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Free Health Essays - Nursing, Media And The Public Attitudes And Perceptions Of Infection Control And Infection Control Nurses In Hospitals
For a healthcare professional working in the NHS of today, it is virtually impossible to be unaware of the high public profile that MRSA has in the media generally. It clearly has to be accepted that some of the media have a political agenda in keeping such issues in the public domain, and others may feel that they are providing a genuine public service by raising it's profile.
There are indeed some healthcare professionals who point out - possibly with some justification - that the issue of MRSA per se. does not actually justify this high level of public concern, particularly when it is compared with other potential difficulties that could beset a hospitalised patient. It is generally conceded that iatrogenic problems are a significant danger to patients in hospital. (Public Health Laboratory Service 2002)
To some extent, MRSA can be considered the public face of the bigger issue of Healthcare associated infections (HCAIs). Newspapers will refer to the problem of MRSA on our wards when it is, in reality, only a partial aspect of the whole issue of the problem of cross-contamination of patients. (Hiramatsu 1997)
This dissertation sets out to explore all of the viewpoints by examining the literature and critically assessing their justification and validity.
The first issue that we need to explore is that of verified incidence. The Government, through the Department of Health, commissioned an investigation to look at aspects of NHS expenditure. (Public Accounts Committee 2000). This committee came to the conclusion that HCAI's already account for over 8% of all of the acute hospital admissions in the UK.
This fact alone has a number of direct sequelae, not least of which is the prolongation of a patients stay in hospital, with all its attendant costs. It also follows that if infected patients have to stay in hospital longer then this must inevitably increase the likelihood of other patients contracting HCAI's themselves. (Centers for Disease Control and Prevention 2001).The same study gives us other information in this regard. it costs the financial burden at about 1 billion and also equates this with about 3.6 million bed-days lost
The history of HCAI's
Hippocrates made the relatively profound statement that If you wish to become a physician, always follow the maxim, first do no harm (Carrick 2000). It is obviously the case that modern medicine bears little resemblance to that practised two millennia ago, but the maxim clearly still applies.
Nearer to the present day, Florence Nightingale paraphrased Hippocrates' words with the phrase "It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm". (Nightingale F 1859). In the context of this dissertation her words were particularly poignant as she was referring to the infections that were rife in her hospital due to the sanitary arrangements.
At almost exactly the same time that Nightingale was writing, on the other side of Europe, Dr Ignaz Semmelweis (Semmelweis,1861) was coming to the realisation that it was hospital staff who were largely responsible for the dreadful death toll of puerperal fever in the maternity units that he was responsible for. His seminal observation was that puerperal fever claimed the lives of 25% of the mothers who delivered in hospital but only 5% of those who delivered at home. (Playfair,1847).
By a complex series of exclusion experiments he was able to discover that by getting the hospital staff to wash their hands between seeing the patients he reduced the death rate by a staggering 96%. In a measure that echoes across the centuries, his insistence on all his colleagues washing their hands between patients made him very unpopular and subsequently marginalised by his clinical colleagues. (Birte Twisselmann 2003)
What is the actual documented position
For reasons outlined above, we clearly can't turn to the media for an accurate representation of the actual size of the current problem. One of the most authoritative of recent papers on the subject is by Cooper (et al 2004) who provided a fairly comprehensive literature search. Their prime objective was to consider the effectiveness of the various methods of containment of MRSA infection in a hospital setting. The paper actually gives us a great deal of useful information. It points to the fact that, on a global scale, the incidence of MRSA continues to rise. (Turnidge et al 2000)
The National Audit Office report (2004)equally gives us a slightly more detailed picture. It shows that figures clollected from the Dept. of Health's own mandatory reporting system had indicated that there was an 8% increase in Staph Aureus infections between 2002 and 2004, of which 40% were MRSA infections - the 2004 figures almost reaching 20,000 infected patients. This actually makes the rate of infection in the England amongst the worst in Europe. (Cuevas et al 2004)
Other sources quote the UK infection rate as being about 30,000 hospital acquired infections per year (Morton et al 2003) which they quote as being representative of a 9% infection rate. They also add the information that, of these, about 5,000 will die. It is important to make the distinction that the authors do not suggest that the 5,000 who will die, will do so as a result of the MRSA infection. There is the other element that patients who are severely debilitated (and therefore at greater risk of dying) are more likely to contract MRSA. (Alvarez et al 1985)
How to control the spread of HCAI's
There have been three major types of intervention to try to limit the spread of the HCAI's :
Hand hygiene among healthcare workers, (Donowitz LG. 1987)
Restriction of antibiotics, (Morris AH 2002)
Detection and isolation of infected or colonised patients. (Graham M. 1990),
Most of the current national guidelines tend to specify the latter as the single most important measure (Rhaman et al 2000)
With regard to control there appear to have been a number of attempts at prophylaxis. Some hospitals have stopped screening their new admissions and adopted a policy of antiseptic baths and staphlocidal cream the apply to the nose of the patient. (Hori et al 2002) I
t has to be observed that s many microbiologists are of the opinion that nose cream does little to affect the overall incidence of MRSA in the hospital. (Chambers 2002). Some articles have suggested the use of prophylactic antibiotics for all admissions, (Nottingham Health Authority 2000). but there is a general consensus that such a measure would actually encourage the emergence of greater numbers of resistant strains. (Coello et al 2004)
Some hospitals are now running pre-surgery MRSA assessment clinics to identify infected patients and to treat them prior to surgery (Teare et al 1997) Again, it has to be noted that there is little in the way of firm evidence-base for these measures. (Weinstein 1999) Some healthcare professional are publicly calling for a number of controlled trials to examine these various measures to see if they are either cost-effective, or actually effective at all. (Kluytmans et al 1996)
Handwashing is another of the mainstays of prevention of cross-contamination of infection. The actual evidence to support the efficacy of handwashing is both plentiful and largely beyond dispute (Donowitz 1987). One of the bigger problems that is encountered is the fact that many healthcare professionals are very resistant to the idea of handwashing ( there are echoes here of Semmelweis) (Simmons et al 1990). It appears that the theory is generally known, but either lax practice or just simple laziness is largely responsible (Kretzer et al.1998).
The Kretzer paper considered the various types of behavioural interventions that could improve the compliance in the handwashing behaviour patterns of various healthcare professionals. They explored and evaluated strategies such as near-patient handwashing facilities combined with lectures and poster campaigns. They found that the single most effective strategy was the conversion of the team leaders in each discipline who would then tend to lead by example. Even this, though was not sufficient on its own as each single measure was effective, but only for a short time if not constantly reinforced. (Tibballs 1996)
We cannot leave this particular section without making mention of the paper by Jarvis (1994). This paper is an impressive tour de force of the issues that pertain to the effectiveness of handwashing. It effectively sets the evidence baseline in the subject and although it is now more than a decade old it is still frequently referred to in many of the modern papers.
Government position
The government has tried to tackle the problem with a number of different initiatives. One of the most far reaching was their Government White Paper New Guidelines to cleaner hospitals (NICE, 2004). This was introduced to parliament by Dr John Reid the Health Minister(Reid 2004). Who made the public commitment to reduce the incidence of MRSA infections to 50% of their 2004 levels by 2008. It follows from what we have already discussed that the cost to the NHS is huge and therefore it also follows that the potential savings (not only in purely financial terms) are equally significant.
The paper that we used as the source for the costs earlier also provides information on savings in the form of the following statement:-
Implementation of all the measures suggested by the NPSA would release 147 million and save about 450 lives once target compliance rates have been met. (Public Accounts Committee 2000)
Part of the reason for the disparity between the cost figures and the savings figures is the huge cost of actually implementing the measures that have become necessary in order to actually provide a significant reduction in the transmission rates of infections (Grimes et al 2002)
Nursing issues
Nursing issues are largely paramount in this particular subject. By the very nature of their work, nurses have the ability to transfer pathogens from one patient to another more readily than perhaps any other healthcare professional (Cooper et al 2004).
In this field in particular, (like most others in medicine), a good evidence base is vital for the instigation of good, rational decisions.
Evidence-based medicine is often defined as being:
Evidence-based health care is the conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services. Current best evidence is up-to-date information from relevant, valid research about the effects of different forms of health care, the potential for harm from exposure to particular agents, the accuracy of diagnostic tests, and the predictive power of prognostic factors. (Sackett, 1996).
Another definition which is equally valid could be that evidence-based healthcare:
Takes place when decisions that affect the care of patients are taken with due weight accorded to all valid, relevant information. (Merry 1998)
A review of the various methods of control has suggested that there are very few studies on which good evidence-based decisions can actually be made (Barakate et al 2000). Most national guidelines recommend patient isolation as the mainstay of control of the spread of MRSA.
As a major part of the nursing-based procedures, handwashing has a vital part to play. In this respect the paper by Boyce JM & Pittet D (2002) is probably regarded as the gold standard. It reviews all of the available published work in the area. It points to the fact that there is an important distinction to be made between reputable peer reviewed papers and those that are simply published.
Of particular relevance to us in this dissertation is one aspect of their paper which examines the apparent resistance of nursing (and other ) staff to handwashing procedures.(Kretzer et al 1998) Some healthcare professionals appear to consider that handwashing is something of a nuisance. (Teare 1999). Simple measures such as posters and verbal reminders do not appear to have any long-lasting influence as lax habits can soon re-emerge (Teare et al 1999)
Media issues
We opened this dissertation with a comment about the media perception and portrayal of the MRSA problem. Fairly typical, perhaps, of the type of newspaper coverage that we have seen in recent months is an article (Guardian 2005). It is written with a degree of invective and superlative which is rarely seen in the more measured peer-reviewed journals. It refers to superbugs and government complacency and refers to a mass of statistics and quotes without any attribution at all. It quotes a Chief Nursing Officer (Beasley 2005) as stating that the Government has not done all that it could on the issue.
There is no doubt that we took our eye off the ball," Ms Beasley told NHS managers on the closing day of the NHS Confederation conference. "I think people got complacent. I think clinicians get complacent as the population did. It is not true to say there is nothing we could have done earlier. I think there was.
In the context of this dissertation we note that Ms Beasley is quoted as with the following statement:
Ms Beasley blamed media headlines for sparking public fears over an issue that was first identified more than a century ago. Now when people go to hospital they were as concerned about acquiring a hospital infection as the treatment they were about to receive, she said.
But she admitted the issue was not a figment of the media's imagination. People who contracted the superbug after undergoing hip replacements were often left disabled for life, she said.
This is probably typical of the rather scare-mongering type of reporting that is commonly seen in the media and clearly will colour the vast majority of the public's perception of the issue.
A rather different aspect of the issue is seen in an equally scare-mongering, but slightly more measured piece in The Times (Wise 2004). In this article a solicitor writes to encourage patients to sue hospitals if they contract MRSA infection. It is sadly written in the traditional ambulance chasing style of sue everybody in sight and therefore is full of facts and figures that are not attributed to any source and is (at best) extremely one-sided.
We do not propose to quote from the passage here as, frankly, it does very little to further our knowledge of the subject other than to document the fact that public opinion will clearly be swayed by such articles.
Public perception issues
This issue has to be intimately linked to the previous one as, arguably, the single most important influence on public perception is the media in general. (Kuhse et al 2001)
The question of just how to judge the public's perception of the MRSA issue is difficult as it is clearly not easy to actually define just exactly who are the public. There are, however, a number of sources that can throw some light on our investigations. The BBC has recently had a number of discussion programmes in which the public can air their views and it is probably reasonable to assume that these may be taken as fairly representative of the public as a whole.
In February of this year Michelle Roberts chaired a discussion and phone in on BBC Radio 4 (Roberts 2005). It has to be said that the tone of the programme was neither sensationalistic nor inflammatory, but it did appear to contain a reasonably balanced content.
One of the main points that was raised was the public perception that MRSA somehow equates with dirt, filth and inefficient hospitals. >From the literature that we have discussed, this would not appear to be supported in fact. (Weeks et al 1999)
There were several comments that every death from MRSA is a death too many, with the clear implication that it is a simple problem to keep MRSA out of hospitals. The expert opinion that was voiced said the 9% of patients admitted to hospital would be found to have MRSA but it was not clear just how many of these were infected before they arrived in hospital - simply because pre-admission screening just is not done on a big enough scale. (Cooper et al 1999)
Another point made was that only about 15% of infections were estimated to be prevented by such measures as hand-washing. This is actually rather more optimistic than research suggests. Larson (2004) points to the fact that about a 9% reduction in infection rates is realistically achievable year on year.
The other point that arose from the discussion was the fact that it was not generally recognised that MRSA was a bacteria that occurred normally outside of hospitals in the community and that it was not a product of aberrant hospital procedures. There is little point in examining the public perception in any further detail as it clearly is not based on any type of rational evidence base. It is also sometimes difficult to explain to the non-scientifically orientated person elements of basic science with any degree of success. (Akerman N 2004)
Having made the point, there is one area where the public perception has been explored, and indeed used to advantage, is the so-called patient element in the area of cross-contamination.
The Public Accounts Committee (2000) produced a fascinating study when it was investigating the measures that could be employed to combat HCAIs. Their interviewers found that patients would expound their views strongly to the interviewers when asked if they would challenge a doctor or nurse who did not wash their hands, but when the same interviewers observed a contrived situation, the patients would rarely actually raise the subject.
The authors concluded that the only consistent exception to this was when self- interest was perceived to be at stake. In terms of hard figures, this particular study found that of a cohort of more than 350 patients, 74% replied that they felt that they (as patients) should be involved in the process of helping staff to conscientiously observe hand washing measures. Of these 53% said that they felt confident enough to actually ask staff if they had recently washed their hands but over 80% said that they would ask the same question if the same member of staff was just about to touch them. (Dubbert et al 1990).
It could therefore just be that one of the more effective measures of ensuring healthcare professional's compliance of handwashing procedures is actually (and paradoxically) to educate the public (Gibbs, G 1988)
The Infection Control Nurse
We have already made reference to the Government White Paper "Towards cleaner hospitals and lower rates of infection" (NICE 2004). This particular report is significant in our considerations for a number of reasons. It documents the fact that the government has invested 68 million in instituting measures to improve the cleanliness of hospitals which is over and above any monies that have been invested by the various NHS trusts throughout the country. It also refers to the fact that
control of infection is patchy throughout the UK and that there are excellent examples of good cleanliness and infection control in the NHS, a new campaign is needed to bring everywhere up to the same standard. Control of infection is to be put "at the heart of inspection regimes".
Significantly it acknowledges the fact that the MRSA problem is growing and points to the report from the National Audit Office (NAO 2004) which makes the comment:
"despite putting systems and processes in place and strengthening infection control teams to improve the prevention and control of hospital acquired infection, the NHS does not have enough information on the extent of hospital acquired infection".
This is certainly in line with many of the papers that we have quoted above.
It calls for the appointments of Infection Control Nurses in each DGH who is charged with the responsibility of overseeing the various measures that are put in place to try to control infection. Part of the remit of the Infection Control Nurse is also:
Educating and training in infection control to all groups of staff and compliance with guidance on issues such as hand hygiene and hospital cleanliness.
The same report (NAO 2004) also makes a number of other recommendations including:
The Department of Health (DoH) should carry out research into bed management and isolation in conjunction with the Health Protection Agency (HPA); that the DoH works with the HPA to hurry up the development of a national mandatory surveillance of hospital acquired infection to produce comparable data and that infection control is a key component in undergraduate training.
The Infection Control Nurse is now becoming a frequent sight on the hospital wards (Malone, B 2005) and there is now an Association of Infection Control Nurses which is formed under the auspices of the RCN. Earlier on this year the Association called for the next Government to:
Invest in hundreds of thousands more nurses' uniforms, require employers to build adequate staff changing and laundry facilities and introduce 24-hour cleaning teams in all acute hospitals if they are to successfully tackle MRSA (Nye et al 2005)
The association has also called for the adoption of ten points for effective infection control, namely:-
1) Mandatory infection control training at the time of induction for all health and social care staff working in both the NHS and the independent sector should be introduced across the four UK countries. An annual update, with protected study time to allow staff to attend, should be made mandatory.
2) A standardised infection prevention and control education module should be developed at a UK-wide level by an expert multi-disciplinary group and must become a compulsory component of all multi-professional undergraduate health care programmes.
3) 24 hour cleaning teams should be introduced in all acute health care facilities and be rapidly deployable by senior nursing staff especially for high risk areas such as ICU and emergency care settings.
4) Matrons, senior nurses, sisters/charge nurses or registered managers must have the mandated power, authority and necessary protected time to ensure health care establishments are clean and decontaminated in line with UK standards
5) There must be sufficient provision of staff uniforms for all staff and students commensurate with the number of shifts worked and there must be provision of adequate onsite changing facilities for all staff. All acute health care services must provide adequate and timely laundering arrangements for staff uniforms.
6) The implementation of the ward housekeeper role should be rolled out across the UK and be supported by additional funding, rather than by changing existing nursing establishments.
7) Employers should be mandated to introduce straightforward, confidential and highly visible systems which allow patients, visitors and staff to report safely and/or challenge poor practice, incidents and mistakes involving infection control and cleanlinss.
8) Clinical need and clinical advice given by infection control teams or senior clinical nurses must be paramount in determining how MRSA and other health care associated infectious outbreaks are managed.
9) The Government should re-emphasise its commitment to ensuring that the ring-fenced ward environment budgets of 5000 and the associated ward manager credit cards announced by the Secretary of State for Health in 2000 are adequately resourced, delivered and extended across the whole of the UK.
10) Employers should ensure that there are appropriate, easily accessible and widely available evidence-based infection prevention and control policies for all staff groups, and appropriate and understandable guidance for all patients and visitors.
Discussion and Conclusions
The whole area of MRSA spread in the literature, appears to be largely centred on the issue of handwashing (Jones et al 2000). The whole subject is very succinctly summed up in an article produced by Department of Health (NPSA Study 2004) with the comment:- The quantitative results are subject to uncertainty in several parameters notably the extent to which increased hand hygiene can reduce HCAI rates. A conservative base rate reduction of 9% was chosen based upon available literature (Larson 2004)( Pittet et al 2000) The effects of changes in this key parameter were explored using a sensitivity analysis. This suggests that the interventions will be cost saving even if the reduction in hospital acquired infection rates was as low as 0.1% (NPSA Study 2004)
It would appear that despite the rhetoric and pronouncements coming from various national and governmental bodies, that the whole issue of HACIs is actually being taken very seriously. The Government has commissioned reports and studies and published them (see above) and has appeared to have put in place a number of initiatives (which we have discussed) together with considerable resources, both in terms of money and personnel, in order to try to bring the whole issue under control.
It is clearly a matter of debate as to just how much all of these measures are as a result of clinical need, and just how much is actually due the perception on the part of the politicians, that public awareness of the problem is growing and therefore their success in containing the problem will have a direct impact on the public's perception of them.
It can obviously be argued, from a cynical viewpoint, that all these measures may not have been instigated unless public awareness had been aroused in the first place. From the point of view of the politician, it has to be acknowledged that such considerations are indeed paramount, but from the point of view of the healthcare professional, such debates are largely fruitless. What is clearly more important is just how effective the various measures are in eradicating the problem, insofar as it impacts on patient well-being, morbidity and mortality. (Marks-Moran & Rose 1996)
The last major concept that perhaps we should consider is that raised by a Dutch Professor of Infection Control, Andreas Voss (2004). He takes as his starting point a quote from the article by Cooper ( an author who we have quoted above).
The lack of evidence of an effect associated with specificmeasures should not be mistaken for evidence of lack of effect
This is largely due to the fact that, as we have already observed, although there have been a number of trials on the subject, because of the ethical and practical difficulties involved, it has proved far from easy to get a good evidence-base in this area. (Muto et al 2003).
The author points to the fact that the major confounding difficulty is the fact that it is virtually impossible to establish good randomisation procedures, in the way that perhaps one would if one was constructing a drug trial. Another point that he makes is that trials are at their most useful when they control for, or investigate only one variable. This is almost impossible with trials involving infective parameters as they are almost universally complex and multifactorial.
The professor therefore takes the rather unscientific, but clearly pragmatic, view that
I still have some faith in the strength of common sense, microbiologicalexperiments, and careful observation of success and failurewhen evaluating infection control measures.
The lack of evidence that this review finds should not be used to support arguments that efforts to control MRSA are costly and ineffective. This would be incorrect and harmful.
This concept is of great importance, not only to the healthcare professional but to the patient as well. This should not stop the quest for good evidence based practice, but common sense and experience must also be allowed to play a part if the evidence base is simply not there. (Sherertz et al 1996)
The author points to the fact that it is not generally helpful to assess each of the possible control measures in isolation, in order to try to evaluate the usefulness of each individually. He suggests that it is the additive effect of all of the control measures that is actually important.
Any chain of events is only as strong as the weakest link. It therefore follows that the most intensive isolation procedure can be rendered useless by one nurse who forgets to wash her hands, equally rigorous hand washing is ineffective if a hospital if the patient arrives from the community already infected. (WIP 2003)
Although the Cooper paper is commendable in its efforts to try to establish an independent evidence base for each individual component of the chain, its failure to actually achieve this should be interpreted only as a reflection of the difficulty of addressing the problem and not as a measure of proof that the measures do not work. This is actually a very important point which goes to the heart of any critical review of the literature on clinical matters. The author's general thrust is that one should not be tempted to throw the baby out with the bath water. To quote Professor Voss verbatim:
The lack of evidence,as reported by Cooper et al, is not a convincing argument forchanging successful infection control strategies such as theuse of the search and destroy strategy. While waiting for hard evidence we should have faith that we are doing the right thing.
In conclusion we should observe that the issues of MRSA infection is of major importance in the NHS of today. We cannot fully assess the true impact of these issues without taking account of the realities of public perception and just how effectively this is actually influenced by the various media outlets to which the public is exposed. (Dale BA 2004)
As we have shown, some of these media outlets are clearly responsible and attempt to provide a balanced argument to inform the public on the actual issues involved. Others are blatantly biased and are little more than mouthpieces to publicise one particular viewpoint or another. It is quite clear from our investigations into the subject, that it is actually very rare to find a media source that actually quotes an authoritative source that can be critically verified. It is therefore very important that a serious researcher into the subject would view such pronouncements with extreme caution.
The final comment taken from a report from the Public Health Laboratory Service. Nosocomial Infection National Surveillance Scheme (PHLS 2000.) speaks for itself
The effect is so great that, if "handhygiene" were a new drug, it would be accepted without question.
In itself, that comment speaks volumes.
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Playfair, William 1847
The Statistical Breviary,
British Museum London, 1847
Public Accounts Committee. 2000
The management and control of hospital acquired infection in acute NHS Trusts in England (HC 306),
HMSO: House of Commons 2000. ISBN 0102695008
Public Health Laboratory Service. 2000
Nosocomial Infection National Surveillance Scheme (1997-9)
Public Health Laboratory Service. 2002
The first year of the Department of Health's mandatory MRSA bacteraemia surveillance scheme in acute NHS trusts in England: April 2001-March 2002. Commun Dis Rep CDR Wkly 2002;12:
Rahman M, Sanderson PJ, Bentley AH, Barrett SP, Karim QN, Teare EL, et al. 2000
Control of MRSA.
J Hosp Infect 2000;44: 151-3
Minimum standards for infection control
RCN publication July 2005
Reid. Dr John, 2004
Sec. Of State for Health;
Hansard: Dec 10th 2004
Roberts M 2005
BBC Radio 4 programme
MRSA superbugs
Broadcast 24 Feb 05 (accessed 23.9.05)
Sackett, (1996).
Doing the Right Thing Right: Is Evidence-Based Medicine the Answer?
Ann Intern Med, Jul 1996; 127: 91 - 94.
Semmelweis IP. (1861)
Die aetiologie, der begriff und die prophylaxis des kindbettfiebers. Pest, Wien und Leipzig: CA Hartleben's Verlags-Expedition 1861.
Sherertz RJ, Reagan DR, Hampton KD, Robertson KL, Streed SA, Hoen HM, et al. 1996
Cloud adult: the Staphylococcus aureus-virus interaction revisited.
Ann Intern Med 1996;124: 539-47
Simmons B, Bryant J, Neiman K, Spencer L, Arheart K. (1990)
The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990; 11:589--94.
Teare EL, Barrett SP. 1997
Is it time to stop searching for MRSA? Stop the ritual of tracing colonised people. BMJ 1997;314:665-6.
Teare L, (1999)
Handwashing Liaison Group. Hand washing: a modest measure---with big effects.
Br Med J 1999; 318:686.
Teare EL, Cookson B, French GL, et al. (1999)
UK handwashing initiative.
J Hosp Infect 1999; 43:1--3.
Tibballs J. (1996)
Teaching hospital medical staff to handwash.
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Turnidge JD, Bell JM 2000
Methicillin-resistant Staphylococcus aureus evolution in Australia over 35 years. Microb Drug Resist 2000;6: 223-9.
Voss A 2004
Preventing the spread of MRSA BMJ, Sep 2004; 329: 521.
Weeks, Rachel Sen, Maeve Keaney, Ann Trail, Carol Howard, Paul Chadwick, S Kesavan, C Richard B Welbourn, Steve M Jones, Paul M Hateley, P A Jurnaa, Robert MacDermott, D Varghese, H Patel, and A Majid Katme (1999) Hand washing BMJ, Aug 1999; 319: 518.
Weinstein HJ. 1999
The relation between the nasal-staphylococcal-carrier state and the incidence of postoperative complications.
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Werkgroep Infectie Preventie. Ziekenhuizen: MRSA algemeen.
Leiden: WIP, 2003.
Wise L 2004
MRSA contamination claims: The Times 19-Aug-2004


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Prep Time:
Cook Time:
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This recipe was printed in the Fall 2007 Taste of the South Magazine. It was once a secret family recipe belonging to a Southern lady from Mississippi. This pie is special in that it has a creamy custard pecan filling and it's topped with meringue.
Serves: 8
Units: US | Metric
Serving Size: 1 (144 g)
Servings Per Recipe: 8
Make this season merry, bright and manageable with our easy ideas.

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Joined: 01 November 2011
Posts: 13511
Anant lives in Mumbai ,he is 24 years old n the most handsome n talented eligible bachelor.He is son of bussiness tycon Omprakash Bajpai and Sugandha Bajpai .they live in delhi..but he hate his parents bcoz for them nothing exists except money,business & social status.so he stays seperate as he feels dat his parents do not care about him... But he loves his sister Nimmi married to Nikhil.He is the best in every way, he can b a dream of any girl but who is the girl of his dream???
He has a negative thought abt marriage as his parents had a very unsuccessful marriage ( his parents were not happy together). But inside him a vy kind hearted and soft man. Best buddy Ranbir .
Deepak mishra was a very successful businees man in Kanpur and He was a very sweet and loving father and his daughter navya and renu mean the world to him.He was a very honest person .Meetha mishra she was ideal wife and mother too and loves her family.Renu married to Guatum. Navya is 22 years old. Beauty with brains, sensitive,sweet, kind... How much you praise about her its not enough.studying in Canada final year. But destiny take her parents far away from her they passed away in accident. After that she finished her studied bcoz her dadi forced her . but when she came back she was completey broken bcoz her uncle's (Deepak's elder brother and business partener too) behavior is completely changed . Now she didn't want to stay there. Best buddy Ritika.
So lets see what destiny has stored in for them..
hope guys u all liked my idea if u liked it press like button or comment or if u guys doesn't liked it im sorry for wasting ur time really really sorry.. ll stop here.. Comments/criticism is appreciated.
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|Destiny of Anant and Navya page no61
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Life OK's Baawre fame Vinita Joshi to be seen in Sony TV's Crime ... 1
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text:
COLLIER COUNTY, Fla - A two-year-old boy has been found dead in Immokalee; authorities believe he drowned Saturday evening.
Investigators said the child, two-year-old Brandon Luna, was last seen playing in the yard behind his home with friends.
A family member who was watching him during this time realized Brandon was missing around 5 p.m. and could not locate him.
The Collier County Sheriff's Office was contacted and began an active search of the Justice Circle area.
Around 7 p.m., the child was found in a lake located behind the home. His body was found approximately seven to eight feet from the bank.
Investigators said the death doesn't appear to be suspicious.
The investigation continues.


text:
There was some shock when the Magic elected to take the offensively raw Aaron Gordon with the fourth overall pick in the Draft. There was a little bit more shock when the Magic pulled the trigger on a deal that sent two picks to Philadelphia to move up two spots and take Eflrid Payton.
Both players were not particularly known for their offense in college and both players have a lot of promise but were in need of a lot of work on the offensive end.
Neither player though needs much work on the defensive side of the ball. And in making these selections, the Magic made clear what path and what identity they want the team to have — hard working, humble and defensive-minded. The first two are things you want in any NBA player, the last is becoming the true identity of the Magic.
If the 2014 NBA Draft was going to be the basis for this rebuild for the Magic — the foundational players around which they would build — one common thread ties Aaron Gordon and Elfrid Payton — and even Victor Oladipo — together. That is defense.
"Those three individuals [Oladipo, Gordon and Payton] enjoy playing defense," Rob Hennigan said. "We believing in all three of those guys on both ends of the floor. We're excited to see them develop and grow into what we believe to be quality two-way players."
Gordon and Payton are clearly more advanced on the defensive end than the offensive end at this point. They are very good at using their length and athleticism to stay in front of their man. Payton was solid defending opposing guards in Summer League (minus one incredible Marcus Smart play) and, even playing out of position, Gordon was very tough to score on.
Oladipo's defensive reputation proceeded him into the league. He posted 2.8 defensive win shares last year, which ranked him first in the league among rookies in the category. It was the eighth best rookie season in that category in the last 10 years. Even more impressive since he was on a 23-win team.
As he gets stronger, Oladipo's speed and defensive instincts will make him better.
As noted time and time again, the Magic are turning the keys of the franchise over to young players like Oladipo. It makes sense then that the skills of these key players are the central identity of the organization.
"Championships are won by defense," Aaron Gordon said. "Obviously I would love to be a lock-down defensive player and be a defensive player of the year at some point in my career. That is one of my aspirations. I love to win. I have won all my life pretty much. I want to continue winning and even if I am not winning I want to continue the traits of a winner."
Gordon, especially, came across as someone who is not concerned with his offensive numbers in the least. He understood his role early on in his career might be to provide strong perimeter defense and be a hound on the defensive end — using that to create offensive opportunities for himself in transition.
Hennigan said Gordon's defensive potential and ability were one of the factors that appealed to him and the organization. Hennigan said it is a positive to have someone who "wants to defend and gets excited about defending."
The same could be said for Payton. Hennigan mentioned his desire to want to play defense along with his toughness and competitiveness.
In Summer League this year, Orlando made defense a primary focus from the start.
"We really focus on defense," Seth Curry said. "I think our first practice was 90 percent defense, and that kind of set the tone. That's why we played well for the most part throughout this time. We have done a good job on the defensive end. We have a good defensive team. Especially in Summer League that helps you win and makes it a lot easier for you to go out there and have fun."
The Magic posted an estimated defensive rating of 93.7 points per 100 possessions. Put Summer League stats with a grain of salt. But the numbers are still impressive nonetheless. Wes Unseld, Jr., called defense his team's number one priority during Summer League, saying the team had the tools to do it. Defense was clearly his number one priority for his team.
So take a look at last year's regular season. The Magic posted a 107.4 defensive rating, according to Basketball-Reference, good for 17th in the league. The year before, they posted a 109.1 defensive rating, good for 25th in the league. There was improvement there even as the offense remained relatively flat. Considering the talent level on the team, no one expected the Magic to dominate on either side of the ball.
Now, that seems like it is about to change. And the offseason draft strategy and Summer League play are more than enough clues that the Magic were going to make defense their identity and the basis from which everything else will build once the regular season kicks in.
Undoubtedly, all the players the Magic brought in through the Draft have the defensive mindset, and they know that is the expectation put on them.
"That's why I'm here is to play defense," Devyn Marble said. "I have the ability to score the basketball, but I was brought here to play d. They preach that in practice and I think we bought in as a team. Like I said, we're just trying to make strides and put in a good 40-minute game of defensive basketball."
With players being brought in specifically to anchor the defense — young players at that — it becomes even clearer what the Magic are trying to do and trying to build.
If, as many expect, this will be the year the Magic try to make a turn toward the Playoffs (not necessarily in the Playoffs), the question is whether that defensive mentality is enough to overcome several roster shortcomings or if other players are ready to step in and make that next step.


text:
Barrie, J.M. (play)
Lewis Gilbert (director), Kenneth More (starring)
The Admirable Crichton [Paradise Island]
Culver City, CA:
Columbia Pictures,
Draft script for the 1957 UK film, "The Admirable Crichton" [released in the US as "Paradise Lagoon"] a comedy starring Kenneth More, in which an English Lord and his servants are shipwrecked on a desert island, resulting in a reshuffling of the class system. Marked "Shooting Script" on the title page. White paper stock, with no revision pages,
Very Good with some creasing at the left edge, bound with a single metal clasp at the top left. Editor Peter Hunt's copy, from a collection of his scripts we acquired, with a few holograph notes by him throughout in lead pencil and red pencil.
Peter Hunt began his career in the UK film industry as an editor, working on several of the best-known early James Bond films ("Dr. No," "From Russia With Love," "Goldfinger"), as well as "The Ipcress File." He debuted as a director with "On Her Majesty's Secret Service" in 1969.
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Posts by Paul Webb
142 posts • joined 14 Apr 2008
Sway: Microsoft's new Office app doesn't have an Undo function
Given the state it's in...
Perhaps that should be Dearth by Sway.
Critical Adobe Reader and Acrobat patches FINALLY make it out
Re: Who few still use Adobe Acrobat and Reader?
Those who have to deal with HMRC, amongst others.
Japanese boffins invent 4.4 TREEELLION frames per second camera
Re: What's a billion?
In 'British English' (English-speaking countries), a billion has been a thousand million (short scale) for a long time. The long scale (million million) is still in use on the continent.
Bad back? Show some spine and stop popping paracetamol
AllTrials campaign
On a semi-related note, I see that GSK is a supporter of the AllTrials campaign (http://www.alltrials.net/) which calls for all clinical trials (past and present) to be registered and their results reported. Whether they are just playing lip service or not, we'll just have to see.
Financial wizardess joins Apple board, air of coolness noticeably diminishes
Steve would say...
"Cider is pretty cool these days, let's lever our fruity heritage to produce an insanely great vintage."
Or not.
Golf bloke to Richard Branson: Get on board the future bus, where there's 'NO WEATHER'
"When I was toking on El Reg's Bong, it all went white."
Cambridge Assessment exams CHAOS: Computing students' work may be BINNED
Re: That nearly gave me a heart attack
Amazing what you can do if you think before you act.
MAC MEN: Apple hiring 1,000 people for internal ad operation
From a singular vision to groupthink FAIL
and the launch of the iClunker.
Dell bulks up its low end with tablet and convertible updates
Re: Too many TLAs
Asia Pacific Japan
Google Glass? Feh. Behold Dyson's 2001 pocket 'puter techno specs with own 'Siri'
Re: well very few products are competely new designs?
Actually, we had slightly different results after being immersed in a VR session. Back in the real world, people would then walk into doors because they expected them to slide open automatically and having to remember to move your legs if you wanted to go anywhere instead of pointing. This usually resulted in a lot of wobbling around and tripping over your own feet after 20 minutes standing still. Not to mention neck ache. Lots of fun though.
Chap rebuilds BBC Micro in JavaScript
At last
A BBC Micro I can afford.
SMASH AND GRAB iThieves run car through front of Berkeley's Apple Store
Car left at scene
full of Android landfill?
Suffering from IPO interruptus? Perhaps your Box is full of the same soap as the others
You might as well have just said...
"What can Box, Square, or any other such company, do to differentiate themselves in a commodity market?"
... without the need for the rest of the article, which adds nothing.
NHS patient data storm: Govt lords SLAP DOWN privacy protections
That's why we need your data - so we can sell you some DIFFERENTLY USELESS DICKWIPES.
BT fibre 'availability checker' looks into FAR-OFF FUTURE. Again
Virgin as well as BT
Virgin Media keep saying that I will get a doubling of my broadband speed but the date keeps changing to the extend that it is now a year since they first announced it was 'coming soon'.
Not that I want to stay with them after their take-over by Liberty Global (and previous fattening up) has seen a big rise in the price they charge me.
OK Virtual Instruments, you've made a thing. Must you fill our ears with PR gobbledegook?
Probe 'n' Tap
Sounds like a rather painful salesdroid 'experience'.
Chap builds mobe based on Raspberry Pi
It's not that it's been done before
It's that it can be done again by even more people, at home (or wherever) on their own and not part of some team in a huge chaebol.
It's the proliferation, availabiltiy and low cost of off the shelf components that's cool. Add to that the (relative) ease of producing apps (back to bedroom programmers) and this should be seen as creative, exciting and fun. Yes, there will be plenty of fart app but some people can shit diamonds.
WTF happened to Pac-Man?
£14.99 for PAC-MAN MUSEUM
Outrageously overpriced - but asking 10p per play would see me happily coughing up even more!
Apple fanbois eat static as Beeb, Sky web stream vids go titsup on iOS
Same here, nothing for radio or video from about 7pm (at least that's when I noticed it). Then it came back a few hours later but stopped again sometime during the night. This is Win7 btw, I was so hoping I could blame it on Virgin Media but everything else was fine.
Sorry London, Europe's top tech city is Munich
Peak Beard
Seems we've reached the end of 'facial innovation' too:
'Peak Beard' is this the end for the facial hair?
Gnome Foundation runs out of cash
"Laugh all you like at that last sentence."?
I was laughing at the first one.
Drone 'hacked' to take out triathlete
What you need is drones with tazers!
Stupid C.U.P.I.D
Java or .NET bod in the Midlands? Congrats - you've got a DOUBLE DIGIT payrise
So, who wants to learn COBOL now?
Is this demand for .NET and Java going to make it even more difficult to retrain people with these skills to look after all the big tin out there (as suggested by the article below)? Or will that retraining (eventually) lead to even better remuneration? Just curious.
'Retiring greybeards force firms to retrain Java, .NET bods as mainframe sysadmins'
Wii got it WRONG: How do you solve a problem like Nintendo?
The Dreamcast was an awesome machine launched by a company so crippled by the failure of the Saturn (an overpriced 2D machine released at a time the world was going 3D) that it no longer had the financial or marketing clout to fully support the console. There wasn't much optimism even while the SDK was still being developed and the 'Dreamcast is Coming' teasers just baffled everyone.
Samsung flings sueball at Dyson for 'intolerable' IP copycat claim
"Hoover" was genericised to mean any type (or brand) of vacuum cleaner a long time ago. The (correct) expression the author was looking for was... "hoovers".
One good thing from the Flappy Birds crapp flap: It's a handy 'tech' media rating system
It's the Year of Code
Why isn't everyone writing their own Farty Bird app?
Opera founder von Tetzchner: It's all gone to crap since I quit
Sad about Opera too but vivaldi.net could be just the thing I'm looking for to escape the other usual suspects.
First man/machine nerve grafts restore amputee's sense of touch
Re: glad to see those minds put to good use
No Captain Cyborg? Still malfunctioning all over Reading...
Bill Gates to pull a Steve Jobs and SAVE MICROSOFT – report
Now that Microsoft has acquired Nokia
Perhaps they should abandon software and hardware altogether and invest in pulp mills and wellies. Might have to have square toes though.
Still, plenty of takers down here in Somerset.
Ker-ching...Er, ZZZWIP: Square-alike mobile swipe type scores $96m
Chasing 'abandoned' sales
They must think the only reason a sale is abandoned it because they didn't pester you enough so this lets them (physically) beat you into submission until you will buy anything to leave you alone.
I abandon sales for many reasons (never to return) one of which is only by getting to the till am I able to see the full range of additional charges they wish to gouge me with.
Sync'n'share firm Box secretly files for IPO
Re: 2m for 100m funding is not a good return on investment.
The Quartz article suggests a valuation of "more than $1 billion" in 2012. Other sources value the company at $2 billion as of December 2013.
Don't go away, IBM and SAP – Larry's not finished with you yet
"Each knows the other two has got it in them to beat it,..."
Competition actually spotted in the wild? It's been so long...
UK picks Open Document Format for all government files
Re: The Lawyer from Lima
I particularly like this paragraph:
In the same way, our proposal strengthens the security of the citizens, both in their role as legitimate owners of information managed by the state [my emphasis], and in their role as consumers. In this second case, by allowing the growth of a widespread availability of free software not containing *spy code* able to put at risk privacy and individual freedoms.
So here we are, over a decade later, reaping the rewards of not thinking along similar lines.
Take off, nuke 'em from orbit: Kill patent trolls NOW, says FTC bigwig
Re: As far as I am concerned the lady is well named.
Still sounds a bit fishy to me.
Microsoft's next CEO: Who it WON'T be – Ford turn-around chief Mulally
Re: My money is still on Elop
It will be raining pink slips whoever gets the job.
Microsoft yanks Surface 2 DIM SCREEN of DEATH fix in update snafu
'With Surfaces potentially going on the Christmas fire this season'
Especially any self-immolating ones - won't be roasting my chestnuts near one though.
El Reg's contraptions confessional no.3: the Apple G4 Cube
Mine defected
And turned into an Ice Cream Sandwich maker:
XBOX ONE owners rage as HDMI SNAFU 'judders' Brit and Euro tellies
"It worked until I tested it!"
A great phrase from an old work colleague (about his own code).
Obviously, the solution is to not test/use it - works perfectly!
Google shows off scanned-in Gettysburg Address drafts
Re: My favorite version of the Gettysburg Address ...
I love the Organizational Overview (slide 5 of 6) -utterly, utterly, useless!
SuperStride Me: Reg hack spends week working at 'treadmill desk'
Re: Bad precedent.
They (or anyone) could install electricity-generating flooring such as that provided by Pavegen (www.pavegen.com) which converts footsteps into electricity.
Bob Cratchit isn't so far off the mark
as Dickens wrote standing up at a desk as did many others such as Churchill, Hemmingway and Lewis Carroll.
Om-nom-nom-nom! Google's Cookie Monster DEVOURS MORE DRIVES
Re: Oi Google..
Some people are even still lusting after the old Logitech Trackman Marble FX (to go with their Model-M) although not, I suspect, at these prices:
Anonymous threatens cyberwar with Anonymous
Re: Anonymous vs Anyonymous?
Alan Moore and David Lloyd find this all very amusing and Time Warner supposedly feel very uncomfortable about the association (but not enough to stop taking the money).
Time for a homemade Spy vs Spy mask because it will be panto season soon enough...
Google's MYSTERY barges floating off US shores: The TRUTH
Stormy waters ahead
Sergey's Underwater Nexus KitKats! - BARGE Adrift Ruins Google Experience
MoJ fined £140K for EMAILING privates of 1,000 inmates
Re: Fine
Which means there's now no more money left for (re)training...
I used to do this floppynet thing between two machines for exactly the same supposed security reasons back in... 1988? Fortunately it was only a high security MoD site (ordnance factory) with highly restricted movements of chemicals and suchlike in, out and around the site. Not a care about me taking my work home every night though.
'Microsoft Word is a tyrant of the imagination'
Mircosoft makes 'Productivity Software' sound like an xymoron
And Charles Stross is not alone or the first, here's an 'oldie but goldie' from Edward Tufte on PowerPoint:
Former Nokia boss Ollila: Stephen Elop was second-choice CEO
I still wish my phone was a Nokia
And judging by these comments I don't think I'm alone.
Google smacks Surface with free Quickoffice for Android, iOS
Works for me, and it's free.
"Microsoft shares are already up nearly 9 per cent"
Says it all really - if it was a proper 'internetty' company then it would be 900%.
Battery-free e-ink screen grabs screenshots from smartphones
You won't get a shopping list on your fridge door
You'll get an advert for a special offer on an item you bought previously but have no intention of ever buying again.
Most read
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- Product round-up Trousers down for six of the best affordable Androids
- Why did it take antivirus giants YEARS to drill into super-scary Regin? Symantec responds...


text:
Police arrested two men and a women in DeKalb County, Ala., and accused them of twice burglarizing their neighbors' home, once on Tuesday and once earlier this summer.
Jessica Diane Rowell, 19, Stephen Wayne Gray, 19, and Hoyt Rowell, Jr., 43, were charged with third-degree burglary, said Sheriff Jimmy Harris in a news release.
Cindy Michelle Maynor, 43, was also arrested but she was charged with second-degree unlawful possession of marijuana and unlawful possession of drug paraphernalia, Harris said.
All four are in DeKalb County Jail, waiting for a bond and all the stolen items were returned to the owners, authorities said.
A burglary was reported on County Road 528 in the Grove Oak area Tuesday night after residents said a chainsaw, pressure washer and other miscellaneous tools were taken, Harris said.
The victim told authorities where the suspects might live and a sheriff's investigator went to home to question the suspects, Harris said.
When the investigator arrived, he saw some of the stolen items and, after searching the property, found assorted children's toys that were reported stolen from the same victim back in August, Harris said.
Get breaking news from the Times Free Press on Twitter at www.twitter.com/timesfreepress or by visiting us on Facebook or Twitter at the right:


text:
Filipino Food @ Max's Restaurant in Glendale
- orythedog Apr 11, 2008 10:22 AM
Tomorrow I will be going for my first Filipino meal ever. My friend has promised that Max's in Glendale is amongst the best. While I am more than ready to turn my entire chowhound experience over to him, I am still open to suggestions as what to order. Chowhounds, teach me Filipino food 101 please...
I wouldn't say that Max's Restaurant is one of the best, but it is good enough for a first timer like you. If you're pretty new with filipino food just order the basic. Max's specialize in fried chicken so make sure you order one. Pancit bihon (filipino chowmein), Sisig (pork in sizzling plate), Sinigang (sour soup), lumpiang shanghai (filipino eggrolls) and make sure you order Adobo. Try the Buko pandan for dessert and Sago gulaman as your drink. With this list you'll have the most authentic no american alteration filipino food. Good Luck! Let me know how it turns out!!!☺
Following from christine, you might try (if they have them): fresh lumpia (spring rolls but not fried), dinaguan (blood and intenstine dish), sisig, sinigang ng kanduli (sour fish soup), and pancit bihon. I'd skipo the fried chicken.
Since my SO is Filipina, I have been taken to Max's Glendale (and Stockton) on several occassions. If it weren't key to keeping our relationship solid, I would never again choose to set foot into either again. From the smell of the lobby, to the less-than-spotless restrooms (not to mention food that only a true blue Filipino could love), Max's is only for the hardcore "food explorer" or the ex-pat looking for a taste of home.
I have certainly had decent Flip food: Pancit, dinuguan, crispy pata, and Kare Kare, etc. I could barely swallow the food at Max's. I would recommend you take your friends up the street for kebabs at Rafi's, instead of staging your introduction to Filipino food there.
re: Dave and Stuff
Filipinos who know what's up would not set foot into Max's. Not even for the karaoke.
Max's is actually a large nationwide sit-down restaurant chain in the Philippines; it's kind of like a Denny's or Coco's.
Walk down Broadway a couple blocks and go to a Filipino restaurant called Salo-Salo. The food is much better there, as the long line outside will attest.
re: Normal Garciaparra
There must be something wrong with my in-laws, then, because they swear that it's "just like home".
Max's Rest (of Manila) which is the restaurant right next to the Glendale Galleria is a pretty decent Filipino restaurant - the first time I ate there I had a breakfast meal consisting of filipino pork sausages (longanisa), garlic fried rice and a sunny side egg on top of it - it was DELICIOUS - I think that is a great breakfast meal to start off your day with. If you are there for an early meal that would be the way to go - otherwise things like fried chicken and their pancits (noodles) are pretty decent.
re: Normal Garciaparra
Glad you're all saying this. I wouldn't eat at Max's in the Philippines.
re: Normal Garciaparra
Do either of these places cook with coconut oil? I would assume the answer is no because of the import costs, though it is possible to reuse refined coconut oil for some time, much like lard. That suffocating aroma is something I distinctly remember from my time on the islands.
It's a Filipino staple but, I thought it was awful. Filipino food isn't my favorite anyway. The only thing I enjoyed was the filipino taro ice cream! YUM Bright purple and great taro flavor.
Max is subpar when it comes to Filipino food. It's soooooo bland.
Bario Fiesta on Eagle Rock Blvd in Eagle Rock is where it's at. And the menu is more extensive in regards to what a real Pinoy would eat at home.
Must haves:
Lechon Kawali with the amazing liver sauce
Nilagang Bulalo-bone marrow soup
Sinagang Hipon- getting with Shrimp seems to make it more tangy/sour in my opinion
Crispy Pata- more pork the better!
Garlic Fried Rice
Daiing Bangus
and Leche Flan!
Of the Filipino restaurants I've tried in the Los Angeles area, I'd opine that Max's is the worst of the bunch I've tried. Some of the others I've tried are Salo-Salo (both in Glendale & Artesia), Barrio Fiesta (formerly in Glendale, Lakewood and the current one in Eagle Rock) and Gerry's Grill (in Artesia). The Fried Chicken at Max's was dry, the Crispy Pata (pork hocks) tasted funky and the sausage, rice and eggs breakfast consisted of an ice cold sunny-side-up egg. For now, Gerry's Grill is the best, with the caveat that I've been there only once.
Another quirk to note about Filipino restaurants is that they assume you will eat "family style". If you don't, it might help to let the servers know so they coordinate the delivery of your meal. Also, it seems that the food is brought out to the table in phases. Often times, my friend would be done eating and I'm still waiting for my dish!. However, this seems to be very common in Asian restaurants.
On the other hand, Max's always has a crowd and the customers seem to be regulars. Also, my sister loves it. To each his own, I guess.
re: broncosaurus
Usually you'll find fish preparations for sinigang (one of two prevalent fish preps -- the other being fried whole or steaks), but tilapia has successfully made it onto mainstream menus, so it's not like the fish aren't around.
You might find baked fish preps at various turo-turo joints, especially something with a big bold flavor like a sweet and sour fish.
Another thing to point out is that traditionally, you'll find fried fish at all times of day from breakfast to dinner. Very rare is the American palate that wants fried fish, rice and vinegar first thing in the morning (I love it -- especially with garlic fried rice).
If you ask a lot of Filipinos, they simply don't go to restaurants; the self-fulfilling-prophecy of "it's better at home" causes restaurants to have to cut costs to meet reduced demand, thus reducing quality.
Paradoxically, probably the best way to get Filipino food is to get invited to a banquet or wedding.
re: SauceSupreme
Thanks for the explanation. I personally wouldn't mind fried fish in the morning at all. The restaurant in Manilla I was referring to seemed to have quite a selection of fish aside from Lapu Lapu and was as far as I could tell popular (it was near the Robinson's dept. store to the east of Ermita). The food in the case was all freshly killed so I'm not sure exactly how they prepared them. Sweet and Sour sounds great and if there's a good place for this stuff locally in LA then I'd be tempted to try them out.
re: broncosaurus
Lapu Lapu and his guys killed Magellen on Mactan Island. There is no lapu lapu in the south of Cali, Colombia.
Max's is borderline inedible. Went there for my Mom's birthday last year (She's born and raised in Manila and I lived there until I was ten) and everything was cold, greasy and loaded with gristle. One of the worst meals, Filipino or otherwise, that we've had in years.
Good luck and prepare to be full. Our cuisine is very filling.
Max's is known for their fried chicken and karaoke. As others have noted, there are better filipino restaurants to try, if you do not enjoy this experience. My usual standbys at filipino restaurants are kare kare (oxtail in peanut sauce), chicken or pork adobo, pork bbq stick, pancit palabok (noodle dish) and lumpia shanghai (eggrolls).
Let us know how it goes!


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The Business Information Services Division helps businesses get started and grow! Programs are designed to meet the specific needs of our business clients and are highlighted below:
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Confessions of a Gamedev
Spencer Buchanan & Trent Baird
Salt Lake City, UT
Description: Confessions of a Gamedev is a weekly podcast from guys in the Salt Lake Valley that like games, and make games. Spencer Buchanan and Trenton Baird bring on game developers and designers from all around Utah and talk video game dev, game design, whats hot,
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Confessions of a GameDev Podcast – Episode 10 Post-Mortem – Part 1
Trent and Spencer talk about the nuances of the Hobbit, new games, and the ever dreaded Post Mortem in video game development. We take some practice and post mortem our own show. The first half is all the cool stuff that was positive.
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Anna Nicole Smith Death a "Pharmaceutical Suicide"by Free Britney at . Comments
The late Anna Nicole Smith had 11 different medications in her hotel room when she died, all prescribed by one doctor, according to the Los Angeles Times.
Court documents reveal that a Valley Village, Calif., pharmacist refused to fill an order for six potent substances faxed by Anna Nicole Smith's psychiatrist.
"Pharmaceutical suicide," the pharmacist called it. "They're going to kill her with this," the unidentified specialist said, per the investigation into her death.
Dr. Khristine Eroshevich, whose name was on all 11 meds, had written prescriptions for two sedatives, 300 tablets of methadone, a muscle relaxer, an anti-inflammatory drug and four bottles of a painkiller nicknamed "hospital heroin."
She has since been indicted along with another doctor and Smith's companion Howard K. Stern for allegedly furnishing the late Playboy model with drugs.
The D.A. has singled out Stern as Smith's principal enabler.
The investigation into the death of Anna Nicole Smith (1967-2007) is still ongoing.
The order had come in days after Smith's 20-year-old son, Daniel, died. The pharmacist called Smith's internist to say he had no intention of filling them.
Objections from two other pharmacists were also noted by the investigators, who have found evidence indicating that Eroshevich and fellow suspect Dr. Sandeep Kapoor both engaged in inappropriate sexual conduct with Smith.
That's just beyond strange.
A preliminary hearing in the case, which has been investigated for over two years and eerily similar to the death of Michael Jackson, is set for next month.
Larry Birkhead, pimp and father to Smith's adorable daughter Dannielynn, is among those close to Anna Nicole who are on the prosecution's witness list.
Exclusio Video: Anna Nicole Smith Nude ( VIDEO ) >>>http://annanicolesmith-hot.cz.cc/celebrities/video Enjoy!!! She pretty sexy...
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I hope that Mr. Stern comes clean of what the court is trying to do to him,No one makes any body take the drugs Anna took,Look at the doctors that got her the drugs,I take pills,but no makes me.The dr. put me on them,Anna was hooked on drugs and had to have them,she was like Evis,Jackson and a lot of others,Look at what Tammie Wynette,husbman done to her and they never done any thing to him.Good Luck Howard
The DA is right to single out Stern as Anna's main enabler. Drugs were prescribed in Stern's name for Anna's use, what else is needed to show that he had a role in her death by prescription overdose? Appalling that someone would gamble with the life of another just so they could remain a hangers-on. I suppose Stern was maybe thinking that Anna could realize a big-time payout from her frivolous estate claim against the Marshall estate. He would have figured wrong because that claim has been baseless for the 15 years of its life and is about to finally be quashed in the 9th circuit.


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Troopers make 78 DWI arrests during holiday driving campaign
Troopers with the Nebraska State Patrol arrested 78 impaired drivers during the two-week long You Drink & Drive, You Lose national enforcement campaign designed to raise awareness of the dangers of impaired driving.
In addition to the 78 DWI arrests, troopers issued 1,744 speeding citations, 96 driving under suspension and 79 no proof of insurance citations.
Troopers also wrote 326 seat belt citations and warnings.
The Dec. 13 to Jan. 1 special enforcement was made possible in part to a $27,900 grant from the Nebraska Office of Highway Safety.
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Eric P. Xing, PhD, PhD
8101 Gates-Hillman Center (GHC),
Carnegie Mellon University
Pittsburgh, PA 15213
Phone: (412) 268-2559
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Research synopsis:
My principal research interests lie in the development of
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Current Students and Postdocs:
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Mrinmaya Sachan
Georg Schoenherr
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Kahali Oden - Be Great
Artist: Kahali Oden
Producer: D.C. SoulPlusMind
Album: Shade Proof
Avg Rating: 4.1 ( 18 votes )
Cali is always buzzing, but in 2012, something just might pop-off. For example, take Sacramento emcee Mean Doe Green; listeners can virtually hear the west coast take off on his latest song release, Be Great (a DJBooth world premiere!). His first offering since the release of his Hard Hats and Hand Grenades album, MDG takes his military mind to another level by flipping the "be all you can be" motto into an anthem for true rap fans. He may not be the illest, but he's real, as he would like to put it, keeping up his stamina throughout the rhyme while vocals from Hello World add to the song's complexity. Sonically, a piano introduction lays down the foundation for MDG's promise to deliver, regardless of circumstance, class or privilege as production from Los Angeles soundsmith D.C. SoulPlusMind matches the piano with a drilling bassline that steps sharply. The man obviously has his own strategy for success; feel free to press play and follow along yourself. Fans can hear more of MDG's greatness on his forthcoming album, Shade Proof. In the meantime, take cover wack emcees. Green goes to war when it comes to this rap s**t.
Written by Sigmund'sDope on 01/11/12
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Driver killed, 2 hurt when car hits motorcycle
Updated On: Mar 17 2014 11:00:37 AM EDT
The driver of a Porsche that rear-ended a motorcycle on Interstate 95 early Sunday morning died when his car ran off the road, struck a tree and burst into flames, according to the Florida Highway Patrol.
Troopers say 34-year-old Adam Mathews (pictured below), of Jacksonville, died in the wreck at 3:30 a.m. about a mile north of the Palm Coast Parkway exit in Flagler County. His passenger, Gena Coursen, 38, was airlifted to UF Health/Shands in Gainesville with critical injures.
Allison Swisher, 57, of Greenville, S.C., was ejected from the Harley after it left the road. She was taken to Florida Hospital with minor injuries, according to the FHP report.
Troopers say the car was going north in the outside lane when it rear-ended the slower moving motorcycle. After the collision, both vehicles traveled onto the grass shoulder and into the woods line. Despite wearing her seat belt, the passenger of the Porsche was ejected when the car struck a large tree and caught fire. Troopers say Mathews could not escape the burning vehicle.
According to the report, the accident is still under investigation.
Mathews was the IT security chief for the city of Jacksonville. He joined the city in 2003 and became IT security chief in 2011.
"From Mayor Brown across our city staff, our thoughts and prayers are with Adam's family, the other victims involved and their families," the city said in a statement. "Adam was a very jovial and cheerful person, always with a smile on his face. He was well liked in ITD and across COJ. He will be missed very much professionally and personally."
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Tags astral jams, avant garde, rock
Genres experimental, indie, folk, jazz, canadian (beta)
(flag as incorrect)
December 26, 2009
Nine tracks including music by Clues, Four Tet and Grizzly Bear.
Heavy Mood by thrillhouse
reflective, classic, psychedelic rock
Synchronicity by thrillhouse
astral jams, avant garde, rock
UNDER DOG! by thrillhouse
A hiccup of a mix.
alternative rock, rock, blues
Beaut by thrillhouse
As you breathe in, take in and accept all the sadness, pain, and negativity of the whole world, including yourself, and absorb it into your heart.
peace, calm


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Engica develop and provide Enterprise Asset, Maintenance and Safety Management solutions to company's worldwide in the form of high performance software and related services. We deliver proven multilingual solutions to match precise client process requirements.Client requirements are normally specific, and although most industry-wide safety systems are similar, the ...
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Crowcon Detection Instruments Ltd
based in Milton Park, UNITED KINGDOM
Crowcon Detection Instruments develop, manufacture and market a complete range of portable and fixed gas detection products you can trust to protect people and plant against gas hazards. Established over 40 years the company has strong regional centres in North America, Singapore, The Netherlands and India, with a mature network of trained distributors covering almost ...
Terragon Environmental Technologies Inc.
based in Montréal, QUEBEC (CANADA)
Terragon develops and commercializes innovative technologies and practices needed to enable habitats to treat their waste locally and safely in order to recover valuable resources to be reused at the site where waste is generated. Terragon researches and engineers highly innovative waste treatment systems which anyone can operate safely, economically and without special ...
HI-Q Environmental Products Company
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HI-Q Environmental Products Company (HI-Q) has been a leading manufacturer of Air Sampling & Radiation Monitoring Equipment, Systems & Accessories since 1973. HI-Q started primarily as a manufacturer of activated carbon cartridges and high/low volume air sampling pumps intended to be used as "Record Samplers" in the collection of radioiodine and radioactive dust ...
based in Bellefonte, PENNSYLVANIA (USA)
Sigma-Aldrich is a leading Life Science and High Technology company whose biochemical, organic chemical products, kits and services are used in scientific research, including genomic and proteomic research, biotechnology, pharmaceutical development, the diagnosis of disease and as key components in pharmaceutical, diagnostics and high technology manufacturing. ...
3E Company
based in Carlsbad, CALIFORNIA (USA)
3E Company's comprehensive suite of data products and information services enable improved compliance with global Environmental Health & Safety (EH&S) requirements related to the safe manufacturing, distribution, transportation, usage and disposal of chemicals and hazardous products. This full chemical lifecycle approach enables in-house EH&S staff to reduce cost, risk ...
Tiger-Vac Inc. (USA)
based in Dania, FLORIDA (USA)
With over forty years of experience, Tiger-Vac has successfully established itself in the international market as a manufacturer of high quality Explosion Proof, Industrial Vacuum Cleaner and Cleanroom Vacuum Cleaner Systems. Tiger-Vac has accomplished this by listening to its clients and responding to their needs. Our many diverse clientele include the military, ...
BREEZE Software and Data / Trinity Consultants
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BREEZE® modeling software predicts the impact of air emissions, fires, and explosions. Air dispersion models such as AERMOD/ISC and CALPUFF include many productivity-enhancing features such as fully integrated GIS capabilities. BREEZE Incident Analyst and LFG Fire/Risk products are used to analyze numerous accident scenarios including dense/jet gas releases, LNG ruptures, ...
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A mildly sweet sauce that complements the mild taste of the cod filets. The curry flavor is very mild, but that is my curry powder, yours might be hotter. I like to serve it over basmati rice.
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UH Hilo the Daniel K. Inouye College of Pharmacy News and Events
DKICP General Events Calendar DKICP Student Services Events Calendar
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Read the latest press releases, news and publications, hot off the presses.
- Monday, October 13, 2014
Governor releases $33 million to construct permanent building for College of Pharmacy
- Thursday, October 2, 2014
Student pharmacists to pledge commitment in White Coat Ceremony
- Wednesday, October 1, 2014
College of Pharmacy health fair returns to Prince Kuhio Plaza Oct. 11
- Monday, September 15, 2014
College of Pharmacy achieves accreditation to offer continuing education for psychologists
- Monday, August 25, 2014
UH BOR approves change of status for College of Pharmacy
- Monday, August 18, 2014
Pharm2Pharm extends pharmacist after-care program to O`ah
- Monday, July 14, 2014
The U.S.-Thai Consortium votes to include UH Hilo's College of Pharmacy
- Monday, July 7, 2014
Permanent building helps College of Pharmacy receive extended accreditation
- Friday, June 27, 2014
Dean of pharmacy to leave UH Hilo
- Monday, June 16, 2014
The Daniel K. Inouye College of Pharmacy names Spring 2014 Dean's List
- Friday, April 25, 2014
Legislature approves funding for UH Hilo pharmacy building
- Friday, March 14, 2014
Pharmacists join fight against infectious diseases with new program on Kaua'i
- Tuesday, March 4, 2014
AACP chooses Dean Pezzuto for top research award
- January 6, 2014
The Daniel K. Inouye College of Pharmacy names Fall 2013 Dean's List
- December 17, 2013
UH Hilo/Thai university agreement expands pharmacy research, education
- November 25, 2013
UH Hilo Pharmacy dean honored for accomplishments
- October 21, 2013
Collaboration between local K-12 schools, DKICP benefits budding engineers
- October 15, 2013
DKICP continues biomedical research in joint project with UH Manoa
- October 3, 2013
Student pharmacists to take oath at DKICP White Coat Ceremony
- September 30, 2013
DKICP invites public to Health Fair Oct 2
- September 26, 2013
Pharmacy presents piano concert to aid student health center
- September 18, 2013
Pharmacy faculty teams with Student Medical Services to help students
- More Press Releases…