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SinusitisNasal congestion; Rhinosinusitis
An in-depth report on the causes, diagnosis, treatment, and prevention of sinusitis.
Sinusitis is an inflammation or infection of the sinuses, the air-filled chambers in the skull that are located around the nose. Symptoms of sinusitis include thick nasal discharge, facial pain or pressure, fever, and reduced sense of smell. Depending on how long these symptoms last, sinusitis is classified as acute, subacute, chronic, or recurrent. Viruses are the most common cause of acute sinusitis, but bacteria are responsible for most of the serious cases.
Non-Drug Treatment of Sinusitis
Home remedies such as saline (salt) washes or sprays are helpful for removing mucus and relieving congestion. Steam inhalation is also beneficial. Patients with sinusitis should drink plenty of fluids to avoid dehydration. Water, which helps lubricate the mucous membranes, is the best fluid to drink.
Drug Treatment of Sinusitis
Medication depends on the type of sinusitis and its cause. Non-prescription pain relievers such as acetaminophen and ibuprofen can help mild-to-moderate pain symptoms. Decongestants may help relieve congestion, but they do not cure sinusitis. Antihistamines can dry the mucus and sometimes worsen the condition. Cough or cold medication is not recommended for children younger than age 4 years.
Because many cases of acute sinusitis resolve within two weeks with non-prescription treatments and home remedies, doctors generally wait at least 7 - 14 days before prescribing an antibiotic.
For chronic sinusitis, antibiotics and nasal corticosteroids are the main treatments, but this condition is difficult to treat and does not always respond to these drugs. Other drugs may also be prescribed. If drugs are ineffective, some patients with chronic sinusitis may need surgery.
Guidelines for Managing Acute Bacterial Sinusitis
According to guidelines from the Infectious Diseases Society of America (IDSA):
- Bacterial sinusitis can be difficult to distinguish from sinusitis caused by a viral infection. It is important to know the difference because viral infections do not respond to antibiotic treatment.
- Bacteria cause only 2 – 10% of acute sinusitis cases. Viruses, such as those from the common cold, are the main cause of acute sinusitis. Most cases of acute sinusitis resolve on their own within a few weeks.
- Doctors distinguish bacterial from viral sinusitis based on how symptoms start, how they progress, and how long they last.
- When an antibiotic is prescribed, the IDSA recommends amoxicillin-clavulanate as a first choice. Many types of antibiotics formerly used for acute bacterial sinusitis are no longer effective or recommended.
Four pairs of sinuses, known as the paranasal air sinuses, connect to the nasal passages (the two airways running through the nose):
- Frontal sinuses (behind the forehead)
- Maxillary sinuses (behind the cheekbones)
- Ethmoid sinuses (behind the nose)
- Sphenoid sinuses (behind the eyes)
Sinusitis occurs if obstruction or congestion cause the paranasal sinus openings to become blocked. When the sinus openings become blocked or too much mucus builds up in the chambers, bacteria and other germs can grow more easily, leading to infection and inflammation.
Sinusitis is classified as acute, subacute, or chronic, or recurrent. The classification is based on how long symptoms last:
- Acute: Less than 4 weeks
- Subacute: 4 - 12 weeks
- Chronic: 12 weeks or longer
- Recurrent: 3 or more acute episodes in 1 year
Sinusitis is always accompanied (and usually preceded) by rhinitis, which is the inflammation of the mucous membrane of the nasal cavities. The two conditions share common symptoms such as nasal obstruction and discharge.
Acute sinusitis can be caused by viral, bacterial, or fungal infections. Allergans and environmental irritants are other possible causes. In most cases, acute sinusitis is caused by an upper respiratory tract viral infection, such as the common cold, and usually resolves on its own.
Chronic sinusitis refers to long-term swelling and inflammation of the sinuses. Chronic sinusitis can result from recurring episodes of acute sinusitis or it can be caused by other health conditions like asthma and allergic rhinitis, immune disorders, or structural abnormalities in the nose like deviated septum or nasal polyps.
Viral, Bacterial, and FungalInfections
Viruses. Viruses cause 90 – 98% of acute sinusitis cases. Acute sinusitis typically starts with the common cold virus. A cold can set the stage for sinusitis by causing inflammation and congestion in the nasal passages, leading to obstruction in the sinuses. .
Bacteria. A small percentage of cases of acute sinusitis, and possibly chronic sinusitis, are caused by bacteria. Bacteria are normally present in the nasal passages and throat and areusually harmless. However, when a cold or other viral upper respiratory infection blocks the nasal passage and prevents the sinuses from draining, bacteria can multiply within the mucus lining of the sinuses, causing sinusitis. Streptococcus pneumonia, Haemophilius influenzae, and Moraxella catarrhalis (a common cause of childhood illnesses) are the bacteria most often linked to acute sinusitis. These bacteria plus other strains, such as Staphylococcus aureus, are also associated with chronic sinusitis. (The role of bacteria in chronic sinusitis is still being debated.) Bacterial sinusitis usually causes more severe symptoms and lasts longer than viral sinusitis.
Fungi. An allergic reaction to fungi is a cause of some cases of chronic rhinosinusitis. Aspergillus is the most common fungus associated with sinusitis. Fungal infections tend to occur in people with sinusitis who also have diabetes, leukemia, AIDS, or other conditions that impair the immune system. Fungal infections can also occur in patients with healthy immune systems, but they are far less common.
Allergies, Asthma, and Immune Response
Allergies, asthma, and sinusitis often overlap. Seasonal allergic rhinitis and other allergies that cause mucus blockage may predispose people to develop sinusitis. Many of the immune factors observed in people with chronic sinusitis resemble those that appear in allergic rhinitis, suggesting that in some people sinusitis is due to an allergic response. Asthma is also strongly associated with sinusitis and many people have both conditions. Some studies suggest that sinusitis may worsen asthma symptoms.
Chronic sinusitis and recurrent acute sinusitis are also associated with disorders that weaken the immune system or produce inflammation in the airways or persistent thickened stagnant mucus. These conditions include diabetes, AIDS, cystic fibrosis, Kartagener's syndrome, and Wegener's granulomatosis.
Structural Abnormalities of the Nasal Passage
Structural abnormalities in the nose can cause blockage and thereby increase the risk for chronic sinusitis. Some abnormalities include:
- Polyps (small benign growths) in the nasal passage block mucous drainage and restrict airflow. Polyps canresult from previous sinus infections that caused overgrowth of the nasal membrane.
- Enlarged adenoids can lead to sinusitis.
- Cleft palate
- Tumors
- Deviated septum (a common structural abnormality in which the septum, the center section of the nose, is shifted to one side, usually the left)
Risk Factors
Sinusitis is one of the most common diseases in the United States, affecting about 30 million Americans each year.
Young Children and Sinusitis
Before the immune system matures, all infants are susceptible to respiratory infections. Babies catch a cold about every 1 - 2 months. Young children are prone to colds and may have 8 - 12 bouts every year. Smaller nasal and sinus passages make children more vulnerable to upper respiratory tract infections than older children and adults. Ear infections such as otitis media are also associated with sinusitis.
The Elderly and Sinusitis
Older people are at heightened risk for sinusitis. Their nasal passages tend to dry out with age. In addition, the cartilage supporting the nasal passages weakens, causing airflow changes. They also have diminished cough and gag reflexes andweakened immune systems and are at greater risk for serious respiratory infections than are young and middle-aged adults.
People with Asthma or Allergies
People with asthma or allergies are at increased risk for inflammation in the sinuses. People with a combination of polyps in the nose, asthma, and sensitivity to aspirin (called Samter's, or ASA, triad) are at very high risk for chronic or recurrent acute sinusitis.
Some hospitalized patients are at higher risk for sinusitis, particularly those with:
- Head injuries
- Conditions requiring insertion of tubes through the nose
- Breathing aided by mechanical ventilators
- Weakened immune system (immunocompromised)
Other Medical Conditions Affecting the Sinuses
A number of medical conditions put people at risk for chronic sinusitis. They include:
- Diabetes
- Gastroesophageal reflux disease
- Nasal polyps or septal deviation
- AIDS and other disorders of the immune system
- Oral or intravenous steroid treatment
- Hypothyroidism (underactive thyroid gland) causes congestion that clears up when the condition is treated
- Cystic fibrosis is a genetic disorder in which the mucus is very thick and builds up
- Kartagener's syndrome, a genetic disorder that impairs function of cilia, the hair-like structures that normally move mucus through the respiratory tract
Miscellaneous Risk Factors
Dental Problems. Bacteria associated with infections from dental problems or procedures cantrigger cases of maxillary sinusitis.
Changes in Atmospheric Pressure. People who experience changes in atmospheric pressure, such as while flying, climbing to high altitudes, or scuba diving, risk sinus blockage and therefore face an increased risk of developing sinusitis. (Swimming also increases the risk for sinusitis.)
Cigarette Smoke and Other Air Pollutants. Air pollution from industrial chemicals, cigarette smoke, or other pollutants can damage the cilia responsible for moving mucus through the sinuses. It is still not clear whether air pollution is an important cause of sinusitis and which specific pollutants are critical factors. Cigarette smoke, for example, poses a small but definite risk for sinusitis in adults. Second-hand smoke does not appear to have any significant effect on adult sinuses, although it may pose a risk for sinusitis in children.
Bacterial Infections
Bacterial sinusitis is nearly always harmless (although uncomfortable and sometimes even very painful). If an episode becomes severe, antibiotics generally eliminate further problems. In rare cases, however, bacterial sinusitis can cause very serious infections.
Infection of the Frontal Bone. Osteomyelitis is infection of the bones. In rare cases, sinusitis can lead to infection of the forehead and other facial bones. In such cases, the patient usually experiences headache, fever, and a soft swelling over the bone known as Pott's puffy tumor.
Infection of the Eye Socket. Infection of the eye socket (orbital cellulitis), which causes swelling and subsequent drooping of the eyelid, is a rare but serious complication of ethmoid sinusitis. In these cases, the patient loses movement in the eye, and pressure on the optic nerve can lead to vision loss, which is sometimes permanent. Fever and severe illness are usually present.
Brain Infection. The most dangerous complication of sinusitis, particularly frontal and sphenoid sinusitis, is the spread of infection by anaerobic bacteria to the brain, either through the bones or blood vessels. Abscesses, meningitis, and other life-threatening conditions may result. In such cases, the patient may experience mild personality changes, headache, altered consciousness, visual problems, and, finally, seizures, coma, and death.
Blood Clots
Blood clots are another danger, although rare, from ethmoid or frontal sinusitis. If a blood clot forms in the sinus area around the front and top of the face, symptoms are similar to infection of the eye socket. In addition, the pupil may be fixed and dilated. Although symptoms usually begin on one side of the head, the process usually spreads to both sides.
Increased Asthma Severity
Many people with moderate-to-severe asthma also suffer from sinusitis and allergic rhinitis. The relationship between sinusitis and asthma is not clear but it appears that sinusitis can predispose people to more severe asthma attacks. Evidence suggests that treating one condition can have a beneficial impact on the other. .
Effect on Quality of Life
Pain, fatigue, and other symptoms of chronic sinusitis can have significant effects on the quality of life. This condition can cause emotional distress, impair normal activity, and reduce attendance at work or school. According to the American Academy of Allergy, Asthma, and Immunology, the average patient with sinusitis misses about 4 work days a year, and sinusitis is one of the top 10 medical conditions that most adversely affect American employers.
General Symptoms of Acute Sinusitis
Sinus symptoms are very common during a cold or the flu, but in most cases they are due to the effects of the infecting virus and resolve when the infection does. General symptoms of acute sinusitis (both viral and bacterial) include:
- Nasal congestion or discharge
- Headache
- Facial pain or pressure
- Cough or scratchy throat
- Fever
- Diminished or absent sense of smell
- Other symptoms may include ear pain or pressure, dental pain, bad breath, fatigue
Acute Bacterial Sinusitis Symptoms
It is important to differentiate between inflamed sinuses associated with cold or flu virus and sinusitis caused by bacteria but it can be difficult to do so. In general, with viral sinusitis symptoms usually last 7- 10 days and then improve. Acute bacterial sinusitis, in contrast to viral sinusitis, usually takes one of the following three paths:
- Persistent symptoms that last more than 10 days and do not improve. Nasal discharge (either clear or colored) and daytime cough are common.
- Severe symptoms,with by a high fever (at least 102 degrees) and thick, green nasal discharge or facial pain that last for at least 3 -4 days starting from the beginning of the illness. (With viral sinusitis, fever usually disappears within the first day or two and green discharge does not appear until after the fourth day.)
- Worsening symptoms following a typical viral upper respiratory infection.These symptomsappear to improve but are then followed suddenly by another set of worsening symptoms (return of fever, cough, severe headache or increase in nasal discharge) after 5 -6 days ("double-sickening")
If symptoms suggest acute bacterial sinusitis, antibiotic treatment is warranted. Bacterial sinusitis is not as common as viral sinusitis, but bacteria are responsible for most of the serious cases of sinusitis.
In children, the most common signs and symptoms of bacterial sinusitis are cough, nasal discharge, and fever. Bad breath is also a common symptom in young children. Headache and facial pain are rare.
Chronic Sinusitis Symptoms
With chronic sinusitis:
- Any of the sinusitis symptoms listed previously may be present
- Symptoms are more vague and generalized than acute sinusitis
- Fever may be absent or just low grade
- Symptoms of sinusitis last 12 weeks or longer
- Symptoms occur throughout the year, even during nonallergy seasons
Symptoms Indicating Medical Emergency
Rare complications of sinusitis can produce additional symptoms, which may be severe or even life threatening. Symptoms indicating a medical emergency include:
- Increasing severity of symptoms
- Eyes may be red, bulging, or painful if the sinus infection occurs around the eyes
- Swelling and drooping eyelid
- Loss of eye movement (possible infection in the eye socket)
- Vision changes
- Pupil fixed or dilated
- Symptoms spreading to both sides of face (may indicate blood clot)
- Development of severe headache, altered vision
- Mild personality or mental changes (may indicate spread of infection to brain)
- A soft swelling over the bone (may indicate bone infection)
Other Causes of Sinusitis Symptoms
Allergies. Symptoms of both sinusitis and allergic rhinitis include nasal obstruction and congestion. The conditions often occur together. People with allergies and no sinus infection may have:
- Thin, clear, and runny nasal discharge
- Itchy nose, eyes, or throat (do not occur with bacterial sinusitis)
- Recurrent sneezing
- Symptoms of allergies appear only during exposure to allergens
Migraine and Other Headaches. Many primary headaches, particularly migraine or cluster, may closely resemble sinus headache. Migraine and sinus headaches may even coexist in many cases. Sinus headaches are usually more generalized than migraines, but it is often difficult to tell them apart, particularly if headache is the only symptom of sinusitis.
Trigeminal Neuralgia. In some cases, headache that persists after successful treatment of chronic sinusitis may be due to neuralgia (nerve-related pain) in the face.
Other Conditions. A number of other conditions can mimic sinusitis. They include:
- Dental problems
- A foreign object in the nasal passage
- Temporal arteritis (headache caused by inflamed arteries in the head)
- Persistent upper respiratory tract infections
- Temporomandibular disorders (problems in the joints and muscles of the jaw hinges)
- Vasomotor rhinitis, a condition in which the nasal passages become congested in response to irritants or stress. It often occurs in pregnant women.
You should see your doctor if you have sinusitis symptoms that do not clear up within a few days, are severe, or are accompanied by high fever or sudden generalized illness.
The first goal in diagnosing sinusitis is to rule out other possible causes of symptoms, and then determine:
- The site where the infection has occurred
- Whether the condition is acute or chronic
- The organism causing the infection (if possible)
Diagnostic Approach to Acute Sinusitis
Medical History. The patient should describe all symptoms such as nasal discharge and specific pain in the face and head, including eye and tooth pain.
After assessing symptoms, the doctor should take a thorough medical history of the patient:
- Any history of allergies, asthma,or headaches
- Recent upper respiratory infections (colds, flu, and infection) and how long they lasted
- History of sinusitis episodes that did not respond to antibiotic treatment. (In such cases, the doctor will usually diagnose chronic or recurrent acute sinusitis and may refer the patient to a specialist for more advanced testing.)
- Exposure to cigarette smoke or other environmental pollutants
- Recent travel (especially by air), scuba diving
- Recent dental procedures
- Medications being taken (particularly decongestants)
- Any known structural abnormalities in the nose and face
- Injury to the head or face
- History of medical conditions that can produce tender areas in the face or sinus regions and nonspecific symptoms of ill health
- Any family or personal history of immune disorders, cystic fibrosis, or Kartagener's (immotile cilia) syndrome
- In small children with sinusitis, whether they attend a day care center or nursery school
Physical Examination
The doctor will press the forehead and cheekbones to check for tenderness and other signs of sinusitis, including yellow to yellow-green nasal discharge. The doctor will also check the inside of the nasal passages using a device with a bright light to check the mucus and look for any structural abnormalities.
Nasal Endoscopy (Rhinoscopy)
Nasal endoscopy, or rhinoscopy, involves the insertion of a flexible tube with a fiber-optic light on the end into the nasal passage. Rhinoscopy allows detection of even very small abnormalities in the nasal passages and can evaluate structural problems of the nasal septum, as well as the presence of soft tissue masses such as polyps. It may also identify small amounts of pus draining from the opening of a sinus. Bacterial cultures can also be taken from samples removed using endoscopy. (Endoscopy is also used for treating sinusitis.)
Imaging Techniques
Computer Tomography. Computed tomography (CT) scanning is the best method for viewing the paranasal sinuses. There is little relationship, however, between symptoms in most patients and abnormal findings on a CT scan. CT scans are only recommended for acute sinusitis if there is a severe infection, complications, or a high risk for complications. CT scans are useful for diagnosing chronic or recurrent acute sinusitis and for planning operations. They show inflammation and swelling and the extent of the infection, including in deeply hidden air chambers missed by x-rays and nasal endoscopy. They may also detect the presence of fungal infections.
X-Rays. X-rays used to be commonly used but they are not as accurate as endoscopy and CT scans for identifying abnormalities in the sinuses, particularly the ethmoid sinuses.
Magnetic Resonance Imaging. Magnetic resonance imaging (MRI) is not as effective as CT in defining the paranasal anatomy and therefore is not typically used to image the sinuses for suspected sinusitis. MRI is also more expensive than CT. However, it can help rule out fungal sinusitis and may help differentiate between inflammatory disease, malignant tumors, and complications within the skull. It may also be useful for showing soft tissue involvement.
Sinus Puncture and Bacterial Culture
Sinus puncture with bacterial culture is the gold standard for diagnosing a bacterial sinus infection. It is invasive and is performed only when patients are at risk of having unusual infections or serious complications, or if antibiotics have not worked. Sinus puncture involves using a needle to withdraw a small amount of fluid from the sinuses. It requires a local anesthetic and is performed by a specialist. The fluid is then cultured to determine what type of bacteria is causing sinusitis.
The best way to prevent sinusitis is to avoid colds and influenza. If you are unable to avoid them, the next best way to prevent sinusitis is to effectively treat colds and influenza.
Good Hygiene and Preventing Transmission
Cold and flu viruses spread when an infected person coughs or sneezes. These viruses can also be transmitted by shaking hands. Everyone should always wash their hands before eating and after going outside. Ordinary soap is sufficient. Waterless hand cleansers that contain an alcohol-based gel are also effective. Antibacterial soaps add little protection, particularly against viruses. Wiping surfaces with a solution that contains one part bleach to 10 parts water is very effective in killing viruses.
Influenza Vaccine. Doctors recommend that most people receive annual influenza vaccinations in October or November. Because influenza viruses change from year to year, influenza vaccines are redesigned annually to match the anticipated viral strains.
Flu vaccines are now recommended for virtually everyone over 6 months of age, except those allergic to eggs or other vaccine compounds.
Pneumococcal Vaccines. Pneumococcal vaccinesprotects against S. pneumoniae (also called pneumococcal) bacteria, the most common bacterial cause of respiratory infections.Pneumococcal vaccination is recommended for all children and for all adults age 65 and older. The vaccine is also recommended for adults younger than age 65 who have health conditions that compromise their immune system or lower their risk for infection as well as smokers and patients with asthma.
General Treatment Approaches
General treatment goals for sinusitis aim to:
- Reduce swelling
- Stop infection
- Drain the sinuses
- Ensure that the sinuses remain open
Most patients with sinusitis do not require aggressive treatment. Home remedies can be very useful.
Bacterial sinusitis, which is treated with antibiotics, accounts for only 2- 10% of acute sinusitis cases. Most cases of sinusitis are caused by viruses, which do not respond to antibiotics. Acute viral sinusitis generally clears up on its own within 7 - 10 days.
It is important to reserve antibiotics for illnesses caused by bacteria. The intense and widespread use of antibiotics has led to a serious global problem of antibiotic-resistant bacteria.
Treatment of Acute Sinusitis:
- Saline nasal irrigation, steam inhalations, good hydration, and decongestants are appropriate for a minimum of 7 - 10 days for patients with mild-to-moderate symptoms, and may be used for longer.
- A diagnosis of acute bacterial sinusitis is based on how symptoms progress or worsen, and if they last longer than 10 days. Symptoms such as high fever and thick, colored nasal discharge may indicate a bacterial infection. [For more information on distinguishing bacterial from viral sinusitis, see Symptoms section.]
- For patients with acute bacterial sinusitis that requires antibiotic treatment, amoxicillin-clavunate is usually the first choice. [See Medications section.]
Treatment of Chronic Sinusitis:
- Chronic sinusitis typically results from damage to the mucous membrane from a past, untreated acute sinus infection. The role of antibiotic treatment for chronic sinusitis is controversial. Special types of antibiotics may be used, and treatment may be needed for a longer time.
- Corticosteroid nasal spray is a helpful treatment. Some doctors also recommend oral corticosteroids (such as prednisone) for patients who do not respond to nasal corticosteroids or for those patients who have nasal polyps or allergic fungal sinusitis.
- Saline nasal irrigation may be used on an ongoing basis.
- If there is no improvement, surgery may be considered. For some people with chronic sinusitis the condition is not curable, and the goal of treatment is to improve the quality of life.
- A thorough diagnostic work-up should be performed to rule out any underlying conditions, including but not limited to allergies, asthma, any immune problems, gastroesophageal reflux disorder, and structural problems in the nasal passages. If a primary trigger for chronic sinusitis can be identified, it should be treated or controlled if possible.
Home remedies that open and hydrate sinuses are often the only treatment necessary for mild sinusitis that is not accompanied by signs of acute infection.
- Drinking plenty of fluids and getting lots of rest is still the best advice for easing mild symptoms. Water is the best fluid and helps lubricate the mucus membranes. (There is no evidence that drinking milk will increase or worsen mucus, although milk is a food and should not serve as fluid replacement.)
- Chicken soup does, indeed, help congestion and aches. The hot steam from the soup may be its chief advantage, although other ingredients in the soup may have anti-inflammatory effects. In fact, any hot beverage may have similar soothing effects from steam. Ginger tea or any hot tea with honey and lemon can be helpful.
- Spicy foods that contain hot peppers or horseradish may help clear sinuses.
- Inhaling steam 2 - 4 times a day is extremely helpful, costs nothing, and requires no expensive equipment. The patient should sit comfortably and lean over a bowl of boiling hot water (no one should ever inhale steam from water as it boils) while covering the head and the bowl with a towel so the steam remains under the cloth. The steam should be inhaled continuously for 10 minutes. A mentholated or other aromatic preparation may be added to the water. Long, steamy showers, vaporizers, and facial saunas are alternatives.
Nasal Wash
A nasal wash can be helpful for removing mucus from the nose and relieving sinusitis symptoms. A saline (salt water) solution can be purchased in a spray bottle at a drug store or made at home. (Mix 1 teaspoon of table, Kosher, or sea salt with 2 cups of warm water. Some people add a pinch of baking soda.) If you prepare your own saline solution, use bottled or boiled water, not plain tap water. Perform the nasal wash several times a day.
A simple method for administering a nasal wash is:
- Lean over the sink head down.
- Pour some solution into the palm of the hand and inhale it through the nose, one nostril at a time.
- Spit out the remaining solution.
- Gently blow the nose.
Neti pots have also become popular in recent years for prevention and treatment of sinusitis. Nasal irrigation with a saline solution through a neti pot involves:
- Lean over the sink with your head tilted to one side.
- Insert the spout of the neti pot in the upper nostril.
- Slowly pour the salt water into your nose while continuing to breathe through your mouth.
- The water will flow through the upper nostril and out through the lower nostril.
- When the water finishes dripping out, blow your nose.
- Reverse the tilt of your head and repeat the process with the other nostril.
Managing Sinusitis in Patients with Allergies
Patients often have various combinations of allergies, sinusitis, and asthma. Treating each condition is important for improving them all. In addition to decongestants, pain relievers, and expectorants, other remedies are available for people who suffer from nonbacterial sinusitis during allergy season.
- Anti-Inflammatory Drugs. Nasal spray corticosteroids (commonly called steroids)reduce the inflammatory response in the nasal passages and airways. They are important in the treatment of asthma and are considered to be the most effective measure for preventing allergy attacks. Leukotriene-antagonists are also useful for sinusitis symptoms.
- Antihistamines. Antihistamine tablets relieve sneezing and itching and can prevent nasal congestion before an allergy attack. Many brands are available by prescription and over the counter. Because they thicken mucus and make it harder to drain out from the sinuses, they should not be used for sinusitis.
- Immunotherapy. Immunotherapy, commonly called allergy shots, may be considered for patients with severe seasonal allergies that do not respond to treatment. Immunotherapy is the only treatment that affects the cause of allergies.
- All drug treatments have side effects, some very unpleasant and, rarely, serious. Patients may need to try different drugs until they find one that relieves symptoms without producing excessively distressing side effects.
Emergency Treatment
Patients who show signs that infection has spread beyond the nasal sinuses into the bone, brain, or other parts of the skull need emergency care. High dose antibiotics are administered intravenously, and emergency surgery is almost always necessary in such cases.
Sinusitis caused by severe fungal infections is a medical emergency. Treatment is aggressive surgery, and high-dose antifungal chemotherapy with a drug such as amphotericin B can be life saving.
Antibiotic drugs are used to treat bacterial, not viral, infections. Unfortunately, because of the overuse and improper use of antibiotics, many types of bacteria no longer respond to antibiotic treatment. The bacteria have become "resistant" to these drugs. Due to the problem of bacterial resistance, doctors have had to switch to different or stronger types of antibiotics to treat bacterial infections.
Amoxicillin, a type of penicillin, used to be the main antibiotic used for sinusitis but it has become less effective. Amoxicillin-clavulanate (Augmentin, generic) has replaced amoxicillin as the antibiotic recommended for treating acute bacterial sinusitis in both children and adults. It is a type of penicillin that works against a wide spectrum of bacteria.
Patients who have a history of penicillin allergy cannot take amoxicillin-clavulanate:
- For adults with sinusitis and penicillin allergies, doctors recommend either doxycycline or the fluoroquinolones levofloxacin or moxifloxacin.
- Children should not take doxycycline because it can cause tooth discoloration. Levofloxacin is the standard alternative antibiotic for children with penicillin allergies.
Other types of antibiotics, such as macrolides and trimethoprim-sulfamethoxaole, have also become ineffective for treating acute bacterial sinusitis and are no longer recommended.
Side Effects. Side effects of antibiotics vary according to the specific drug and the patient's individual response. Many patients experience few side effects, but they many include:
- Upset stomach.
- Vaginal infections. (Taking supplements of acidophilus or eating yogurt with active cultures may help restore healthy bacteria that offset the risk for such infections.)
- Allergic reactions can occur with all antibiotics but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock.
- Certain drugs, including some over-the-counter medications, interact with antibiotics. Informyour doctor of all medicationsyou are taking and of any drug allergies.
Nasal-spray corticosteroids, commonly called steroids, are effective drugs for treating allergic rhinitis. Although they are not approved for treating sinusitis, they may be helpful for patients with sinusitis (either chronic or acute) who have a history of allergic rhinitis. Nasal spray steroids can help reduce inflammation and mucus production.
Corticosteroids available in nasal spray form approved for treating nasal allergy symptoms include:
- Triamcinolone (Nasacort, generic). Approved for children over age 6.
- Mometasone furoate (Nasonex). Approved for use in patients as young as age 3.
- Fluticasone (Flonase, generic). Approved for children over age 4.
- Beclomethasone (Beconase, Vancenase), flunisolide (Nasalide, generic), and budesonide (Rhinocort). Approved for children over age 6.
Side Effects. Corticosteroids are powerful anti-inflammatory drugs. Although oral steroids can have many side effects, the nasal-spray form affects only local areas, and the risk for widespread side effects is very low unless the drug is used excessively. Side effects of nasal corticosteroids may include:
- Dryness, burning, stinging in the nasal passage
- Sneezing
- Headaches and nosebleed (these side effects are uncommon but should be reported immediately to your doctor )
Decongestants are drugs that help reduce nasal congestion. They are available in both pill and nasal spray forms. However, decongestants will not cure sinusitis. Nasal decongestants may actually worsen sinusitis by increasing sinus inflammation.
Due to the lack of evidence for the benefit of nasal decongestants in treating sinusitis, the FDA ordered manufacturers of over-the-counter (OTC) nasal decongestant products to remove from their labeling all references to sinusitis. The Infectious Diseases Society of America does not recommend nasal or oral decongestants for patients with acute bacterial sinusitis.
Your doctor may still recommend that you take either an OTC or prescription nasal decongestant to help relieve blockage symptoms associated with sinusitis. If you think you have sinusitis, check with your doctor before taking a decongestant. Do not try to treat sinusitis by yourself.
Decongestants should never be used in infants and children under the age of 4 years, and some doctors recommend not giving them to children under the age of 14. Children are at particular risk for central nervous system side effects including convulsions, rapid heart rates, loss of consciousness, and death.
Antihistamines are included in many cold and allergy medications. Because they dry and thicken nasal secretions, they make sinus drainage difficult and may worsen sinusitis. Patients with sinusitis should not take antihistamines.
Surgery can unblock the sinuses when drug therapy is not effective or if there are other complications, such as structural abnormalities or fungal sinusitis.
Insertion of a Drainage Tube
The simplest surgical approach is the insertion of a drainage tube into the sinuses followed by an infusion of sterile water to flush them out.
Functional Endoscopic Sinus Surgery
Functional endoscopic sinus surgery (FESS) is the standard procedure for most patients requiring surgical management of chronic sinusitis or polyposis. The procedure allows correction of obstructions, including polyps and ventilation and drainage to aid healing.
Candidates for the Procedure. In general, patients should have tried and failed extensive medical therapy. This usually includes several prolonged courses of broad-spectrum antibiotics, nasal corticosteroids, nasal saline irrigation, allergy testing and immunotherapy where appropriate, and sinus drainage where appropriate.
Patients who may benefit from endoscopy include those with:
- Nasal or sinus polyps who have not responded to intranasal or oral corticosteroids
- Congenital anatomic abnormalities
- Evidence of bone involvement
- HIV/AIDS or other immune system impairments who have chronic or recurrent sinusitis
Procedure. The surgery generally proceeds as follows:
- Adults need only a local anesthetic for the procedure, although a general anesthetic is needed for children.
- Before the procedure, a computed tomography (CT) scan is taken for use by the surgeon in planning the procedure and as a guide to the sinuses during surgery.
- A flexible tube, a miniature camera, and a fiber-optic light are inserted through a single small opening.
- The surgeon uses special instruments to remove diseased bone or tissue and clear obstructions. For instance, shavers are used to gently remove soft tissue. Bone cutters are sometimes used to open the floor of the frontal sinus and restore drainage (called the modified Lothrop procedure). Lasers may be used to remove bone, coagulate the passageways, or clear obstructions.
Complications. Serious complications of FESS are very rare, but may include cerebrospinal fluid leakage, meningitis, hemorrhage, or infection.
Postsurgical Care. Postsurgical care involves the following:
- The patient will experience a dull ache around the nose and sinus cavity that can be treated with pain medication.
- Following surgery, the patient should flush the sinuses twice daily with a saline or alkaline solution.
- Antibiotics may be prescribed for several weeks until postnasal drip has stopped, and corticosteroid sprays and antihistamines may be needed.
Success Rates. It may take several months for the mucous membranes to completely recover, but 85 - 90% of patients have good to excellent relief of their symptoms after surgery. Children may need a second procedure 2 - 3 weeks after the first surgery to remove crusty matter.
Balloon Sinuplasty
A newer type of surgical procedure threads a small balloon through the sinus passages. As the balloon is gently opened, the sinus passages expand, allowing drainage to occur. The procedure is best suited for select patients with sinusitis disease in the maxillary (behind cheek bones), frontal (behind the sides of the forehead), and sphenoid (behind the eyes) sinus regions. It is inappropriate for patients with disease in the ethmoid (between the eyes) sinuses because of risk of eye injury .
Invasive Conventional Surgery
Endoscopy is now used in most cases of chronic sinusitis, but in severe cases, invasive surgery using conventional scalpel techniques to remove infected areas may be required. This may be the case with acute ethmoid sinusitis in which pus breaks through the sinus and threatens the eye, with very severe frontal sinusitis, with invasive fungal sinusitis, or when cancer is present in the sinuses.
- www.entnet.org -- American Academy of Otolaryngology - Head and Neck Surgery
- www.aaaai.org -- American Academy of Allergy, Asthma, and Immunology
- www.acaai.org -- American College of Allergy, Asthma, and Immunology
- www.niaid.nih.gov -- National Institute of Allergy and Infectious Disease
- www.american-rhinologic.org -- American Rhinologic Society
Ahovuo-Saloranta A, Borisenko OV, Kovanen N, Varonen H, Rautakorpi UM, Williams JW Jr, et al. Antibiotics for acute maxillary sinusitis. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000243.
Ah-See KL, MacKenzie J, Ah-See KW. Management of chronic rhinosinusitis. BMJ. 2012 Oct 30;345:e7054.
Anon JB. Upper respiratory infections. Am J Med. 2010 Apr;123(4 Suppl):S16-25.
Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am. 2007 Jun;21(2):427-48, vii.
Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012 Apr;54(8):e72-e112. Epub 2012 Mar 20.
DeMuri GP, Wald ER. Clinical practice. Acute bacterial sinusitis in children. N Engl J Med. 2012 Sep 20;367(12):1128-34.
Dykewicz MS, Hamilos DL. Rhinitis and sinusitis. J Allergy Clin Immunol. 2010 Feb;125(2 Suppl 2):S103-15.
Hamilos DL. Chronic rhinosinusitis: epidemiology and medical management. J Allergy Clin Immunol. 2011 Oct;128(4):693-707; quiz 708-9. Epub 2011 Sep 3.
Harvey R, Hannan SA, Badia L, Scadding G. Nasal saline irrigations for the symptoms of chronic rhinosinusitis. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD006394.
Jarvis D, Newson R, Lotvall J, Hastan D, Tomassen P, Keil T, et al. Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy. 2012 Jan;67(1):91-8. Epub 2011 Nov 4.
Ling FT, Kountakis SE. Important clinical symptoms in patients undergoing functional endoscopic sinus surgery for chronic rhinosinusitis. Laryngoscope. 2007 Jun;117(6):1090-3.
Meltzer EO, Hamilos DL. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines. Mayo Clin Proc. 2011 May;86(5):427-43. Epub 2011 Apr 13.
Rabago D, Zgierska A. Saline nasal irrigation for upper respiratory conditions. Am Fam Physician. 2009 Nov 15;80(10):1117-9.
Rosenfeld RM, Andes D, Bhattacharyya N, Cheung D, Eisenberg S, Ganiats TG, et al. Clinical practice guideline: adult sinusitis. Otolaryngol Head Neck Surg. 2007 Sep;137(3 Suppl):S1-31.
Ryan MW, Marple BF. Allergic fungal rhinosinusitis: diagnosis and management. Curr Opin Otolaryngol Head Neck Surg. 2007 Feb;15(1):18-22.
Sacks PL, Harvey RJ, Rimmer J, Gallagher RM, Sacks R. Topical and systemic antifungal therapy for the symptomatic treatment of chronic rhinosinusitis. Cochrane Database Syst Rev. 2011 Aug 10;(8):CD008263.
Review Date: 6/24/2013�
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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Get an overview of this hotel3-star hotel, walk to Hua Hin Railway Station
Collecting Nectar Points
Special Offer: Book by 2 August 2017 and collect double Nectar points!
Simply enter your Nectar card number when you check out. Your points will be credited 35 days after you return from your trip.
*Terms and conditions apply.
Popular property highlights
Situated in Hua Hin, this hotel is within a 10-minute walk of Hua Hin Shopping Mall and Hua Hin Railway Station. Hua Hin Night Market and Klai Kangwon Palace are also within 3 mi (5 km).
Hotel Features
Along with a rooftop terrace, this hotel has coffee/tea in a common area and concierge services. WiFi in public areas is free. Additionally, dry cleaning, a 24-hour front desk, and limo/town car service are onsite.
Room Amenities
All 16 rooms provide conveniences like sitting areas and refrigerators, plus free WiFi and LCD TVs with cable channels. Other amenities available to guests include balconies, free bottled water, and safes.Information missing or incorrect? Tell us!Opens in a new window
Hotel Alley
Hotel Amenities
Hotel Amenities
Hotel Alley features a rooftop terrace, tour/ticket assistance, and a garden. Wireless Internet access is complimentary. This Hua Hin hotel also offers coffee/tea in a common area, concierge services, and dry cleaning/laundry services.
Hotel Alley has designated areas for smoking.
- 24-hour front desk
- Total number of rooms - 16
- Number of floors - 4
- Breakfast available (surcharge)
- Coffee/tea in common areas
- Concierge services
- Dry cleaning/laundry service
- Designated smoking areas
- Tours/ticket assistance
- Free WiFi
- Limo or Town Car service available
- Rooftop terrace
- Garden
- Number of buildings/towers - 1
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Room Amenities
- Balcony
- Separate sitting area
- Air conditioning
- Phone
- Refrigerator
- Free bottled water
- Daily housekeeping
- Private bathroom
- Free toiletries
- Shower only
- Hair dryer (on request)
- In-room safe
- Desk
- Cable TV service
- Free WiFi
- Rollaway/extra beds (surcharge)
Nearby Things to Do
- Golfing nearby
Hotel Policies
Check-in time starts at 2 PM
Minimum check-in age is 18
Check-in time ends at 10 PM
Check-out time is noon
Payment types
Children and extra beds
- Children are welcome.
- Rollaway/extra beds are available for THB 700 per night.
- Cribs (infant beds) are not available.
- No pets or service animals allowed
You need to know
Extra-person charges may apply and vary depending on property policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
No cribs (infant beds) available
No elevators
No pets or service animals allowed
Optional extras
- Rollaway bed fee: THB 700 per night
Hotel Name
- Alley Hua Hin
- Hotel Alley
- Hotel Alley Hua Hin
We should mention
No pets and no service animals are allowed at this property.

subset: commoncrawl


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This is a mover property class. It works closely with 'pcmove.linear' and 'pcmove.actor.standard' in order to help in making higher level movement actions while checking collision detection along the way.
PcMover can be used when you want to control movement of an entity by specifying a point to move to.
Currently it has only one method to move to a certain point in the map, and another one to stop it, but it is possible that later other methods will be added.
PcMover depends on PcLinearMovement and PcActorMove property classes, so you need to create these on the entity or PcMover won't work.
With MoveTo an entity can be pointed to a certain point in some sector and it will try to move to the specified distance of the point. The method accepts an optional parameter to set whether to make an initial line of sight test before starting movement. If this test is activated and there is no direct line of sight to target point, then movement will be aborted.
Note this property class will test for arrival based only on x and z axis, to avoid entity never arriving due to entity center and destination not being in perfect alignment (which is easy due to the own entity body for example).
You can use MoveTo from API or as a cel action.
This method allows to manually interrupt some movement. After calling this, the mover will forget about what it was doing.
You can use Interrupt from API or as a cel action.
This property class can send the following messages to the behaviour.
pcmover_arrived: Will be sent when destination is reached.
pcmover_impossible: Sent when the (optional) initial line of sight test fails.
pcmover_interrupted: Sent if a new movement is started while another one is under way, or movement is manually interrupted using interrupt.
To define an entity that uses this property class we add a <propclass> stance to the entity or entity template <addon> section. Usually though, this property class will be added manually to entities, but there is nothing preventing you from creating this already in the map.
<addon entityname="FinalMonster" plugin="cel.addons.celentity"> <propclass name="pcobject.mesh"> <action name="SetMesh"> <par string="EvilMonster" name="name"/> </action> </propclass> <propclass name='pcmove.linear'> <action name='InitCDMesh'> <par float='10.0' name='percentage'/> </action> </propclass> <propclass name="pcmove.actor.standard" /> <propclass name="pcmove.mover" /> <behaviour layer="blpython" name="moverent"/> </addon>
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Swallows Wall Stickers
Product Description
These swallows wall stickers are perfect to create a vibrant ambience in any room of your house. Each swallow can be applied individually, leaving it to you to decide how much space they cover.
The pack contains 25 swallows in total, each swallow measuring on average 16cm x 16cm.
All of our wall decals/stickers are precision cut from our high grade low-tac self adhesive vinyl in the colour and direction of your choice. Supplied with detailed fitting instructions and pre-applied application tape to ensure transfer is made in no time, correctly and with ease.
Additional Information
|The Binary Box
|58 x 58 cm
The Binary Box
The Binary Box Wall StickersAs one of the original manufacturers and innovators of contemporary wall art in the UK with an ever growing exclusive range of high quality exciting and stylish designs we are able to offer a range of styles to complement your existing décor or create a bold new statement in your home. You'll find items for living rooms bedrooms children's rooms and even bathrooms. Created from specially selected high grade low-tac self-adhesive matte finish vinyl all of our products are quick and easy to apply to any flat interior surface (walls ceilings furniture windows mirrors etc.) and best of all are all fully removable for when it's time to make a change to a new brand new style! Our wall stickers will instantly transform any room by adding colour and style. Simple to apply in minutes all of our kits include full instructions and are easily removable. We have wall decals for kids rooms bathroom nursery and modern wall graphics for all tastes. All of our wall art can be produced in a variety of colours to suit your decor. We produce removable vinyl wall decals an exciting solution for styling the the look of your home at an affordable price. Our wall transfers are perfect to add a finishing touch or to create a full wall mural. How to Remove Wall Stickers 1. Getting Started: All you need is a hairdryer to remove our stickers. Start from one of the corners and heat up the vinyl for 30 seconds. 2. Peel off wallsticker slowly Once you have heated the corner start to peel this away from the wall very slowly keep moving the hair dryer to apply heat to the vinyl before you peel away any part of the sticker. Job done If your walls are not in the best condition or there are many layers of paint please take your time to ensure no paint flicks off the wall. If in doubt apply heat for a little longer and this will loosen up the adhesive even more.
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The original recipe was submitted by Frieda F. in the Greendale Church cookbook. I've increased the amount of dry mustard and decreased the sugar to suit our taste.
Mustard Sauce
- 2/3 cup sugar
- 1 Tbsp. dry mustard
- 4 eggs
- 1/4 cup vinegar
- 1 Tbsp. butter
- Mix dry ingredients first.
- Beat 4 eggs until lemon coloured and fluffy.
- Gradually add dry ingredients and vinegar.
- Microwave at high for 1 minute.
- Stir well.
- Continue to microwave at one minute intervals (I often use a lower power), stirring each time until mixture thickens but is still creamy. You will need to watch it carefully that it does not overcook. Do not allow it to bubble. When it overcooks it loses its creamy texture.
- Stir in butter and cool.
- Refrigerate until serving. Serve with baked ham.
Store any leftovers in the fridge. This is also delicious spread on ham or sausage sandwiches.
The second sauce is a favourite of our oldest son's. Because of the raisins in it I prefer to serve it when Plumamous is not on the menu.
Raisin Sauce
- 1/4 cup brown sugar
- 3 Tbsp. cornstarch
- 1 1/2 cups water (you can use some of the broth from the ham as part of the water. Just be aware that it will be somewhat salty)
- 1/4 cup vinegar
- 1/2 cup sultana raisins (washed)
- Juice and rind of 1/2 a lemon or orange
Add liquids and stir well.
- Blend dry ingredients in glass bowl or pot.
- Stir in raisins, juice and rind.
- Microwave at one minute intervals, stirring each time or cook over medium heat on stove.
- Cook until it thickens and begins to bubble.
- Serve warm with baked ham or roast pork.


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Cortisol levelSerum cortisol
A cortisol level is a blood test that measures the amount of cortisol, a steroid hormone produced by the adrenal gland.
How the Test is Performed
A blood sample is needed. For information on how this is done, see: Venipuncture
How to Prepare for the Test
Usually, the health care provider will ask that the test be done in the morning. This is important, because cortisol levels vary throughout the day.
The health care provider may ask you to stop taking drugs that can affect the test. Drugs that can increase cortisol measurements include:
- Estrogen
- Human-made (synthetic) glucocorticoids, such as prednisone and prednisolone
Drugs that can decrease cortisol measurements include:
- Androgens
- Phenytoin
How the Test Will Feel
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Why the Test is Performed
The test is done to check for increased or decreased cortisol production. Cortisol is a steroid hormone released from the adrenal gland in response to ACTH, a hormone from the pituitary gland in the brain.
Cortisol affects many different body systems. It plays a role in:
- Bone
- Circulatory system
- Immune system
- Metabolism of fats, carbohydrates, and protein
- Nervous system
- Stress responses
Different diseases, such as Cushing's disease and Addison's disease, can lead to either too much or too little production of cortisol. Cortisol levels are often measured to help diagnose these conditions and to evaluate how well the pituitary and adrenal glands are working.
Normal Results
Normal values for a blood sample taken at 8 in the morning are 6 - 23 micrograms per deciliter (mcg/dL).
The examples aboveare common measurements for results for these tests. Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or may test different specimens.Talk to your doctor about the meaning of your specific test results.
What Abnormal Results Mean
Higher than normal levels may indicate:
- The pituitary gland near the brain makes too much of the hormone ACTH (calledCushing's disease) because ofexcess growth of the pituitary gland, or a tumor in the pituitary gland or elsewhere in the body (such as the pancreas, lung, and thyroid)
- Tumor of the adrenal gland that is producing too much cortisol
- Tumor elsewhere in the body that produces cortisol
Lower than normal levels may indicate:
- Addison's disease, when the adrenal glands do not produce enough cortisol
- Hypopituitarism, when the pituitary gland does not signal the adrenal gland to produce enough cortisol
Other conditions under which the test may be performed:
- Acute adrenal crisis
- Ectopic Cushing's syndrome
- Pituitary Cushing's (Cushing's disease)
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
- Excessive bleeding
- Fainting or feeling light-headed
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
Normally, cortisol levels rise and fall during the day, repeating on a 24-hour cycle (diurnal variation). Highest levels are at about 6 - 8 a.m. and lowest levels are at about midnight.
Physical and emotional stress, as well as illness,can increase cortisol levels, because during the normal stress response the pituitary gland releases more ACTH.
Higher than normal cortisol levels are expected in women who take estrogen or birth control pills.
Stewart PM, Krone NP. The adrenal cortex. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011: chap 15.
Review Date: 12/11/2011
Reviewed By: Nancy J. Rennert, MD, Chief of Endocrinology & Diabetes, Norwalk Hospital, Associate Clinical Professor of Medicine, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.


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Italy 2006 W-Cup home goal keeper shirt in maroon long sleeve with faded blue design on each side.Features embroidered team badge in the center and heat transfer Puma logo at the left side ,right shoulder and at the left sleeve.100% polyester.
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Review Details
B-6 Sheepskin Jacket
- Product Review (submitted on July 23, 2010):
- I have received my jacket and am enjoying it very much. i never thought i would hope for cold weather, but the last few days have been chilly and excellent custom b6 jacket weather. your jacket has received many compliments and i am pleased with the quality, workmanship and custom modifications like the fore arm pocket. thank you for the excellent work.


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Course Descriptions
Department of Foreign Languages, Literatures and Cultures
Department of Justice Studies
Following most course titles and credit hours is the anticipated semester offering, indicating whether a course may be scheduled in the fall, spring or summer semester. This information is provided to help students plan their course schedules. The anticipated semester offering is not the same as the schedule of classes, and the semesters listed are indicative of when the courses may be offered, not a guarantee that the course will be available every semester listed.
A G in bold and italics or an asterisk (*) preceding the course prefix and number indicates a course which potentially meets general education requirements. (If the course is part of a course sequence, the asterisk appears after the appropriate course's prefix and number.) See General Education information.
If a course has a separate laboratory period, the number of lecture hours and the number of laboratory hours per week will be shown in parentheses immediately following the course title.


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Alright ladies, let's talk about sex. Blushing yet? Here are the answers to 11 of your most embarrassing sex questions.
Get the nutrients your body needs in just the right amount.
Which foods aggravate your bladder the most? Find out now.
10 common culprits of daytime fatigue.
Dim the lights and break out the…eggs? These 10 foods will kick your sex drive into high gear.
Is the PS3 the new Prozac … or causing ADHD in your kid?


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Dr. Kristina M. Ropella is the Opus Dean of the Opus College of Engineering. She received her bachelor's degree in biomedical engineering from Marquette in 1985 and earned master's and doctoral degrees from Northwestern University. She returned to Marquette and joined the biomedical engineering faculty in 1990 and served as the chair of the Department of Biomedical Engineering from 2004–2013, when she was named the executive associate dean.
Ropella has focused her research and teaching career on biosignal processing, bioinstrumentation and medical imaging. Currently, her lab is developing clinical applications of functional magnetic resonance imaging, including presurgical planning and evaluation of rehabilitative outcomes after injury or pathology. She is collaborating with the Medical College of Wisconsin to use her fMRI research results to improve the tool's clinical uses. Her work has been funded by the National Institutes of Health, the Ralph and Marion Falk Medical Research Trust, the National Science Foundation, the Department of Education, the Whitaker Foundation, and MCW.
Ropella has taught a variety of undergraduate and graduate classes, including Introduction to Biomedical Engineering Methods, the Art and Business of Science, Advanced Biomedical Signal Processing, Computer Applications in Biomedical Engineering, and Statistics for Biomedical Engineers. She is co-director of the Functional Imaging doctorate program, jointly offered with MCW. She has twice received the college's Outstanding Teacher Award (1994 and 2002); received the university Faculty Award for Teaching Excellence (2002); and was named the Wisconsin U.S. Professor of the Year by the Carnegie Foundation for the Advancement of Teaching and the Council for Advancement and Support for Education (2007). Among other honors, she was the recipient of the Milwaukee Business Journal's "40 Under 40" (2000) and Women of Influence (2008) awards. She is a fellow of the American Institute for Medical and Biological Engineering and is currently serving on its board of directors. She has served on other national boards, including the Biomedical Engineering Society, the Council of Chairs in Biomedical Engineering, and the IEEE Engineering in Medicine and Biology Society.


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10 Items You Can Buy For Fall and Wear Forever
With 44 international editions, ELLE sends a veritable army of well-dressed ambassadors out into the global fashion fray—and one of our most watched is the fantastically named Leaf Greener. Beloved by street-style shutterbugs Garance Doré and Tommy Ton, the 30-year-old Beijing native's look blends outré pieces (a chartreuse Diana Broussard chain collar is a staple) with sporty schoolgirl basics, mixing local finds with American and European designer pieces. Here, Greener breaks it down for her U.S. counterparts.
Greener's take on the between-season suit? The subtle clash of a houndstooth Dior top and purse and glen plaid Boy by Band of Outsiders shorts. Add to that a pair of ultrachunky Céline wedges, an Estelle Dévé choker, and a beloved $80 metal-and-pottery animal-head ring from Taiwanese design studio Haoshi.
The Only Shoe You'll Ever Need and How to Wear It: 1 Black Bootie, 6 Ways


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K-State Equestrian Announces 2013 Recruiting Class
K-State Equestrian Announces 2013 Recruiting Class
Nov. 23, 2012
MANHATTAN, Kan. - Kansas State head coach Casie Maxwell has announced the signing of five new Wildcat riders for the 2013-14 season. Henley Adkins, Tori Bentley, Alexis Graves, Alyssa Lombardi, and Katie Ramsey have all signed National Letters of Intent (NLIs) during the early signing period and will join the Wildcat family in 2013-14 as freshmen.
"These 5 riders will add tremendous athletic and academic depth to our existing roster," said Maxwell about her new additions. "They hold tremendous pride in their academics, have a passion for riding and competition, and loved the K-State family experience, all which I believe will make them great additions to our program. We are excited about their wealth of experience in the arena and expect them to be impact players for our team."
A native of Moorpark, Calif., Adkins joins the Wildcats as a Hunter Seat rider looking to bolster K-State's lineup. In 2012, Adkins earned the reserve championship in the Ronnie W. Mutch Equitation Championship, as well as qualifying for the USEF Pessoa Hunter Seat Medal Finals, the USEF Talent Search Finals (West) and the ASPCA National Maclay Finals. She was also the USHJA nominee for the 2012 USEF Sportsman's Award and a nominee for the 2012 Junior Equestrian of the Year.
During 2011, Adkins was a national finalist in the EAP, as well as in the ASPCA National Maclay Finals. She also took home the LAHJA Equitation Championship and Overall High Point Championship in 2009, along with the SFHJA Overall High Point Reserve Championship, the LAHJA Horsemanship Medal Final Championship and the Dorothy Groth Sportsmanship Award. In addition to her impressive record on the back of a horse, Adkins boasts a 4.0 GPA, and she has been a member of Moorpark High School's honor roll from 2009 through 2012 as well as a member of the National Honor Society in 2011 and 2012.
Bentley comes to K-State via Milton, Ga., and will join the team as a Hunter Seat rider. In 2012, she qualified and competed at the Platinum Performance Talent Search Finals (East) and earned the bronze medal of distinction, as well as qualifying for the 2012 Hunterdon Cup. In 2011 and 2012, Bentley qualified and competed in both the USEF Pessoa Hunter Seat Medal Finals and the ASPCA Maclay Regional Finals. She has also boasted a high ranking in the Washington International Horse Show Equitation Standings (East) as well as being an EAP qualifier.
Bentley serves as the Junior President of the Georgia Hunter Jumper Association. She is a member of the National Society of High School Scholars, has earned a 3.70 GPA as well as competes as a member of her high school's varsity swim team. Bentley's parents, Rob and Laura Bentley were both All-American tennis players at Appalachian State University in 1982.
Graves will be joining the Wildcats from Coto de Caza, Calif., and will add talent to the Hunter Seat squad. In 2012, Graves rode her way to a win in the 2012 ASPCA Maclay Regional Finals (Zone 10) as well as earning a fourth-ranked standing in the Washington International Horse Show Equitation Standings (West). Graves also qualified and competed at the USEF Pessoa Hunter Seat Medal Finals and the ASPCA Maclay National Finals in 2012, along with earning a fifth-place finish at the 2012 CPHA Junior Medal Finals.
In 2011, she finished eighth in the ASPCA Maclay Regional Finals (Zone 10), fourth in the CPHA Foundation Finals and third in the CPHA Junior Finals. As a young equestrian, Graves boasted many top placings in regional equitation championships as well as top finishes at AA rated horse shows up and down the West Coast.
Hailing from Frankfort, Ill., Lombardi will add depth to K-State's Horsemanship side. Lombardi is currently top 10 in the Nation in Youth Hunt Seat Equitation and has been named the 2012 LLQHA Youth 14-18 Year End All-Around Champion, while earning the 14-18 All-Around Champion award in 2011 for both the LLQHA and ILQHA. In 2011 she earned a Youth AQHA Championship and finished 5th in the Nation for limited rider Hunt Seat Equitation. To date she has earned 2 Superiors, 26 AQHA All-Around titles and 18 AQHA Reserve All-Around titles to date. She has accumulated over 430 AQHA points in her career, qualified for the AQHYA World Show multiple times, and has multiple top 10 finishes in Horsemanship, Equitation, and Trail at the Quarter Horse Congress. Outside of the arena, Alyssa has held many ILQHYA officer positions and is currently the Region 3 Director for AQHYA. She will serve as the 2013 President elect for ILQHYA. In addition to her riding highlights, Alyssa maintains a 3.60 GPA and participates in the History and Math Honors Society at her high school.
A product of Mount Juliet, Tenn., Ramsey will join the Wildcats' Hunter seat squad. In 2012, she earned impressive placings in the 15-17 Large Junior Hunter divisions at the Pennsylvania National Horse Show and the Washington International Horse Show. Ramsey also qualified and competed at the 2012 USEF Pessoa Hunt Seat Medal Finals and the ASPCA Maclay Regional Finals. In 2011, she was the NAL High Point Children's Hunter Rider. Ramsey was
the 2008 USEF National Champion in the Medium Green Pony Hunters and was the 2009 National Reserve Champion in the Medium Pony Hunters.
Throughout her career, she has earned top finishes at the Pennsylvania National Horse Show, the Washington International Horse Show, USEF Pony Finals and AA horse shows nationwide in the Junior Hunters, Children's jumpers, Equitation and Pony Hunters. Academically, Ramsey has been named to the President's List all 4 years of high school and is a member of the National Honor Society and Key Club.
The Wildcats finished the 2012-13 fall season with an overall record of 6-2. K-State will kick-off the spring season on Feb. 1, when the Wildcats travel to Fresno, Calif., for a pair of meets against Fresno State and Auburn.
– k-statesports.com –


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Tariff Download Facility
user guide
Welcome to the Tariff Download Facility
This database contains comprehensive information on Most- Favoured-Nation (MFN) applied and bound tariffs at the standard codes of the Harmonized System (HS) for all WTO Members. When available, it also provides data at the HS subheading level on non-MFN applied tariff regimes which a country grants to its export partners. This information is sourced from submissions made to the WTO Integrated Data Base (IDB) for applied tariffs and imports and from the Consolidated Tariff Schedules (CTS) database for the bound duties of all WTO Members.
The information contained in this database complements the summary tariff statistics published in the
World Tariff Profiles
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Users interested in more detailed information and analytical features can consult the WTO's
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for those RTAs that have been notified to the WTO.
Refer to
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A bungled attempt to woo Bob Carr to Canberra to serve as foreign minister has raised fresh concerns about Julia Gillard's authority, just days after her resounding victory in the leadership ballot.
Mr Carr, the former NSW premier, confirmed yesterday that he had been approached to fill the Senate vacancy created by the resignation of Mark Arbib, and that the offer included him serving as the minister for foreign affairs. The offer, he said, was made by ''party officers'', not Ms Gillard.
Fairfax online revealed on Tuesday that the offer was made by the NSW Labor general-secretary, Sam Dastyari, who rang Mr Carr after learning of Senator Arbib's resignation. Both the defence and foreign affairs portfolios were discussed and Mr Carr stipulated he wanted foreign affairs.
Mr Dastyari passed on to Ms Gillard's office that Mr Carr was interested and on Monday night, Ms Gillard rang Mr Carr ''two or three times''. A source said Ms Gillard did not have to repeat the offer because there was an implicit understanding that Mr Carr would be given foreign affairs.
His drafting had the support of senior ministers, including the Treasurer, Wayne Swan, and the Finance Minister, Penny Wong, but was withdrawn on Tuesday morning amid internal objections.
Mr Carr, who was on standby to fly to Canberra for an announcement, was told by Mr Swan that the Defence Minister, Stephen Smith, who was offered foreign affairs after Kevin Rudd resigned, resisted stepping aside.
In a statement last night, Mr Smith did not deny that he objected to Mr Carr's drafting.
In response to a direct question, his spokesman said only that portfolios were ''entirely a matter for the Prime Minister''.
There was deep frustration in Labor yesterday that so soon after the leadership ballot, the government was mired in another mess of its own making.
''This was an unalloyed good news story and we've managed to f--- it up,'' said a minister.
One MP who strongly backed Mr Rudd on Monday threw his hands in the air. ''Can't blame Rudd for this one,'' he said.
At first yesterday, Ms Gillard rejected that she had been rolled by the objections of Mr Smith and others. ''Of course my door is open to talk to people as I work my way through the reshuffle but the decisions are mine and I'll make them,'' she said.
After Mr Carr confirmed he had been made an offer, Ms Gillard, under questioning from the opposition foreign affairs spokeswoman, Julie Bishop, said: ''Don't believe everything you read''.
Tony Abbott said Ms Gillard's newfound leadership authority had lasted just 24 hours.
''It's like being beaten up by Clark Kent,'' he said of her bowing to Mr Smith.


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The new site, which can be accessed from the main New Jersey State website, includes the following sections:
· Following the First Lady, chronicling the first lady's visits to businesses and organizations throughout the state;
· Mary Pat's Favorite Things, featuring some of the first lady's favorite things from museums, restaurants and other Garden State attractions;
· Photo Gallery, displaying images from events attended by Mrs. Christie;
· Links to Sites Highlighting Jersey Pride;
o Drumthwacket, the Governor's official residence and nationally recognized house museum that is also listed on the National Register of Historic Places;
o The New Jersey Hall of Fame, honoring and recognizing New Jersey citizens who have made invaluable contributions to society and the world beyond; and
o New Jersey Fresh, promoting Jersey produced products that can be found at roadside markets, u-pick-it farms and agritourism events.
"I've met and been inspired by so many people who are impacting New Jersey in their own unique way – big and small. I hope that everyone will take the time to visit this site regularly to learn more about the good work that's going on in our state," added Mrs. Christie.
# # #
Press Contact:
Michael Drewniak
Kevin Roberts


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Jed Rodrigues Pereira, MSW, LCSW, LCADC
Licensed addiction specialist and licensed Couples Counselor
6 Shore Road, Linwood, New Jersey 08221
With my experience in my Rabbinical work, and my practice, I will mediate all family issues, and quickly address all components that require attention. I have had tremendous success with family therapy, in which the family attends a session and through my therapy method, are able to reveal their inner emotions. I have counseled many families in my office, and have saved entire families from falling apart.


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NEW HAVEN, Conn. - The University of Pennsylvania women's golf team showed its potential this weekend at the Yale Fall Intercollegiate, with a lineup featuring four freshmen placing third out of 17 teams.
Of particuar note, Penn shot 293 in Saturday's second round, tying the program record for team score in a round. The only non-freshman in the lineup, junior Amanda Chin, carved up the course and tied for second overall while carding a 69 on Saturday. Marissa Kay had a 71 on Saturday, while Isabella Rahm and Franchesca de la Torre carded 74s on different days. Sophia Chen, meanwhile, went as lowas 76 twice on the weekend.
Host Yale won the team title, carding 292-292-290--874 to defeat second-place Xavier by 19 strokes. Penn was third (304-293-302--899), followed by Seton Hall (903) and Boston University (907).
Chin finished the tournament at 75-69-74--218. Kay ended up tying for 16th in the field, shooting 79-71-76--226, while Rahm carded 74-77-78--229 and tied for 21st. Chen shot 76-76-80--232 and tied for 29th in the field, while de la Torre shot 80 and 84 before tying for low Penn honors on Sunday with her 74. She finished the tournament at 238, tying for 47th.
Yale's Elisabeth Bernabe won the individual title; she shot 69-72-73--214 to defeat Chin and teammate Seo Hee Moon by four strokes.
Penn returns to tournament action October 13-14 at the Harvard Invitational.
Download: 2 - Yale Fall Intercollegiate.pdf


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This bastion of traditional Burgundy has probably never made a heavy wine, and this bottle fit the Truchot paradigm to a T.
Subtle, silky red fruit encased in earth. Balanced, light on its feet, yet persistent in flavor and gorgeous in texture. No trace of 2004s green elements, just Truchot Burgundy. Amazing wine.


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Artist's Biography"A New Star Vibist," as he has been trumpeted by Jazztimes, Jon Metzger has developed an international presence through extensive touring, recording, and lecturing. A winner of a National
Endowment for the Arts Fellowship Grant for Performance, he has appeared at well-known jazz venues across the United States and has led his quartet on tours of Germany, Italy, Holland, Belgium, and Austria. He has played for kings and queens and other heads of state while serving as a jazz ambassador to more than 20 foreign countries in the Near East, Northern and Sub-Sahara Africa, and Central America under the auspices of the United States Information Agency's Arts America Program. He has also performed at the Spoleto Festival, both in Spoleto, Italy and Charleston, South Carolina; appeared at the East Coast Jazz Festival in Washington, DC; dueled vibes with Lionel Hampton at the Jazzfest Festival in Kingston, Jamaica; performed with Gunther Schuller as part of the American Composers Series at Strathmore Hall Arts Center (Maryland); and been featured in the Martin Williams Jazz Concert Series at the Kennedy Center.
His seven recordings as a leader have received widespread airplay and critical acclaim. The Washington Post called his release Into the Light "music that simultaneously appeals to the head, heart, and feet," while Jazztimes added "Metzger's musicianship shines," and Cadence concluded "Metzger is a flawless vibraphonist." On these releases Metzger was joined by Fred Hersch, Phil Markowitz, Marc Johnson, Harvie Swartz, Joey Baron, Jack Wilkins, and Allison Miller, among others. He has appeared on dozens of other recordings including six CDs with vocalist Ronnie Wells and pianist Ron Elliston (one was a Cadence top ten jazz release choice), Iris Benjamin's Passing By, and the NC Jazz Repertory Orchestra's Benny Goodman Swing Collection. He was also the first artist profiled on the Southern Arts Federation's landmark Jazz South radio program and is now the only artist selected more than once.
Metzger has conducted masterclasses from Boston's Berklee College and the University of North Texas to the University of North Florida and CAL Arts and has lectured at the Smithsonian Institution. He has also given many clinics at the Percussive Arts Society's International Convention and the International Association of Jazz Educators Conference. He has been endorsed for 17 years by the vibraphone manufacturer Musser which offers subsidies for his clinic appearances. His numerous articles have appeared in Percussive Notes, Jazz Player Magazine, and Sticks & Mallets Magazine. His many works for percussion are published by C. Alan Publications, and his 366-page method book, The Art and Language of Jazz Vibes (EPM), is considered the standard in the industry. Now the Artist in Residence and Associate Professor of Music at Elon University, where he was presented with the coveted Distinguished Scholar Award, he also currently serves as the Associate Editor of the International Association of Jazz Educators' Journal. Metzger, 46, holds both Bachelor and Master of Music degrees from the North Carolina School of the Arts. Originally from the Washington, DC area, he lives with his wife, Linda, and their basset hound in North Carolina.


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The Who's Roger Daltrey reflects on 'Tommy'
Listen to The Who on iHeartRadio
The Who's new "super deluxe" edition of "Tommy" arrives in stores Monday.
The latest version of the band's 1968 rock opera includes the digitally remastered original album, along with a disc of 20 never-before released demos from the project and a live performance cobbled together from different shows The Who played back in 1969.
Frontman Roger Daltrey tells Billboard.com the demos allow listeners to hear the evolution of the songs, and how the other band members put their own "personalities" into Pete Townshend's compositions. He adds that when The Who played "Tommy" in concert, it "gained a different power altogether."
Roger explains that the group wouldn't let the audience interrupt the performance with applause after each song, so at the end "the reaction was extraordinary" because it had been bottled up and building throughout the show.
Daltrey admits "Tommy" seems to "rear its head every four or five years for some reason," but it's "always good." The singer says each time he revisits the project he hears something new in it. He adds that "as the years go by it means different things." Another "Tommy" related release will arrive early next year.
The BBC recently aired the new documentary Sensation - The Story of Tommy, which will arrive on DVD in March.
Photo Credit Getty Images


text:
Van Morrison receives hometown's highest honor
Listen to Van Morrison on iHeartRadio
Van Morrison is being recognized by his hometown.
The rock legend was honored on Friday with the Freedom of the City award at an event in Belfast, Northern Ireland.
The "Belfast Telegraph" says in presenting the award, the city's Lord Mayor described the singer as one of Belfast's greatest stars. He also quoted Morrison's lyrics in saying the honor represents the local residents' "love, respect and gratitude for Van Morrison from the 'dark side of the street to the bright side of the road.'"
Morrison also played a special concert as part of the ceremony, after receiving a special scroll and a gold key.
He's just the second person in the past ten years to be given Belfast's Freedom of the City award.
Photo Credit Getty Images


text:
Our officials cannot escape their responsibility, and they should not evade it.
Our mockery of celebworld helps us evade the soul-crushing decadence concealed within.
One gets the sense that they are wearing a mask to confuse their readers, and even to evade them.
I can imagine exactly how I'd use them: to evade government surveillance of my financial transactions.
Every human being is in the ring staring down the bull, trying to evade, conquer, and kill.
So he began to resist her with the more pleasure that he could at least evade her questions.
It is not altogether suspicion, but she really does evade his glance.
How can I evade its ghastly grip, how keep myself from suicide, from the desperate hankering after death?
Our policy is to evade a peril we cannot control or destroy.
But in trying to evade Tom's crashing right hand, he missed his shot and was grazed by Tom's fist.


text:
PHILADELPHIA - A winning streak will come to an end on Wednesday at The Palestra. On Saturday, Penn (3-2) won its third straight game—in a span of six days—with a decisive road win at Bucknell. The Quakers will now host the Bison's conference rival Army (7-1), which has won seven straight. Tip off is at 7 p.m. and the game can be seen on The Penn Sports Network.
Catching the Game
If you can't make it out to The Palestra, fans can watch the game on the Penn Sports Network as part of the Ivy League Digital Network. Live stats can be found at PennAthletics.com and live twitter updates (@PennWBB) are also available throughout the contest. A complete recap and box score can then be found at PennAthletics.com shortly after the conclusion of the game.
In the Series vs. Army
These teams are meeting for the fourth straight season. The home team has won each of the previous three years and four straight in this series. The Quakers lost in West Point in 2010 and 2012, but topped the Black Knights at The Palestra in 2011. All three of those games were decided by 10 points or less. Overall, the Quakers lead the all-time series, 4-3, and are 2-1 at home against Army—the only loss came in 1981.
About the Black Knights
Army lost its season opener to St. Francis Brooklyn—its only common opponent with Penn—by a similar score. The Quakers lost 56-51 at home and Black Knights fell 56-53 on the road. Army has since won seven straight games. All but one of those games came at home, including a two-point win over Brown. Army allows just 55.8 points per game—second-fewest in the 10-team Patriot League and holds opponents to a league-low 34.3 shooting percentage. The Black Knights are also second in rebounding and three-point defense. Offensively, Army boast the PL's top field goal percentage (.438) and is second in three-point percentage (.388). Kelsey Minato leads the Patriot League in scoring with 18.5 points per game and has a team-high 27 assists. She shoots 94.1 percent from the charity stripe and 44.4 percent from beyond the arc. Olivia Schretzman is tops among the Black Knights with 8.0 rebounds per contest. Aimee Oertner is second in the league with a team-best 55.6 field goal percentage and 18 blocks. Jen Hazlett leads the team with 10 steals.
Against the Patriot League
In the four-plus seasons under head coach Mike McLaughlin, the Quakers are 5-5 against Patriot League foes, including Saturday's eight-point road win at Bucknell. Penn has now won four of the last five since 2011 with the only loss in that span coming at Army last season (58-53).
Tough Start
Though the Quakers started 0-2, they have faced some tough competition. Entering Wednesday night, Penn's first two opponents this season are a combined 15-2. St. Francis Brooklyn is 7-2 and its only two losses are to BCS opponents in St. John's and Miami (Fla.). No. 4/5 Notre Dame is undefeated through eight games.
Best Start
Despite that challenging start to the season, the Quakers have a chance to match the best six-game start in program history. Currently at 3-2, the Quakers are a win away from matching the 1980-81 and 2011-12 teams for that distinction.
Winning Ways
In head coach Mike McLaughlin's first season at the helm of the Quakers, Penn won just two games. But the Quakers have set a program record by improving their record in three consecutive years - which led to the second-most wins in program history last year. Since that two-win season, the Red and Blue have had six different winning streaks of three or more games, including a high of six games (all against Ivy opponents) last season.
Decembers to Remember
The holiday season has been kind to the Quakers under head coach Mike McLaughlin. Penn has won five straight games in December and eight of the last nine (and 11 of the last 13). In contrast, the Red and Blue were 1-5 in November over the last two years.
Penn Trends
After the win over LIU Brooklyn, Penn remains undefeated on Thursdays under fifth-year head coach Mike McLaughlin (5-0) ... Penn is 3-0 this year when Alyssa Baron leads the team in scoring ... The Quakers have had at least two players score in double figures in every game this year ... Penn has had three different leading rebounders in the last three games ... The Quakers have won 12 straight games when they have outrebound their opponent ... Alyssa Baron has started 92 consecutive games for the Quakers ... Penn is 9-1 under Coach McLaughlin when scoring more than 70 points (only loss came in double overtime, 88-84, at Harvard in 2011).
Magic Number: 60
The statistic that may most indicate a Penn win or loss? 60 points. Since head coach Mike McLaughlin took over at Penn, the Quakers are 30-8 (.789) when they score 60 points, including 2-0 this season. In comparison, the Quakers are just 16-65 (.198) when they've scored less than 60 points under Coach McLaughlin. The trend continues defensively. Over the last four seasons, the Red and Blue are 9-44 (.170) when allowing more than 60 points. But when holding opponents under that number, the Quakers hold a winning record of 37-29 (.561).
Co-Ivy and Big 5 Player of the Week
Senior captain Alyssa Baron, who became the fourth player in program history to reach 1,400 career points at La Salle, led Penn in scoring in all three games last week to help propel the Quakers to three wins in six days. For the week, the Miami, Fla., native averaged 18.7 points, 4.3 rebounds, 3.0 steals, 2.7 assists, and shot 50.0% from the field and 94.7% from the free throw line. For her efforts she was namedCo-Ivy League Player of the Week and Co-Big 5 Player of the Week by the respective league offices on Monday.
A Penn Win Would...
... be the fourth straight overall.
... match the program's best six-game start at 4-2.
... mark the third straight at home against Army.
A Penn Loss Would...
... be the second straight to Army and third in last four years.
... be the first at home to Army since 1981.
... make the Quakers 3-3 overall.
... be less good than a win.
Last Time Out
A big effort from a big frontcourt propelled Penn to a big road win over Bucknell, 69-61, at Sojka Pavilion on Saturday afternoon. Freshman forward Sydney Stipanovich posted her first collegiate double-double with 15 points and 11 rebounds - both career highs. Meanwhile, junior forward Kara Bonenberger poured in another 16 points as the duo guided Penn to its third straight win. It was an up-tempo game from the start as Bucknell pushed the pace. The teams traded baskets through the first 10 minutes and Bucknell led 16-13. But the Bison went the next 18 minutes without a field goal. Penn capitalized. With the score tied at 19-19, Penn went on a 28-4 run. They ended the first half with 13 of the last 17 points for a 32-23 lead at the break, then scored the first 15 of the second half. Bucknell trailed by 24, but got within six late. The Quakers staved off the Bison though.
Up Next
Finals. The Quakers have 10 days until their next game, but will be busy as student-athletes. Leading into the City Six matchup with Drexel on Saturday, Dec. 21, Penn will have Finals week. The Battle for 33rd Street tips off at 2 p.m. at The Palestra and can be seen on the Penn Sports Network.
Download: 5-Army.pdf


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|Re: Ks.cfg and XFS
|Eric Sandeen <sandeen@xxxxxxx>
|Mon, 28 Jan 2002 16:06:22 -0600 (CST)
On Fri, 25 Jan 2002, Tony Vickers wrote: > I had to reinstall the build system. So I used SGI's XFS installer along > with RH 7.2's disc #1,#2. So Yes I do have the full XFS stuff. As far as > coping the XFS CD-ROM files last how can you make sure this happens? How to make sure? Just copy the files off the XFS cd last. I don't know what kind of setup you have for your kickstart source - is it a network source, or are you using local CDs, or...? > looked at the Rev number on the XFS files and they are newer. So if I were It's not the RPM files that matter so much as the install run-time files. You can have extra RPMs lying around, as long as you have the xfs installer bits, it will use the right RPMs. > to assume that the system is smart to use the latest file would I be right? > Is it also possible that I got by chance a ISO file when I downloaded it > from SGI? I'm not sure what you mean by this. > This is off topic, but, is there a doc on how to make the same type of BOOT > CD that SGI uses? Not really. We had to dig around in the anaconda source to figure it out. There was a thread on the red hat kickstart-list a while ago that might help, if you check the archives. -Eric p.s. the reiser folks had an easier time of it since reiserfs support is already in the kernel...
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text:
Meat & Moustaches
CrossFit Ethos
Thursday, November 15, 2012 from 7:00 PM to 11:30 PM (PST)
On November 15th, CrossFit Ethos will be hosting our first annual "Meat & Mustaches," gala event, in support of Movember and prostate cancer awareness month, at Brü Grill & Market in Lake Forest. Tickets must be purchased in advance and will include dinner, one beer, a t-shirt, a kick ass take home bag and a night filled with more fun than anyone should reasonably have in the span of just a couple of hours. Come dressed for a night of high class mustachioed fun complete with a silent auction, raffle, music and really cool people. See you there!
In order to purchase these tickets in installments, you'll need an Eventbrite account. Log in or sign up for a free account to continue.


text: MAKE readers, meet Sean Charlesworth. That's him on the left right, beside the gorgeously elaborate 3D-printed model—the OctoPod Underwater Salvage Vehicle 5 (OPUS V)—that he designed, printed, and assembled, over the course of six months, in fulfillment of the thesis requirement for his recent master's in Digital Imaging and Design. Parts were designed in Cinema 4D and Maya, and printed on an Objet Connex500 multi-material polymer photojet 3D printer. Many more details are availabe in Goli's recent interview with Sean, and if you're coming to Maker Faire New York, you can chat with Sean and/or the Octopod, in person, over in the "3D Printer Village" in Zone B.


text:
Krissy Evans is a good girl. She always has been. Until...
In These Arms
- by ninarose
- Rating:
- Published: 5 Dec 2014
- Updated: 5 May 2016
- Status: In Progress
Bella is your typical teenage girl, sure she has her ups and downs but that's besides the point. She is happily living in the UK with her loving parents and her big sister Amy who is more like her best friend. With good grades, plenty of friends and a boyfriend, Bella's life couldn't be more complete. She soon discovers that life is never that easy. Upon learning the death of her sister Amy who was tragically killed in a car accident, Bella's life starts spiralling out of control. Between moving countries and adjusting to a new school, Bella struggles to move forward with the loss of her sister. Her cousin Scott who has always been more of a brother is thrilled to have her living in America which is where her parents decided to relocate. He soon discovers that she is not the same bubbly and happy girl she used to be. Can he get her to open up and attempt to put her broken heart back together? Or can Scott's best friend Liam who takes a shine to Bella help her through her grievance? I
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Results 1 to 1 of 1
Thread: Meeting Frank Feldman
Meeting Frank Feldman
A man walks out to the street and catches a taxi just going by. He gets into the taxi, and the cabbie says, 'Perfect timing. You're just like Frank.
Passenger: 'Who?'
Cabbie: 'Frank Feldman. He's a guy who did everything right all the time. Like my coming along when you needed a cab, things happened like that to Frank Feldman every single time.'
Passenger: 'There are always a few clouds over everybody.'
Cabbie: 'Not Frank Feldman. He was a terrific athlete. He could have won the Grand-Slam at tennis. He could golf with the pros. He sang like an opera baritone and danced like a Broadway star and you should have heard him play the piano. He was an amazing guy.'
Passenger: Sounds like he was something really special.
Cabbie: 'There's more. He had a memory like a computer. He remembered everybody's birthday. He knew all about wine, which foods to order and which fork to eat them with. He could fix anything. Not like me. I change a fuse and the whole street blacks out. But Frank Feldman, could do everything right.
Passenger: 'Wow, some guy then.'
Cabbie: 'He always knew the quickest way to go in traffic and avoid traffic jams. Not like me, I always seem to get stuck in them. But Frank, he never made a mistake, and he really knew how to treat a woman and make her feel good. He would never answer her back even if she was in the wrong; and his clothing was always immaculate, shoes highly polished too - He was the perfect man! He never made a mistake. No one could ever measure up to Frank Feldman.'
Passenger: 'An amazing fellow. How did you meet him?'
Cabbie: 'Well, I never actually met Frank, he died and I married his f...ing widow!
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