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Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes
Author + information
- Received November 19, 2002
- Revision received January 26, 2003
- Accepted February 25, 2003
- Published online June 4, 2003.
Author Information
- Peter Ammann, MD*,*,1 (peter.ammann{at}kssg.ch),
- Marco Maggiorini, MD‡,
- Osmund Bertel, MD*,
- Edgar Haenseler, MD§,
- Helen I Joller-Jemelka, MD∥,
- Erwin Oechslin, MD¶,
- Elisabeth I Minder, MD†,
- Hans Rickli, MD¶ and
- Thomas Fehr, MD‡
- ↵*Reprint requests and correspondence:
Dr. Peter Ammann, Division of Cardiology, Department of Internal Medicine, Kantonsspital St. Gallen, CH-9007, St. Gallen, Switzerland.
Objectives We sought to assess the mechanism and prognostic value of elevated troponins in patients without acute coronary syndromes (ACS).
Background Cardiac troponins are used as specific markers for the diagnosis of ACS. Recent studies reported a considerable number of critically ill patients without ACS as being troponin-positive, especially patients with sepsis, pulmonary embolism, renal failure, and stroke.
Methods We analyzed 58 consecutive, critically ill patients admitted for reasons other than ACS, according to their troponin status. Thirty-day mortality, left ventricular ejection fraction (LVEF), and a panel of inflammatory cytokines were compared between troponin-positive and troponin-negative patients. Relevant coronary artery disease was excluded either by stress echocardiography or autopsy.
Results Of the 58 critically ill patients, 32 (55%) without evidence of ACS were troponin-positive. Positive troponin levels were associated with higher mortality (22.4% vs. 5.2%, p < 0.018) and a lower LVEF (p = 0.0006). Troponin-positive patients had significantly higher median levels of tumor necrosis factor (TNF)-alpha, its soluble receptor, and interleukin (IL)-6. A subgroup of 10 aplastic patients was troponin-negative at study entry. Three became troponin-positive during leukocyte recovery and subsequently died, whereas all the others stayed troponin-negative and survived. Flow-limiting coronary artery disease was not demonstrable at autopsy or stress echocardiography in 72% of troponin-positive patients.
Conclusions Elevated troponin is a mortality risk factor for medical intensive care patients admitted for reasons other than ACS. It is associated with decreased left ventricular function and higher levels of TNF-alpha and IL-6.
Cardiac isoforms of troponin I (cTnI) and troponin T (cTnT) are highly sensitive and specific markers of myocardial injury. The measurement of cTnI and cTnT in blood has recently been accepted by the Joint Committee of the European Society of Cardiology and the American College of Cardiology as the standard biomarker for the diagnosis of acute myocardial infarction and by the American College of Cardiology and the American Heart Association for the diagnosis and management of unstable angina (1,2). In the setting of an acute coronary syndrome (ACS), cardiac troponins identify patients with a several-fold increased risk of death in the subsequent weeks (3). Besides this enthusiasm for troponin measurements in ACS, there have been several reports demonstrating a high incidence of elevated troponin levels in patients with sepsis and septic shock (4–9). In contrast to the extensive literature on troponins in ACS, which suggests that abnormal concentrations of cardiac troponins always represent irreversible myocardial damage, there is evidence that cardiac troponins might be released by other mechanisms, such as reversible myocardial ischemia (10). This fits the observation that myocardial depression during sepsis is a fully reversible process in patients surviving sepsis (11). Cardiac troponins have also been reported to predict mortality in early sepsis, end-stage renal disease, acute stroke, and pulmonary embolism (5,12–14). Therefore, it is of great interest to understand the underlying mechanisms leading to elevated cardiac troponins, besides ACS. Hence, the aim of this study was to investigate the mechanism of elevated cardiac troponins in patients admitted to the intensive care unit and understand their impact for predicting mortality in patients without ACS.
Study population
Fifty-eight critically ill patients referred to two medical intensive care units for sepsis, septic shock, systemic inflammatory response syndrome, and other severe diseases, except ACS, myocardial infarction, or recent cardiac surgery, were consecutively included within 24 h after admittance. Definitions of sepsis, septic shock, and systemic inflammatory response syndrome (SIRS) corresponded to the criteria of the consensus conference (15). In short, SIRS is defined as a systemic inflammatory response to a variety of clinical insults. The response is manifested by two or more of the following conditions: temperature >38°C or <36°C, heart rate >90 beats/min, respiratory rate >20 breaths/min or Paco2<32 mm Hg, and white blood cell count >12,000/mm3or <4,000/mm3. Sepsis is defined as SIRS in response to proven infection. Septic shock is defined as sepsis-induced hypotension, despite adequate fluid resuscitation needing catecholamine support.
Patients presenting with chest pain and one additional sign of acute coronary artery disease (dynamic ST-segment elevation or depression >1 mm on the 12-lead electrocardiogram or creatine kinase levels twice the upper limit), patients with recent cardiac surgery and those admitted to the intensive care unit only for the purpose of observation <24 h were excluded. Because of these strictly applied exclusion criteria, the majority of the study population in our medical intensive care units consisted of patients with severe infections, and only a minority suffered from other diseases (Table 1). The local ethics committee of both hospitals approved the study. All patients, or in case of unconsciousness, their closest relative, signed a written, informed consent.
Data collection
The Simplified Acute Physiology Score II (SAPS-II) was used to analyze disease severity at study entrance (16). The original reference provides a mathematical model to calculate mortality from SAPS-II. The approximate percentages are as follows (SAPS-II/mortality): 20 points/5%, 40 points/25%, 50 points/50%, 60 points/70%, and 80 points/90%.
The left ventricular ejection fraction (LVEF) was assessed by echocardiography, using the Simpson biplane formula (17), within 24 h of study inclusion by a cardiologist blinded to the troponin levels. Patient survival was assessed 30 days after study inclusion. In case of death, an autopsy was performed. To exclude relevant coronary artery disease in troponin-positive patients, dobutamine stress echocardiography was performed according to standard procedures (18)in survivors within three months after recovery. Analysis of stress echocardiograms was performed by two experienced cardiologists.
Laboratory diagnostics
Blood samples for determination of cardiac troponins and cytokines were taken at the time of study inclusion and after 3, 12, 24, 48, 96, and 192 h. Analysis of cardiac troponins was performed from the serum on a day-to-day basis, and samples for the determination of cytokine levels were centrifuged immediately after the blood was taken and frozen at −20°C. The cTnT levels were assessed with the third-generation test (Elecsys) from Roche Diagnostics (Rotkreuz, Switzerland), and cTnI levels with a second-generation test using the AccessAnalyzer (Beckman Coulter Inc., Fullerton, California). The cutoff level was indicated as 0.1 μg/l by the manufacturer for both cTnI and cTnT and was predefined before starting the study. Patients with at least two positive troponin measurements (cTnI or cTnT) were called "troponin-positive." C-reactive protein measurement was done on an Integra 700 analyzer (Roche Diagnostics), and levels >5 mg/l were considered positive.
Tumor necrosis factor (TNF)-alpha was assessed by an enzyme-linked immunosorbent assay (ELISA) (Endogen, Boston, Massachusetts; cutoff <6.3 pg/ml). For determination of TNF-alpha receptor, an ELISA from Bender Med Systems (Vienna, Austria; cutoff <0.49 ng/ml) was used. Analyses of interleukin (IL)-1-beta, IL-6, IL-8, and soluble intercellular adhesion molecule-1 were performed with ELISA (R&D Research and Diagnostics System, Minneapolis, Minnesota). Cutoff levels were <0.1 pg/ml, <3.1 pg/ml, <0.1 pg/ml, and <300 ng/ml, respectively.
Statistical analysis
Continuous data are expressed as the mean value ± SD or as the median value with interquartile range, as appropriate. The chi-square test was used to compare troponin-positive and -negative patients with respect to "shock" and "no shock" status. The association between LVEF and troponin levels was calculated using Spearman nonparametric correlation. Group comparisons of all continuous variables were calculated using Mann-Whitney statistics. Survival curves were prepared according to the method of Kaplan-Meier (19), and univariate survival distribution was compared by the log-rank test. Two-sided p values <0.05 were considered to be statistically significant. Statistical calculations were performed using the statistical package StatView, version 4.0 (SAS Institute Inc., Cary, North Carolina).
Patient characteristics
The baseline clinical characteristics of the study population are presented in Table 1. Twenty-seven patients (47%) had sepsis or systemic inflammatory response syndrome, and six of them were aplastic due to chemotherapy of hematologic malignancies. Septic shock requiring supportive therapy with catecholamines was diagnosed in 24 patients (41%), and 4 of them were aplastic. The remaining seven patients (12%) were hospitalized due to a variety of conditions, such as intoxication, gastrointestinal bleeding, pulmonary disease, and diabetic coma. The severity of diseases was indicated by a high mean SAPS of 42 points at study inclusion. A causative microbial agent could be isolated in 38 (75%) of 51 patients with sepsis or septic shock. Gram-positive bacterial infection was found in 15 patients, gram-negative infection in 19, and mixed or fungal/viral infection in 4 patients. Eleven (73%) of 15 patients with gram-positive infection and 11 (58%) of 19 patients with gram-negative infection were troponin-positive.
Troponin status and mortality
Thirty-two (55%) of all 58 study patients, or 32 (63%) of 51 patients admitted for sepsis, SIRS, or septic shock, were troponin-positive. The majority of troponin-positive patients (72%) were positive for cTnT and cTnI. The remaining patients were positive for either cTnT or cTnI (Table 1). Seventeen (71%) of 24 patients with shock were troponin-positive, compared with 15 (44%) of 34 patients without shock (p = 0.04). The SAPS (43 ± 17 vs. 42 ± 12; p = 0.74) and age (59 ± 21 vs. 50 ± 19; p = 0.08) did not differ significantly between troponin-positive and -negative patients.
Thirty days after study inclusion, mortality was assessed in all patients according to their cardiac troponin status (Fig. 1A). A total of 16 patients (27.6%) had died. Mortality of troponin-positive patients was significantly higher than that of troponin-negative patients (p = 0.018). The hazard ratio to die from any cause was 4.0 (95% confidence interval 1.2 to 8.9) for troponin-positive patients. When subgroups were analyzed according to their hemodynamic status ("shock" vs. "no shock"), a significantly higher mortality (p = 0.03) was found only in troponin-positive patients without shock, but not in those with volume-refractory shock receiving catecholamine therapy (Fig. 1B).
Cardiac involvement
Among the 32 troponin-positive patients, significant flow-limiting coronary artery disease could be excluded by dobutamine stress echocardiography after recovery from disease in 16 patients, by coronary angiography in one patient, and by autopsy in six cases (Table 2). In one patient, subacute myocardial infarction (n = 1) and high-grade coronary artery stenosis with individual cardiomyocyte necroses (n = 1) could be demonstrated at autopsy. One coronary angiogram and one stress echocardiogram showed evidence of an old myocardial scar, but no signs of actual ischemia. In summary, flow-limiting coronary artery disease was not demonstrable in 72% of troponin-positive patients. We found a significantly lower LVEF in cardiac troponin-positive as compared with troponin-negative patients (48 ± 13% vs. 60 ± 10%; p = 0.0006). All patients with LVEF below 45% had sepsis or septic shock and were either cTnI- or cTnT-positive. In contrast, only 19 (42%) of 45 patients with LVEF ≥45% were troponin-positive. A statistically significant inverse correlation between cTnI levels and LVEF was found, with a relatively low correlation coefficient (r = 0.44, p = 0.0006) (Fig. 2).
Cytokine levels
The median cytokine levels in cardiac troponin-positive and -negative patients are presented in Table 3. Troponin-positive patients showed significantly higher levels of TNF-alpha (p = 0.0007), its soluble receptor (p < 0.0001), IL-6 (p = 0.0007), and C-reactive protein (p = 0.0002). In contrast, there was no difference in the median levels of IL-1-beta (p = 0.11), IL-8 (p = 0.26), and soluble intercellular adhesion molecule-1 (p = 0.07). Subgroup analyses revealed that the observed median cytokine level difference between troponin-positive and -negative patients was mainly generated by the subgroup of patients without volume-refractory shock. Significantly higher levels of TNF-alpha, its soluble receptor, IL-6, and C-reactive protein for troponin-positive compared with troponin-negative patients were found in the subgroup with sepsis or SIRS, but not in those patients with volume-refractory septic shock (Table 3).
Role of neutrophilic granulocytes
All 10 aplastic patients with sepsis or septic shock were troponin-negative at the time of study entrance. Three of them became troponin-positive shortly after leukocyte recovery and subsequently died. In contrast, all others remained troponin-negative and survived.
In the present study, 32 (55%) of 58 critically ill patients consecutively admitted to two medical intensive care units due to severe illnesses other than ACS, or 32 (63%) of 51 patients admitted for sepsis, SIRS, or septic shock, were troponin-positive. Mortality was fourfold higher and LVEF significantly lower in troponin-positive patients as compared with troponin-negative patients. To our knowledge, this is the first study that attempted to systematically exclude significant coronary artery disease by autopsy or stress echocardiography in the majority of troponin-positive patients. Remote stress echocardiography cannot definitively exclude microembolism from non–flow-limiting unstable plaques as a cause for elevated troponins. However, ethical considerations did not allow us to perform coronary angiography in every one of these severely ill patients to check this hypothesis for troponin release. Our data indicate that troponin elevation may be used as a new mortality risk factor for intensive care patients without coronary artery disease. It is noteworthy that there was no significant difference in the SAPS between troponin-positive and -negative patients, although a significantly higher percentage of patients presenting with shock, compared with those without shock, were troponin-positive. This was surprising. According to our results, troponin in intensive care patients gives additional prognostic information beyond conventional risk scoring.
In troponin-positive patients, the median levels of TNF-alpha, its soluble receptor, and IL-6 levels were significantly higher than those of troponin-negative patients. These findings suggest but cannot prove, due to the observational study design, that myocardial depression with elevation of cardiac troponins might be mediated by TNF-alpha. This hypothesis is supported by in vitro studies showing that TNF-alpha leads to reduced contractility of cardiomyocytes (20). Although clinical trials with anti-TNF antibodies or p55 TNF receptor fusion protein in patients with severe sepsis failed to improve survival (21–23), this does not exclude that elevated TNF-alpha blood levels may cause myocardial damage and hence contribute to the poor survival in these patients. However, as suggested in a previous review (24), our results also indicate that neither the systemic inflammatory response to sepsis nor troponin positivity is sufficient to explain circulatory shock in patients with severe sepsis.
Ten of our patients developed sepsis or septic shock while they had aplasia. At recruitment, all were troponin-negative. During leukocyte recovery, three of them became troponin-positive and subsequently died, whereas all the others stayed troponin-negative and survived. This observation suggests that, in addition to TNF-alpha, mediators produced by young and highly activated neutrophilic granulocytes may cause troponin elevation in patients with sepsis or septic shock. In healthy volunteers, it has been reported that pretreatment with granulocyte colony-stimulating factor considerably increased the plasma levels of TNF-alpha, its soluble receptor, and IL-6 on administration of endotoxin (25). Further studies are warranted to confirm this new possible interaction between young highly active granulocytes and myocardial damage in a larger patient population. These findings might be relevant for all septic patients receiving granulocyte colony-stimulating factor during aplasia.
Based on the findings of Piper et al. (26), who showed cardiac enzyme release without cell necrosis after reversible ischemia in vitro, we speculate that TNF-alpha and mediators produced by neutrophilic granulocytes may lead to an increased permeability of the cardiomyocyte membrane for macromolecules and therefore leakage of troponin without myocyte necrosis (10).
We found a significantly higher mortality of cardiac troponin-positive patients admitted to medical intensive care units for reasons other than ACS. Our data show an association between troponin positivity and TNF-alpha, IL-6, and left ventricular dysfunction. Further studies in larger patient populations must establish whether elevated troponin may be used as an independent mortality risk factor for intensive care patients without ACS.
↵1 Drs. Ammann and Fehr contributed equally to this work.
- Abbreviations
- acute coronary syndromes
- cTnI
- cardiac troponin I
- cTnT
- cardiac troponin T
- interleukin
- left ventricular ejection fraction
- Simplified Acute Physiology Score
- systemic inflammatory response syndrome
- tumor necrosis factor
- Received November 19, 2002.
- Revision received January 26, 2003.
- Accepted February 25, 2003.
- American College of Cardiology Foundation
- ↵Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. J Am Coll Cardiol 2000;36:959–69
- Braunwald E.,
- Antman E.M.,
- Beasley J.W.,
- et al.
- ↵
- Heidenreich P.A.,
- Alloggiamento T.,
- Melsop K.,
- McDonald K.M.,
- Go A.S.,
- Hlatky M.A.
- ↵
- ↵
- ver Elst K.M.,
- Spapen H.D.,
- Nguyen D.N.,
- Garbar C.,
- Huyghens L.P.,
- Gorus F.K.
- ↵
- ↵
- Dierkes J.,
- Domrose U.,
- Westphal S.,
- et al.
- James P.,
- Ellis C.J.,
- Whitlock R.M.,
- McNeil A.R.,
- Henley J.,
- Anderson N.E.
- Giannitsis E.,
- Muller-Bardorff M.,
- Kurowski V.,
- et al.
- ↵
- Bone R.C.,
- Balk R.A.,
- Cerra F.B.,
- et al.
- ↵
- ↵
- Schiller N.B.,
- Shah P.M.,
- Crawford M.,
- et al.
- ↵
- Mazeika P.K.,
- Nadazdin A.,
- Oakley C.M.
- ↵
- ↵
- Kumar A.,
- Thota V.,
- Dee L.,
- Olson J.,
- Uretz E.,
- Parrillo J.E.
- ↵
- ↵
- ↵
- Pollmacher T.,
- Korth C.,
- Mullington J.,
- et al.
- ↵


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Do I need to submit applications for licensure or licensure renewal to the state board of pharmacy if I am VAWD accredited or seeking VAWD accreditation?
Initial licensure and renewal applications and fees must be submitted to the applicable state boards of pharmacy. Initial licensure and state licensure renewal are not included in the VAWD application process.

subset: commoncrawl


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Such a high quality keychain that I was really surprised. The weight of leather keychains is impressive and the quality finish amazing. I purchased it for my employees or customers and everyone commented on the quality when he passed it around. Highly recommended!
Simple without a tonne of features that only serve to confuse I think. You go with more functional elements on a promo tool and one of those features is bound to break at these prices meaning the whole product will be tossed in the bin. keep it simple stupid is a good mantra for promotional products.
Then you're in trouble :) Glad these little pear shaped items have done nothing but give that nice feeling of reciprocity based expenditure from our repeat clients. The perfect wee promo tool for a business like mine. Simple and to the point. It is wearable and is good enough to wear and do its job.
When I paid less than 40 cent per unit I expect something a little "tatty" but what I get si a good representation of what I do, I do good work so I give a good quality product. I think that makes sense. The clip elements are strong enough to last and that stitching speaks volumes that these guys know what they are doing.
Great to see the per unit discounts kicking in after such a low minimum order quantity, definitely possible to add 1000s of these to my marketing budget again next year, just need to get our end of year figures now to see if there is an upswing I can attribute to these in order to get the go-ahead.
That's what I think at least. That was the reasoning behind my decision to go with a basic keychain function but with the additive of handstitched leather. I think it looks good as a fashion accessory and I've been proven right by the number of these I've seen around our city.
The Cool Pear Shape Leather Key Chain provides a great help to your customers with its awesome features that includes swivel hook, that is offered by PapaChina and has some of the versatile uses which can be used for holding keys for your customers thereby creating a huge amount of recognition for your company among your customers and make it an unforgettable brand.


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Sapiens: A Brief History of Humankind
SKU: 000000000002164597, EAN kodas: 9780099590088, ISBN kodas: 9780099590088, Spalvingumas: Nespalvotas, Viršelio tipas: Minkštas, Originalo kalba: Anglų, Puslapių skaičius: 512, Leidimo metai: 2015-09-01, Formatas: 20x13x4,5, Knygyne: 13.29, Leidykla: The Book Service
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Apie prekę
Dr Yuval Noah Harari has a PhD in History from the University of Oxford and now lectures at the Hebrew University of Jerusalem, specialising in World History. Sapiens: A Brief History of Humankind has become an international phenomenon attracting a legion of fans from Bill Gates and Barack Obama to Chris Evans and Jarvis Cocker, and is published in over 45 languages worldwide. It was a Sunday Times Number One bestseller and was in the Top Ten for over nine months in paperback. His follow-up to Sapiens, Homo Deus: A Brief History of Tomorrow was also a Top Ten Bestseller and was described by the Guardian as 'even more readable, even more important, than his excellent Sapiens'.
Fire gave us power. Farming made us hungry for more. Money gave us purpose. Science made us deadly. This is the thrilling account of our extraordinary history – from insignificant apes to rulers of the world.
Earth is 4.5 billion years old. In just a fraction of that time, one species among countless others has conquered it: us.
In this bold and provocative book, Yuval Noah Harari explores who we are, how we got here and where we're going.
'I would recommend Sapiens to anyone who's interested in the history and future of our species' Bill Gates


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Channelizing Devices
Delineators are stocked in both 28 and 42 inch styles. All delineators use two glue on high intensity reflective 3 inch bands. 12 pound recycled rubber bases are stocked and heavier bases can be special ordered. Plastic traffic barrels for both weight filled (sand bag) bottoms and tire ring bottom weights are available to fit any specification required. Standard traffic cones are stocked in 6, 12, 18 and 28 inch sizes. Also stocked are slim line 28 inch and standard 28 inch with two reflective bands. Pavement markers, pavement tape, temporary overlay markers, concrete barrier markers and the adhesive are also stocked.


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Phononic's survey findings were featured in this story from Refrigerated & Frozen Foods, highlighting consumer preferences in the grocery landscape.
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Phononic announced the deployment of the first-of-their kind Phononic F200 Merchandising Freezers in PNC Arena's new grab-and-go eatery.
Phononic Vice President and General Manager of Food and Beverage, Dana Krug, shared some thoughts on Amazon's expansion plans.
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Sandra Fluke responds to Nationwide Campaign Against Contraceptives
Sandra Fluke responds to Nationwide Campaign Against Contraceptives
Sandra Fluke
United States House of Representatives
House Democratic Steering and Policy Committee
February 23, 2012
Congressman Elijah Cummings:
As I had noted in my opening, there is currently a nationwide campaign at both the state and federal levels not only to restrict insurance coverage, but in some instances to outlaw many forms of commonly used contraceptives.
If those efforts are successful and prohibit commonly used contraceptives like IUDs and some forms of the pill, it would roll back the clock for women across the country.
Can you describe what the impact would be on you and your classmates?
Well I think for millions of women it would be an increase in the number of people who have the medical complications I've been talking about today.
One woman came to me recently, since this happened, and described that she needs contraception to prevent seizures. So she has several seizures a month if she doesn't have contraception to balance her hormones. And that's just an incredible intrusion on her life, her ability to manage her daily affairs if she doesn't have access to that medical prescription. So that's one of the huge impacts.
I think another impact that it's really important that we all think about, is that contraception when it first became available was a revolution in this country. It allowed women to enter employment and educational opportunities that had previously not been accessible because they were unable to control their reproduction in the same way. And I just can't imagine rolling back the clock on that progress.
This work is in the public domain in the United States because it is a work of the United States federal government (see 17 U.S.C. 105).


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3.—(1) In Article 3 of the Education (Student Loans) (Northern 1990 NI 11. Ireland) Order 1990 (arrangements for loans for students out of money made available by Department) after paragraph (1) there shall be inserted the following paragraph—
"(1A) The Department may, in pursuance of arrangements with persons by whom private sector student loans are made, pay subsidy to those persons in respect of such loans; and in this paragraph "private sector student loans" means loans made to eligible students towards their maintenance otherwise than out of money made available by the Department.".
(2) The Schedule (which makes amendments in consequence of paragraph (1)) shall have effect.
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Taught by Alumni in the Field, Students Show Work at Advertising Competition
Webster students in the School of Communications won second place in the National Student Advertising Competition (NSAC) regionals in Kansas City last week.
The NSAC is an annual contest held by the American Advertising Federation for teams of college students. Each year a corporate sponsor provides an assignment outlining the history of a product and current advertising situation. The students must research the product, its competition, identify potential problem areas and devise a completely integrated communications campaign. Each student team works as a small ad agency and then "pitches" it's campaign to a panel of judges.
For the competition, the Webster students formed an "agency" they called BlackBird Creative and put together a campaign for Walmart and Glidden Paint. They competed against the other schools in the NSAC District 9: Clarke University, Drake University, Drury University, St. Louis University, University of Missouri-Columbia, University of Missouri-St. Louis, University of Nebraska-Lincoln and University of Northern Iowa. They tied for second place with Drury. The first-place award went to University of Nebraska-Lincoln.
Webster alumni Julie Clark, associate creative director at Momentum Worldwide, and Michael Whitmer from Novus International teach the course. They both participated in the class twice during their time at Webster.
"We are incredibly proud of the students' commitment to the class and their campaign," Clark said. "Together, they built an award-winning, integrated marketing campaign for Glidden paint at Walmart. The Webster team's creativity, hard work and dedication were evident on the AAF District 9 NSAC competition stage last Friday."
The students who competed were a mix of junior and senior Advertising majors with one Media Communications major and one Art major. These are the students who made up BlackBird Creative:
- Nicole Abernathy
- Danica Babb
- Hanna Brindisi
- Emily Congdon (Art)
- Jamie Cook
- Lauren Dreyer
- Jorge El-Azar
- DoHyun Lee
- Amanda Menke
- Julie Rechtien
- Adam Riley
- Clare Rohr
- Alexander Sonsthagen
- Stephanie Stough (Media Communications)
- Kelsey Tsukayama
Congratulations to all the students!
Category: Advancement, Alumni, Featured, Student Affairs and News, Webster News


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Daily & Cultural Activities
Daily Activities
Time and time again our guests remark on how much their holiday has been enriched by the warmth, friendliness, sense of fun and depth of local knowledge shared freely with them by our Activities Team members. And this too is often why they return, time and again, to The Rarotongan rather than stay at an isolated bach. Because here at The Rarotongan, you can enjoy one of the most extensive free activities programmes you are likely to find anywhere on Earth. It's all laid on, right here at The Rarotongan.
- Resort Orientation – others include this as a bonus offer (!!), here at The Rarotongan, it's a given …
- Snorkelling Lessons in the Pool or Lagoon – great for when you're a bit rusty, or haven't had a go before. Very patient, sympathetic instructors.
- Snorkelling Safaris in pristine Aroa Lagoon Marine Reserve – it's good to go with a knowledgeable guide, then use our Snorkelling Map another time and do it your way (yip, we even publish an Aroa Lagoon Snorkelling Map – only at The Rarotongan!)
- Night Snorkelling – unique to The Rarotongan, and one of our most popular and fascinating excursions
- Fish Feeding – this is one of the absolute highlights for so many guests, young and young at heart! The fish are the friendliest you'll fine anywhere
- Guided Kayaking Safaris – drink in some great views of the majestic mountains from Aroa Lagoon
- Guided Nature & Village Walks – The Rarotongan is located in beautiful Aroa, between Rutaki and Kavera villages, well away from any other resorts or hotels. It's a picturesque little area to explore, especially when you go with someone who knows the locals and the lay of the land.
- Beach Volleyball on prime Aroa Beach
- Water Polo in the Waterfalls Pool
- Tennis Coaching
- Crab Hunting – of course we employ a catch and release system.
- Crab Racing – people, they'll bet on anything!
- Culture – no, this is not a code-word for boring (see below)
Check out the Activities Blackboard (located beside the Activities Hut) or your nightly Guest Newsletter for the day's schedule of activities, and enjoy! Open every day, from 8am to 6pm.
Cultural Activities
Everyone at The Rarotongan Beach Resort & Spa is very proud of our Cook Islands history, our culture, our music, our dance and our people, and we're excited to be able to share it with you as part of our Complimentary Daily Activities Programme.
Often the word 'culture' conjures up something heavy, worthy, and not very interesting. Not so in Rarotonga. Here 'culture' is another word for fun, laughter and high spirits. Nowhere on Earth will you find a people more genuinely willing to share their culture with you - in a natural, unaffected way, peppered with a lot of good humour.
Some of the highlights of our range of cultural activities include:
- Coconut Show – see how the masters climb tall coconut palms (technically speaking, not 'trees'), pluck a nut and show you how to husk and open it
- Ei (lei) making – In Hawaiian, a lei. In Rarotongan, an ei. Learn to make your own from fresh tropical blooms – one of our most popular activities, and you can wear it to our riveting 'Legends of Polynesia' Island Night Dinner / Show that evening.
- Hura (hula) dancing – once you've seen genuine Cook Islands dancing, you'll realize why these are the best dancers in all of Polynesia, sought after around the world for 'Polynesian Shows'. You'll feel good shakin' your booty – plus you'll gain a new appreciation for just how skilled they really are. Then again, they've been doing this since before they could walk.
- Log drum playing – when Cook Islanders play their drums, you can hear the heartbeat of Mother Earth. The instinctual sense of rhythm, the super-human speed of the beat – it's a sound which drives straight to your soul. They make it look natural and almost effortless. Just try it and see.
- Ukelele playing – for many, the lilting island strings is like the signature sound of the South Pacific. Enjoy strumming your own island tune, your way.
- Pareu tying – there's so many looks you can get from one length of fabric, why doesn't the whole world live this way? So easy, breezy and … inexpensive!
- Palm frond weaving – learn how to make your own sun hat from coconut fronds
- Ika Mata – learn to make the Cook Islands national dish, yum (make from the freshest tuna steeped in fresh coconut milk, onion, tomato, and a little chilli)
Cook Islands culture continues to be something lived and breathed by the people in their every day lives. Because most Cook Islanders speak English, it is relatively easy to gain a little insight into the richness of the culture – unlike places where there is a language barrier, or where tourists are not genuinely welcomed. Our Activities Team is always willing to share their deep love and knowledge of their culture with you as our valued guest. Immerse yourself in some wonderful aspects of exotic Cook Islands culture, and by doing so, deeply enrich your vacation experience – and have a whole heap of fun doing it!
Waterfall Swimming Pool
Right beside the Activities Hut is the waterfalls swimming pool. Which is handy, as that's also right beside Aroa Beach. And because The Rarotongan is luckily located right on the sunshine southwest coast, this means there's sunshine all day on the freshwater pool, the beach, and the lagoon – right up until sunset that is (often a glorious, blazing island sunset). There's plenty of comfortable pool loungers to enjoy, so grab your complimentary pool / beach towel from the Activities Hut and make yourself comfortable for another day in Paradise. After you've soaked up some rays, take a cool dip in the pool. Someone's gotta do it.


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Granada Hotel in Puebla offers 100 rooms classified as Single Standard, Single Plus, Single Deluxe, Double Standard and Double Deluxe. Our hotel in Puebla features modern and comfortable spaces for a superior rest; choose what suits you best and book online through this website.
Standard Single
Single Standard Room of Granada Hotel is located in our facilities' first floor, with 1 double bed and capacity for 2 people in every room. Fully carpeted with a work desk and 21" TV with cable signal.
Plus Single
Also, in our first floor, you can find Single Plus rooms each one with 1 double bed and capacity for 2 people. Featuring wooden floor, vanity mirror, work desk and LCD TV screen with cable signal.
Deluxe Single
Granada Hotel in Puebla offers Deluxe Single rooms located in the second floor with 1 king size bed and capacity for 2 adults and 1 child. Featuring wooden floors, work desk, LCD 31" TV screen with cable signal and full bathroom including a comfortable tub.
Standard Double
Double Standard rooms are located in the first floor including 2 double beds and space for 4 people. Featuring carpeted floors, work desk and TV with cable system.
Deluxe Double
Granada Hotel in Puebla also gives you Deluxe Double Rooms with 2 double beds and capacity for 4 people. It features wooden floor, vanity mirror, work desk and 21" TV with cable system.
*We offer you rooms specially intended for people with physical disabilities, available with previous notice.


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NEW YORK — At some point during the Colorado Rapids visit to the New York Red Bulls last weekend, the two teams did more than play against each other.
On Tuesday, three days after the Red Bulls defeated the Rapids 3-1 at Red Bull Arena, the two clubs announced a trade, New York sending midfielder/striker Macoumba Kandji to Colorado in exchange for midfielder Mehdi Ballouchy.
MLS INSIDER POLL: Who got the better deal?
Kandji has played his entire MLS career for the Red Bulls after being acquired from the Atlanta Silverbacks in USL-1 in 2008. The 25-year-old Senegalese striker started most of the 2009 season, but has seen his minutes decreased in 2010 due to several midfield and striker acquisitions by the team, most notably Thierry Henry and the emergence of Dane Richards.
Kandji has four league goals this season, and scored against Premier League side Manchester City in a midseason friendly, a performance which reportedly garnered interest from Bolton and Blackpool.
Ballouchy has played four years in MLS. The 27-year-old Moroccan was drafted by Real Salt Lake in 2006, scoring two goals for the club before being traded to Colorado in 2007 in exchange for midfielder Kyle Beckerman. Ballouchy has scored three goals this season for the Rapids.
Colorado will play their next game at home against the New England Revolution, while Ballouchy and the Red Bulls travel to Texas to take on FC Dallas on Thursday night.


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Plain English Summary
Background and study aims
Skeletal muscles (muscles that are under our control, allowing us, for example, to move and maintain our posture) are electrically active, and the signals measured from skeletal muscle cells can be used to detect medical problems. When we are resting, our skeletal muscles are normally electrically inactive, but pain can cause an increase in electrical activity. This activity can be measured using an instrument called an electromyograph. This study will use an electromyograph to find out how well a new spinal manipulation technique developed for relieving pain in thoracic spine muscles (muscles in the middle of your back) performs compared to an established manipulation technique. If the new technique results in greater pain relief than the conventional treatment, the electromyograph will record less electrical activity.
Who can participate?
Participants aged between 18 and 30 with acute or chronic pain in their thoracic spine muscles.
What does the study involve?
Participants are randomly allocated to one of two groups. Participants in group 1 undergo the new spinal manipulation technique. Group 2 are treated using the established technique. Pain and tenderness felt by each participant and the electromyography activity of their thoracic spine muscles are measured before treatment begins, immediately after the treatment and a week after treatment.
What are the possible benefits and risks of participating?
Not provided at registration
Where is the study run from?
Alcalá University (Spain)
When is the study starting and how long is it expected to run for?
July 2014 to October 2014
Who is funding the study?
Alcalá University (Spain)
Who is the main contact?
Dr Daniel Pecos-Martin
Trial website
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
Study information
Scientific title
Manual therapy effects on the electromyographic activity of the thoracic erector spinal muscles
Study hypothesis
An anterior/posterior articular manipulation technique on the thoracic spine produces better changes in electromyography activity and the pain related with erector spinal muscle.
Ethics approval
Alcalá ethics committee, 3/2/2014, ref. M2013/044/20140131
Study design
Single-blind randomized clinical trial
Primary study design
Secondary study design
Randomised controlled trial
Trial setting
Trial type
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet
Subjects with localized pain in the thoracic region of the back. Musculoskeletal pain related to activity.
1. Experimental group: application of a PA contact mobilization using the T7 vertebra pisiforme about 3 minutes, with 20 seconds interval, with a frequency of 1 to 2 Hz. The mobilization amplitude grade III was applied.
2. Placebo group: application of a PA contact mobilization using the T7 vertebra pisiforme about 3 minutes, with 20 seconds interval, with a frequency of 1 to 2 Hz. The mobilization to a lower grade was applied as described by Maitland
Intervention type
Drug names
Primary outcome measure
Electromyography activity of thoracic spine muscles
Secondary outcome measures
Pain in thoracic spine muscles
The primary and secondary outcomes will be measured before treatment, immediately after and, finally, a week later.
Instruments used:
1. Pain: VAS
2. Tenderness: Algometry
3. Muscle activity: superficial electromyography
Overall trial start date
Overall trial end date
Reason abandoned (if study stopped)
Participant inclusion criteria
1. Acute or chronic pain in the thoracic spine of nonspecific origin
2. Aged 18 to 30 years
3. Body Mass Index (BMI) < 29
Participant type
Age group
Target number of participants
Participant exclusion criteria
1. Previous history of surgery
2. Cardiovascular disorders
3. Neurological, musculoskeletal, osteoporosis, tumor, cancer diseases, radicular pain and / or neuropathy
Recruitment start date
Recruitment end date
Countries of recruitment
Trial participating centre
Universidad de Alcalá
Alcalá de Henares
Funder type
Funder name
Alcalá University (Spain)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2015 results in: http://www.ncbi.nlm.nih.gov/pubmed/27012824


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- Ripple - 1 Panel Module
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1 Panel Kit (800mm wide straight) - this is a complete module and can be used as a standalone single banner or as part of a larger system and includes:
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Prices shown exclude VAT
It's ability to fit into the boot of a small car makes it ideal for fly away events and exhibitions. Flexible and extremely cost effective, the ISOframe Ripple will literally change the shape of your exhibition display experience. You can re-use and reconfigure the size and shape of the display for future events, saving you time and money, and with media screen attachments, spotlights and a table available as accessories, the Ripple is the most convenient portable display system currently available.
Need more inspiration or ideas? We have an extensive gallery of stand configurations and layouts to give you some starting points.
Contact us for a password to access the gallery page. Click here to access the gallery.
Contact us for a password to access the gallery page. Click here to access the gallery.


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Summer has finally arrived in Manhattan, Kansas. Flowers are blooming, vegetables are ripening, and the sun is shining. A lot! The summer is also a great time to relax just a bit from the busy school year and reflect on Kansas State University's many engaged partnerships and initiatives.
We have to start with the big news and that is Kansas State University submitted its official application to the Carnegie Foundation to be reclassified as a community-engaged university in April. Submitting this application capped a year-long effort by the Center for Engagement and Community Development and a 25-member Carnegie task-force. The K-State team compiled a great deal of information and data regarding engagement, conducted numerous interviews with campus engagement stakeholders, and facilitated five focus groups representing nearly 50 domestic and international partners. This application revealed an amazing breadth and depth of engagement at K-State. We won't know if our application is successful until January, 2020, but a big thank you to everyone involved in this important effort.
The other stories in this newsletter represent the breadth of engagement that is characteristic of Kansas State University and that was revealed in the Carnegie application. The newsletter stories highlight engagement ranging from the local to the international. The engagement stories focus on K-State's commitment to be a partner on the significant issues facing our local and international communities. Stories in this newsletter feature campus and community partnerships that are working to address housing, food access, civic participation, and reconciliation following decades of armed conflict. Partnerships in this newsletter are being led by faculty, professional staff, and K-State Research and Extension educators. They represent collaborations with high schools, K-State students, small business owners, funders, philanthropic foundations, and housing stakeholders.
The stories in this newsletter remind readers of the type of engaged work that has been at the core of Kansas State University since our land-grant beginning.
We hope you enjoy.
David E. Procter, Director


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Fitch Ratings has given a 'BBB-' rating to Prudential Financial Inc.'s (PFI) issuance of $1 billion of 5.875 percent fixed to floating rate junior subordinated notes that will be due in 2014.
The proceeds from the issuance are expected to be utilized to prefund maturing debt as well as to call elements of outstanding retail notes at par.
Fitch maintains that, according to its rating criteria, the hybrid debt issuance has not been assigned any equity credit and PFI's Financial Leverage Ratio is not affected.
The company's leverage ratio (a method used to calculate a company's ability to meet its financial obligations) was at 35 percent in June of 2012 compared to 32 percent in 2011. The ratio did however increase as anticipated when PFI adopted a new accounting standard for deferred acquisition costs which in turn reduced shareholder's equity and increased the leverage ratio by 2 percent and a first half increase in debt. Total leverage was flat at year-end 2011, standing at 42 percent.


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METS: Ike Davis homers twice in win over Pirates
NEW YORK -- Ike Davis connected twice and reached a career-high 30 homers, Jenrry Mejia pitched five effective innings for his first major league win and the New York Mets beat the plummeting Pittsburgh Pirates 6-2 Monday night for their fourth straight victory.
Davis had a career-best five RBIs and David Wright had a run-scoring single to move within two hits of tying Ed Kranepool's franchise record of 1,418 hits.
The Pirates lost for the 31st time in 43 games since improving to a season-high 16 games above .500 (63-47) on Aug. 8. They started the day 6½ games back in the wild-card race with several teams ahead of them, and now need to win six of their last nine just to finish at break even.
Pittsburgh's Andrew McCutchen went 1 for 3 with a triple to keep his batting average at .336 -- behind only Melky Cabrera, who is at .346 but has removed himself from consideration.
Davis' homer to left-center off Kyle McPherson (0-2) in the fourth came after Wright walked. Davis hit a three-run shot off Jeff Karstens in the fifth to make it 6-0, a batter after Wright had an RBI single.
Nearing the end of a lost season of their own, Mejia's outing has to be encouraging for the Mets. Rushed to the big leagues at 20 years old in 2010, the team's top pitching prospect went 0-4.
Mejia (1-1) had reconstructive elbow surgery in May 2011 after starting out in the minors.
This was Mejia's fourth appearance for the Mets this year. He gave up five runs in three innings in his first start on Sept 15 at Milwaukee.
Mejia allowed four singles and two walks Monday. The right-hander struck out four and only his last out was made by an outfielder.
Davis got off to a horrendous start after the 25-year-old slugger missed much of last season with an ankle injury. He was diagnosed with a likely case of Valley Fever during spring training and didn't lift his batting average above .200 for good until July 4. Still, he has three multihomer games this year, including a three-homer game on July 28 at Arizona, and has connected 18 times since the All-Star break and leads the team with 88 RBIs.
Pirates manager Clint Hurdle said McPherson needed to be more aggressive in his second major league start. Instead he had trouble finding the plate and was lifted after 4 1-3 innings. He gave up four runs and four hits with three walks. He struck out three.
Garrett Jones had an RBI single in the eighth and Jose Tabata a run-scoring single in the ninth for Pittsburgh.
NOTES: Davis' first homer was the Mets' 19th longball aided by the new Citi Field dimensions. The visiting team has 25 such homers since they brought in the fences before this season. ... Mets RHP Frank Francisco (elbow tendinitis) has not pitched since Sept. 16 but manager Terry Collins says that because there is no structural damage in the closer's arm he is still day to day. ... Hurdle said there "zero" hesitancy to get Karstens (5-4) another start but he'd like to see Jeff Locke (0-2), Tuesday's starter, and McPherson pitch, too. ... LHP Collin McHugh (0-2) will start for Mets on Tuesday against Locke.


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Emergency Closure Procedures
Sometimes school closure at short notice is unavoidable and this is usually due to adverse weather or issues with the heating or water systems in the school. The decision to close is never taken lightly but Moor Row Primary School will always consider the health and safety of pupils and staff when making such a decision.
In the event of an emergency school closure, you will be notified by text message as soon as the decision is made. As we are limited to a certain number of words in a text message, additional information will be provided via the school website and Facebook page as soon as this is possible. Please understand that this additional information may not be immediate as staff will prioritise health and safety. In the unlikely event that you do not receive information informing you of school closure and your child arrives at school, there will be a member of staff here to meet them and make contact with you. We have a number of staff who live in the village who can get here even when weather is particularly bad. If this happens they will be supervised until contact is made with you.
Thank you for your understanding and support.


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$ 55.01
Unbelievably fluffy and warm - this high quality cozy fleece blanket is impossible to leave behind, wherever one might go. The perfect size for snuggling on the couch, by the fireplace or at outdoor events.
.: 100% Polyester
.: One side print
.: Plush backside
$ 39.45
Unicorn Rainbow Leggings
Stylish, durable, and a hot fashion staple. These polyester/spandex leggings are made of a comfortable microfiber yarn, and they'll never lose their stretch.
• Fabric is 82% polyester, 18% spandex
• Four-way stretch
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• Imported fabric that's cut, sewn, and printed in California
View full product details
$ 21.85
These beautiful indoor pillows come in various sizes. Pillows can have one design front and back, or you can create a different design on each side. Made and printed in the U.S.A.
Fabric: Spun Polyester
Filling: Included
$ 29.00Bring your favorite design everywhere you go.


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Plant Stress Tolerance
Methods and Protocols
- Editors
- (view affiliations)
Part of the Methods in Molecular Biology book series (MIMB, volume 1631)
Part of the Methods in Molecular Biology book series (MIMB, volume 1631)
This second edition provides up-to-date and new chapters covering the most important widely-used techniques in plant stress tolerance, including cutting-edge strategies, in a manner that ensures effective results. Plant Stress Tolerance: Methods and Protocols, Second Edition guides readers through reviews on epigenetics, long noncoding RNAs, and the influence of microbiome on drought tolerance, the volume then continues with methods describing the identification of stress-responsive genes, proteins, posttranslational redox modifications, DNA methylation, histone modifications, measurement of glutathione, lipids, raffinose family oligosaccharides, polyamines, as well as quantification of abscisic acid, and the enzymes involved in ROS detoxification. Written in the highly successful Methods in Molecular Biology series format, chapters include introductions to their respective topics, lists of the necessary materials and reagents, step-by-step, readily reproducible laboratory protocols, and tips on troubleshooting and avoiding known pitfalls.
Authoritative and practical, Plant Stress Tolerance: Methods and Protocols, Second Edition aims to ensure successful results in the further study of this vital field.


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At the southernmost tip of Portugal, the Algarve region is renown for its beaches and fine tourism industry which draws roughly 10 million visitors annually.
In particular, the Algarve is an increasingly popular destination during holiday season not only for residents of nearby European countries but also around the globe.
For those who are wondering how difficult transportation is to reach the region, it is much easier these days to find routes there. The Algarve has become a 12-month tourist destination due to its year-round Mediterranean climate. Temperatures usually hover between the 20Cs and the 30Cs though it can get very rainy in the winter months and quite dry from June to August. While Faro is the administrative center for the Algarve region, all the cities aren't too big, allowing many tourists a chance to step away from the large urban scene for a time.
The region also is relatively cheap in terms of taking a holiday and its tourism industry includes its fine cuisine and many cruise ships. It also has great scenery from the beaches to the area's mountain range.
Memorable holidays in Algarve
When it comes to sights to see and things to do in the region, the Algarve has plenty of options available to tourists.
Whether it is a sightseeing trip to Old Town Faro or taking in all the beautiful scenery along the lush beaches of southern Portugal, there are a variety of activities available for tourists. Any of them can make for memorable holidays in Algarve.
Some of the more popular ones include taking a coastal cruise with the Insonia Caves being a major point of interest, a jeep safari in Guadiana National Park, a small-group kayak excursion, or paddleboarding along the coastline. As for top locations, Zoomarine Park, the Quarteira Market, the historical town of Lagos, or a trip across the Spanish border to Seville are all possibilities.
Hotels in Algarve
Because of that, hotels in Algarve cover the entire financial gamut and range from the high-class to local guesthouses. However, many are moving away from the resorts and are choosing smaller accommodations.
Flights to the Region
One of the popular reasons as to why the region has become a prime tourist hot spot is due to finances. There isn't a lack of cheap flights to Faro Airport these days. In fact, cheaper flights to Faro have gradually increased in recent years as more of the large low-cost airlines have added routes to and from Faro.
Some of the top airlines such as Ryanair, Lufthansa, British Airways, and Iberia have regular flights to Faro. Other low-cost carriers such as easyAir also have flights to and from Faro Airport.
Airport Transfers To Faro
Because of the increase in tourist activity within the region in recent years and the growth in arrivals to Faro Airport, it is easier than ever to get to your hotel or guesthouse. Among the options are taxis, buses, and trains.
However, a private transfer is usually the cheapest and most effective route to go. While taxis are available 24 hours a day, they tend to be expensive. There is only one bus route which currently services Faro Airport and there is only one train route going to and from the airport as well.
So when it comes to airport transfers to Faro and touring the Algarve region, visit Algarveshuttles.com. This site provides a wealth of information as they even have transfer information, reviews, and even transfers to theme parks, hotels, and nearby golf courses. Thank you for reading the Algarve Shuttles Blog.