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Baxton Studio RT228-OCC-Wenge-WC Stamford Bar Cabinet
Product Description
Available while supplies last.
This Baxton Studio Stamford bar cabinet is offered in a dark brown finish.
One look is all it takes to see why we think this modern dry bar is perfect for entertaining!
- Widely-opening doors
- Two cabinet doors swing fully open to reveal horizontal wine bottle storage, vertical bottle storage, hanging wine glass racks, a drawer and even more on the back of the doors
- Dark brown wenge stained rubberwood veneer and MDF frame
- Made in Malaysia
- Should be dusted with a dry cloth for cleaning purposes
- Shelves are not removable
Additional Dimensions:
- 4 Storage Rack Behind 2 Doors: Width: 15.25" - Back-To-Front: 3.5" - Height: 18"
- Left Cabinet Upper the Wine Rack: Width: 15" - Back-To-Front: 12" - Height: 19.375"
- 12 Wine Rack: Width: 3.625" - Back-To-Front: 12" - Height: 3.625" (each)
- Right Cabinet Upper the Drawer: Width: 15.25" - Back-To-Front: 12.5" - Height: 10.875"
- Drawer: Width: 13.375" - Back-To-Front: 8.5" - Height: 2.5"
- Bottom Storage Space: Width: 15" - Back-To-Front: 12" - Height: 15.18"
Color/Finish: | Dark Brown | |
Materials: | Rubberwood / MDF | |
Usage: | Assembly Required | |
Application | Indoor, Residential | |
Assembly Required Some products are shipped to your door step assembled while others may require light assembly. | Assembly Required | Ready to Assemble |
Distressed Finish Furniture distressing is the act of making a piece look as though it is worn out or antique. This style has become a very popular finish in the industry. Narrow your results here by whether or not you desire a distressed finish. | Distressed Finish | Non-Distressed |
Type of Home Bar This option allows you to filter for the type of home bar you wish to purchase. This option filters use, function and style of the home bar. | Type of Home Bar | Bar Cabinet, Home bar, Indoor |
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5 out of 5
Write a ReviewThe Cabinet
By frank s. from Naples, FL on Jul 10, 2014
Design, and assembly is well engineered. Product overall quality is very good.
Shipping damage was severe and required considerable parts replacement which was handled excellently by ATG Customer service. I recommend being available for receipt and acceptance of delivery, and immediate inspection of all parts..Mechanical ability is required for assembly.
Shipping damage was severe and required considerable parts replacement which was handled excellently by ATG Customer service. I recommend being available for receipt and acceptance of delivery, and immediate inspection of all parts..Mechanical ability is required for assembly.
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Additional Details
Mfr Part # | |
Sku | |
Group # | 1322395 |
Category | Home Bar Furniture - 1068 |
Style | Modern - 3 |
Sales Rank | 58 |
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Inspector General: Dept. of Justice Is Misreporting Terror Statistics
(CNSNews.com) - A follow-up to a 2007 audit released Monday by the Department of Justice's (DOJ) Office of the Inspector General (OIG) found that DOJ did not accurately report terrorism-related statistics in 24 of the 26 categories auditors reviewed.
"For purposes of this audit, we considered the misreporting of a statistic as significant if the statistic was either overstated or understated by 10 percent or more," the report stated.
The follow-up audit casts new doubt on the "number of terrorism-related cases filed, the number of defendants convicted at trial or by guilty plea, and the number of defendants sentenced to prison" previously reported by DOJ.
"These inaccuracies are important because Department management and Congress need accurate terrorism-related statistics to make informed budgetary and operational decisions," the audit states.
Major inaccuracies in "terrorism-related statistics" were reported by the Federal Bureau of Investigation (FBI), the Executive Office for U.S. Attorneys (EOUSA), and the DOJ's Criminal Division.
"We found that EOUSA overstated one statistic showing the number of terrorism-related defendants within our sample who had been judged guilty in FY 2009 by 13 percent, and then overstated the same statistic for the defendants within our FY 2010 sample by 26 percent," the OIG reported.
"EOUSA's implementation of the revised procedures was not effective to ensure that terrorism-related statistics were reported accurately. . . EOUSA inaccurately reported all 11 statistics we reviewed during this follow-up audit."
They include "significantly overstated statistics," miscounting and double counting of cases between fiscal years, incorrect coding, and lack of "support for the reported statistics," the OIG report said, blaming the problem on a "lack of internal controls."
The EOUSA's annual reports "only show the numbers reported for each statistic, but do not show necessary supporting details such as case numbers, defendant names, and disposition dates."
For example, in 2010, EOUSA overstated the reported number of cases actually terminated during FY 2010" by 14 percent. "The cases for four defendants were incorrectly coded as Terrorism/National Security Critical Infrastructure cases."
In another case that "should have been coded as an Organized Crime Drug Enforcement Task Force case instead of an Export Enforcement Terrorism-Related case," the defendant faced conspiracy charges for the "intent to distribute over 50 kilograms of marijuana and was involved in the importation and delivery of approximately 200 pounds of marijuana."
In order to prevent "continued inaccurate reporting," the OIG recommended that EOUSA establish an annual reminder system calling for the re-coding of cases, update "reporting practices to clearly define the methodology used to collect the data," "clarify reporting practices," and monitor compliance.

subset: commoncrawl


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For new questions please post at magento.stackexchange.com, the community-run support site for the Magento community. We will be providing updates on the new forum solution soon. For questions or concerns please email email@example.com.
Does Magento have to facility to link to live XML feeds to add new producs? What is involved in setting this up?
In a word: No. This is a custom feature that I need as well. I have contacted several Magento partner developers about this and the average quote is between $8,000-$10,000 (one estimated $30,000, but after I replied with the equivalent of 'Uhh, are you serious?' they came back with $10k)
Speaking of XML feeds, how about using XML to generate a feed for a 3rd party fulfillment provider? Or a order import feed for a 3rd party call center?


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| |
Name | "Ishmael" |
Aliases | Unknown |
First Appearance | Metal Gear Solid V |
Other Appearances | None |
Sex | Male |
Nationality | Unknown (presumed American) |
Born | Unknown |
Physical Appearance | Bandaged head. |
Affiliations | Unknown |
Identifying Features | Head wrapped in bandages |
Voice Actor's (English) | Keifer Sutherland (MGSV) |
Voice Actor's (Japanese) | Unknown |
Ishmael is a new character in Metal Gear Solid V. In the Ground Zeroes trailer he is shown giving Big Boss a shot of digoxin to help him get up on his feet. Ishmael led Big Boss to an elevator since he could not walk. Once infront of the elevator they see a child with a gas mask (supposedly Psycho Mantis) levitating up into the ceiling. After the lift explodes, what looks like Colonel Volgin, appears in the flames. Ishmael and Big Boss then head back the way they came towards the emergency stairs.
Ishmael's name comes from the main character from the Moby Dick book. He also refers to Snake as Captain. Just like Ishmael called Ahab, Captain Ahab in the Moby Dick book. Whether this has any connection to the flaming whale in the trailer and Moby Dick Productions remains to be seen.
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▼ Temporary Closure Notice (updated 2/28/2015)Starting from March 7th, 2015 Cosaru.com will be closed for a few months.The last date I can ship packages will be Friday, March 6th, 2015.So if you're planning to buy pre-made costumes, please make sure to complete the payment by Thursday, March 5th, 2015.I'm definitely planning to re-open the shop although the date is uncertain at this moment.And when I come back, I'll post the news on the website, blog, and facebook.I apologize for taking such a long break. And I appreciate all love and care that customers showed to Cosaru.com.There are still a lot of costumes I want to make.And I'll do my best to come back to my sewing machine as soon as possible.* Website, blog, and facebook will remain open for viewing.Thank YouWith Best Regards,Cosaru ...


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Holdays.net Home
J Charley Turquoise Charoite Navajo Sterling Necklace Set Vintage
Photos enlarged to show detail
PLEASE review dimensions to be sure it is the right size
for you before buying
PRIMO Vintage Navajo inlay Necklace and earring set, Gorgeous work, and beautiful colors, make this a real prize. The design is a bold setting, in the Navajo Style, with a nice heavy fringe and deep carving on the border. The artist, J. Charley, has used beautiful deep purple Charoite with a soft Pink Coral and the softest most beautiful blue-green Turquoise that looks like Royston. A stunning combo, I Love it. Made in 1984.
International Buyers – Please Note:
Import duties, taxes, and charges are not included in the item price or shipping cost.These charges are the buyer's responsibility. Shipping may take up to 2 weeks. Please check with your country's customs office to determine what these additional costs will be prior to offerding or buying.
WE ACCEPT PAYPAL ONLY. Arizona residents must pay 7.1% sales tax.
We ship promptly after payment has cleared. We ship by USPS First Class Mail. Shipping done Monday- Friday. If item(s) are lost or damaged during transit, we cannot be held responsible.
We accept returns within 14 days for money back or exchange. Items must be returned in new condition less the cost of shipping. Buyer pays return shipping.
Please contact me immediately if you are unhappy with your purchase. I would prefer to be made aware of any concerns before anyone leaves negative response. I have a 100% return policy within 14 days of receipt, less shipping charges. I don't charge re-stocking fees because, so far, I have had less than a handful of returns. Positive response is not just important to my business -- it's vital because rewards its Sellers with high positive response scores. I very much appreciate prompt Positive response once your receive your merchandise. Once I receive response from my customers, I in turn leave response for my customers. Thanks so much for doing business with Wild Horse Traders.
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925 Sterling Silver Reversible Cross Turquoise And Coral Pendant With Chain
Handmade Navajo Sterling Silver Blue Green Turquoise Necklace & Ear Rings Set
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Jump to: Conference or Workshop Item Number of items: 1. Conference or Workshop ItemWang, Y., Tomor, A. and Melbourne, C. (2010) Study of fatigue behaviour of brick masonry. In: ARCH'10- 6th International Conference on Arch Bridges, Fuzhou, China, 2010. This list was generated on Mon Mar 2 03:21:04 2015 GMT. |


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What does TIME mean in IEEE?
This page is about the meanings of the acronym/abbreviation/shorthand TIME in the Academic & Science field in general and in the IEEE terminology in particular.
International Workshop on Temporal Representation and Reasoning
Find a translation for TIME in other languages:
Select another language:
What does TIME mean?
- time, clip(noun)
- an instance or single occasion for some event
Discuss this TIME abbreviation with the community:
Use the citation below to add this abbreviation to your bibliography:
"TIME." Abbreviations.com. STANDS4 LLC, 2015. Web. 1 Mar. 2015. <http://www.abbreviations.com/term/516555>.
TIME also stands for:
- Display or Set computer time
- Teaching Innovation, Motivation, and Excellence
- Technology Information Multimedia And Entertainment
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- Teens In Mission Evangelism
... and 19 more »
Nearby & related abbreviations:
Alternative search:
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Recipe of the Day
Plum Clafouti
A family favourite that fills the house with a cinnamon aroma. A delicious plum dessert, dusted with icing sugar! — GibsonsGirl
Similar Recipes | More Daily Recipes
Staff Picks
Baron's Blackberry Cobbler
Raspberry Icebox Cake
Scrumptious Strawberry Shortcake
Lemon Ice II
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Fresh Fruit and Yogurt Ice Pops
Peach Pie the Old Fashioned Two Crust Way
No Bake Lime Mousse Torte
Summer Desserts 367
Fresh Southern Peach Cobbler
Easy Batter Fruit Cobbler
Blueberry Pie
Blueberry Buckle
Triple Berry Crisp
Blackberry Cobbler II
Blueberry Sour Cream Coffee Cake
Classic Tiramisu
Strawberry Angel Food Dessert
Molten Chocolate Cakes With Sugar-Coated Raspberries
Best Ever Blueberry Cobbler
Blueberry Crumb Bars
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Creamy Blueberry Pie
Old Fashioned Peach Cobbler
Blueberry Coffee Cake I
Strawberry Trifle
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Blackberry Pie I
Muffins are great for breakfast, with coffee, or just as a snack on the go.
Soup is what the doctor ordered to cure those winter blahs.
Delicious recipes, party ideas, and cooking tips! Get a year of Allrecipes magazine for $7.99!
Watch tips for cleaning, prepping, and storing all types of mushrooms.
See how to care for cast iron cookware so it lasts for years and years.
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Please turn on active scripting for price and buy button.
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Reviewed By Kenneth K (SAN ANGELO, TX) Reviewed for a 2009 Ford F-150 —2/5/2014 6:28 PM
Quite - Great stopping power. Fast shipping.
Reviewed By Scott H (IRVINE, CA) Reviewed for a 2003 Ford F-150 —1/7/2015 12:47 AM
I had these installed along with new stock rotors,and have enjoyed the more confident braking. They had made a lot of noise until bedded in (following EBC directions)but have quieted quite nicely. I was never happy with the feel of the brakes since the truck was brand new and have been looking for a better feel. I have found it with these brake pads.


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Lap Band in Mexicali |
Updated: Kevin Williams on July 19th, 2013 | no responses. |
CostOur lap band packages for Mexicali begin from $5,500. We recommend that you fill the online estimate form for the latest prices and discounts on bariatric surgery. Length of Hospital StayAverage length of hospital stay is about one night. Conditions for Qualifying for Gastric Banding with BSW in Mexicali
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Madison Dual Chime Mantel Clock
The elaborate wood inlay front looks elegant on anyone's mantel. Fluted columns hold up the large round arch and the dial sits behind a glass lens. Dual-chime with volume control. More
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"The harder you work, the luckier you get." by Gary Player
Below is the poem entitled Nature in the mix which was written by poet Annalise a.k.a. Audrey Haick. Please feel free to comment on this poem. However, please remember, PoetrySoup is a place of encouragement and growth.
Read Poems by Annalise a.k.a. Audrey Haick
Best Annalise A.K.A. Audrey Haick Poems
daffodils--- spring blossoms happy smiles periwinkles blue attire--- blaze like stars the black hole grave yard for stars no headstones--- ~*~ 2/09/13 Note: For Gigno's Ellip Contest ( Listed under Haiku Form)


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RFE: Conference Listings
This service is a joint project of RFE and EconBiz.
SoFiE - The Society for Financial Econometrics
- Dates:
- April 16-16, 2010
- Description:
- Volatility and Systemic Risk
- Location:
- NYU, New York City, New York
- Subject:
- The focus of the conference is to understand both economically and statistically the dramatic movements in volatilities and correlations experienced in global financial markets since Sept 2008. Some of these financial market risks we now know were systemic and the conference will showcase new research on both statistical and economic measures of systemic risk. Such measures are potentially important inputs to the new regulatory environment. The conference will emphasize academic, regulatory and practitioner points of view.
- Notes:
- JEL Code:
- Sponsor:
- Jointly sponsored by the The Center for the Study of Auctions, Procurements and Competition Policy (CAPCP), the Center for Research on International Financial Energy Security (CRIFES) at Pennsylvania State University, and FinEx Plus LLC.
- http://sofie.stern.nyu.edu/april16


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If you are front end coder you must know how important is to make cross browses, valid CSS and xHTML code. And also you must know how much time we are spending in all those hacks and fixes for various browsers. I've written about some of them earlier on PNG transparency issues, Yellow fields in web form, Vertical align div etc..
Here is the list of 10 hand picked CSS hacks and tricks which can help you in your CSS code and also save some time.
1. Vertical align div
2. Min-Height
selector { min-height:500px; height:auto; !important height:500px; }
3. PNG transparency
4. Autoclear
.container:after { content: "."; display: block; height: 0; clear: both; visibility: hidden; } .container {display: inline-table;} /* Hides from IE-mac \*/ * html .container {height: 1%;} .container {display: block;} /* End hide from IE-mac */
5. Reset CSS
html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, dl, dt, dd, ol, ul, li, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { border:0pt none; font-family:inherit; font-size:100%; font-style:inherit; font-weight:inherit; margin:0pt; outline-color:invert; outline-style:none; outline-width:0pt; padding:0pt; vertical-align:baseline; } table { border-collapse:separate; border-spacing:0pt; } caption, th, td { font-weight:normal; text-align:left; } blockquote:before, blockquote:after, q:before, q:after { content:""; } blockquote, q { quotes:"" ""; } strong { font-weight:bold; } em { font-style:italic; } * { margin:0pt; padding:0pt; }
6. Scrolling Render IE
html { background : url(null) fixed no-repeat; }
7. Opacity
#transdiv { filter:alpha(opacity=75); -moz-opacity:.75; opacity:.75; }
8. PRE Tag
pre { white-space: pre-wrap; /* css-3 */ white-space: -moz-pre-wrap !important; /* Mozilla, since 1999 */ white-space: -pre-wrap; /* Opera 4-6 */ white-space: -o-pre-wrap; /* Opera 7 */ word-wrap: break-word; /* Internet Explorer 5.5+ */ }
9. Li Background Repeat IE
<!--[if lt IE 7]> <style> #leftnav li { zoom: 1;} /* haslayout=true */ </style> <![endif]-->
10. Good to know
@charset "UTF-8"; /* ---------------------------------------------------------------------- WinIE7 ---------------------------------------------------------------------- */ *:first-child+html selector{property:value;} /* ---------------------------------------------------------------------- WinIE6 & Mac IE ---------------------------------------------------------------------- */ * html selector{property:value;} /* ---------------------------------------------------------------------- WinIE6 ---------------------------------------------------------------------- */ /*\*/ * html selector{property:value;} /**/ /* ---------------------------------------------------------------------- MacIE ---------------------------------------------------------------------- */ /*\*//*/ selector{property:value;} /**/
Have some feedback? Leave a comment
689 Comments So Far
Useful and great list of hacks that as you said all coders should be aware of. Thanks for the great resource.
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Arrival of Japanese Consul, 1860. [American Views. New York City.] (June 1860)
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Law and Society
Law and Society Minor The minor in Law and Society focuses on exploring the relationship between law in the books and law on the streets. It focuses on a variety of approaches to law as intended and experienced. The minor is intended for students interested in expanding knowledge and skills in preparation for law school, graduate school, careers in the public and private sectors. The program consists of an integrated, interdisciplinary package of courses in research and analytic methods in applied social sciences and the humanities. Requirements of the program include completion of 18 hours between specified courses and selected field experiences. Students must take Law and Social Inquiry (or equivalent), an Experiential Component and accompanying colloquium, and a capstone experience. As part of the minor, students will choose 2 courses from one of three concentration tracks. The UMD Carey School of Law will teach one course in each track: Constitutionalism & International Law; Migration, Race & Ethnicity; Crime & Punishment. For more about the minor please visit: www.mlaw.umd.edu Students are required to take the following courses:
All courses used to satisfy the requirements of the minor must be completed with a grade of "C-" or better. Must maintain GPA of 2.0 or better. |


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Sirius XM, Frontier Financial: Early Volume Plays
NEW YORK ( TheStreet) -- Sirius XM (SIRI - Get Report) was one of several stocks poised to move on above-average volume Tuesday after the satellite radio company said it swung to a profit in the first quarter.
Sirius XM said it had an adjusted profit of a penny a share, compared to the Thomson Reuters average estimate for a break-even quarter. Revenue was up from a year ago to $670.6 million, although that fell short of the $671.3 million consensus. The average revenue per subscriber rose to $11.48, while subscriber acquisition costs per subscriber fell to $59.
Sirius XM reaffirmed its full-year guidance, saying it expects revenue of over $2.7 billion, more than 500,000 net subscriber additions and positive free cash flow.
Sirius XM shares were higher by a penny, or 0.8%, to $1.24 in the premarket session. The 50-day average daily volume for Sirius XM is 158 million, according to the
Sirius Somber on Howard Stern
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Personal Finances
News about Personal Finances, including commentary and archival articles published in The New York Times.
Chronology of Coverage
Feb. 22, 2015
Jeff Sommer Strategies column examines the virtues and downsides of debt, which can supercharge investment returns when used wisely as leverage; examines data showing trend in macrocosm in relation to the United States housing market over past decade. MORE
Feb. 21, 2015
Tara Siegel Bernard Your Money column notes that Fidelity and other retirement plan providers are increasingly tailoring their messages for customers based on gender, ethnic identification and income level; observes that push to cater to specific needs of women is particularly relevant to Fidelity, given that its internal research suggests that women are increasingly heads of households and breadwinners. MORE
Feb. 21, 2015
Paul Sullivan Wealth Matters column relates advice from sommeliers at some of New York City's finest restaurants about picking out wines; notes that sommeliers face challenge of choosing for customers from selection of hundreds if not thousands of wines in matter of minutes. MORE
Feb. 18, 2015
Op-Ed article by Prof Adam Seth Levine describes experiments he conducted from 2008 to 2012 that gauged how likely people were to spend money on variety of causes, given wording of messaging; observes that his research showed that if prospective donors were reminded of their own financial constraints, they were less likely to donate, even if issue in question affected them personally; reflects on implications for political messaging. MORE
Feb. 7, 2015
Ann Carrns Your Money Adviser column warns consumers with low credit scores about dangers of applying for so-called fee harvester cards, which offer very low credit limits but charge high upfront fees that gobble available credit, effectively driving up interest rate; offers suggestions for how to build credit without one of these cards. MORE
Making Money Decisions When You Lose Your Job
About 1.7 million people lose their jobs every month, creating a hugely stressful situation and requiring potentially life-altering choices.
February 28, 2015, Saturday
MORE ON PERSONAL FINANCES AND: Layoffs and Job Reductions
Personal Finances
Health Insurance and Managed Care
Finding the Right Balance of Time and Money
We exchange time for money in the form of work, and money for time in the form of convenience. Our happiness may depend on finding an equilibrium.
February 23, 2015, Monday
MORE ON PERSONAL FINANCES AND: Personal Finances
Credit Card Balance Transfer Can Reap Savings if Done Cautiously
Credit card companies are responding to consumers' debt confidence by offering more attractive balance-transfer offers.
February 22, 2015, Sunday
Debt's Two Sides: Riches and Misery
When it's used wisely, debt becomes leverage and can increase your investment returns. Used badly, it can land you in the poorhouse.
February 22, 2015, Sunday
MORE ON PERSONAL FINANCES AND: Credit and Debt
Personal Finances
Real Estate and Housing (Residential)
Financial Advice by the Demographics
Fidelity and other retirement plan providers have begun rewriting the script when it comes to advising specific employees, including women, Hispanics and members of specific generations or income groups.
February 21, 2015, Saturday
MORE ON PERSONAL FINANCES AND: Women and Girls
Fidelity Investments
Pensions and Retirement Plans
Personal Finances
Financial Planners
Reading Restaurant Wine Lists, for Blockbusters and Values
Here are some ways good sommeliers find the right wine for a customer out of hundreds or thousands of bottles.
February 21, 2015, Saturday
Don't Talk About Those Unpaid Bills
People who are economically insecure aren't galvanized by political messages that mention their financial problems.
February 18, 2015, Wednesday
MORE ON PERSONAL FINANCES AND: United States Politics and Government
Personal Finances
Psychology and Psychologists
Credit and Debt
Rethinking Money, Not as Good or Bad but as a Tool
A shift in thinking changes attitudes about saving and spending; we are no longer focused on positive or negative but on the outcome of our actions.
February 17, 2015, Tuesday
Surviving the Perils of the Quest for Higher Yield
Alternative investments like master limited partnerships and foreign bonds may come with significant tax headaches as well as high returns.
February 15, 2015, Sunday
Stressed by Money? Get on the Couch
The young field of financial therapy tries to identify disorders in how people view money, to better advise them on planning and investments.
February 10, 2015, Tuesday
MORE ON PERSONAL FINANCES AND: Therapy and Rehabilitation
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What to know: Ebola
Published On: Jul 29 2014 08:08:07 AM CDT
Updated On: Dec 28 2014 03:21:11 PM CST
The world's worst Ebola outbreak on record has now killed more than 7,000 people. Learn more about this deadly disease and its symptoms.
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Thank you for registering for TicketsNow email alerts. As a first time subscriber, you will receive an email with a 10% discount for use on your first order!
Neil Diamond is a singer and songwriter who rose to fame throughout the 1960s, 70s and 80s. Famous for tunes that have become standards like "Cherry, Cherry," "Girl You'll Be a Woman Soon," "Holly Holly," and "Sweet Caroline," Diamond is one of the most successful adult contemporary artists on the Billboard charts just behind superstars Barbara Streisand and Elton John. Diamond is an artist that is celebrated in the industry with Grammy Awards, Golden Globes and inductions into the Rock and Roll and Songwriters halls of fame. Known for his musicianship and amazing live performances, Diamond is famous for his steady voice and amazingly garish shirts. Don't miss your opportunity to see an amazing show put on by one of the music's best; get your Neil Diamond tickets now! A New York native, Diamond was not originally inclined towards music. Instead, he was studying medicine at university until he took a gig penning tunes for a music publishing business for $50 per week. Unsuccessful attempts at beginning his own singing career in the early 1960s saw Diamond return to writing hits for bands like The Monkees. In the mid-1960s Diamond got his first hit in "Solitary Man." Once he churned out a handful more hits, Diamond began to play live as a special guest for bands the likes of The Who. Once Diamond's career got a foothold, he moved to Los Angeles. Following the move, his sound morphed from rock to pop before settling into the style that has made Diamond famous the world over. By the time the 1970s rolled around Diamond was playing to sold out crowds at the Greek Theatre. A true music icon, Diamond has had versions of his songs recorded by everyone from Urge Overkill to Johnny Cash. Witness the energy that is a live Neil Diamond concert and take away a musical memory that's a piece of history. A great performance anytime, the reviews from concertgoers shout "Diamond is pure gold," "fantastic," declaring that Neil Diamond is an amazing live concert event for the entire family! Grab your opportunity to experience a musical icon when you buy your Neil Diamond concert tickets today!


text: Wound Management • October 11, 2001 • Gavin Greenfield and Bob Johnston Objectives • Wound Healing • Wound Evaluation – History, Physical examination • Wound Preparation • Wound Closure • Specific Wounds – face, scalp, eyebrow, eyelid, ear, lips, intraoral, puncture, fingertip and nail, foreign bodies, bites Wound Healing • "the primary goal of wound care is not the technical repair of the wound; it is providing optimal conditions for the natural reparative processes of the wound to proceed" – Richard L. Lammers (Roberts and Hedges) Skin Anatomy • Epidermis – keratinized squamous epithelium – avascular • Dermis – dense, fibro-elastic tissue – highly vascular – cells of dermis mainly fibroblasts responsible for elaboration of collagen, elastin, ground substance • Subcutaneous layer (superficial fascia) – connects dermis to underlying tissue – contains variable amounts of adipose tissue Case 1 • 1st year medical student comes in with laceration to hand. You evaluate the wound and feel it is appropriate for primary closure. He asks you how the wound will go about healing itself? What do you tell him to appease his curious mind? Wound Healing • Stages – hemostasis – inflammation – epithelialization – fibroplasia – contraction – scar maturation Wound Healing • Inflammation – serves to remove bacteria, foreign debris, and devitalized tissue – a biologic debridement – if this stage is prolonged (from infection, foreign material, etc.) will get persistent inflammation and result in poor wound healing Wound Healing • Epithelialization – in sutured wounds, surface of wound develops epithelial covering impermeable to water in 24-48 hours – eschar and surface debris impair this process by inhibiting the migration of the epithelial cells Wound Healing • Fibroplasia – by fourth day fibroblasts begin synthesizing collagen, initiating scar formation – characterized clinically by pebbled red tissue in wound base Wound Healing • Contraction – movement of skin edges toward center of defect, primarily in direction of underlying muscle – everting skin edges at time of repair accounts for the subsequent wound contraction Wound Healing • Scar Maturation – amount of scar tissue influenced by physical forces acting across wound – strength of wound increases rapidly from day 5-17, more slowly for additional 14 days, and further collagen remodeling / maturation for 2 years – strength of scar tissue never quite reaches that of unwounded skin Case 2 • Pt presents with two wounds – one is sharp, linear laceration on L hand from a clean knife. While riding her bike to hospital she falls on a pristine, flat, clean road and lands on dorsum of hand producing a jagged irregular laceration. • Which of the two has higher chance of infection? Why? Case 3 • Alcoholic, diabetic street person presents with laceration to R forearm. He thinks he did it about 24 hours ago but can't remember mechanism. On examination small amount of soil type debris in wound. • How will you manage this case? Wound Evaluation – History American College of Emergency Physicians: Clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Ann Emerg Med Vol 33 No. 5 May 1999 • identify all extrinsic and intrinsic factors that jeopardize healing and promote infection – mechanism of injury – time of injury – environment in which wound occurred • potential contaminants, foreign bodies – species of animal if bite – pt's medical problems / immune status • tetanus immunization status • handedness / vocation Wound Evaluation - History • Risk Factors for wound infection (Singer et al. Risk factors for infection in patients with traumatic lacerations. Academic Emergency Medicine. July 1, 2001; 8(7): 716-20) – older age – diabetes – laceration width – presence of foreign body Wound Evaluation – History (mechanism of injury) • Type of force causing wound • Acute traumatic wounds caused by one or combination of 3 forces – shear – compressive – tensile Wound Evaluation – History (mechanism of injury) • Shear Forces – produced by sharp objects that cut through the skin – amount of energy required to cut skin with sharp object is low therefore little energy directed to surrounding tissue with minimal cell damage – results in lower risk of infection and problems with wound healing because remaining tissue is not devitalized Wound Evaluation – History (mechanism of injury) • Compressive and Tensile Forces – compressive forces produced when blunt object impacts the skin at right angles (wounds tend to be stellate or complex with ragged/shredded edges) – tensile forces produced when a blunt object impacts skin at oblique angles (wounds tend to be triangular or produce a flap) – compared to shear forces much more energy deposited with high amounts applied to area around wound – results in devitalization of surrounding tissue with higher incidence of wound infection Wound Evaluation – History (mechanism of injury) • Shear vs. Compressive / Tensile Forces – Infection • with compressive / tensile forces the critical number of bacteria needed to produce infection is much lower (~100,000 organisms per gram of tissue) • with shear forces the number of bacteria needed to produce infection is much higher ~ 10,000,000 organisms per gram of tissue Wound Evaluation – History (time of injury) • "golden period" refers to time after injury that wound can be safely closed without increased risk of infection – delay in wound cleaning is most important variable – contrary to popular belief not a fixed number of hours – "there is little change in wound infection rates in most areas of the body for up to 19 hours after a variety of traumatic injuries, and infection rates of simple wounds involving the head are essentially unaffected by the interval between injury and repair" • Berk et al. Evaluation of the "golden period" for wound repair: 204 cases from a third world emergency department. Ann Emerg Med 17:496, 1988 Wound Evaluation – History (time of injury) • accelerated growth phase of bacteria starts at 3 hours post wound Timing of Closure • primary, delayed primary, secondary – decision to close a laceration is multifactorial – base decision on wound history, physical examination, host factors • Revisit Case 3 Wound Evaluation – Physical Examination • Examine for: – amount of tissue destruction – degree of contamination – damage to underlying structures • Wounds may be classified into 6 categories – lacerations – abrasions – crush wounds – avulsion wounds – puncture wounds – combination wounds Wound Evaluation – Physical Examination • Lacerations – if caused by shear force little tissue damage at wound edge and margins are sharp and wound appears "tidy" – if caused by compressive or tensile forces, more force is required to produce the laceration and therefore more tissue trauma; often appear jagged, contused Wound Evaluation – Physical Examination • Abrasions – results from forces applied in opposite directions (e.g. skin grinding against road surface) Wound Evaluation – Physical Examination • Crush Wounds – caused by impact of an object against tissue, especially over a bony surface, which compresses the tissue – at higher risk for subsequent compartment syndrome Wound Evaluation – Physical Examination • Avulsions – wounds in which a portion of tissue is completely separated from its base and is either lost or left with a narrow base of attachment Wound Evaluation – Physical Examination • Puncture Wounds – wounds with a small opening and whose depth cannot be visualized • Combination Wounds Wound Evaluation – Physical Examination • Amount of tissue destruction / devitalized tissue Wound Evaluation – Physical Examination • Degree of Contamination – bacteria and foreign material – primary determinants of wound infection are the amount of bacteria and dead tissue remaining in wound – the presence of undetected reactive foreign bodies in sutured wounds almost guarantees infection Wound Evaluation – Physical Examination • Underlying Structures – nerves, vessels, tendons, bones, joints Wound Evaluation – Physical Examination • Wound Location – has considerable importance in the risk of infection – high endogenous bacterial counts in hairy scalp, forehead, axilla, groin, foreskin of penis, vagina, mouth, nails – wounds in areas of high vascularity more easily resist infection (scalp, face)' Delayed Primary Closure • wound preparation (debridement, cleansing, etc.), dress with saline soaked fine mesh gauze, follow up in 72-96 hours for debridement, repeat cleansing and closure if no evidence of infection Skin Preparation • prevents transfer of bacteria into wound from instruments, suture needles, gloved fingers • use whatever (no research suggest one better than another) • important to distinguish between skin preparation and wound cleansing Wound Cleansing (not skin preparation) • Soaking – of little value and may actually increase bacterial counts (Lammers, Fourre, Callaham et al. Effect of poviodine-iodine and saline soaking on bacterial counts in acute, traumatic contaminated wounds. Ann Emerg Med 19: 709, 1990) Wound Cleansing (not skin preparation) • Mechanical Scrubbing – gentle scrubbing may be useful in wounds older than 3-4 hours (a glycoprotein matrix enters wound and may protect it from further attempts to lower bacterial counts with irrigation) • Debridement of devitalized tissue paramount to reducing risk of infection • Scalpel excision of wound margins can be used in grossly contaminated wounds Wound Cleansing (not skin preparation) • Irrigation – Equipment? • 35 cc syringe with 18 G needle produces about 7-8 psi – Solution? • NS or 1% poviodine-iodine solution (ie. diluted Betadine) (Dire and Walsh: A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med 1990; 19:704-708) – infection rate in poviodine arm was lower than saline arm but not statistically significant (4.3% vs 6.9%) • Hydrogen peroxide kills fibroblasts and occludes microvasculature, chlorhexadine toxic to tissue defenses, detergents contained in scrub solutions cause tissue damage in wounds – How much? (all expert opinion – no clinical trials) • minimum of 100-300 cc with continued irrigation until all visible particles removed • 50-100 cc per cm of wound length • if irrigation alone is ineffective in removing contaminants from a wound, the wound should be lightly scrubbed Prophylactic Antibiotics - Topical • Ointments – reduce formation of crust which could inhibit epithelialization – prevent dressing from adhering to wound – routine use encourages pt inspection of wound – one randomized, double blind clinical trial demonstrated reduced infection rate • Dire et al. Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED. Acad Emerg Med 2:4, 1995 Prophylactic Antibiotics - Systemic • no role for routine antibiotic use for most wounds (Cumming et al. Antibiotics to prevent infection of simple wounds: A meta-analysis of randomized studies. Am J Emerg Med 13:396, 1995) • specific wounds: contaminated with debris, feces, saliva; punctures, bites, extensive tissue destruction, wounds in avascular areas, oral lacerations, wounds involving joint spaces, tendons, or bones; presence of impaired host defenses Wound Closure - Sutures • Classification: nonabsorbable vs absorbable • Size (according to diameter): 6-0 face, 5- 0,4-0 trunk and extremities, 3-0 scalp, sole of foot Wound Closure – Sutures - Nonabsorbable • Natural or Synthetic / Monofilament or Multifilament – natural incite tissue reactivity (therefore increase risk of infection, synthetic less so) – monofilament have less pliability and knot security than multifilament but multifilament increase risk of wound infection • Natural multifilament - silk – easiest to handle but poses greatest risk of infection because of tissue reactivity (it is both a natural suture and multifilament) • Synthetic monofilament – nylon (Ethilon), polypropylene (Prolene), polybutester (Novafil) • Synthetic multifilament – nylon, polyester (Mersilene) Wound Closure – Sutures - Absorbable • Natural (collagen) or Synthetic (polymers) • Natural – plain gut and chromic gut – plain gut loses tensile strength the quickest (half life 5-7 days); produces marked tissue reactivity; generally used only for oral mucosal closures (because heal so quickly) – chromic gut absorbed less rapidly than plain gut but faster than synthetics (half life 10-14 days); less tissue reactivity than plain gut because of chromic coating; useful in situations where suture removal may be difficult Wound Closure – Sutures - Absorbable • Synthetic Multifilament – polyglycolic acid (Dexon), polyglactin 910 (Vicryl) – most commonly used in emerg for sq layers • Synthetic Monofilament - polyglyconate (Maxon), polydioxanone (PDS II) • Remember – presence of any suture material in a wound increases risk of infection; subcutaneous sutures have highest risk Wound Closure - Staples • lower tissue reactivity than even the least reactive suture material • get less accurate closure with higher chance of malapposition of wound edges and development of scar • generally reserved for sites where scar is less of an issue (hairy scalp) – Kanegaye et al. Comparison of skin stapling devices and standard sutures for pediatric scalp laceration: A randomized study of cost and time benefits. J Pediatr 130:808, 1997 Wound Closure - Tapes • useful for flat, dry, nonmobile surfaces where wounds fit together with no tension –ie superficial, straight laceration under little tension • more resistant to infection than sutured wounds • adherence of tapes improved with use of benzoin to skin surface • recommend not getting wet but… • should stay in place as long as equivalent suture and will spontaneously detach as underlying epithelium exfoliates Wound Closure – Tissue Adhesives (2-octylcyanoacrylate) • closes wounds by forming an adhesive layer on top of intact epithelium, which holds edges together • cause inflammatory reaction within wounds • Useful – edges less than 5 mm apart, clean, sharp edges, clean nonmobile areas, laceration less than 5 cm in length • Not useful – wounds near eye, on mucous membranes or mucosal surfaces, wet wounds or those exposed to body fluids, or in areas with dense hair, wounds under significant tension Wound Closure – Tissue Adhesives (2-octylcyanoacrylate) • Literature – in selected lacerations produces cosmetic appearance that is comparable with standard suture closure • Singer et al. Prospective, randomized, controlled trial of tissue adhesive (2- octylcyanoacrylate) vs. standard wound closure techniques for laceration repair. Acad Emerg Med 1998; 5:94-99 • Quinn et al. A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of laceration. JAMA 1997;277:1527-1530 • Quinn et al. Tissue adhesive versus suture wound repair at 1 year: Randomized clinical trial correlating early, 3 month, and 1 year cosmetic outcome. Ann Emerg Med 1998;32:645-649 • Maw et al. A prospective comparison of octylcyanoacrylate tissue adhesive and suture for the closure of head and neck incisions. J Otolaryngol 1997;26:26-30 – may be useful for wounds under higher skin tension • Saxena Octylcyanoacrylate tissue adhesive in the repair of pediatric extremity lacerations. Am Surg 1999 May;65(5):470-2 • in above study they looked at 32 children with high skin tension lacerations (hand, feet, over joints). Following closure splints were applied to restrict movement Wound Closure – Tissue Adhesives (2-octylcyanoacrylate) • Application – hold wound edges together with tissue forceps (???), lightly wipe applicator tip over area starting at least 5 mm from edge of wound in direction of long axis of wound (some authors support perpendicular application), 3-4 thin layers, hold wound edges together for 60 s post application – avoid ointments and dressings Wound Closure – Tissue Adhesives (2-octylcyanoacrylate) • Tips – avoid latex gloves – use vinyl gloves – avoid plastic instruments (ie. tissue forceps) – if enters wound needs to be wet sponged immediately – use antibiotic ointment for removal of hardened Dermabond in wound Specific Wounds – Face • high vascularity therefore low incidence of infection • debride minimally to preserve normal facial contours • be more aggressive with layered closure Specific Wounds - Forehead • unrepaired muscle layers more likely to produce scars • be liberal with deeper sutures in wounds under tension • reapproximate skin tension lines and hairline precisely Case 7 • 8 month old boy presents with 2 days progressive lethargy with weakness L side of body. 1 month ago was bitten on scalp by dog. What has happened and how? Specific Wounds - Scalp • 5 layers • can bleed +++ • shaving increases risk of infection; clip hair or use ointment to mat it down • check for disruption of galea and repair if present (either single or layered closure) • subaponeurotic (subgaleal) loose connective tissue contains emissary veins that communicate with intra-cranial venous sinuses – subgaleal hematomas can become infected and infection can be transmitted intra-cranially via emissary veins Specific Wounds - Eyebrow • minimal if any debridement; if needed angle scalpel parallel to direction of hair shafts to minimize damage to hair follicles and resulting alopecia • never shave eyebrows • use edges to serve as landmarks for reapproximation Specific Wounds - Eyelids • Layers (out to in): skin, subcutaneous tissue, muscle (orbicularis oculi and levator palpebrae in upper eyelid), supporting tissue (forward continuation of sub-galeal aponeurotic layer of scalp), tarsal plate (dense fibroelastic plate), conjunctiva • with any eyelid laceration ensure no penetrating globe injury Specific Wounds - Eyelids • When to repair – superficial; use 6-0 or 7-0 nonabsorbable synthetic, small bites • When to refer – lacerations involving inner surface of lid – lacerations involving lid margins (imperfect closure results in ectropion or entropion) – lacerations involving lacrimal duct (clue is laceration of lower lid medial to punctum) – lacerations associated with ptosis (levator injury) – lacerations extending into tarsal plate Specific Wounds - Ears • Anatomy – auricle (pinna) – modified horn shaped structure composed of elastic cartilage covered by skin – converges onto the external auditory meatus (canal) – earlobe • with blunt forces ensure no ruptured TM • examine closely for subchondral hematoma – absolutely have to avoid persistent hematoma – need perfect hemostasis to prevent formation of hematoma – if present consider plastics or ENT referral Specific Wounds - Ears • gaping through and through lacerations require 3 layer closure – 1st – one or two sutures will approximate cartilage edges, include anterior and posterior perichondrium in suture – 2nd – approximate posterior skin – 3rd – anterior surface of ear using landmarks joined point to point • all repaired ears should be enclosed with compression dressing Specific Wounds - Nose • Anatomy – separated into two halves by the septum (cartilaginous structure) – tip formed by two C-shaped alar cartilages covered directly by skin • Exposed cartilage increases risk of infection and therefore needs to be covered • Nasal trauma can result in septal hematoma – can lead to permanent thickening of the septum with subsequent airway obstruction – pressure from a septal hematoma may cause necrosis and subsequent erosion / rupture of septum – aspirate with 18G needle or horizontal incision at base; nasal packing following drainage will prevent reaccumulation Specific Wounds - Lips • Anatomy – skin, vermilion border, vermilion, oral mucosa – obicularis oris • Always inspect intraoral and mucosal lip wounds for foreign bodies – esp. teeth and teeth fragments • Lacerations through vermilion border – use traction to the lips place first stitch at vermilion border – need perfect alignment – then repair obicularis oris – then repair skin and remainder of lip Specific Wounds - Lips • Through and through lacerations – 3 layer closure – 1st – mucosal layer with rapidly absorbable suture – 2nd – orbicularis oris – 3rd – skin Specific Wounds – Intraoral Armstrong. Lacerations of the Mouth. Emergency Medicine Clinics of North America Vol 18, No 3 August 2000 • Irrigation as per normal • lacerations of buccal mucosa and gingiva heal without repair of wound edges not widely separated • Small (<2cm) intraoral lacerations need not be repaired • Close bigger lacerations and lacerations with flaps that fall between chewing surfaces with absorbable sutures (plain gut, chromic gut or synthetic absorbables) Specific Wounds – Finger tip and nail injuries • Anatomy – eponychium, lunula, nail root, nail, hyponychium, germinal matrix, nail bed (matrix) – finger tip injuries are defined as occurring distal to the insertion of the flexor and extensor tendons at the level of the lunula – classified as Zone I, II, III Specific Wounds – Finger tip and nail injuries • Tip injuries with skin and pulp tissue loss only (no exposed bone) – if less than 1 square cm can treat conservatively with serial dressing changes alone (wound heals by secondary intention) – if severed skin tip available can use as full thickness graft; amputated tissue is debrided, de-fatted, then sutured in place – if greater than 1 square cm can consider using split or full thickness graft from distant site vs conservative management Specific Wounds – Finger tip and nail injuries • Tip injuries with exposed bone – if bony protuberance < 0.5 cm and soft tissue defect less than 1 square cm trim back bone with rongeuer and consider leaving wound open to heal by secondary intention with serial dressing changes – if wound dorsal obliquely angulated can treat with bone shortening followed by primary closure of wound using adjacent volar tissue – amputations in a transverse or volar obliquely angulated often require referral for sophisticated flaps Specific Wounds – Finger tip and nail injuries • Nail Growth – germinal matrix produces bulk of nail plate – sterile matrix produces a layer of cells that is added to the under surface of the growing nail – if nail bed injury results in scarring of sterile matrix will get a poorly adherent nail with ridging – cosmetically not appealing – takes 4 months for a new nail to reach hyponychium Specific Wounds – Finger tip and nail injuries • Injuries to nail and surrounding structures – nail bed injured when force directed to dorsum of nail crushing nail bed against underlying tuft of distal phalanx • Subungual hematoma – tradition deems that if occupies more than 50% of nail bed area, remove nail and repair associated nail bed laceration – Two prospective studies found simple trephination produced good results (Seaberg et al. Treatment of subungual hematomas with nail trephination: A prospective study: Am J Emerg Med 9:209, 1991. Meek et al. Subungual hematomas: is simple trephining enough? J Accid Emerg Med 15:269, 1998) – Roberts and Hedges suggest that if nail adherent do not routinely remove nail to search for bed laceration – remove nail and fix bed lacerations if nail partly avulsed or loose, or if there are deep lacerations that involve the nailbed – replace avulsed nail after bed repair and suture in place Case 4 • 16 year old healthy male playing tennis steps on a nail that punctures bottom of shoe and punctures sole of foot. • How will you approach and manage this pt? Specific Wounds – Puncture Wounds Reference: Up To Date 2000 • usually due to nails • deeper the penetration, higher the incidence of infection • wounds in area of MTP joints penetrate deeper because this is weight bearing area • increased risk of infection with wounds to forefoot or shoe wearing at time of puncture Specific Wounds – Puncture Wounds • Microbiology – partly dependent on environmental location – Staph aureus, beta-hemolytic streptococci (GAS), gram negatives – pseudomonas common with wounds through shoes Specific Wounds – Puncture Wounds • Evaluation – routine wound evaluation as previously discussed – have low threshold for x-rays, especially re presence of foreign body Specific Wounds – Puncture Wounds • Initial Management – no prospective trials in literature – Tetanus – foreign body removal – surface scrubbing – questionable role for irrigation – probably no role for coring, probing – rest, foot elevation Specific Wounds – Puncture Wounds • Antibiotics – no prospective, randomized trials – consider wound and host factors Case 5 • Pt working in lumbar yard and walks by piece of wound – catches leg on it and ends up puncturing lower leg with piece of wood. He feels "something is in there". • Manage Soft Tissue Foreign Bodies • foreign bodies promote infection, prolong inflammatory phase of healing and result in poor wound healing • infections resulting from foreign bodies are typically resistant to antibiotics • every wound has a potential foreign body • listen to pt's if they think "something in there" • all wounds require deliberate and careful exploration Soft Tissue Foreign Bodies • Radio-opaque – metal, aluminum, bone, teeth, glass, certain plastics, gravel, sand – obtain x-rays with underpenetrated "soft-tissue technique" • Radio-lucent – organic material like wood, thorns, cactus spines, some fish bones, most plastics – sometimes indirect evidence of presence (radiolucent filling defect when object is less dense than surrounding tissue) Soft Tissue Foreign Bodies • if wound caused by radio-opaque material and no foreign body found on exploration or plain films – end search; otherwise: • CT • Ultrasound • MRI Soft Tissue Foreign Bodies • Not all need to be removed • Indications for foreign body removal – Potential for inflammation or infection – Toxicity – Functional and cosmetic problems – Potential for later injury Case 6 • 25 year old female piano player presents with 8 cm curvilinear laceration to dorsum of dominant hand from a dog bite. Specific Wounds - Bites • Epidemiology – 60-90% dog bites, cats 1-15%, rodents 1-7%, other species less than 2% • Dog Bites – jaws can exert +++force but teeth not sharp – results in relatively superficial crush injuries – face and scalp most common site in children – incidence of infection 5-10% – infection rate on face 1-5% Specific Wounds - Bites • Cat Bites – typical bite is a puncture wound – possess long, slender, pointed teeth – overall infection rate about 14% (80% according to 2001 Sanford Guide); 28-80% in NEJM article Specific Wounds - Bites • Microbiology of dog and cat bites (Talan et al. Bacteriologic Analysis of Infected Dog and Cat Bites. NEJM January 14, 1999) – almost always polymicrobial – aerobes, anaerobes – Pasteurella canis most common isolate in dog bites – Pasteurella multocida most common isolate in cat bites – authors suggest that if antibiotics prescribed a beta lactam antibiotic combined with a beta lactamase inhibitor would be appropriate choice for prophylaxis Specific Wounds - Bites • Dog Bite Management (Cummings. Antibiotics to prevent infection in patients with dog bite wounds: a meta-analysis of randomized trials. Ann Emerg Med 1994;23) – face, scalp, trunk – solid support for primary closure – ?distal extremities – look at wound and patient factors; can probably primarily suture all dog bite wounds – prophylactic antibiotics only in high risk wounds (hands, wound / patient factors) Specific Wounds – Bites • Cat Bite Management – puncture wounds should be left open – primary closure on face and scalp only – consider delayed primary closure in other locations – consider prophylactic antibiotics in all cases Specific Wounds – Human Bites • Epidemiology – 60-75% hands and upper extremities • Microbiology – polymicrobial – mixed gram positive, gram negative, aerobic, anaerobic – eikenella corrodens – Hepatitis B • Complications of human bites most commonly occur in hand wounds Specific Wounds – Human Bites • Management – routine wound evaluation and care – non-hand wounds can be closed primarily – hand wounds need to be left open to heal by secondary intention or delayed primary closure – routine prophylactic antibiotics in hand wounds only Objectives • Wound Healing • Wound Evaluation – History, Physical examination • Wound Preparation • Wound Closure • Specific Wounds – face, scalp, eyebrow, eyelid, ear, lips, intraoral, puncture, fingertip and nail, foreign bodies, bites Take Home Points • Evaluate wound and patient factors when determining closure, risk of infection, antibiotics, etc.; infection is enemy • Lacerations caused by compressive/tensile forces result in more complications than lacerations caused by knife cut (shear forces) • "golden period" is not fixed and dependent on many variables • V-Y plasty for fingertip amputations • re bites: routine antibiotics for all cat bites and dog and human bites to hand


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Fulton Financial Advisors/Clermont Wealth Strategies Recognized As 2011 Best Wealth Manager Of Central PA
LANCASTER, Pa., Jan. 20, 2011 (GLOBE NEWSWIRE) -- Fulton Financial Advisors/Clermont Wealth Strategies was recently recognized as the Best Wealth Manager in Central PA for 2011 by the Central Penn Business Journal (CPBJ). Fulton Financial Advisors/Clermont Wealth Strategies is part of Fulton Financial Corporation (Nasdaq:FULT).
The list was compiled based on the results of client surveys that the CPBJ conducted. Businesses and individuals were evaluated on eight criteria: customer service, integrity, knowledge/expertise, being proactive in their advice, communication, value for the money, and meeting the client's needs and overall performance.
"This validates the great job our team is doing to provide superior client experiences in the midst of turbulent investment markets," said Dave Hanson, CEO Fulton Financial Advisors.
In addition to being named the Best Wealth Manager in Central PA, two of the company's relationship managers, Jessica Malone and Ken Norman, were listed among the 25 best individual wealth advisors in Central PA by the CPBJ. "Fulton Financial Advisors/Clermont Wealth Strategies is proud to receive this recognition," said Paul Nicholas, executive vice president, Clermont Wealth Strategies. "We take pride in our team's experience, knowledge and integrity and their commitment to deliver the personal attention necessary to help our clients achieve their financial goals.CONTACT: Laura Wakeley (717) 291-2616
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Corned beef brisket in a crock pot
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Cooks.com - Recipes - Crock Pot Beef Brisket
Tip: Try pot beef brisket for more results. Results 1 - 10 of ... CROCK POT CORNED BEEF. Place corned beef in slow cooking pot. Barely cover with ...
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Tip: Try brisket crock pot for more results. Results 1 - 10 of ... CORNED BEEF AND CABBAGE. You will need a large crock pot for this. Put the potatoes ...
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Place corned beef in slow cooking pot. Barely cover with water. Add ... Recipes related to Crock Pot Corned Beef. Stir Fried Beef. Beef And Vegetable Casserole ...
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Home > Recipes > Crockpot > Crock Pot Corned Beef And Cabbage ... Put ingredients other than cabbage in Crock-Pot. Add cabbage to liquid after 3 hours on ...
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1. CROCK POT CORNED BEEF AND CABBAGE. Place in Crock-Pot in order: Put ... Combine all ingredients in a crock pot. Cover and cook on low setting 8-10 hours or on ...
Crockpot Corned Beef Cabbage Recipe
For all your crockpot lovers, here's a flavorful crock pot corned beef and cabbage dish, made with corned beef brisket, potatoes, cabbage, and carrots.
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Catch Sunny Anderson on Her New Show This Fall: Home Made in America With Sunny
by Sarah De Heer in Food Network Chef, Shows, September 14th, 2012Join Sunny Anderson as she hits the road to track down the unsung heroes of the American culinary world: home cooks. Sunny travels across the country to discover the inspirational stories of the people behind the recipes, while learning a few tips and tricks of her own on her show Home Made in America with Sunny Anderson premiering Saturday, October 6 at 9:30am ET/PT. Whether Sunny tastes Grandma Williams' authentic squash pie, which is the talk of Fayetteville, N.C. or Mary's high-demand granola recipe, these homemade recipes tell a story, and each starts in the home kitchen.
This road trip will have Sunny traveling through Baton Rouge, La., to try a shrimp bisque family recipe, Oklahoma for award-winning barbecue brisket and Texas for the best home-smoked ribs in town. One episode has Sunny exploring her own stomping grounds in Brooklyn, N.Y., to find Carmen Rodriguez, a home cook turned business owner creating buzz with her unique cupcakes.
Tune in to this six-episode daytime series: Premieres Saturday, October 6 at 9:30am ET/PT.
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Comments (
176 )-
Where are the cupcake recipes
Those wing sauces look AMAZING. I also love making cupcakes and want to make those flan cupcakes, but there are no recipes to be found! Not cool, Food Network!
follow this link for recipe and wing sauce http://www.dirtysteves.com/Recipes.html
I hate people who lie Sunny where is the recipe for the wing sauce? your show said it would be on your wed sight
they're having upload issues
Went to site where the " Cupcakes" were to be found, and no luck. Please post recipes if you want America to watch the show. BOOO Food Network!!!!!!
You promised cupcake recipes!
Cupcake recipes!
What's up, Darlene! Girl… thanks for recording this show. I wanted the Dirty Steve's Wings recipe, as well. I was so pissed when I could not find the recipes too. Ok. Who has the cupcake recipes.
I wanted those recipes as well. I was so sad that I couldn't make those wings for football Saturday tonight. :o(
Brooklyn Cupcake's Tres Leches Cupcakes
2 1/2 cups cake flour
1 teaspoon baking powder
1 teaspoon baking soda
1 teaspoon fine salt
1 stick unsalted butter, at room temperature
1 1/2 cups granulated sugar
3 large eggs, at room temperature
1 teaspoon vanilla extract
1 1/4 cup milk, at room temperature
Tres Leches Mix (recipe below)
Whipped Cream Mascarpone Frosting (recipe below)
Cinnamon for garnishPreheat the oven to 350 degrees F. Line cupcake tins with paper liners.
Sift together the flour, baking powder, baking soda and salt.
Cream the butter and granulated sugar with a hand mixer until fluffy. Add the eggs one at a time, beating well between each addition. Add the vanilla and milk, and mix until well blended. Fold in the flour mixture. Do not over mix. Fill cupcake liners 3/4 full. Bake for about 20 minutes or until golden brown and top springs back.
Once the cupcakes have cooled, about 30 minutes, inject the cake with about 2 ounces of the Tres Leches Mix. If you do not have an injector, fork the cupcake gently on the top. Then spoon the Tres Leches on top, so as not to break up the cake. Let the cupcakes sit in the fridge for at least an hour to allow the liquid to absorb into the cake.
Top each cupcake with some of the Whipped Cream Mascarpone Frosting, and sprinkle with cinnamon.
Yield: about 18 standard cupcakes
Prep Time: 30 minutes
Cook Time: 20 minutes
Inactive Prep Time: 30 minutes
Ease of Preparation: easyTres Leches Mix:
1 (12 ounce) can evaporated milk
7 ounces sweetened condensed milk
3/4 cup heavy creamCombine the three milks in a blender until well combined, and then chill in the refrigerator for at least 1 hour.
Whipped Cream Mascarpone Frosting:
4 cups heavy cream
1 teaspoon vanilla extract
3/4 cup confectioners' sugar
4 ounces mascarpone cheeseChill a metal bowl. Add the heavy cream, vanilla extract and confectioners' sugar. Start to beat the heavy cream until you see the liquid thicken, and then add the mascarpone cheese. Continue to whip to stiff peaks.
Put the frosting in a piping bag with a star tip, frost cupcakes.
thanks !!!!!!!!1
Thank you! <3
Thank you for the recipe, Do u have the flan one?
finally found this after searching for hours
Where are the Dirty Dave's recipes??? Sunny said they would be on the show's website.
I am pretty sure she didn't say that since his name is Steve.
Aren't you the genius. I'm sure you know what he meant, and I agree with him. Sunny, you need to make sure what you say on your show (w.r.t. where we can find recipes) is accurate. This has happened far too many times and I will never watch your show(s) again.
Relax people, they already said that there was a problem uploading the recipes, I'm sure they will be up Monday or Tuesday when they return to work…..patience is a virtue.


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LOS ANGELES - Dan Gadzuric is a mysterious person. On-court, he is a massive center who goes out game after game and bangs around with the nation's best centers. He plays aggressively and throws down monster dunks.
Off the court, his persona is quite different. He is just another member of the UCLA community, trying to blend in with a diverse student body. If he wasn't wearing athletic apparel, he might be mistaken for just a tall student with a book bag.
One word that dominates all of Dan Gadzuric's thoughts about basketball is "physical." During an interview, many his answers involved something about the physical nature of basketball. Whether talking about his game or opponents, being physical is an important part of playing his position. He lists Jerome Moiso as one of his favorite opponents because he goes up against him every day in practice and it helps him to improve his game. Another favorite opponent is Stanford's Mark Madsen, who brings a tremendous degree of aggressiveness to each contest.
Gadzuric's affection for basketball's physicality is accompanied by a quiet "go about your business" attitude. When asked which cartoon character he would compare himself to, he chose the Tasmanian Devil "because he is physical. You can't joke around with him."
Indeed, joking around is something that is not associated with Gadzuric's college basketball career. As one of the nation's top high school prospects, he was in the process of exceeding all expectations as a college freshman. He led the Bruins in field goal shooting (54.0) and blocked shots (1.3/game). He was the fifth leading scorer (8.6 ppg) and third leading rebounder (5.7 rpg). Twenty-six games into his freshman year, his season was cut short by a knee injury. He turned to his teammates for motivation following his setback.
"I tried to support my teammates, even though I wasn't playing, and their feedback really helped me," he said.
Since last year, Gadzuric has been making the long recovery journey. And, after a stellar 18 points, 11 rebounds performance against Syracuse, he is well on his way. A true sign of an outstanding athlete is the ability to acknowledge weaknesses and to work to correct any problems. Gadzuric is aware of the weaknesses in his game, primarily his free throw shooting and footwork.
"Before each game, I shoot a lot of free throws because my free throws are suffering right now," he explained. "I also practice my post moves in order to prepare before the game." In addition, he admits that his "mental approach needs improvement."
Reserved off-court, this silent giant prefers to maintain his privacy, yet he did provide a glimpse into his personal side. The following are a few answers that not only distinguish him from his teammates, but help to learn more about him.
At what age did you start playing basketball?
Why did you choose to attend UCLA?
If you could travel back in time, which of Coach Wooden's teams would you want to be a member of?
What's your favorite class at UCLA?
Who do you go to for advice?
If you could trade places with anyone for a day, who would it be?
What is your favorite food?
What are your hobbies and interests?
Where do you see yourself in 10 years?
By Marisa N. Schwertfeger
I started playing basketball around the age of 14 or 15.
It is a great environment and it is very diverse. I feel very comfortable here and that is important to me.
I would want to be a member of one of the teams with either Lew Alcindor or Bill Walton.
I have really enjoyed the math classes that I have taken.
I get advice from a lot different people. I don't go to a specific person because I like to have a broad perspective.
I wouldn't trade places with anybody. I'm happy with myself!
My favorite food is meat. I eat a lot of meat, like New York steak.
My hobbies include reading, going out and socializing. Actually, I don't go out that often. Basketball takes up a lot of my time, so I try to make the most of my "off time."
I see myself in a positive place, whatever or wherever that may be.
UCLA Media Relations Assistant


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Valve cover gasket leaks are common after 60,000 miles. Symptoms will include oil drips under the vehicle and burning oil smell from the engine compartment.
Google+Car Problem Reports
BMW 328Ci Oil leaks from engine area
BMW 328Ci Problem
3 Reports
Model Year Affected: 2000
Average Mileage: 97,500 mi (65,000 mi - 130,000 mi)
Visitor, 2000 BMW 328Ci, 65,000 mi
burning oil coming from the engine compartment
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Quality Inn Airport 10232 Natural Bridge Rd. Saint Louis, MO 63134 Phone: (314) 427-5955 Fax: (314) 427-3079 |
City Museum
701 North 15th Street
St. Louis, MO 63103
+1 314 231 2489
Mo to Th from 09:00 AM to 05:00 PM,Fr to Sa from 09:00 AM to 12:00 AM
Located in a former shoe manufacturing building, this museum will satisfy both the young and the young-at-heart. With three floors of interesting, educational and fun-filled rooms, it is one of the best downtown attractions. The museum is run by a group of artists and professionals who together produce an awesome array of exhibits. Feel the authenticity of the multilevel enchanted caves, the architectural museum and the giant aquarium.Earn valuable points toward free nights.


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Room For Improvement
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Join Date: Dec 2008
Posts: 3,989
vCash: 500
Originally Posted by
I'd also be interested in hearing anyone's specific tactical or strategic gameplan adjustments that could be made.
I know it's the fact that the Pens and Caps are two evenly matched teams, but it seems like we were having too much trouble transitioning out of the neutral zone than we should have. It's not like Pittsburgh is a overly defensive-minded team like the Devils or Rangers.
Hopefully it's just us being lazy or overconfident about our breakouts cause that can be a fairly easy correction!
I'd really appreciate hearing from someone who's into hockey strategy to chime in on this.
Not much really. Pinch aggressively and skate the puck out as much as you can so we can enter the zone with speed. Every time we get the puck in the neutral zone and then accelerate from zero onward ends in disaster. Don't relinquish possession easily (don't dump and chase if you don't wanna chase). Just toss it back and regroup. Play 3-1-1 offense but be able to easily transition to 2-1-2 defense. Have Sloan or Clark take a career ending run at Kunitz when the game is out of reach for either them or us.
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Teva Strengthens Respiratory Franchise With Acquisition Of MicroDose Therapeutx
Teva Pharmaceutical Industries Ltd. (NYSE: TEVA) today announced that it has entered into a definitive agreement to acquire MicroDose Therapeutx, a privately-held pharmaceutical and drug delivery company focused on inhalation technologies and products for lung diseases and infections with the potential to dramatically improve efficacy and patient compliance.
With the addition of MicroDose's technologies and products, Teva is taking a significant step toward expanding its respiratory pipeline. Teva will now have access to MicroDose's proprietary technology including its multi-dose dry powder nebulizer device, which requires no preparation and can be administered in under 30 seconds. MicroDose's current pipeline is anchored by MDT-637 for respiratory syncytial virus (RSV) - an inhaled, low dose, small molecule, fusion inhibitor which prevents viral replication, delivered via MicroDose's technology.
"I am thrilled that Teva can now count the exciting MicroDose products and technologies amongst our growing respiratory portfolio. The MicroDose platform is both simple and attractive, and their addition will help us to address the unmet needs of the youngest and oldest patients, who have a requirement for a better way of taking the medicines they rely upon," stated Michael Hayden, President, Teva Global R&D, and Chief Scientific Officer.
Under the terms of the deal, Teva will acquire all of MicroDose's outstanding shares for a payment at closing of $40 million, additional payments of up to $125 million upon achievement of regulatory and development milestones, plus sales-based milestones and tiered royalty payments upon commercialization of MDT-637 and an earlier stage Asthma/COPD medicine.
Anand V. Gumaste, President, CEO and Chairman of MicroDose, stated, "We believe this agreement provides a unique opportunity to advance MicroDose's platform technology and development programs for the greatest benefit of patients. Teva has a strong and growing franchise in respiratory diseases, with extensive experience in both delivery mechanisms and novel therapeutic modalities. Teva also has a worldwide market presence and leading global supply chain."Check Out Our Best Services for Investors
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David Peltier identifies the best of breed dividend stocks that will pay a reliable AND significant income stream.
Product Features:
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- Updates with exact steps to take - BUY, HOLD, SELL
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Every recommendation goes through 3 layers of intense scrutinyquantitative, fundamental and technical analysisto maximize profit potential and minimize risk.
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SRMTHFG!: The Novelization Chapter 1Chapter 1: Destiny's CallOn a piece of land in the midst of a vast crystal lake was the city of Shuggazoom. It was a place where cars used air as their means to travel; a place where most pets were mechanical machines (loyal and obedient to their owners like the actual beings), and a place where buildings stood high, their metal structure nearly blinding to look at on especially bright sunny days. The untiring activity of the city went on as it always did, the civilians' forms casting reflections on the waterfront. No one ever admired it or even spared a glance at the impressive sight in their hassle. It was not that the Shuggazoomians were dull individuals or single-minded, but it so happened that they agreed on one thing only: If it's not interesting or it has no reason to cause concern, then ignore it and go about your business.This brings to mind what would be the most appropriate term to describe Shuggazoomians: close-minded.In their noggins, there was never that flicker of a b
Worth Fighting ForWorth Fighting For (LBP2 Fanfiction)ClivexEveClive figured that nothing could get any worse than it already was. He was (unsurprisingly) wrong.It seemed to be like only yesterday when he was working in his precious factory when it was still standing. His life was sort of okay. Not much troubles (at least any that weren't too bad).Now here he was caught up with all of this dreadful nonsense with that nasty Negativitron. He and the remaining members of the Alliance were on their way to the Cosmos to stop the monstrous creation and rescue Avalon. It was almost funny that he only seem to be aware of the fact that they were also going right towards their pending doom. What hope did they have in stopping the Negativitron? They might as well find some cans and hide out where it was safer.But no one decided to heed poor old Clive' advice, insisting that the fate of CraftWorld and Avalon's life was at stake and they couldn't afford to waste time.That was just marvelous.His drawn f