text:
The spectrum of P-wave changes in leads II and V1 with right, left and bi-atrial enlargement is summarised in the following diagram:
Electrocardiographic Criteria
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
In lead II
Bifid P wave with:
- Amplitude ≥ 2.5mm
- Duration ≥ 120 ms
In V1
Biphasic P waves with:
- Initial positive deflection ≥ 1.5mm tall
- Terminal negative deflection ≥ 1mm deep
- Terminal negative deflection ≥ 40 ms duration
Combination criteria
- P wave positive deflection ≥ 1.5 mm in leads V1 or V2
- Notched P waves with duration >120 ms in limb leads, V5 or V6
- Pulmonary hypertension due to:
- Chronic lung disease (cor pulmonale)
- Tricuspid stenosis
- Congenital heart disease (pulmonary stenosis, Tetralogy of Fallot)
- Primary pulmonary hypertension
Left Atrial Enlargement
- Mitral valve disease
- Aortic valve disease
- Hypertension
- Aortic stenosis
- Mitral incompetence
- Hypertrophic cardiomyopathy (HOCM)
Example ECGs
Example 1
Biatrial enlargement due to idiopathic cardiomyopathy:
- Biphasic P waves in V1 with a very tall positive deflection (almost 3 mm in height!) and a negative deflection that is both deep (> 1 mm) and wide (> 40 ms).
Example 2
Biatrial enlargement:
- P waves in lead II are tall (> 2.5mm) and wide (> 120 ms).
- P waves in V2 are tall (> 1.5 mm), while the terminal negative portion of V1 is deep (> 1mm) and wide (> 40 ms).
Related Topics
- Chung DC, Nelson HM. ECG – A Pictorial Primer [internet]. Accessed 12/12/2011.
- Edhouse J, Thakur RK, Khalil JM. ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ. 2002 May 25;324(7348):1264-7. Review. PubMed PMID: 12028984; PubMed Central PMCID: PMC1123219 [Full Text].
- Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002 May 18;324(7347):1201-4. Review. PubMed PMID: 12016190; PubMed Central PMCID: PMC1123164 [Full Text].
- ECGs by Example, 3e
- Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, 6e
- Marriott's Practical Electrocardiography 12e
Further Reading
- ECG BASICS — Waves, Intervals, Segments and Clinical Interpretation
- ECG A to Z by diagnosis –alphabetical diagnostic approach to the ECG
- ECG CLINICAL CASES — ECG's placed in clinical context with a challenging Q&A approach
- 100 ECG Quiz — Self-assessment tool for examination practice
- ECG Reference SITES and BOOKS — the best of the rest
- LITFL ECG IMAGE Database — Searchable database of LITFL ECG's
- ECG and Cardiology Eponymous Syndromes — Cheats guide to eponymous emancipation
- ECG Exam Template — a framework for answering ECG exam questions.
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1. Acronym for Indian Institutes of Technology - Joint Entrance Examination. A multiple choice test in Physics, Chemistry and Maths taken by high-school (grade 12) students who seek admission into the 7 IITs - which are considered India's best engineering institutes. The IIT-JEE is considered one of the toughest exams in the world with about 720,000 students competing for 6000 seats
I haven't even watched a movie for the past year, been slogging 24/7 for the IIT-JEE
by Shyamrao July 16, 2008
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Hi, I'm trying to mount a sitemap which is loaded from a resource. The spring configurator seems to have problems with this, because I'm getting a FileNotFoundException. Some parent of ChildXmlWebApplicationContext tries to load the file '/resource://test.xmap' (and I try to load the sitemap 'resource://test.xmap' of course). The code goes trough ChildXmlWebApplicationContext.getResourceByPath(String path), but fails on line 101 (creating a new URL object that starts with the "resource://" scheme). Then it captures the error, and delegates the loading to a super class, which tries to load '/resource://test.xmap'. Should the ChildXmlWebApplicationContext use the SourceResolver, instead?? Thanks, Bart.
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Gear ratio NEED HELP!
I am planning a diesel conversion in the future and I'm going to buy a bolt on Ford 8.8, but i need help deciding the gear ratio. It is suggested to get 3.07 with 33" tires for the diesel. but I don't plan on doing to whole conversion for a while. So my question is, which gear set would be the best for both while I'm waiting to get the diesel. I'm trying to only buy gears once, is it possible? I'm running 33s with my D35 i think i have 4.11s right now and its ok, id like a little more power. Also I think i might go to 35s after the diesel swap.
What transmission are you going to run/are running?
hopefully my stock NV3550, but probably the AX15
5 speed manual
Not sure how the engine swap will be on gears. My guess is you have 3.73's or lower now. 4.11 only came with the 4 banger and rubi, unless somebody did a gear swap. Consider your crawl ratio, current would be about 40, if you swap in 3.07's.. it will drop to 33. (even with the engine swap. Add 35's in the mix.. some place between 4.11 and 4.88's would be my vote, but that based on the 4.0L.
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Knee cartilage loss in symptomatic knee osteoarthritis over 4.5 years
DOI: 10.1186/ar1962
© Wluka et al; licensee BioMed Central Ltd. 2006
Received: 5 January 2006
Accepted: 21 April 2006
Published: 16 May 2006
The objective of this study was to describe the rate of change in knee cartilage volume over 4.5 years in subjects with symptomatic knee osteoarthritis (OA) and to determine factors associated with cartilage loss. One hundred and five subjects were eligible for this longitudinal study. Subjects' tibial cartilage volume was assessed by magnetic resonance imaging (MRI) at baseline, at 2 years and at 4.5 years. Of 105 subjects, 78 (74%) completed the study. The annual percentage losses of medial and lateral tibial cartilage over 4.5 years were 3.7 ± 4.7% (mean ± SD; 95% confidence interval 2.7 to 4.8%) and 4.4 ± 4.7% (mean ± SD; 95% confidence interval 3.4 to 5.5%), respectively. Cartilage volume in each individual seemed to track over the study period, relative to other study participants. After multivariate adjustment, annual medial tibial cartilage loss was predicted by lesser severity of baseline knee pain but was independent of age, body mass index and structural factors. No factors specified a priori were associated with lateral cartilage volume rates of change. Tibial cartilage declines at an average rate of 4% per year in subjects with symptomatic knee OA. There was evidence to support the concept that tracking occurs in OA. This may enable the prediction of cartilage change in an individual. The only significant factor affecting the loss of medial tibial cartilage was baseline knee pain, possibly through altered joint loading.
Clinicians, faced with a patient with osteoarthritis (OA), have taken a somewhat nihilistic approach with respect to the modification of structural disease progression. Modifiable risk factors for disease progression have been difficult to identify with radiographic measures; the possible exception is weight loss, although evidence to support this is inconsistent [1, 2]. Our understanding of joint cartilage development and the pathophysiology of OA has previously been limited by the lack of a non-invasive method for assessing joint cartilage in vivo. There has been increasing interest in the use of magnetic resonance imaging (MRI) to measure the disease severity of knee OA [3–6].
Knee cartilage volume measured with MRI is one such approach, which shows promise as a method of quantifying disease severity in OA. It is a valid and reproducible measure of articular cartilage [5, 7]. It correlates inversely with radiographic grade of disease, such that subjects with knee OA have less knee cartilage than normal healthy subjects [8]. It is possible to estimate normal cartilage volume to distinguish diseased knees from healthy ones [8, 9].
Once knee OA is established, knee cartilage tends to be lost more rapidly than in healthy adults [10–13]. Over 2 years, we have shown the annual rate of loss of total tibial cartilage to be between 4.4% and 6.2% in people with symptomatic knee OA [10], nearly double the rate of loss in healthy subjects without knee pain [12, 13]. Although it has been suggested that cartilage loss is episodic in OA, structural evidence to support this is lacking [14]: it is unclear whether the average rate of loss is stable. Complicating this is the recognised high variability of cartilage loss both between individuals who are healthy or who have OA [10, 12] and between those with progressive and non-progressive OA [14]. It is therefore unclear whether the average rate of loss remains similar over the longer term or the pattern of loss is linear.
Studies with only two measures are unable to examine patterns of change and are limited in their capacity to examine for potential risk factors for disease progression because change is confounded with measurement error. In addition, regression to the mean will induce a spurious negative correlation between initial cartilage volume and change in cartilage volume. Longitudinal studies with more than two measures for each subject have the potential to provide a better estimate of the true change for each subject than do studies with two measures, because a true underlying linear change can be distinguished from measurement error and other sources of within-individual variability over time [15]. We have extended the observation of a cohort of community-dwelling subjects with predominantly mild symptomatic knee OA to determine the change in knee cartilage volume in subjects with knee OA over 4.5 years [10], and factors that may affect this.
Materials and methods
This report is an extension of the observation (at an average of 4.5 years) of a community-based cohort of 123 subjects with symptomatic mild knee OA, who had previously been followed for 2 years to determine the rate of cartilage loss [10]. All participants in the previous study who had undergone baseline MRI, who were alive, who had not received a joint replacement in the study joint and who had no contraindication to MRI imaging (such as a pacemaker, a metal implant or claustrophobia) were invited to take part in this study. There were 105 eligible subjects since 18 of the original participants had undergone knee replacement surgery.
Subjects with mild to moderate knee OA had been recruited by advertising, as described previously [10]. The study was approved by the ethics committee of the Alfred and Caulfield Hospitals in Melbourne, Australia. All subjects gave informed consent.
Inclusion criteria
Inclusion criteria were age over 40 years and symptomatic (at least one pain dimension of the WOMAC (Western Ontario and McMaster University Osteoarthritis Index) score above 20% and osteophytes present) knee OA (American College of Rheumatology clinical and radiographic criteria [16]). Subjects were excluded if any other form of arthritis was present or if there was a contraindication to MRI (such as a pacemaker, a cerebral aneurysm clip, a cochlear implant, the presence of shrapnel in strategic locations, metal in the eye, or claustrophobia), inability to walk 50 feet without the use of assistive devices, hemiparesis of either lower limb, or planned total knee replacement.
At baseline (time zero), each subject had a weight-bearing anteroposterior tibiofemoral radiograph, taken in full extension, of the symptomatic knee. Where both knees had OA and were symptomatic, the knee with the least severe radiographic OA was identified and used. These were independently scored by two trained observers who used a published atlas to classify disease in the tibiofemoral joint. The radiological features of tibiofemoral OA were graded in each compartment, on a four-point scale (0 to 3) for individual features of osteophytes and joint space narrowing [17]. In the event of disagreement between observers, the films were reviewed with a third independent observer. Intra-observer and inter-observer reproducibility for agreement on features of OA (osteophytes and joint space narrowing, grades 0 and 1 versus grades 2 and 3) ranged between 0.85 and 0.93 (κ statistic) [18].
At baseline (time zero) and at each subsequent visit (2 and 5 years), subjects were weighed to the nearest 0.1 kg (after removal of shoes and bulky clothing) with a single pair of electronic scales, and their height was measured to the nearest 0.1 cm (shoes removed) with a stadiometer. Body mass index (BMI; weight/height2 (kg/m2)) was calculated. General health status was assessed with the Short Form 36 [19]. Knee function (0 to 1,700), pain (0 to 500) and stiffness (0 to 200) were assessed with the WOMAC at baseline, 2 years and 5 years, where 0 represents no symptoms [20].
MRI assessment
An MRI was performed on each subject's symptomatic knee (or the knee with the least severe radiographic OA where both were symptomatic) at baseline, two years later [10] and about five years later (present study). Knee cartilage volume was determined by image processing on an independent workstation with the software program OSIRIS, as described previously [5, 18]. Knees were imaged in the sagittal plane on the same 1.5-tesla whole-body magnetic resonance unit (Signa Advantage HiSpeed GE Medical Systems, Milwaukee, WI, USA) as used previously, using a commercial receive-only extremity coil. The same sequence and parameters were used as in the previous study [10]. Sagittal images were obtained at a partition thickness of 1.5 mm and an in-plane resolution of 0.31 mm × 0.83 mm (512 pixels × 192 pixels).
Cartilage volume was measured at time 0 and 2 years by two trained observers, and the data were used to compare baseline and loss to follow-up. For examination of change in knee cartilage over 5 years, all MRI taken at 0, 2 and 5 years were remeasured by two different trained observers. The volume of cartilage overlying osteophytes was not included in measurements. Measurements of all MRI on a single subject were made within one month, independently, blinded to subject identification and timing of MRI. Each of the two observers measured cartilage volume on each scan once. Their results were compared. If the results were within ± 20%, an average of the results was used. If they were outside this range, the measurements were repeated until the independent measurements were within ± 20%, and the averages used. Repeat measurements were made blind to the results of the comparison of the results of the other scans. The coefficients of variation for the measurement of total, medial and lateral cartilage volume measures were 2.6%, 3.4% and 2.0%, respectively [18].
Areas of medial and lateral tibial plateaux were determined by creating an isotropic volume from the input images, which were reformatted in the axial plane. Areas were measured directly from these images. The coefficients of variation for the measurement of the medial and lateral tibial plateau areas were 2.3% and 2.4%, respectively; the average of the areas was used [18]. Osteophytes were not included in these measurements.
Knee angles were measured by a single observer, as has previously been described from standing anteroposterior radiographs [21–23]. Lines were drawn through the middle of the femoral shaft and through the middle of the tibial shaft. The angle subtended at the point at which these lines met in the centre of the tibial spines was based on a modified method of Moreland and colleagues [21], as described and used recently [22, 23]. The angle subtended by the lines on the medial side was measured with OSIRIS software. Thus, an angle less than 180° was more varus and an angle greater than 180° more valgus. The intra-observer variability in 50 subjects 4 weeks apart was 0.98 (intraclass correlation coefficient).
Statistical analysis
Descriptive statistics for characteristics of the subjects were tabulated. Independent-samples t tests and χ2 tests were used to compare variables in those who completed the study with those who were lost to follow-up. Annual change in cartilage volume was computed as (initial volume minus second volume)/time between scans, so that positive numbers reflect a loss of cartilage. Annual percentage change in cartilage volume was computed as 100 × (initial volume minus second volume)/(initial volume multiplied by time between scans). The difference in average rate of change over the two study periods (0 to 2 years and 2 to 5 years) was assessed by paired t tests. To explore the possible factors affecting the rate of change in cartilage volume, random coefficient models were employed [15]. Conceptually, these models are formulated via a two-stage process. In the first stage, a linear regression model is postulated for the true underlying pattern of change of cartilage volume over time for each individual (for instance, initial cartilage volume and rate of change), and these patterns are allowed to differ for each individual. In the second stage, regression models are postulated to ascertain how the baseline and rate of change of cartilage volume parameters from the first-stage model vary according to specified factors/covariates [15]. The factors we considered in such analyses were age, gender, height, weight, BMI, baseline WOMAC scores (pain, stiffness and function), initial cartilage volume, bone size, grade of osteophyte present, and knee malalignment. Models with a linear rate of change over time for each individual were applied, together with main effect and interaction terms with time for each potential predictive factor. Assessments of model assumptions were made by means of residual diagnostic plots [15]. Analyses were performed with the SPSS statistical package (version 12.0.1; SPSS, Cary, NC, USA), and with Stata (version 9; Stata Corporation, College Station, TX, USA) for the random coefficient modelling.
One hundred and five subjects were eligible for this study. Of these, 78 (74%) subjects completed the study, by undergoing a third MRI scan at 4.5 ± 0.35 years (mean ± SD). Reasons for failure to participate included significant co-morbidity (9), moved interstate (3) and loss to follow-up/refusal to participate (15). Those subjects who were unable to complete the study because of total knee joint replacement before the third MRI were ineligible to participate.
Characteristics of study population
Eligible population (n = 105)
Subjects with MRI at 4.5 years (n = 78)
Subjects lost to follow-up at 4.5 years (n = 27)
p a
Age, years
62.5 (10.7)
63.8 (10.6)
61.6 (11.3)
Number of women, %
59 (53%)
44 (54%)
17 (63%)
Height, cm
168 (9.3)
168 (9.2)
167 (9.5)
Weight, kg
80.1 (15.0)
80.5 (15.3)
79.3 (14.4)
28.4 (5.1)
28.4 (4.8)
28.7 (5.9)
79 (45)
78 (43)
81 (53)
38 (23)
37 (21)
42 (28)
298 (171)
290 (161)
324 (201)
416 (228)
406 (214)
449 (272)
Kellgren Lawrenceb
Knee anglec, degrees
181 (6)
181 (6)
180 (5)
Tibial plateau area, mm2
2,065 (405)
2,085 (394)
2,008 (438)
1,358 (257)
1,352 (239)
1,374 (308)
Cartilage volume at baseline, mm3
1,754 (500)
1,780 (513)
1,676 (459)
1,945 (580)
1,946 (576)
1,946 (602)
Annual cartilage loss over first period, %
4.3 (6.3)
4.3 (6.5)
4.3 (7.4)
4.7 (6.8)
4.1 (5.9)
6.1 (4.6)
Rate of change for subjects completing follow-up, over the total, first and second time periods
4.5 yearsa
First period: 0–2 yearsa
Second period: 2–5 yearsa
Difference (95% CI)
Annual rate of cartilage loss, mm3/year
135 (135)
143 (247)
125 (144)
18 (- 46 to 81)
63 (78)
69 (149)
56 (85)
12 (- 28 to 52)
72 (73)
75 (140)
69 (77)
6 (- 31 to 42)
Annual percentage cartilage loss
3.94 (3.68)
4.04 (7.25)
4.11 (4.39)
- 0.07 (- 1.91 to 1.76)
3.74 (4.72)
3.87 (9.49)
3.77 (5.88)
0.10 (- 2.44 to 2.64)
4.42 (4.65)
4.60 (9.10)
4.80 (5.60)
- 0.20 (- 2.40 to 1.99)
The raw data, using only two time points, suggested that medial tibial cartilage and lateral tibial cartilage increased in 13 and 7 people, respectively, over the course of the study. However, using the random coefficient model, incorporating all three measures for each subject to improve the estimate of individuals' true underlying rates of change together with 95% prediction intervals, showed that only one of these subjects exhibited an increase beyond the prediction uncertainty for lateral volume only, thereby suggesting a possible true increase in lateral cartilage volume for this individual.
Over 4.5 years, the average amount of 'total' tibial cartilage (medial plus lateral tibial cartilage) lost per year was 135 ± 135 mm3/year (Table 2). When this was calculated as a percentage of the initial baseline cartilage, this represented an annual rate of loss of 'total' tibial cartilage of 3.9 ± 3.7% (mean ± SD; 95% confidence interval (CI) 3.1 to 4.8%). The distribution of the annual percentage change in total cartilage is shown in Figure 1. The average amounts of medial and lateral tibial cartilage lost per year were 62.7 ± 78 mm3 and 72.2 ± 73 mm3 (Table 2). This represents an annual rate of loss of medial tibial cartilage of 3.7 ± 4.7% (mean ± SD; 95% CI 2.7 to 4.8%) of initial cartilage. Lateral tibial cartilage was lost at an annual rate of 4.4 ± 4.7% (mean ± SD; 95% CI 3.4 to 5.5%) of initial cartilage. Over the complete period, the annual volume of loss of medial and lateral tibial cartilage was moderately correlated (r = 0.60, p < 0.001). There was evidence of tracking of both medial and lateral cartilage volumes over time, in that the relative rankings of cartilage volumes of individuals remained similar across the three time periods of the study (Spearman rank correlations ranged from 0.67 to 0.89 for medial, and from 0.87 to 0.94 for lateral).
Factors potentially affecting change in cartilage volume over 4.5 years
Univariate analysis
Multivariate analysisa
Regression coefficient
Regression coefficient
Medial cartilage
Initial ageb
- 10.9 to 18.2
- 29 to 54
- 0.65
Body mass indexf
- 1.68
- 2.3 to 4.6
Initial cartilage volumeg
- 19.4 to 56.1
Bone sizeh
- 1.8 to 8.6
WOMAC paini
- 6.7
- 7.1
- 10.8 to - 3.4
Lateral cartilage
Initial ageb
- 11.2 to 19.3
- 36.3 to 50.7
Body mass indexf
- 0.8
- 3.4 to 3.9
Initial cartilage volumeg
- 1.2
- 23.6
- 63.2 to 16.0
Bone sizeh
- 2.6 to 8.4
WOMAC paini
- 1.6
- 1.7
- 5.5 to 2.2
Because pain was the only important factor in predicting cartilage loss, and it may be understood to comprise the separate domains of biomechanical and inflammatory disorders, we performed a post hoc analysis. In this, we grouped the three mechanical questions within the pain subscale (pain walking on the flat, pain walking up/down stairs, pain standing upright) and the two questions relating to inflammation (pain in bed at night and pain sitting/lying up) together to examine the effects of these domains on change in medial and lateral cartilage volume. These demonstrated that increased symptoms captured by the biomechanical questions were related to reduced cartilage loss in both medial (p = 0.03) and lateral (p = 0.01) cartilages. However, the questions on inflammation were not related to change in cartilage volume (p = 0.22 medial, p = 0.07 lateral).
There was no evidence that the change in cartilage volume over time was nonlinear (p = 0.50 for medial and p = 0.62 for lateral quadratic time effects). Analysis of residual diagnostic plots did not display any evidence of violation of the assumption of linearity of the change over time for individuals. Additional analyses (not tabulated) relating change in knee pain and change in weight to rate of cartilage loss did not produce any significant results, nor did examination of level of physical activity, knee angle or grade of osteophyte.
We showed that in 78 subjects with symptomatic knee OA, the rate of tibial cartilage loss was ongoing beyond 2 years, at a rate of between 3.1% and 4.8% per year over 4.5 years. Higher initial pain scores were associated with diminished medial and total tibial cartilage loss. There was a moderately strong positive correlation between the percentage loss of medial and lateral tibial cartilage. In addition, the use of the random coefficient modelling structure enabled an assessment of the relationship between the true rate of cartilage loss and initial cartilage volume – an assessment that is plagued by regression to the mean when using only the observed rates of change and initial cartilage volumes in the sample. For example, the finding for the medial compartment that the relationship between initial volume and rate of change was diminished after multivariate adjustment would not have been obtained if the simple observed rates of change had been regressed on the observed initial volumes, and a spurious effect of initial volume as a predictor of change would have emerged.
This is the first study to examine whether average annual cartilage loss in subjects with symptomatic knee OA is similar over the medium term, with biannual loss stable over two periods. We found the average total tibial cartilage loss to lie between 3.1% and 4.8% per year over 4.5 years. These results are consistent with the magnitude of loss observed in previous studies that examined subjects over 2 years [10, 11, 24]. Over 2 years, in the initial cohort of 123 subjects with symptomatic knee OA, we showed the annual rate of loss of total tibial cartilage to lie between 4.4% and 6.2% [10]. Over 24 months, another group, examining 32 subjects, found similar results, with the annual total tibial cartilage loss between 2.2% and 6.6% [11]. The only study examining change in 11 subjects over about 3 years found no mean significant change over this time period [24]. However, the 95% confidence intervals for annual medial tibial cartilage change included a loss of 3.9% per year to a gain of 3.0% per year in that study. We found that the distribution of rate of change was normal over 2 years, and also at 4.5 years [10]. The sensitivity to change of the MRI volume measurements over the various periods using the Standardized Response Mean index [25] can be obtained simply from Table 2 by dividing the average change by the SD of the changes. These are of the order of 0.50, 0.75 and 0.90 for the periods 0 to 2 years, 2 to 5 years and 0 to 5 years, indicating that MRI volume measures display increased sensitivity to change with longer follow-up of subjects.
The moderately strong correlations seen between cartilage volume measured at each time point suggests that tracking of individual change in cartilage volume occurs in those with knee OA. This means that subjects maintain their relative ranking over time in terms of cartilage volume, compared with other subjects within the study. This phenomenon has been described in adult women aged 30 to 94 years, regarding tracking of bone mineral density [26]. It has also been shown to occur in children and adolescents with regard to height and also to the accrual of bone mineral content [27]. It has been suggested that this is under genetic control, unless strong environmental factors intervene. Similarly, change in cartilage volume has also been shown to have strong genetic determinants in healthy adult children of those who have had knee arthroplasties [28].
Our results for predicted rates of change for individuals suggested that only one subject gained lateral cartilage volume beyond prediction uncertainty over the course of the study. It is possible that this increase in volume was related to a gain of cartilage or it might have been due to swelling related to early OA in that compartment [29, 30]. Quantification of cartilage volume is unable to differentiate between these two possibilities.
Some cross-sectional studies have suggested an effect of age on cartilage volume [8, 9], although others have not [31]. Only a longitudinal study, such as this, is able to differentiate between the within-individual cartilage loss of individuals (for instance, expected change in one person over one year) as they age and the cross-sectional effects of age across different subgroups of people (for instance, comparisons between people who differ by one year of age only). The average rate of medial cartilage loss within an individual over 1 year was estimated as 61.2 μm3/year (longitudinal effect of age), whereas the difference in average volumes of two groups of people differing by 1 year in age (cross-sectional effect of age) is expected to be 6.6 μm3 (Figure 2). The longitudinal rate of loss in lateral tibial cartilage was 71.3 μm3/year compared with the cross-sectional difference of 14.2 μm3 per year of age. This illustrates that, in this study population, the longitudinal rates of change are far greater than cross-sectional differences, which is similar to findings relating to bone mineral density [32, 33]. This suggests that interpreting cross-sectional age effects in studies with similar populations as representing change in an individual may be unhelpful and misleading, The implication is that classification systems based on these assumptions may be flawed.
There is increasing evidence that biomechanical effects are important in the progression of knee OA [34–36]. We found lower levels of knee pain to be associated with higher rates of cartilage loss in the medial tibial cartilage. This contrasts to previous findings, with our initial report of this cohort (123 subjects) [10] and a similar study (110 subjects) [37], both over 2 years, of no effect of baseline pain over 2 years. The present study took place over 4.5 years and showed that for every increase in WOMAC pain score of 10 (of a maximum of 500), there was an reduction in annual cartilage loss of about 10% (6.7 mm3/year). The previous studies, over a shorter period, may not have had power to show this effect. Our findings may be explained by subjects with painful knee OA adapting their gait in response to pain, to reduce pain, by reducing external adduction moment [38, 39]. This reduces compressive force on the cartilage, which may reduce cartilage loss [1]. Conversely, pain reduction increases external adduction moment, which has been associated with increased disease progression [34, 38]. Joint loading has been shown to affect articular cartilage in knee OA [34].
The main study limitation relates to the loss to follow-up of 27 subjects, with a completion rate of 74%. The subjects who did not undergo knee joint replacement surgery and were lost to follow-up were similar to those who completed the study, including disease severity, and lost cartilage at a similar rate during the first 2 years of the study. Indeed, of the 123 subjects who participated in the initial study, 63% underwent MRI at the 4.5 years follow-up. The 18 who underwent knee joint replacement have already been shown to have lost cartilage more rapidly than those who did not undergo joint replacement [40]. It is possible that our study might have underestimated somewhat the average rate of cartilage loss in all subjects with OA, given the exclusion of subjects who underwent knee replacement over the study period, who are known to lose cartilage more rapidly [40]. The presence of swelling in early OA may also reduce the cartilage loss seen.
We found few predictors of rate of change in cartilage volume. This may be because there is a strong genetic component to cartilage loss [28] or may simply reflect a lack of power related to limited sample size, reducing our ability to detect modest determinants of change. Other factors such as meniscal pathology and cruciate ligament integrity have been shown to affect the incidence of OA and subsequent cartilage loss [41, 42]. We were unable to examine for these pathologies because of the limited MRI sequences that were used in this study.
Another limitation is that the model was restricted to assuming that change was linear because only three time points were available. This may be a reasonable assumption over a short period (less than five years) because we found no evidence to the contrary. However, the assessment of linearity in this study was complicated by the large amount of variability observed in cartilage volume measurements for individuals around their predicted change. Observing a greater number of measurements over time will be needed to confirm whether the pattern of cartilage loss is linear. The within-individual variability in cartilage volumes not accounted for by linear loss may be due to other factors that may affect change in cartilage volume varying with time, such as effusion, trauma, inflammatory change and pain. It may also be that loss is not truly linear, in contrast with reduction in bone mineral density [26], but shows mild exponential 'decay', with reduced activity. Finally, despite our attempts to minimise measurement error by means of reader training and blinding, it is possible that this still represents a substantial component of the unexplained within-individual variability.
OA is a complex disease, affected by many factors, including genetic, environmental, traumatic and biomechanical factors. This study shows that change in knee OA occurs in a linear pattern and provides an estimate of cartilage loss over the medium term (4.5 years), which will help in study design and also in estimating the effect of interventions aimed at reducing structural change in knee OA. Larger studies, incorporating multiple determinants identified in the pathogenesis of OA, may be able to extract the relative roles of these varied factors. This study cautions against the use of cross-sectional data to make statements about longitudinal changes with age within individuals.
= body mass index
= confidence interval
= magnetic resonance imaging
= osteoarthritis
= Western Ontario and McMaster University Osteoarthritis Index.
We thank Judy Hankin and Judy Snaddon for their help and support in coordinating this study and maintaining subject participation, the MRI Unit at the Alfred Hospital for their cooperation, and Kevin Morris for technical support. We thank especially the study participants who made this study possible. This work was supported by the National Health and Medical Research Council (NHMRC) of Australia. AEW is the recipient of an NHMRC Public Health Fellowship and co-recipient of the Cottrell Fellowship, Royal Australasian College of Physicians. YW and FH are recipients of NHMRC PhD Scholarships.
Authors' Affiliations
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- Raynauld JP, Martel-Pelletier J, Berthiaume MJ, Labonte F, Beaudoin G, de Guise JA, Bloch DA, Choquette D, Haraoui B, Altman RD, et al: Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes. Arthritis Rheum. 2004, 50: 476-487. 10.1002/art.20000.View ArticlePubMedGoogle Scholar
- Cicuttini F, Forbes A, Asbeutah A, Morris K, Stuckey S: Comparison and reproducibility of fast and conventional spoiled gradient-echo magnetic resonance sequences in the determination of knee cartilage volume. J Orthop Res. 2000, 18: 580-584. 10.1002/jor.1100180410.View ArticlePubMedGoogle Scholar
- Cicuttini FM, Wluka AE, Wolfe R, Forbes A: Comparison of tibial cartilage volume and radiologic grade of the tibiofemoral joint. Arthritis Rheum. 2003, 48: 682-688. 10.1002/art.10840.View ArticlePubMedGoogle Scholar
- Burgkart R, Glaser C, Hinterwimmer S, Hudelmaier M, Englmeier KH, Reiser M, Eckstein F: Feasibility of T and Z scores from magnetic resonance imaging data for quantification of cartilage loss in osteoarthritis. Arthritis Rheum. 2003, 48: 2829-2835. 10.1002/art.11259.View ArticlePubMedGoogle Scholar
- Wluka AE, Stuckey S, Snaddon J, Cicuttini FM: The determinants of change in tibial cartilage volume in osteoarthritic knees. Arthritis Rheum. 2002, 46: 2065-2072. 10.1002/art.10460.View ArticlePubMedGoogle Scholar
- Berthiaume M, Raynauld JP, Martel-Pelletier J, Labonte F, Beaudoin G, Bloch D, Choquette D, Haraoui B, Altman RD, Hochberg M, et al: Meniscal tear and extrusion are strongly associated with progression of symptomatic knee osteoarthritis as assessed by quantitative magnetic resonance imaging. Ann Rheum Dis. 2005, 64: 556-563. 10.1136/ard.2004.023796.PubMed CentralView ArticlePubMedGoogle Scholar
- Wluka AE, Wolfe R, Davis SR, Stuckey S, Cicuttini FM: Tibial cartilage volume change in healthy postmenopausal women: a longitudinal study. Ann Rheum Dis. 2004, 63: 444-449. 10.1136/ard.2003.008433.PubMed CentralView ArticlePubMedGoogle Scholar
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This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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1. chunks6:07 PM GMT on June 28, 2012
Dear Rob:
Sarah and Emily could be twins on the 'finding your way somewhere' dept. Sarah could go to a place 50 times, but the one time she had to navigate on her own - no clue!! They say that genius level people have no sense of direction because they can't be bothered paying attention to ordinary stuff. I can believe this statement.
Good news yesterday! Cody got his registered letter from the Province. He achieved 80% (honors) on his provincial exam and thus can now join the apprentices and be indentured. There was some pretty happy people here yesterday. That's two for two graduating with honors for me. How could a mother be prouder? Tomorrow is the graduation at harbour station. I am looking forward to seeing him walk across that stage.
We are having off and on showers. I go out when the sun is out and in when it rains. Hoping to get a few things done. It is looking like thunder to me. We will see.
Well, break in the clouds. Must get to. Have a good one and stay dry. Word. Chunks.
Member Since: December 31, 1969 Posts: Comments:


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Span Global Services
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Don't miss a story. Like us on Facebook. Like Dallas News' Facebook Page
UPDATE, 9:20 a.m. For now, at least, live coverage of the Spelling Bee has been moved to ESPNews. The French Open tennis tournament is running past its allotted time on ESPN2. TEXT HERE
The semifinal and championship rounds of the 2012 Scripps National Spelling Bee take place in Washington, D.C. (Actually, just outside Washington. This year's competition is at the Gaylord National Resort & Convention Center in National Harbor, Md.)
The semifinal rounds will be televised live on ESPN2, beginning at 9 a.m. Dallas time.
Those who survive those rounds return for the championship, live on ESPN at 7 p.m.
Chetan Reddy, a seventh grader at Plano's C.M. Rice Middle School, and Mark De Los Santos, an eighth grader at Holy Rosary Catholic School in Arlington, are among the 50 semifinalists.
It's Chetan's third trip to the National Spelling Bee; he's qualified each time by winning a regional competition sponsored by The Dallas Morning News. Last year in Washington, he tied for 27th place.
According to a biographical sketch on the spelling bee website, he's a fan of Dirk Nowitzki and the Hunger Games trilogy. He likes Scrabble, excels at math, and is thinking about a career in economics. "He is able to name all 50 U.S. States in alphabetical order in less than a minute."
Mark (below) has been to the national be once before, in 2010. His interests include medicine, physics and history. "He likes to read nonfiction books, sing, play guitar, collect coins and stamps, and write short stories and poems. ... He would like a career in neuroscience."
George W. Bush and Laura Bush return to the White House for the unveiling of their official portraits.
Todd J. Gillman, our Washington Bureau chief, reports that the former president's father and mother, George H. W. Bush and Barbara Bush, already summering at their home in Kennebunkport, Maine, are expected to swing by for the ceremony. (It's not every day, after all, that you get to see your kid's presidential portrait unveiled.)
That means there will be three presidents and three first ladies at the White House, a rare event. President Barack Obama and first lady Michelle Obama will host a private lunch for the Bushes. And the Bushes.
It's the last day of classes in Dallas public schools, as well as those in many other area districts, including Richardson, Carrollton-Farmers Branch, DeSoto, and McKinney.
Others, including Plano, Frisco, Coppell, and Irving, end classes on Friday.
Summer has already started for students in Rockwall and Highland Park, among others.


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Citizen Way$9.99Citizen Way returns with their follow up album, 2.0, a project offering an amplitude of impactful pop-rock songs that are sure to connect with listeners. The project continues the band's purpose and drive to reveal the heart of God through their music and inspire people to l... Learn More
A Thousand Little Things
Point of Grace$13.99Add Your ReviewThe women of Point of Grace celebrate 20 years together with their 12th album, A Thousand Little Things. Brimming with the beautiful harmonies, encouraging lyrics and graceful melodies that Shelley Breen, Denise Jones and Leigh Cappillino are known for, A Thousand Little Thi... Learn More
Air for Free
Relient K$11.99Add Your ReviewAir For Free is Reliant K's ninth studio album. The project was co-produced by the band's long time producing partner Mark Lee Townsend and features 16 tracks penned by Matthew Thiessen. Since the band formed in 1998, Relient K has released nine studio albums, seven EPs, t... Learn More
All or Nothing
MIKESCHAIR$9.99Add Your ReviewIncludes Two Family Christian Exclusive BONUS tracks Creating uplifting music, serving others and giving their all to God are all in the DNA of MIKESCHAIR. Now they are back with their third studio album, All or Nothing. "All or Nothing" was the first song that MIKESCHAIR... Learn More
All the People Said Amen
Matt Maher$11.99Add Your ReviewAll The People Said Amen is Matt Maher's fourth project with Essential Records. The album delivers raw, worshipful moments that draw the line between the divine and the everyday, and speak to and encourage listeners as they play through the album.Featuring brand new songs mi... Learn More
American Prodigal
Crowder$13.99Coming off the massive success of Neon Steeple including multiple Grammy nominations and career-best radio success, Crowder returns with his sophomore album, American Prodigal. Leaning more into the roots and rock elements that helped Neon Steeple stand out, American Prodiga... Learn More
American Prodigal - Deluxe Edi ...
Crowder$16.99Coming off the massive success of Neon Steeple including multiple Grammy nominations and career-best radio success, Crowder returns with his sophomore album, American Prodigal. Leaning more into the roots and rock elements that helped Neon Steeple stand out, American Prodiga... Learn More
Amy Grant In Motion: The Remixes
Amy Grant$19.99Add Your ReviewThe all new In Motion: The Remixes from Amy Grant features a collection of hits remixed by well known remix engineers and DJs. With hits like "Baby Baby," "Every Heartbeat," and "That's What Love Is For" this remix album brings a new sound to the songs that hav... Learn More
As Family We Go
Rend Collective Experiment$13.99Add Your ReviewRend Collective's latest album, As Family We Go, features engaging and upbeat songs, including hit single "You Will Never Run," all bringing listeners closer to God. This a follow up to there #1 album The Art of Celebration.Track List Celebrate Free As A Bird You Will Nev... Learn More
Be One
Natalie Grant$13.99Natalie Grant on her new album, "With all that's happening in our culture today, it's easy to panic. The truth is, yes, we are living in very challenging times. But the biggest problem is not the presence of darkness but the absence of light. In Matthew 5, Jesus says that WE... Learn More


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I'm just wondering what people think of his as a character. Does he really love Desdemona and why? Is he extremely insecure?
i think he does love her but not that much to believe iago..
I don't think it's real love, even though he thinks it is. I think it is lust. I believe he is really infatuated with her, as their relationship is still in the early stages, but they have not been together long enough to formulate a strong bond or trusting relationship. Iago knew this and played Othello.


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Combine all of the ingredients except the caramel color, stirring until the dough comes together. Knead until smooth, adding additional water or all-purpose flour if needed--the dough should be soft and quite sticky. Let the dough rise until puffy, about
Lightly grease your hearth rye bread pan (or other wide, 2-pound capacity loaf pan).
Divide the dough in half. Pat one half into an 11 x 8-inch rectangle. Knead the caramel color mixture into the other half of the dough. Pat this dough into an 11 x 8-inch rectangle and place it on top of the plain dough. Beginning with a long edge, roll t
Bake the bread in a preheated 400°F oven for 15 minutes, then reduce the oven temperature to 350°F and bake for an additional 20 to 25 minutes, tenting it lightly with aluminum foil if it appears to be browning too quickly. Remove the bread from the oven,


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track list
Album Celebrate the Season
Label Whole Earth
Released December 21, 2006
This site contains content from artists, fans, and writers from around the internet in it's natural form. Such content is not representative of Viacom Media Networks.
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This patch is written on top of my queue containing type='number' but I can move 'number' to the todo list if it gets reviewed before.
As visible in the test_bug590363.html source code, all input types verified. The verified input types are listed in the testData and todoTypes variables.


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LEGAL STEROIDS USA – BUY 2 GET 1 FREE On EVERYTHING !
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imContentSink.jsm is the file where we filter out unwanted content from received messages before displaying them, so we should really not let regressions slip into it.
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Patch v2
Mike, I think you wrote way more unit tests than Patrick and me, so I'm wondering if you would have some interesting feedback to offer on this.
Note for the code review: The change to newRuleset is just some cleanup. The change to cleanupNode fixes https://bugzilla.instantbird.org/show_bug.cgi?id=962.
Comment on attachment 657938 [details] [diff] [review]
Patch v2
+ // Allow id only with numbers.
+ addGlobalAllowedAttribute("id", function(aId) /^[0-9]+$/.test(aId));
Not /^\d+$/?
Besides that it looks OK (and all the tests pass ;)). As far as I can tell this should be a pretty thorough test of the content sink.
Comment on attachment 657938 [details] [diff] [review]
Patch v2
Review of attachment 657938 [details] [diff] [review]:
Looks OK to me.


text:
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20:24 Adoram. After serving not only under David but also under Solomon (1 Kin. 4:6 note), Adoram will be stoned by "all Israel" during the early days of King Rehoboam (1 Kin. 12:18).
forced labor. The Hebrew word translated "forced labor" here and in 1 Kin. 12:18 is used to describe the hard labor imposed on subjugated peoples like the Israelites in Egypt (Ex. 1:11), or the surviving Canaanites after the Israelite conquest (Josh. 16:10; Judg. 1:28). It also describes the labor done by conscripts from Israel itself on the building projects of Solomon (1 Kin. 9:15). Neither Adoram nor forced laborers are included in the first summary of David's government (8:15–18), which may suggest that forced labor was not introduced until later on in David's reign (see perhaps 12:31).
Jehoshaphat . . . recorder. That is, perhaps a "royal herald" (see 8:16 note).
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David Freedman, 38 Barley Snyder, LLP, Partner
David Freedman is a partner with Barley Snyder, LLP, a full-service law firm, where he is a member of the Employment Law Group, representing employers before state and federal courts and administrative agencies on a broad array of employment law.
Prior to joining Barley Snyder in 2008, Freedman served as a law clerk for the Hon. Sylvia H. Rambo and also as an assistant city attorney for the city of Richmond, handling political matters such as election law challenges, employment cases, commercial and construction disputes and criminal matters. As part of Barley Snyder's management team, Freedman is frequently called upon as a public speaker regarding cutting-edge employment law issues.
Active within the community, Freedman is president of the board for Clare House and serves on the Personnel Committee for United Way of Lancaster County. He has also served on the board of trustees for La Academia Partnership Charter School.
David Freedman
Barley Snyder, LLP
Lancaster, Lancaster County
Superhero Name: Nerd Boy


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Lady Panthers top Lady Bulldogs
Mon, 2013-12-16 10:40
CENTERVILLE _ Centerville's Lady Bulldogs slipped to 3-4 on the season following a 20-15 loss to the Catholic High School Lady Panthers here Thursday at the CHS Gymnasium.
Kayla Robinson led the Lady Bulldogs in scoring with seven points followed by Alyrria Austin with four points, Nyketra Kennedy with three points and Jasmine Gunner with one.
Centerville will play host to Franklin on Tuesday.
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Dale Earnhardt Jr. touched by congrats from Charlie Daniels
Dale Earnhardt Jr. says the reaction to his Sprint Cup victories is always bigger than what he can envision, and Sunday's end of a 143-race winless skid naturally was no different.
In addition to a wave of seemingly non-stop national news media attention that lasted a few days, there was an outpouring of support for NASCAR's most popular driver from celebrities, fans and peers who were happy he was back in victory lane at Michigan International Speedway after an absence of four years and two days.
Among the most touching tributes came from country music star Charlie Daniels. The man who made The Devil Went Down to Georgia famous tweeted to his 34,000 followers, "Yeah Jr. Way to go!!!" and "Jr. Won one on Father's day for the intimidator." Daniels also tweeted a race-day photo of himself with late seven-time champion Dale Earnhardt in honor of Earnhardt Jr.'s 19th career victory.
"I met Charlie Daniels a long time ago while racing in the Nationwide Series, and he told me how much of a fan he was then of the sport," Earnhardt said Friday at Sonoma, Calif., before practice for Sunday's Toyota/Save Mart 350. "And for him to say something about it on his social-media accounts meant a lot to me. Little things like that made it pretty special. My peers coming to victory lane to congratulate me means a lot.
"I've gone into victory lane and congratulated other drivers, and you want to tell them you're happy for them. But you don't think about what it means to them. It means a lot. That was pretty cool for Brad (Keselowski), Matt (Kenseth) and my teammates were happy, but it was cool to see other guys I'm direct competitors with … there was all kinds of cool stuff happening all week long that made it pretty special."
Another touching story was relayed by brother-in-law L.W. Miller, husband of Earnhardt's older sister, Kelley. Miller said the father of one of his friends had gotten so ill in recent days he couldn't recognize his sons.
"And all he was talking about was the race," Earnhardt said. "That really brings it home and makes you realize how something like that affects the people you know and you don't think about and it makes a big difference in a lot of people's lives. That was pretty amazing to hear a story like that. You don't ever take for granted that people are tuned in that much."
With many eyes upon him this weekend at Sonoma (one of two road courses on the circuit), Earnhardt is hoping to maintain the momentum at a track where he hasn't scored a top 10 (his best finish is 11th in 2003, '04 and '10). He recently tested his No. 88 Chevrolet at the Road Atlanta track in Braselton, Ga.
Through Earnhardt has focused on honing his craft at turning left and right while shifting throughout the 1.99-mile layout, he said road-course talent also seems to be innate skill.
"I don't take them lightly, but I know that's not my forte," he said. "You come in here and have to have a positive attitude and take the good with the bad the same.
"It's just in the genes. There's guys that are really good at it with little explanation as to why. I think it's an itch you have or you don't. You can go to Bondurant (a road-racing school in Arizona) and get speed and find your inner Boris Said. It's like being able to play golf well, something you have to do all the time. If you neglect it or don't take it seriously, you won't be good at it. You can't pick up a bag of clubs and go hit every four months and think you're going to play a good round. You have to practice to be good at it."
Regardless of how he performs Sunday, Earnhardt is confident about remaining at title contender. The Michigan win moved him four points behind Kenseth for the championship lead with 11 races remaining until the Chase for the Sprint Cup.
To focus on the job this season, Earnhardt said he had changed his lifestyle quite a bit by dialing down time spent on online racing and video games with friends. He also has gotten more active while trying to stay in better shape, joining a softball league team in Mooresville, N.C., near his house.
"I don't know if momentum is real or not," he said. "You keep going to the track and keep studying and testing and trying to learn. You have a bad week, you have to put it behind you. We've got a lot of confidence and feeling really good about what we've been doing. Best I've felt in a really long time. You just trying to keep doing your job and ask every day, 'Can I work harder and be smarter, and what can I do to bring even more to the table?' You can't ever get complacent, because in this sport there's always someone else about to step it up another notch.
"I haven't competed for a title yet. This seems to be my best opportunity. I expect to be in that conversation or answering questions about it as long as we keep up our consistency."
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Home Needles Industrial Machine Needles Schmetz Industrial Needles Canu 32:10 134-35


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This was one of the best tours I've been on, even in the rain! We had a traditional Swedish picnic and tried some new foods. The guide was very knowledgeable and made sure that we saw all the wildlife possible on a rainy evening.
Very fantastic n true nature excursion. Tour operator is very co -operating n creative, saw real forest n wild life of Sweden. Feel of countryside n ride in Sweden historic places was also fine. Definitely a must for every nature lover
It's was the epic tour. We saw every thing: Moose, Rain dears, Wild pigs and even a small little Bamby.
My advice, get a good Camara with zoom and have your allergy bills ready since :)
Nice change of pace. Our guide, Hannah, was great. Saw deer, boar, moose, a rune, and the beautiful countryside.
Jeffrey K USA
We were lucky and saw a good bit of wildlife on our tour. Our guide, Hanna, was very knowledgeable about the areas we visited and and the animals that we saw. It was surprising how much wildlife is close to the city of Stockholm.
We were very lucky to see 10 Moose even though it was getting pretty dark for the last 6. It was pretty amazing. The Swedish meal was great and my gluten free requirement was catered for with no problem. Only one criticism was that the bus windows were dirty and since you are looking for Moose in near darkness in the distance from inside a small bus/people mover this was surprising and a little disappointing. Otherwise a great tour and great value for money.
Fine tour and several sightings of moose, wild boar, roe deer, hare/rabbit. Knowledgeable guide who also was a careful, smooth driver, with an able assistant. Pleasant midsummer meal and good companion guests on the tour. Altogether an interesting, fine evening out, giving an indepth view of Swedish wildlife and their care for the countryside.
Was quite fun to go out to the woods and see all the animals including moose and boar. The dinner wasn and #39;t good if you and #39;re not a meat eater. It started and ended later than necessary. The tour guides were interactive and full of information. Unfortunately there are no opportunities for toilettes.
We had a great time on the tour. We stopped for Fika coffee and sweets at a small picnic area. Our tour guide was very knowledgeable and did her best to make sure we saw animals. Highlight of the trip was seeing a moose and being able to get out and get some photos of it in the field. Great experience!
I enjoyed it. Unfortunately it was difficult to take good pictures with a normal camera since most of the animals came out after twilight. We did see wildlife though.
Disappointed in the limited wildlife, which I know you can't control or guarantee. Would start a half hour earlier at 8:00 instead of 8:30. By the last hour or so of the tour it was not light enough to be worth being out there. Guide brough coffee and snacks, which was a very nice touch. But the snacks were the huge muffins like we have in the US. I wanted some authentic Swedish pastries and/or cookies, not US stuff!
This is a good tour if you want to see everything in a day.. if not I find this tour abit too rush.. There was no time for photographs at all.. they just go thru every site in a flash and explain to you as you walk through.. so basically if you want to take some photos for yourselves, it would be difficult. Good for those who only want to see and hear :)
Trip was focused on seeing target megafauna - in that respect it was very successful. Elk - about ten, some within 100 meters. Feral pigs - a mom and 3 young quite close, plus others. A fox. Various roe deer, a life species for us.
The first stop muffins were a nice touch, but having only coffee w at least 3 tea drinkers out of 7 participants was not.
The small group size (7) was ideal - the minivan w tinted windows made it difficult to see - this was, after all, a tour from 8:30 pm to midnight.
The tour guide was sweet, and knew where to find the animals - but she really didn't know all that much about them or their habitat/characteristics/etc. e.g., are these elk same species as those found in North America?
All in all, it was pleasant, and I expect those interested primarily in seeing the afore-mentioned animals would rate it higher. We're spoiled from many tours led by professional naturalists, so read this review w that caveat.
This was a nice trip but did only saw 4 animals. The guide was very knowledgable.
So, so. Didn't see enough local wildlife -- mostly small deer which I can see in New York.
I'll start by saying our tour guide was actually really lovely, so the review should reflect on her. The actual tour was really disappointing and so expensive for what we got. I had thought there would be some walking/exploring in a more rural environment. That's not the case. We were in a mini van driving up and down a road looking into farm land with binoculars. I was unlucky enough to have a middle seat at the back of the van, which meant that I had to attempt to look between other people's heads and the head rest using binoculars to see anything. We only got out at one point. Mainly saw deer and hares, which is not a novelty being from New Zealand.
Just be informed that this is driving in a van up and down farm land. Not walking in bush. No photo opportunities. And avoid the middle seats!
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Sam Phillips has been in music for a long time. She began as Leslie Phillips in the Christian music industry in the 80s. Then, in exasperation at not being able to express herself properly she moved to the general market and followed that move with a name change. She became known as "Sam" and produced several pop albums with producer (and husband) T Bone Burnett. Then a couple of years ago she made "Fan Dance" which sent her on a completely different musical direction. "Fan Dance," released on Nonesuch Records, moved Phillips squarely into quirky folk-pop. The songs were good. Chillingly good, actually.
"A Boot And A Shoe" isn't a major change from "Fan Dance." There are subtle differences, but the prevalent sound is folky-pop. Sam accompanied by acoustic guitar with other oddities thrown in to boost the songs along.
The best comparison, and one I did not think up but wretchedly stole for my own sake, is to take "Fan Dance" and mix it with some Tom Waits. Granted, Sam Phillips' voice sounds nothing like Waits, however, she utilizes a similar rhythmic rattle and clatter (without, perhaps, going to quite the extreme that Waits does).
As with all Nonesuch Records releases, "A Boot And A Shoe" is exquisitely packaged in a slipcase with some artsy photography. If you buy a Nonesuch release, you know it's not going to be just thrown together. It's high quality from the package inside to the production of the music.
If you liked "Fan Dance" and want to see a bit of an expansion on that sound, you will enjoy this release. If you wanted to see more growth you may find it hard to listen all the way through "A Boot And A Shoe." Once you give it some time it will start to grow on you the way it grew on me. Oh, and if you happen to be one of those who was extremely disappointed with Phillips' departure from pop, save your money and only get this if you find it cheap.Powered by Sidelines


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Please join us for the Camp Daggett Adventure Center's 9th Annual Kayak for a Cause on Walloon Lake – July 15 & 16, 2017.
This fundraiser for the Camp Daggett Adventure Center (CDAC) helps to raise scholarship dollars used in support of schools and other groups of students who would participate in the CDAC team-building programs. These programs…[Read more]


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Cysteine catabolism is dependent upon two unique enzymes that are the only known mammalian thiol dioxygenases-enzymes adding molecular oxygen to a sulfhydryl group to form a sulfinic acid. These two unique enzymes are cysteine dioxygenase (CDO), encoded by CDO1, and cysteamine dioxygenase (ADO, 2-aminoethanethiol dioxygenase), which we recently showed to be encoded by human gene C10orf22. The clinical literature and, more recently, the study of CDO polymorphisms in disease and control populations, have shown a strong association of impaired metabolism of cysteine to sulfate and taurine and/or CDO loss-of-function mutations with a variety of autoimmune and neurodegenerative diseases. CDO is one of the most highly regulated metabolic enzymes responding to diet that is known, and this robust regulation of CDO activity suggests that cysteine homeostasis is very important to the living organism. Our long-term goals are integrate molecular and organismal studies (a) to further elucidate the structure-function relations in CDO and ADO to provide insights into thiol chemistry and regulation of these enzymes and (b) to further elucidate the roles of CDO and ADO in intermediary metabolism and regulation of physiological function in healthy individuals as well as the possible roles and contributions of CDO deficiency to autoimmune and/or neurodegenerative diseases.
Our specific aims related are (1) to define the catalytic mechanism of CDO through structural and spectroscopic studies of complexes of wild type and mutant enzymes in complex with substrates, products and substrate analogs;(2) to crystallize and solve the structure of wild type ADO, and carry out studies to characterize its catalytic mechanism;(3) to characterize the phenotype of CDO-knockout or CDO-deficient mice, including those with tissue- specific CDO gene disruption;(4) to determine whether adverse effects of CDO gene disruption are affected by dietary manipulations (e.g., reduced by restricted cysteine, supplemental taurine, or supplemental sulfate, or amplified by diets containing excess sulfur amino acids, low taurine, or low sulfate);(5) to assess the functional contribution of CDO expressed in specific cell types or tissues to cysteine metabolism and regulation of cysteine levels;(6) to determine whether specific mechanisms that might contribute to the development or progression or severity of autoimmune and/or neurodegenerative disease -- including reduced taurine mediated antioxidation, reduced expression of the complement regulatory protein DAF, reduced capacity for sulfation of glycosaminoglycans, and increased production of H2S -- are altered in the CDO knockout mouse model;and (7) to assess the role of ADO in cysteamine metabolism and in the biosynthesis of hypotaurine/taurine by generating and studying an ADO knockout mouse model.
Cysteine homeostasis is very important to the living organism, and cysteine dioxygenase, the major enzyme involved in regulating body cysteine levels, can undergo ~300-fold changes in activity in response to changes in dietary protein content with these changes being accomplished within hours of the diet change. The clinical literature and the study of polymorphisms of the gene encoding cysteine dioxygenase (CDO1) in disease and control populations have shown a strong association of impaired metabolism of cysteine to sulfate and taurine and/or CDO1 loss-of-function mutations with a variety of autoimmune and neurodegenerative diseases. Further exploration of the structure and function of cysteine dioxygenase and use of a mouse knockout model to study the effects on loss-of-function mutations of CDO1 and their modification by diet will further our ability for prediction and early diagnosis of related disease states and for prevention of disease or alleviation of disease prevention by dietary modifications.
|Sikalidis, Angelos K; Mazor, Kevin M; Lee, Jeong-In et al. (2014) Upregulation of capacity for glutathione synthesis in response to amino acid deprivation: regulation of glutamate-cysteine ligase subunits. Amino Acids 46:1285-96
|Roman, Heather B; Hirschberger, Lawrence L; Krijt, Jakub et al. (2013) The cysteine dioxgenase knockout mouse: altered cysteine metabolism in nonhepatic tissues leads to excess H2S/HS(-) production and evidence of pancreatic and lung toxicity. Antioxid Redox Signal 19:1321-36
|Driggers, Camden M; Cooley, Richard B; Sankaran, Banumathi et al. (2013) Cysteine dioxygenase structures from pH4 to 9: consistent cys-persulfenate formation at intermediate pH and a Cys-bound enzyme at higher pH. J Mol Biol 425:3121-36
|Ueki, Iori; Roman, Heather B; Hirschberger, Lawrence L et al. (2012) Extrahepatic tissues compensate for loss of hepatic taurine synthesis in mice with liver-specific knockout of cysteine dioxygenase. Am J Physiol Endocrinol Metab 302:E1292-9
|Ueki, Iori; Roman, Heather B; Valli, Alessandro et al. (2011) Knockout of the murine cysteine dioxygenase gene results in severe impairment in ability to synthesize taurine and an increased catabolism of cysteine to hydrogen sulfide. Am J Physiol Endocrinol Metab 301:E668-84
|Stipanuk, Martha H; Simmons, Chad R; Karplus, P Andrew et al. (2011) Thiol dioxygenases: unique families of cupin proteins. Amino Acids 41:91-102
|Stipanuk, Martha H; Ueki, Iori (2011) Dealing with methionine/homocysteine sulfur: cysteine metabolism to taurine and inorganic sulfur. J Inherit Metab Dis 34:17-32
|Sikalidis, Angelos K; Lee, Jeong-In; Stipanuk, Martha H (2011) Gene expression and integrated stress response in HepG2/C3A cells cultured in amino acid deficient medium. Amino Acids 41:159-71
|Sikalidis, Angelos K; Stipanuk, Martha H (2010) Growing rats respond to a sulfur amino acid-deficient diet by phosphorylation of the alpha subunit of eukaryotic initiation factor 2 heterotrimeric complex and induction of adaptive components of the integrated stress response. J Nutr 140:1080-5
|Stipanuk, M H; Ueki, I; Dominy Jr, J E et al. (2009) Cysteine dioxygenase: a robust system for regulation of cellular cysteine levels. Amino Acids 37:55-63
Showing the most recent 10 out of 30 publications


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The aging process brings with it a multitude of obstacles, from memory loss to health issues. At Covenant Village of Turlock, the continuing care retirement community is hoping to help area seniors combat these problems through a free health and fitness program.
Smith Chevrolet-Cadillac is heading into the New Year with an environmentally conscious approach, as the Turlock auto dealership recently connected with local solar energy installer JKB Energy to bring a rooftop solar system to their site.
Stanislaus County has recorded its first influenza-related death as the season hits the peak time for contagions.
While Turlock actively prepared for what was originally forecast to be the storm of a decade this past weekend, the city came out relatively drier than other regions throughout California which were dealt blizzard warnings and flooding, leaving many residents without power or forced to evacuate.
Josh Gottlieb is no stranger to the pawn business. The owner of Turlock's newest shop, Mid Valley Pawn, essentially grew up in the industry, as his parents ran a pawn shop of their own in Sonora. Now, his expertise in the pawn business has enabled him to successfully open the city's first pawn shop in nearly a decade.
Mayor Gary Soiseth dropped by a special pajama party story time at the Turlock Library on Monday. The Mayor read Bob Shea's "Dinosaur vs. Bedtime" to the preschoolers, who looked ready for bed.
U.S. Air Force Airman Alan J. Trelles graduated from basic military training at Joint Base San Antonio-Lackland, San Antonio, Texas.
Superheroes, zombies and even some celebrities will take the Stanislaus County Fairgrounds by storm come February at the city's first-ever Comic Con, giving Turlock geeks and pop culture fanatics the opportunity to gather under one roof and celebrate the world of comics, science fiction and fantasy.
Emanuel Medical Center will be kicking off its celebration of American Heart Month in February with the Glow Red Luncheon with special guest Cheryl Burke from "Dancing with the Stars."
Type of business: Fitness gym
Turlock residents hoping to hop their way into the new year will soon be able to do so, with construction on the city's Get Air Indoor Trampoline Park expected to begin this month.
Covenant Care at Home is an amazing place primarily because of the people who work there. Each has learned the Malmberg approach to caregiving - treat the patient as a family member and remember that this could be you. The staff embrace their highs and lows with the same level of commitment and caring. Led by Ronda Malmberg and an incredible team of women and men, they bring quality care to patients, one at a time, at home. One outstanding team member is Jill Chiesa.
Those living in Stanislaus County who rely on a well for their drinking water can now get a free well assessment.
Flooding is expected to occur city-wide this weekend as a severe storm that the City of Turlock said is "typically experienced only once in a decade" is forecasted to bring three to four inches of rainfall to Turlock.
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If you were to ask Modesto resident Vanessa Martinez what Valentine's Day meant to her prior to Tuesday, she likely would have said that ...
Just three weeks ago, Nael Abdulqader was unsure if he would ever see his family again. He was permitted into the United States as a ...
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