounding the scheme. And if you fancy warming up before you workout there are bike racks outside Morrisons, next door to the gym.
If you're looking for a 24-hour budget gym in Bradford with a ladies only section and ladies only classes, we tick all the boxes so why not sign up today? You won't regret it.


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Jul 3, 2014
The Trendiest Ways to Eat Your Favorite Superfoods
By living in New York, it's easy to take advantage of the glorious shows playing on Broadway, but no show captures my attention more than the Summer Fancy Food Show at the Javits Center! The average supermarket displays...
Bonnie Taub-Dix, RDN
Nutrition Intuition
How to eat with instinct and insight
Tag: whole grains
Jan 15, 2014
The Dreaded C Word: Constipation
Let's face it: constipation is not a fun subject to talk about. Words like bloat, cramps, and gas are not exactly terms you'd be texting with friends. But in our rushed lives, we rarely find time to sit and relax, let...
Sep 26, 2013
Grainotto: A Whole New Risotto
A slowly simmering al dente rice dish of creamy deliciousness can only describe the one and only Italian specialty, risotto. Traditionally prepared with a high-starch, short grain white rice cooked in stock, with meat,...
Aug 29, 2013
8 Health Halo Foods That Are Far From Angelic
Food labels should be like the table of contents of a book — they should describe what's really inside. Labels represent the link between supermarkets, manufacturers, and consumers, helping supermarkets showcase...
May 20, 2013
Do Carbs Really Rule (You)?
When was the last time you had a bad cold or the flu and, at the same time, you had a hankering for a big juicy steak? I'll bet your answer is "never," even if you're a steak lover. When we...

subset: commoncrawl


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John Paul Jones, at sea and in the heat of battle, was the great American hero of the Age of Sail. He was to history what Patrick O'Brian's Jack Aubrey and C. S. Forester's Horatio Hornblower are to fiction. Ruthless, indomitable, clever; he vowed to sail, as he put it, "in harm's way."
John Paul Jones is more than a great sea story. Jones is a character for the ages. John Adams called him the "most ambitious and intriguing officer in the American Navy." The renewed interest in the Founding Fathers reminds us of the great men who made this country, but John Paul Jones teaches us that it took fighters as well as thinkers, men driven by dreams of personal glory as well as high-minded principle to break free of the past and start a new world. Jones' spirit was classically American. Evan Thomas brings his skills as a biographer to this complex, protean figure whose life and rise are both thrilling as a tale of dauntless courage and revealing about the birth of a nation.
"Superlative....Both Jones and his latest biographer can justly be praised as masters of their respective crafts." (Publishers Weekly)
"Evan Thomas captures all the incongruities, vanities, blazing ambition, and phenomenal courage of his subject." (David McCullough, author of John Adams)
"With the skill appropriate to a polished journalist, Thomas chronicles the short, but glorious, life of a brilliant, but frustratingly difficult, man, who was the first American naval hero....This is a fine account of the life of an admirable, but deeply flawed, man." (Booklist)
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Swashbuckler or Saviour
- Bruce
Enlightening Text, Horrible Narrator
- Ryan Peinhardt


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Calcutta: Mohun Bagan, who have had a roller-coaster ride in the National Football League, face Mahindra United at home Friday. There is renewed optimism in the camp since Bhaichung Bhutia is returning to the fold after almost two months.
The star striker sounded quite confident on the eve of his comeback game. Dont give up on us, we may be nine points behind leaders East Bengal, but there are still nine games to go, Bhutia said after practice Thursday.
It was really disappointing to sit out for such a long a period of time, but Im really looking ahead to the coming games, he added.
Bhutia will be playing upfront with George Ekeh, while Jose Barreto will operate from behind. Bhaichungs return will act as a huge boost to our chances, Barreto said. He also felt that Bhutias inclusion will help him get extra space to manoeuvre.
Coach Subrata Bhattacharya said he has no option but to go all out. Were in a tight corner and we have no option but to win, he said. Left-half Rennedy Singh has a minor injury. Well decide on his inclusion in the XI tomorrow, the coach added.
Mohun Bagan are on 21 points from 12 games while Mahindra have 13.


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Jun 28, 2016 - 03:44 pm .- In the 1970s, a teenager boarded a boat to escape the cruelty of war in his homeland of Vietnam. He landed as a refugee in a foreign land.
Jun 17, 2016 - 06:02 am .- The Catholic faithful shouldn't believe a misleading newspaper ad that says Sunday Masses are being held in a hotel room in the city of Colombo, the Archbishop of Colombo has said.
Jun 16, 2016 - 12:39 am .- Encounter and dialogue are the proper response to disagreements over morality, said the Catholic bishops of the Philippines, emphasizing in the wake of the Orlando shooting that hatred and violence have no place in the lives of Christians.
Jun 8, 2016 - 12:36 am .- Inspired by Pope Francis' encyclical on caring for creation, and concerned by environmental threats around them, Catholic parishioners in Thailand are planting hundreds of new trees.
Jun 7, 2016 - 06:18 am .- California's assisted suicide bill will go into effect on June 9, and the Archdiocese of Los Angeles is fighting back — with prayer.
Jun 6, 2016 - 04:00 pm .- After sex abuse and other allegations were leveled against Guam's archbishop, Pope Francis on Monday appointed a Vatican official to be the local Church's apostolic administrator while an investigation is carried out.
Jun 1, 2016 - 11:09 am .- A Syro-Malabar Catholic bishop from the southern Indian state of Kerala has a special way to celebrate the Year of Mercy: he is donating his kidney to save a young Hindu man battling for his life.
May 26, 2016 - 04:25 pm .- The president-elect of the Philippines, Rodrigo Duterte, recently described the country's bishops as corrupt and "sons of whores" for allegedly resorting to seeking favors from politicians.
May 19, 2016 - 01:23 pm .- Fr. Tom Uznunnalil, the Indian Salesian priest kidnapped by extremists in March is alive and close to being released, according to Indian government officials.
May 8, 2016 - 04:09 pm .- Mothers across the globe are celebrating Mother's Day today with their husbands and children. But for many women in China, Mother's Day is a haunting reminder of the cost of their country's harsh reproductive laws.
May 3, 2016 - 12:04 am .- Members of the international Catholic aid agency Caritas visited Nepal last week to mark the anniversary of a devastating earthquake that left millions homeless, bringing aid and a spirit of solidarity.
Apr 27, 2016 - 03:02 am .- Two members of a Chinese church demolition crew have been detained by police after they allegedly bulldozed the wife of a Christian pastor who had attempted to halt the destruction of her church.
Apr 22, 2016 - 12:08 am .- In a small town in India's Goa state, the Feast of Our Lady of Miracles draws devotees from multiple religions – and coconut oil plays a role in their observances.
Apr 18, 2016 - 02:52 pm .- Japan's Catholic bishops are coordinating efforts to help the thousands of people affected by the two earthquakes which struck the city of Kumamoto on the southwestern island of Kyushu last week.
Apr 15, 2016 - 06:08 am .- Just weeks after the deadly Easter Sunday attacks on Christians, Catholics in Pakistan had a time to rejoice: five new young priests were ordained for the Capuchin Franciscans.
Apr 12, 2016 - 12:04 am .- Catholic officials attended the inauguration of a new mosque in Bangkok earlier this week, in an effort to foster interreligious dialogue, and harmony between their communities in Thailand.
Apr 7, 2016 - 03:06 am .- Exposure to pornography harms children to such an extent it should be considered child abuse, Australia's Catholic bishops said in a recent call for action.
Apr 6, 2016 - 05:29 pm .- After rampant rumors spread of the crucifixion of kidnapped priest Father Tom Uzhunnalil, an Indian government official told the nation's bishops on Saturday that the priest is alive and that they are working on ensuring his safe and quick return.
Apr 5, 2016 - 12:04 am .- Bishop Ronald Mulkearns, who led the Diocese of Ballarat in Australia's Victoria state from 1971 to 1997, died Monday at the age of 85. He had been accused of covering up sexual abuse of children in his diocese.
Mar 30, 2016 - 11:50 am .- After the circulation of rumors claiming Fr. Tom Uzhunnalil was tortured and crucified on Good Friday, the Indian bishops have written to the government urging greater effort in locating the priest.


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I'm a member of Kibbutz Shomrat. Many of us are most interested in which kibbutz Bernie Sanders spent time as a volunteer in the 60s. He could be the first Jewish president of the United States.
'The kibbutz was marvelous. People could do things in which they had no background whatsoever.'


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Timothy Mahoney
Assistant Principal, Dorseyville Middle School
Timothy Mahoney is the assistant principal at Dorseyville Middle School. He comes to Fox Chapel Area from the Pine-Richland School District where he served as an intervention specialist and the special education department chairperson. He has also worked as a special education teacher in the Butler Area School District and for The Watson Institute.
Mr. Mahoney has a Bachelor of Arts in psychology from Lycoming College in Williamsport, Pennsylvania, where he also received his special education certification. He has a master's degree in special education supervision from Slippery Rock University. His principal's certification is from Indiana University of Pennsylvania.
Contact Information
Timothy Mahoney
Assistant Principal, Dorseyville Middle School
Fil Prevost


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Polo Ralph Lauren
Polo Ralph Lauren Men's Accessories, Pebbled Leather Slim ID Card Case
Ships from USA , delivers within 14-21 DaysAdd to wishlist
- Rectangular silhouette with single-needle stitching around the perimeter
- Designed with two card slots and an ID window
- Ralph Lauren's embossed pony accents the front; "Polo Ralph Lauren" accents the interior
- 2 1/2" H x 4" L
- Leather
- Spot clean
- Imported
- Web ID: 88134607
Special Offers
Return Policy
No questions asked return or exchange*: items may be returned or exchanged for a full refund in the original form of payment or a Vogily Credit within 14 days after shipping. Your satisfaction is our biggest prize, so we do everything to ensure that you are happy with your purchase. All products are 100% authentic, procured from brands directly and are backed by our purchase protection with 10 times money back guarantee. *Please refer to the detailed return policy on the site for exceptions
Ships from USA , delivers within 14-21 Days


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SaiGon GP English 6 month(s) ago
Prosecutors from 15 countries will meet Thursday and Friday in Brasilia to discuss a massive bribery scandal at Brazilian conglomerate Odebrecht which has spread across Latin America, source from Vietnamnews.
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VGP – President Sanchez Cerén of El Salvador said his country will soon open a diplomatic mission in Viet Nam, a move to strengthen economic and trade ties between the two nations.
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If the disqualification of a large part of the Russian Olympic team had less to do with politics than with the country's state-sponsored doping system, plenty of people both inside and outside Russia would like to turn the resulting tension into a jingoistic grudge match between Russia and the West.
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Authorities in El Salvador on Friday raided the local offices of Panamanian law firm Mossack Fonseca, seizing documents and equipment, the country's attorney general's office said.
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The Vietnam General Department of Preventive Medicine under the Ministry of Health anticipates that the Zika virus will spread across the nation— though no cases have been reported to date.
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William Hernandez, tired and aching, had just finished a 24-hour shift as a coroner examining more than a dozen corpses in the capital of El Salvador, victims of gang warfare that has made the Central American country one of the most violent in the world.
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The first flight for Cuban migrants stranded in Costa Rica will leave on January 12, the Central American country's foreign minister said on January 6.
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(VOV) - Vietnam Ambassador to Mexico and El Salvador Le Linh Lan attended the first congress of the Farabundo Martí National Liberation Front (FMLN) in El Salvador on November 6-8 by special invitation.
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The World Architecture Festival 2015 has made a shortlist of top seven most beautiful religious buildings in the world, including Chua Da (Stone Pagoda) in Nha Trang city, Khanh Hoa province, according to Singapore-based Business Insider.
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The World Architecture Festival 2015 has made a shortlist of top seven most beautiful religious buildings in the world, including Chua Da (Stone Pagoda) in Nha Trang city, Khanh Hoa province, Vietnam. The festival and awards announcement will be held in November in Singapore.
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Police in Ho Chi Minh City have confirmed that they arrested last month a Salvadorian man who had allegedly trafficked 42 kilos of cocaine into Vietnam over the past year.
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The Merchandise Mart is the prestigious building of Regus office space in its own unique zip code. Located in vibrant River North, this building is the world's largest commercial building and gets 20,000 visitors a day. Lease office space in this design hub and growing tech epicenter.
Regus clients include design-focused small companies and startups. Motorola and Yelp corporate offices are in the building. Tech firms, 1871 and Matter, are on the same floor as the center so it's easy to network with like-minded individuals.
This center boasts a modern look with exposed ceilings and concrete floors. The quaint, loft-style business lounge comes equipped with furniture and WIFI. You can collaborate with ease in our private team spaces.
Enjoy a sociable way of working in a communal workspace, with flexible options so you'll only pay for what you use.
Drop in whenever you need, with desk space in a professional, shared environment on a first come first served basis.
Select from 5 or 10 days per month at your chosen location.
Make yourself at home with a personal desk and storage facilities in a professional, shared environment.
Get unlimited access 24/7 at your chosen location.
Flexible workspace for an hour, day, week, month, or years.
Prices are per person per day on a 24-month agreement, subject to availability.
To arrange a visit, speak to our team on 1-855-400-3575
Whatever your business, whatever your budget we'll help find the right workspace.
Whatever your business, whatever your budget we'll help find the right workspace.
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Best landscape and friendly atmosphere you find only on this place
Indonesia is not at all bad choice for kids, adults and old people, it become one of the top and familiar tourist spot. Every year the number of tourist is kept on increasing only tourist not only feels it is beautiful place but also a safer place. It is a tourist spot so that country government has arranged all the things for the tourist convenience. It is highly populated country and every month you can find one or other festivals. One should take part on it to learn new things about their custom some of the tourist also refer it as paradise island. It gives you good changes and you can escape from your day-to-day stress also. Taking a regular tour helps to get refreshment to your mind, you can get all products for affordable price also so do not miss the chance of shopping. You get almost different variety of things on this country market.
Infrastructure is quite unique
Even though their economy is like well developed countries still they are maintaining a proper transport facility to every places. Infrastructure is also they are trying to develop it comparing to year back to now you can find many changes on it. This country has earning more number of profits due to the tourist only in fact their economy is rising due to tourist only. You can get a hotel and other ordinary service apartments for cheap price. Every day you can find some fun in this place so you will not get a chance also to get bored. Beach resorts help to get a good view and you can enjoy the best scenery from your room also.
Enjoy a right blend of traditional and festivals
Instead of taking stress better take TourBali they will ease your tensions they help you in all the booking and travelling process. You get the resorts and hotel without any difficulties even during the festival and vacation periods because more number of hotels and resorts are there at your service. From many countries people are visiting Indonesia for its simple and best landscape. Pottery village and Komodo islands gives you unique experience.


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April 29th, 2015
The Funk Soul Universe: Galactic and Joe Bataan
It's an exploration of the funk universe on American Routes. New York City's pioneer of Afro-Latin Soul, Joe Bataan, tells us about his boogaloo beginnings, melding latin beats with soulful sounds and his move toward "salsoul" and rap. And a conversation with Stanton Moore and Ben Ellman from New Orleans' Galactic about their love of all things funky from the Crescent City and beyond.
April 22nd, 2015
American Routes Live! The Meters, Drive-By Truckers, and Baton Rouge Blues Festival
Time for some "Fire on the Bayou" at a rare reunion of New Orleans' funk jam band and studio wizards, The Meters on stage at the Howlin' Wolf club. Then Drive-By Truckers, fronted by Mike Cooley and Patterson Hood, bring their poetic and critical style of Southern rock to New Orleans' historic Civic Theatre. Finally we roll 80 miles upriver to the Baton Rouge Blues Festival, featuring dapper Mississippian Little Freddie King; Louisiana swamp blues guitarist Lil Buck Sinegal; Creole zydeco accordionist Jeffery Broussard; and Naomi Shelton & the Gospel Queens from New York. Turn on, tune in and chill out!
April 15th, 2015
Guitar Heroes: Pat Martino & Ben Hall
Join us this week for an exploration of the guitar in jazz, blues and country music. We'll visit with modern jazz guitarist Pat Martino at his home in Philadelphia and find out more about his formulas for playing jazz solos. Then it's a conversation with up and coming thumbpicking guitarist Ben Hall, who walks us through the Merle Travis songbook.
April 8th, 2015
Festival Time in Lafayette, LA
Join us on the festival grounds in Lafayette, LA for the annual Festival International. We'll sample outstanding live performances in Cajun, Creole, Latin and Blues, including Keb' Mo', Sonny Landreth, and Steve Riley. Be sure to get out your dancing shoes for cumbia with Miami's Locos Por Juana, two-steps with Yvette Landry and Cajun waltzes with the Lost Bayou Ramblers. Plus an all-star South Louisiana tribute to the best of swamp pop, Cajun classics and zydeco.
April 1st, 2015
Lovers, Brothers and Others: Making Sweet Music Together
Music made by couples, families and siblings often has a special quality. The same is true of people who have a musical attraction to one another: Lennon and McCartney, or Fats Domino and Dave Bartholomew. Country traditionalist and mandolin player Marty Stuart was 12 years old when he met country chanteuse Connie Smith at a road show in his native Mississippi. Decades later Marty and Connie were married. They talk about their spring-fall relationship and making music together as "old souls." We'll talk to Joan Baez about writing for Bob Dylan and her singing his songs. Plus the Black Keys tell us how they teamed up, as did real brothers Trombone Shorty and James Andrews. We'll also hear from the Cajun married duo of Marc and Ann Savoy.
Distributed By: PRX
Additional Support Provided By: OffBeat Magazine
& the New Orleans Jazz and Heritage Foundation


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Kinematic predictors of single-leg squat performance: a comparison of experienced physiotherapists and student physiotherapists
Rehabilitation, physical therapy and occupational health
The single-leg squat (SLS) is a common test used by clinicians for the musculoskeletal assessment of the lower limb. The aim of the current study was to reveal the kinematic parameters used by experienced and inexperienced clinicians to determine SLS performance and establish reliability of such assessment.
Twenty-two healthy, young adults (23.8 ± 3.1 years) performed three SLSs on each leg whilst being videoed. Three-dimensional data for the hip and knee was recorded using a 10-camera optical motion analysis system (Vicon, Oxford, UK). SLS performance was rated from video data using a 10-point ordinal scale by experienced musculoskeletal physiotherapists and student physiotherapists. All ratings were undertaken a second time at least two weeks after the first by the same raters. Stepwise multiple regression analysis was performed to determine kinematic predictors of SLS performance scores and inter- and intra-rater reliability were determined using a two-way mixed model to generate intra-class correlation coefficients (ICC3,1) of consistency.
One SLS per leg for each participant was used for analysis, providing 44 SLSs in total. Eight experienced physiotherapists and eight physiotherapy students agreed to rate each SLS. Variance in physiotherapist scores was predicted by peak knee flexion, knee medio-lateral displacement, and peak hip adduction (R2 = 0.64, p = 0.01), while variance in student scores was predicted only by peak knee flexion, and knee medio-lateral displacement (R2 = 0.57, p = 0.01). Inter-rater reliability was good for physiotherapists (ICC3,1 = 0.71) and students (ICC3,1 = 0.60), whilst intra-rater reliability was excellent for physiotherapists (ICC3,1 = 0.81) and good for students (ICC3,1 = 0.71).
Physiotherapists and students are both capable of reliable assessment of SLS performance. Physiotherapist assessments, however, bear stronger relationships to lower limb kinematics and are more sensitive to hip joint motion than student assessments.
The single-leg squat (SLS) is a functional clinical test used by physiotherapists in the musculoskeletal assessment of the lower limb. Despite ubiquity of use, little is known of the validity and reliability of the test. Specifically, the relationship that physiotherapy assessment bears with kinematic parameters is unclear. Furthermore, the influence of clinician experience on the validity and reliability of SLS assessment is yet to be established. Thus, a comprehensive investigation of SLS kinematics in light of experienced and inexperienced physiotherapist assessment is warranted to justify the utility of the test.
There is some evidence that kinematic patterns, particularly at the knee, are characteristic of musculoskeletal conditions or related to lower limb injury risk
The SLS test is touted to be a simple method of identifying clinically abnormal movement patterns to assist clinicians with screening and diagnosis. As such, a modicum of descriptive reports on the kinematics of the SLS have emerged
Though a small body of work is available lending support to the SLS test and its sensitivity to injury identification, most reports are limited to two-dimensional descriptions of kinematics or confined to a single joint. Furthermore, investigations to date have not considered the association between joint kinematics and clinician assessment or the influence of clinical experience. Therefore, the purpose of the present study was to determine kinematic predictors of perceived SLS quality for experienced and student physiotherapists and assess inter- and intra- rater reliability of SLS performance rating for experienced and student physiotherapists. We hypothesised that (i) physiotherapist and student ratings of SLS performance would be predicted by hip and knee joint kinematic variables and (ii) physiotherapist ratings of SLS performance would be more reliable than physiotherapy student ratings.
Study design
A cross-sectional study design was used to analyse SLS performance in healthy, young adults. Three-dimensional motion analysis was employed to determine lower limb joint kinematics and two-dimensional video capture was used to record SLSs for later rating. Physiotherapists and physiotherapy students were additionally recruited to rate the quality of SLS performance for comparison with kinematic data and to determine rater reliability. Written informed consent was obtained from each volunteer before data collection, and all experimental procedures were approved by the Griffith University Human Research Ethics Committee.
We recruited healthy, young men and women to perform a series of SLSs. Participants were included if they were generally healthy, ambulatory, and between the ages of 18 and 35 years. Participants were excluded if they had any of the following: recent surgery or injury to the lower limb; previous lower limb orthopaedic surgery; balance or co-ordination impairment; or were taking medications known to impair movement or balance. We further recruited experienced musculoskeletal physiotherapists and physiotherapy students to rate the SLS performances. For the purpose of this study physiotherapists were deemed experienced if they had completed a post-graduate musculoskeletal physiotherapy qualification and had at least five years post-registration clinical experience. Students were included if they were currently enrolled in the second-last year of the physiotherapy program at Griffith University.
Data collection procedures: SLS kinematics
Participants performed three separate SLSs on each leg with the starting leg determined by coin toss. For each SLS, participants were instructed to begin by standing on one leg with the opposite knee flexed to approximately 90 degrees, arms folded across their chest, and looking ahead. Participants were then asked to squat down on the weight-bearing limb in a slow controlled manner as far as possible without losing balance, before returning to the starting position. All participants were allowed a maximum of three practice attempts. In accordance with previous investigations
For each SLS, both two-dimensional video and three-dimensional motion analysis data were collected. Video data were collected with a high-definition digital video camera (Sony DCR-SX40E, Sydney, Australia) which was subsequently viewed at a later date for rating by both experienced physiotherapists and physiotherapy students. The video camera was positioned directly in front of the participant at a distance of three metres and a height of one metre. Each video recording was transferred to a personal computer and cropped (i.e. temporally) to ensure a consistent start and finish point for viewing each performance and avoid pre- and post-squat movements influencing ratings. The vertical position of the frame of reference excluded the head of each participant, but allowed unobstructed observation of the lower limbs, pelvis and trunk.
Three-dimensional kinematic data were collected using a ten-camera VICON motion analysis system (MX13 Cameras, Oxford Metrics, Oxford, UK) operating at 200 Hz. Retro-reflective markers were attached to specific anatomical landmarks including the second metatarsal head, medial and lateral malleoli, calcaneus, medial and lateral femoral condyles, and right and left anterior superior and posterior superior iliac spines. In addition to individual markers, clusters of four markers were securely attached to the shank and thigh segments (Figure
Figure 1
Marker placement and laboratory set up for single-leg squat motion capture and video recording
Marker placement and laboratory set up for single-leg squat motion capture and video recording.
Raw three-dimensional coordinate data were filtered using a zero-lag fourth-order low-pass Butterworth filter, with a cut-off frequency of 8 Hz. Filtered marker trajectories were subsequently used to compute three-dimensional segment (pelvis) and joint (hip and knee) kinematics using BodyBuilder modelling software, version 3.6 (Vicon; Oxford Metrics). The convention used to describe kinematics was in accordance with the recommendations of the International Society of Biomechanics
Data collection procedures: physiotherapist ratings
Of the three SLSs performed on each leg, we chose to analyse the second squat of both the right and left leg for each participant, providing 44 SLSs in total. In a clinical setting, the SLS is typically rated on the performance of an individual squat rather than the average of multiple squats, providing support for this method of analysis. Following the identification of 44 SLSs for analysis, experienced musculoskeletal physiotherapists and physiotherapy students viewed the SLSs in random order on a personal computer. Raters were instructed to view each video twice at normal speed with no exceptions (i.e. no pausing or rewinding) and rate each performance. A 10-point ordinal scale was employed to emulate the clinical setting, with a score of 1 representing 'very poor' and a score of 10 representing 'very good'. Ten ordinal points were preferred over minimal scales (e.g. good/fair/poor) to avoid ambiguities in the classification of performance quality. Similar scales have previously been used to classify gait quality from video footage
In order to examine inter- and intra-rater reliability, all raters were invited to view the videos again two weeks later following the same instructions. Again, videos were viewed in random order.
Data analysis
Data analyses were restricted to the combined up and down phase of each squat. The start of each squat was defined as the point where knee flexion angle changed by more than two degrees, while the end was defined as the point where minimal knee extension occurred following the up phase. The dependent variables used for statistical analyses were extracted from each trial using custom-designed software in Matlab 7.8.0 (The MathWorks, Natick, MA).
Statistical analysis
Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) version 20.0 for Windows (IBM, Chicago, IL, USA). Means and standard deviations were calculated for subject characteristics. Stepwise multiple linear regression analysis was used to determine joint kinematic predictors of SLS performance scores for experienced physiotherapists and physiotherapy students. Inter- and intra-rater reliability was determined using a two-way mixed model to generate intra-class correlation coefficients (ICC3,1) of consistency. Interpretation of ICC3,1 values was made according to the scale described by Rosner
Participant characteristics
A total of 22 healthy young adults (13 men and 9 women; 23.8 ± 3.1 years of age) consented to participate in the trial. Participants were 1.73 ± 0.07 m tall with a body mass of 69.4 ± 12.5 kg and body mass index of 22.9 ± 2.8 kg.m-2. Eight experienced post-graduate trained musculoskeletal physiotherapists and eight physiotherapy students in their penultimate year of study volunteered to rate the SLSs identified for analysis. Physiotherapists had 17.6 ± 7.7 years of clinical experience (range: 11 – 35 years).
Physiotherapist ratings
Mean physiotherapist rating of SLS quality was 6.4 ± 1.3 on the first occasion and 6.4 ± 1.3 on the second occasion, while mean student rating of SLS quality was 6.0 ±1.6 on the first occasion and 6.0 ± 1.7 on the second occasion. Neither physiotherapist nor student ratings differed significantly between the two occasions.
Kinematic predictors of SLS performance
Sex-specific analysis of joint kinematic data revealed no significant differences with the exception of peak knee flexion (Table
Reliability of ratings
Inter-rater reliability was good for physiotherapists (ICC3,1 = 0.71) and students (ICC3,1 = 0.60), while intra-rater reliability was excellent for physiotherapists (ICC3,1 = 0.81; range 0.66-0.87) and good for students (ICC3,1 = 0.71; range 0.50-0.87).
In establishing the utility of the SLS test in clinical practice, our goals were to (i) determine the lower limb joint kinematic variables that best predicted therapist ratings of SLS performance, (ii) evaluate whether kinematic predictors of SLS performance were influenced by rater experience, and (iii) assess the reliability of the SLS assessment for novice and experienced physiotherapists. We found that peak knee flexion angle was the strongest predictor of SLS performance and that knee joint medio-lateral displacement enhanced the multivariate model prediction of SLS performance for both experienced and student raters. The model prediction was further enhanced by the inclusion of peak hip adduction angle for experienced physiotherapists, indicating that they took into account both hip and knee movement when determining SLS performance. As a result, experienced physiotherapists demonstrated higher inter- and intra- rater reliability than their less experienced counterparts.
Around 70% of all ACL injuries are incurred through a non-contact mechanism
Peak knee flexion was the strongest predictor of SLS performance. Unlike others
In agreement with our hypothesis both physiotherapists' and students' scores were predicted by knee medio-lateral displacement. Not surprisingly, differences in knee motion in the frontal plane have been identified in different patient populations
In partial agreement with our hypothesis, peak hip adduction was a significant predictor of SLS performance, however only for physiotherapists. In fact, predictors for students were only apparent at the knee. This distinction may be clinically important as significant differences in hip adduction have been reported for patient groups
We found that both physiotherapists and physiotherapy students were capable of reliable SLS assessment, although clinical experience enhanced both inter- and intra-rater reliability. The fact that physiotherapy students also demonstrated good within- and between-rater reliability in their assessments supports the robustness of the test itself. This finding is in support of Crossley and colleagues
Although our design and testing protocol were intended to closely reflect routine clinical practice, several limitations warrant acknowledgement. Firstly, our sample included only healthy, young individuals comprising a mix of sexes. Exclusion of participants with lower limb pathology may be considered a limitation, though that significant findings were forthcoming highlights the sensitivity of the assessment. As we were primarily interested in the assessment of the SLS rather than a characterisation of the kinematics, reporting sex-specific data was not considered necessary. Secondly, the requirement for multiple raters and repeat measures necessitated the use of videos for rating, which might reduce the authenticity of the clinician-patient interaction. Finally, a relatively short period of time (i.e. two weeks) was used between the first and second ratings; however, our intention was to emulate a reasonable patient follow-up timeframe for maximum clinical applicability.
In conclusion, we found that both physiotherapists and physiotherapy students were capable of reliably rating SLS performance in a cohort of healthy young adults. Further, we found that physiotherapist ratings were more strongly related to three-dimensional kinematics at both the hip and knee joint, as opposed to physiotherapy student ratings which were solely related to knee joint kinematics. In order to better understand the utility of the SLS test in clinical practice (and athletic screening), future work will investigate gender differences and the contribution of lower limb muscle activity in patient populations.
Competing interest
Authors declare that there are no competing interests.
Authors' contributions
BW and SH contributed to the design of the study. BW, SH, and CC collected the data. SH and CC performed the data management. BW and SH performed the data analysis and were in charge of data interpretation. BW wrote the draft manuscript. All authors participated in data interpretation and contributed to manuscript revisions. All authors read and approved the final version.
There are no acknowledgements or sources of funding.
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Hip-muscle activation during the lunge, single-leg squat, and step-up-and-over exercises
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Pre-publication history
The pre-publication history for this paper can be accessed here:


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Former Indigenous partnerships minister Curtis Pitt could be Labor's only surviving MP north of Mackay in Queensland....
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|Criticism, interpretation, etc
|Additional Physical Format:
|Online version:
Gatta, John.
Gracious laughter.
Columbia : University of Missouri Press, 1989
|Named Person:
|Edward Taylor; Edward Taylor; Edward Taylor; Edward (Schriftsteller Taylor; Edward Taylor
|Material Type:
|Government publication, State or province government publication, Internet resource
|Document Type:
|Book, Internet Resource
|All Authors / Contributors:
John Gatta
|0826207049 9780826207043
|OCLC Number:
|xvii, 228 pages : illustrations ; 23 cm
|Divinity at play. Another view of the Puritan divine ; Wit's anatomy: from mind to humor ; Taylor's play: reverent parody and the comic imagination --
Pills to purge New England melancholy. The diagnosis of Puritan sorrow ; Wit, meditation, and the word --
From depravity to festival. The aesthetics of depravity ; The problem of audience and expression ; The festal attraction of the Lord's Supper --
The comic design of Gods determinations touching his elect. The character and precursors of Gods determinations ; The divine plot and human parody of creation ; The ludicrous trials of the doubting soul and the unwitting compliance of Satan ; Christ's curious paradise regained --
A festival frame of spirit: the preparatory meditations. The contemplative spark: Taylor's poetic triptych ; Patterns of play in the meditations --
Songs and valedictions: later meditations and other verse. Typological wit and the holy delight of canticles ; Taylor's wit of valediction.
|John Gatta.
Study of the New England colonial poet, Edward Taylor, and the relationship between his verbal wit and his religious commitment to Puritan belief. Gratt evaluates the anti-utilitarian dimensions and Puritan themes in Taylor's poems to draw larger conclusions about the New England Soul.
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- Taylor, Edward, -- 1642-1729 -- Humor.
- Taylor, Edward, -- 1642-1729 -- Criticism and interpretation.
- Taylor, Edward, -- 1642-1729.
- Taylor, Edward (Schriftsteller, -- 1642-1729)
- Devotional literature, American -- History and criticism.
- Christian poetry, American -- History and criticism.
- Wit and humor -- Religious aspects -- Christianity.
- Puritans -- New England -- Intellectual life.
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- Puritan movements in literature.
- Comic, The, in literature.
- Christian poetry, American.
- Devotional literature, American.
- Puritans.
- Puritans -- Intellectual life.
- New England.
- Humor.
- Poetry in English -- American writers -- Taylor, Edward, 1642-1729 - Critical studies
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text: Home Grown Africa was born out of an awareness of one of the largest issues impacting our nations unemployment. Set about to create a fair trade 100% local production process. From the design to fabric to print and handwork they ensure that they make use of individuals/businesses that they can work together with to help expand and grow their business as well as their own.


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A Clinical Guide to Pediatric Weight Management and Obesity, 1st Edition
Respiratory Complications
Obesity has a profound impact on the respiratory system. Excess adiposity alters structure, affects function, and may influence the metabolic status of the lung. Structurally, excess adipose tissue deposition in and around the pharynx has been implicated in increasing the likelihood of upper airway obstruction (UAO) (1). Abdominal fat deposition may compromise respiratory excursion (2), and infiltration of adipocytes into the diaphragmatic muscle may alter respiratory mechanics and function (3). The inflammatory state induced by the production of adipokines may exacerbate asthma (4).
Compromise of the respiratory system by obesity has implications for obesity progression and treatment.
- Children who have sleep-disordered breathing (SDB) are more likely to suffer from tiredness, poor performance in school, deficits in attention and memory, and poor decision making (5,6,7,8).
- These deficits all compromise a child's ability to fully participate in activities, which may encourage further weight gain.
- Children who are tired and inattentive may often be labeled "lazy and unmotivated," causing a vicious cycle of discouragement and low self-esteem.
- Obese children who have worsening asthma often have activity restrictions that compromise calorie burning.
The respiratory complications of obesity can also contribute to long-term morbidity. Severe obstructive sleep apnea syndrome (OSAS) can result in pulmonary hypertension, right ventricular enlargement, and heart failure. Left ventricular hypertrophy can occur and is linked to the severity of OSAS (9). Systemic hypertension has also been reported in children as well as adults (10). Some findings suggest that the severity of OSAS is related to that of neurocognitive impairment (5). Finally,
respiratory compromise from asthma can lead to inactivity, physical deconditioning, worsening obesity, and chronically impaired lung function.
Upper Airway Obstruction
State of the Problem
The effect of obesity on the incidence of UAO in childhood is superimposed on the traditional causes of UAO, such as enlarged tonsils and adenoids, craniofacial anomalies, and hypotonia. Therefore, the spectrum of symptomatology ranges from traditional childhood symptoms in younger aged patients, when tonsillar enlargement is prevalent, to a more adult presentation in the obese adolescent.
Obstructive sleep apnea is estimated to affect 0.7% to 3.4% of all children (11). In one series of obese children, polysomnographic abnormalities were found in 37% of patients studied (12). In obese children referred for snoring or abnormal breathing during sleep, 59% were diagnosed with OSAS (13). Symptoms of UAO may appear at any point in childhood as obesity worsens. Obese infants have been found to have an increased number of 3- to 10-second episodes of airway obstruction, more gross body movements, and more sleep stage shifts than nonobese infants (14).
UAO is a prominent respiratory manifestation of excess adipose tissue accumulation.
Other components of SDB include the following:
- Snoring
- Upper airway resistance syndrome (UARS)
- Upper airway obstruction
- Obesity hypoventilation syndrome (Pickwickian syndrome)
Appreciation of this continuum of SDB is important because sleep disruption, in addition to later hypoxemia and hypercarbia, is thought to account for significant compromise of prefrontal cortex function, which has direct implications for learning and behavior in childhood (8).
The following definitions are listed to help clarify the types of respiratory disturbances that are linked to obesity.
- Sleep-disordered breathing—Breathing disorders during sleep that range in severity from primary snoring through persistent snoring, UARS, OSAS, and obesity hypoventilation syndrome.
- Primary snoring—Snoring that occurs without obstructive apnea, gas exchange abnormalities, or excessive arousals (15).
- Upper airway resistance syndrome (UARS)—Snoring with partial UAO that leads to repetitive episodes of increased respiratory efforts ending in arousals. The sleep pattern is disrupted and daytime symptoms may occur. No evidence of apnea, hypopnea, or gas exchange abnormalities can be found on polysomnography (10).
- Obstructive sleep apnea syndrome (OSAS)—A disorder of breathing during sleep that in children is characterized by prolonged partial UAO and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns (15). The condition is characterized by alternating apneic pauses and arousals, often with oxygen desaturation and/or hypercarbia, producing restless sleep and a feeling of fatigue on awakening (15).
- Obesity hypoventilation syndrome—Results from continuous partial airway obstruction that leads to paradoxical respiratory efforts, hypercarbia, and often hypoxemia (16).
- Obstructive apnea—Cessation of oronasal airflow with continued respiratory effort (17).
- Hypopnea—A reduction but not complete cessation of airflow (17), clinically manifested by shallow breathing.
- Apnea index—The number of total apnea episodes during sleep plus the number of total hypopnea episodes during sleep divided by the total sleep time in minutes (17).
Although not all obese children have SDB, obesity increases the likelihood of SDB, and the more obese a child is, the more likely he or she will be to exhibit some symptoms of sleep disturbance and compromised daytime functioning (13).
It is easy to imagine that excess adipose tissue accumulation in the head, neck, and upper airway can cause narrowing and respiratory compromise (1). In addition, fatty infiltration of the muscles of the hypopharynx and diaphragm may affect muscle function (3). Obesity in adults has been shown to cause decreased chest wall compliance, reduced strength of inspiratory muscles, and a restrictive ventilatory pattern, which predicts hypercapnia (18), and reduced lung volumes have been thought to reflexly induce a reduction in the size of the upper airway (19). Evidence also suggests that the metabolic effects of obesity may contribute to disturbances of respiration during sleep. For example, leptin, an obesity-associated cytokine, has been found to correlate with OSAS, and it decreases when treatment with continuous positive airway pressure (CPAP) is administered (20). Tumor necrosis factor-α
(TNF-α) and interleukin-6 (IL-6) produce sleepiness and fatigue and are both elevated in sleep apnea and obesity (21). The presence of enlarged adenoids and tonsils will exacerbate hypercarbia and hypoxemia in obese children with SDB because the shape of the palate changes, nasal passages are narrowed, the face is flatter and broader, and the glabella is flattened (13).
Clinical Manifestations
Clinical manifestations of SDB can be divided into sleep-related nighttime symptoms, which involve disturbances of breathing and sleep, and daytime symptoms, which involve tiredness and reduced cognitive functioning (Table 6.1).
Obese children with OSAS have shown deficits in memory and learning on standardized tests when compared with obese children without OSAS (5). Even normal weight children with simple snoring showed deficits in attention and lower memory and intelligence scores than nonsnorers, along with reduced performance and verbal and global intelligence quotient (IQ) scores (22). Symptoms of UAO can be confused with those of attention deficit disorder (ADD), and children with UAO may be thought to have ADD or unfortunately may be labeled "lazy" or "unmotivated." In one study of a cross-section of school children, early childhood snoring was associated with poor academic performance in middle school (23). Serious complications of UAO can occur in childhood, such as the following:
- Systemic hypertension
- Pulmonary hypertension
- Cor pulmonale
TABLE 6.1. Clinical manifestations of sleep-disordered breathing
Obesity hypoventilation syndrome is at one end of the spectrum of respiratory disturbances caused by excess adiposity. It results from the interactions of small lung volume due to relatively mobile chest wall and restriction of diaphragmatic movement due to abdominal fat, which increase the work of breathing (16). This sets up a breathing pattern that is shallow and rapid and reduces the proportion of each breath available for gas exchange (16). The Pickwickian syndrome is marked by an impaired ventilatory response to hypercarbia, which occurs centrally. The exact mechanism of obesity-related hypoventilation is unknown. In leptin-deficient ob/ob mice, a diminished central response to hypercapnia is reversed by administration of leptin (24). This finding may be pertinent to obese patients who, although having high levels of leptin, are leptin resistant (20).
Clinical manifestations of the obesity hypoventilation syndrome (18) are as follows:
- Daytime somnolence, difficulty with arousal from sleep
- Hypercapnia
- Polycythemia
- Right ventricular hypertrophy
- Cyanosis
- Periodic respiration, apneic pauses
- Right ventricular failure associated with alveolar hyperventilation (18)
Total lung capacity, functional residual capacity, and expiratory reserve volume are decreased, resulting in alveolar hypoventilation, arterial hypoxemia, and hypercarbia (18). Ventilation-perfusion mismatches may also occur, and patients so affected may be more susceptible to respiratory compromise when pulmonary infections occur (16). These patients have a complex course and significant morbidity and should be under the care of a specialist.
Every obese child should be asked about the quality of his or her sleep, and attention paid to any problems in school performance or behavior, as they may be symptoms of SDB.
The physical examination reveals an obese child who may or may not also show evidence of adenotonsillar hypertrophy, such as mouth breathing, nasal obstruction during wakefulness, adenoidal facies, and hypernasal speech. Complications such as systemic hypertension or increased component of the second heart sound, indicative of pulmonary hypertension, may be detected (15).
The "gold standard" of diagnosis of SDB is nighttime polysomnography (7). Although some symptom checklists have proved useful in predicting SDB in the research setting, there has been no large-scale clinical evaluation of these scales (25).
Parental observation, video taping, and audio taping are suggestive but not necessarily predictive of a positive or negative sleep study (7).
Standards of measurement on polysomnography are the following (6):
- Respiratory effort as assessed by abdominal and chest wall movement
- Airflow at nose/mouth or both
- Arterial oxygen saturation via pulse oximetry (noninvasive)
- Electrocardiographic (ECG) rate and rhythm
- Electromyography in the anterior tibial region to monitor arousals
- Electroencephalographic (EEG), electro-oculographic, and electromyographic measurement for sleep staging (6)
If cardiac disease is suspected, a chest radiograph, echocardiogram, and electrocardiogram should be obtained (9).
The definitive treatment for obesity-associated SDB is weight loss (26). When indicated, tonsilloadenoidectomy (T & A) is performed. If T & A is not indicated, or if the sleep study is positive after a T & A, CPAP, bilevel airway pressure (BiPAP), or oxygen therapy is used.
- Tonsilloadenoidectomy.Obesity exacerbates UAO due to enlarged tonsils and adenoids (27). Careful attention to postoperative monitoring is important, especially in children with central nervous system (CNS) dysfunction, hypotonia, severe OSAS, age less than 3 years, and craniofacial anomalies in addition to obesity (28). Postoperative morbidity has been more frequently observed in patients with severe preoperative obstructive symptoms, such as daytime somnolence, retractions, choking, cyanosis, frequent waking, and apnea, and in patients with moderately to strongly positive sleep studies, patients in whom surgery was performed urgently, and patients with cardiomegaly (29). Postoperative weight gain is a known effect of T & A in normal weight children and has been reported in obese and morbidly obese children after T & A for obstructive sleep apnea (27).
- CPAP.This has been shown to be an effective treatment for OSAS in children (30). CPAP is accomplished by an electronic device that delivers constant air pressure via a nasal mask, prongs, or nasal pillows, leading to mechanical stenting of the airway and improved functional residual capacity in the lung. CPAP must be titrated in a sleep laboratory and periodically readjusted (15), and children may require behavioral desensitization for effective use (16). Other measures that have been reported to increase compliance include improved mask fit, use of a low-pressure alarm, and frequent clinic visits (30). Side effects of nasal congestion, dryness, rhinorrhea, eye irritation, conjunctivitis, dermatitis, and skin ulceration due to poor mask fit or pressure have been noted (30).
- BiPAP.This is delivered during expiration and inspiration by mask or nasal prongs (31). BiPAP has proved effective in reducing the apnea/hypopnea index and increasing oxygen saturation in obese patients with OSAS (31).
- Oxygen therapy.If oxygen therapy is to be used in children, it should be evaluated during continuous CO2monitoring in the sleep laboratory to assess its effect on hypoventilation (15).
- Other surgical options.For patients not responding to the usual treatment, other surgical options may be considered. These patients should be referred to pediatric surgical subspecialists, and options may include uvulopharyngopalatoplasty, craniofacial surgery, and, in severe cases, tracheostomy (15).
Special Situations
Postsurgical complications have been reported in children with obstructive sleep apnea after T & A, which have included (28):
- Increased snoring
- Increased work of breathing during sleep
- Consistently low oxygen saturation requiring continued repositioning and supplemental oxygen
- Need for nasal CPAP or BiPAP
- Requirement for prolonged intubation
- Need for reintubation
These complications were associated with younger age, more severe apnea, decreased oxygen saturation, and associated medical problems, including hypotonia, morbid obesity, craniofacial abnormalities and upper airway burn, young age, cor pulmonale, respiratory distress index (RDI) greater than 40, or oxygen saturation nadir lower than 70% (28). In a small series of obese patients (14 patients) ages 4 to 15, two patients required overnight BiPAP, one required prolonged intubation, and three required supplemental oxygen after T&A (32).
Prader-Willi Syndrome
In obese Prader-Willi syndrome (PWS) patients, hypercapnic ventilatory responses were blunted compared with those in nonobese PWS patients or obese control subjects. Isocapnic hypoxic ventilatory responses were absent or severely reduced in both obese and nonobese PWS patients (33). There have been case reports of PWS patients treated with growth hormone who experienced obstructive apnea, respiratory infection, and sudden death (34). Such reports would militate against the use of growth hormone in these patients.
State of the Problem
The rise in childhood obesity since the 1980s has been paralleled by a rise in asthma rates. Asthma and obesity also often occur together (35), and increases in body mass index (BMI) have been associated with a greater incidence of asthma (36).
Weight reduction in obese individuals has been shown to alleviate asthma symptoms (35).
In a longitudinal population-based cohort study adjusted for risk factors, being overweight or obese at age 11 years was associated with a threefold increased risk for persistence of infrequent wheezing after adolescence and with a twofold increased risk for persistence of asthma (37). A study of 5- to 6-year-old children showed that the prevalence of doctor-diagnosed asthma rose with increased BMI; interestingly, this effect was confined to girls (38). In a meta-analysis of overweight and asthma, high body weight in infancy or childhood was linked with a higher incidence of asthma (39). In a study of urban minority children, those with asthma were more likely to be obese than those without, and 30% of the children with asthma had a BMI greater than the 95th percentile, whereas only 12% of the children without asthma were obese (40).
The link between obesity and asthma is not entirely clear, although both are associated with chronic inflammatory states. Asthma is a chronic inflammatory disease of the airways that causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough. This inflammation also produces an increase in existing bronchial hyperresponsiveness (41). Obese children may have gastroesophageal reflux as well, which can precipitate wheezing and asthma. Obesity has also been characterized as an inflammatory state (42), and overweight nonasthmatic children have been shown to have a higher susceptibility to exercise-induced bronchospasm (43). In addition, leptin, a proinflammatory cytokine present in higher levels in obese children (42), has also been found in increased levels in normal weight boys with asthma when compared with nonasthmatic controls (44).
Mechanical factors may also contribute to asthmatic symptoms. Lung volumes and thoracic wall distensibility were found to be decreased in obese girls (45), and obesity is associated with a breathing pattern of higher frequencies and lower tidal volumes (35). As a result of this shallower breathing pattern, there is less bronchial smooth muscle stretch and greater muscle stiffness, resulting in more difficulty stretching, muscle fiber shortening, and increased bronchial hyperresponsiveness (35).
Clinical Manifestations
Overweight may contribute to increased severity of asthma and, in a study of inner city black and Hispanic children, was associated with a lower than predicted peak expiratory flow rate. In addition, these obese asthmatic children were reported to miss more school days and receive more medications than nonobese asthmatic children (46). Obese children with and without asthma report more coughing, wheezing, and dyspnea than nonobese children (47). Increased bronchial responsiveness may lead to avoidance of exercise, which can lead to or exacerbate obesity (48).
Evaluation and Treatment
Obese children are at higher risk for asthma and may present with a diagnosis already in place. However, obese children may have a very low level of activity and may not voluntarily report symptoms, so a careful history for asthma, particularly exercise-induced asthma, should be obtained. Care must be taken to identify altered activity patterns, such as dropping out of sports or activities, "slowing down," and losing interest, which might be the result of increased respiratory symptoms such as shortness of breath, chest tightness, and wheezing. Attention to changes in exercise symptoms needs to be maintained over time. As increased physical activity becomes part of a weight management strategy, previously unrecognized respiratory symptoms may emerge.
Asthma treatment should be optimized in all children and is especially critical in obese children. Those who may have decreased physical activity because of asthma symptoms need to feel confident that exercise is safe and possible, and optimal asthma care can provide this support.
Ongoing Support
- Children with sleep apnea need ongoing monitoring and support, not only to encourage weight loss but also to monitor progression of symptoms and use of CPAP or BiPAP.
- Asthma management should be optimized in all children, with attention focused on preventing exacerbations and maximizing pulmonary function to allow for optimal activity.
Impact on Weight Management
OSAS may contribute to worsening of the metabolic and cardiovascular picture associated with obesity. Nocturnal sleep and respiratory disturbances in obese patients with sleep apnea are independent risk factors for hyperinsulinemia (49). SDB may increase the risk of developing the metabolic syndrome (50). Repeated episodes of apnea and hypopnea are known to cause transient elevations in blood pressure during sleep, and daytime blood pressure increases linearly with an increasing
apnea/hypopnea index (51). Moreover, OSAS is associated with stroke and heart disease in adults (52).
In adults, SDB has also been associated with increased sympathetic nervous system activity (53), decreased baroreceptor sensitivity (54), accentuated vascular responsiveness (55), and abnormal salt and water metabolism (56), all of which could contribute to hypertension.
An inverse correlation between memory and learning performance and the apnea/hypopnea index was found in morbidly obese children with OSAS (5). Beebe and Gozal (8) have proposed that the effect of OSAS in children, causing sleep disruption and intermittent hypoxemia and hypercarbia, alters cellular and chemical homeostasis that leads to deficits in prefrontal cortex function. Deficits in behavioral inhibition, set shifting, self-regulation of affect and arousal, working memory, analysis/synthesis, and contextual memory, all of which play an important role in executive functioning, can occur (8). Executive functioning has been referred to as the ability to develop and sustain an organized future-oriented and flexible approach to problem situations (8). These are all skills important for participating in therapies to create behavior and lifestyle change involved in obesity treatment.
Asthma is a consideration in any weight management plan. Poorly controlled asthma may preclude the increased activity necessary to achieve improved energy balance. In addition, asthma and exercise asthma may become apparent in an obese child who initiates exercise as part of a weight management plan. Exercise is also important in asthma treatment, and a prescription for exercise has been endorsed for all asthmatic subjects by the American College of Sports Medicine and the American Thoracic Society (57).
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Thursday, July 23, 2009
The Magazine of Fantasy and Science Fiction
Of all the SF magazines, I think it's probably F&SF which has had the longest, broadest and deepest impact on the scene. All the others, I'm sure, have their plus points, but F&SF simply eclipses the rest of the field.
I couldn't resist a big pile of nearly twenty copies when I saw them on a stall at a collectibles fair last weekend. They are the US edition, which is often hard to find here in the UK, and my little handful ranges from the 1950s to the 1970s. I thought I would share some of the amazing cover art.
Labels: Book Covers, Illustration, SF
2 comments:
- John C said...
By coincidence I've just this week finished the interior design for a new anthology, The Very Best of F&SF. I have a single copy of the mag from 1967 from which I was able to borrow their logo graphics. Quite a collection with a host of famous names throughout. (No Delany, before you ask...)
- 8:32 pm
- Mike said...
Back in the good old days of, erm, 1997 the corner shop in Littleport, Cambridgeshire, sold all sorts of crazy magazines. On the magazine shelf, for some reason, was a book called "Oi, Robot" which was a bunch of competition entries from this magazine. Many of which were hilarious. I spent about 2 years of school making references to it, to the bemusement of everybody else.
I might just have to dig it up again, come to think of it.
- 10:55 pm
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text:
Why I've decided to go for it and run my first marathon in 2017
Early in 2017, Tara has decided that this is going to be her year. In mid-January, she has signed up for her first marathon.
January 10th, 2017 by Tara Campbell | Posted in Blogs, Gotta Run! | Tags: beginners, Marathon
I went to bed last Friday night with my alarm set to wake me up at 2:50 a.m. The last time I set it that early was for my first flight down to Omaha, Nebraska where I now live. And just as that early-morning rising proved to be life-changing, so too was Friday's.
I believe running a marathon must change a person. Not fundamentally who they are, but the way they see the world, and themselves in it. The lessons learned, the experience gained, and the pure power of stretching one's limits to give their all over 42.2 kilometres, simply must leave a lasting, perspective-altering impression.
RELATED: Lessons learned by an avid distance runner
And now, in early 2017, I have decided to run my first marathon.
That decision wasn't made on whim, nor was it entirely expected. Rather, what brought me to be sitting in the chilly darkness of 3:00 a.m. on Friday morning with my laptop screen reflecting the Lincoln Marathon registration webpage brightly back at me, was the culmination of many miles, many highs and many lows, and even more self-reflection in this training this far. I can best describe the decision to run my first marathon as one that properly snuck up on me, gently knocking at the door of my imagination. Bit by bit, the idea became firmly planted into my mind. Over time, I began feeling a pull strong enough that I realized it was time to go for it.
I've had my sights set on the marathon since the start of my running journey but I didn't want to take that step until I felt I could put my best foot forward. This fall, after running my second half-marathon, I loosened my grip on that thought. I opened my mind to the prospect of simply getting the first one under my belt.
RELATED: The case for building base mileage all winter long
As the deadline to register for the Lincoln Marathon approached, I knew it was decision time. This is Nebraska's most popular marathon, which means it fills to capacity within hours of opening its registration. I started sorting through all the thoughts I've had on the marathon over the past couple of years, and reflecting on the experience I've gained as a runner. I felt in my gut that it was time to run a marathon, but I didn't want this to be a decision based solely on that. So, I set out to articulate my reasons for running a marathon at this point in my journey. It was important for me to be able to clearly and honestly answer the question: Why now?
To my surprise, the answers came easily as I sat at my computer to tap them out in an email to my partner Candace. I wanted her to know why I was making this decision, and to be part of the conversation– she has been with me since the beginning of this adventure, and continues to be my strongest supporter.
Here's some of what I wrote in that email. It's worth noting that I consider the third answer to be the pivotal one.
Marathon 2017: Why now?
1. The challenge, the beauty of the distance and the test of endurance has been on my mind since the start of my running journey.
2. I need experience running the distance to reach my full potential. To wait is to only put off the inevitable.
3. I'm ready to accept the process and outcome of my first marathon without the pressure of a top performance. I have the long game in perspective.
4. My body is showing to be ready to handle the mileage necessary.
5. I have the support, and belief in the timing, from my coach.
Over the next several months I'll be utilizing the experience I've gained to train smart and to train hard. Along the way I'm sure there will be plenty more to learn and therein lies the beauty of running: one never stops learning.