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Most Cited Journal of Emergency Nursing Articles
The most cited articles published since 2011, extracted from Scopus.
A Simulation Study to Improve Quality of Care in the Emergency Department of a Community HospitalZhen Zeng | Xiaoji Ma | Yao Hu | Jingshan Li | Deborah Bryant
Volume 38, Issue 4, July 2012, Pages 322-328
In this article, a computer simulation study to improve the quality of care at the emergency department at a community hospital in Lexington, Kentucky, is presented. The simulation model is capable of evaluating the quality of care in terms of length of stay, waiting times, and patient elopement and has been validated by being compared with the data collected in the emergency department. Sensitivity analyses have been carried out to investigate the impact of workforce and diagnosis equipment on quality performance. The results suggest that, to ensure better clinical outcome, more nurses are needed; in addition, an additional computed tomography scanner is recommended. The model also shows that implementing team nursing policy (for 2 nurses) could lead to significant improvement in the emergency department's quality of care. Such a model provides a quantitative tool for continuous improvement and flow control in the emergency department and is also applicable to other departments in the hospital. © 2012 Emergency Nurses Association.
Using Action Research to Plan a Violence Prevention Program for Emergency DepartmentsDonna Gates | Gordon Gillespie | Carolyn Smith | Jennifer Rode | Terry Kowalenko | Barbara Smith
Volume 37, Issue 1, January 2011, Pages 32-39
Introduction: Although there are numerous studies that show that emergency department (ED) violence is a prevalent and serious problem for healthcare workers, there is a lack of published evaluations of interventions aimed at reducing this alarming trend. Using an action research model, the authors partnered with six hospitals to plan, implement and evaluate a violence prevention and management intervention. Phase one of this project involved gathering information from employees, managers and patients using focus groups. Methods: Ninety-seven persons participated in one of twelve focus groups. The Haddon matrix was used to develop focus group questions aimed at gathering data about the pre-assault, during assault, and post-assault time frames and to compare these findings to planned strategies. Analysis consisted of identification of themes related to interventionstrategies for patients/visitors, employees, managers, and the work environment. Results: Thematic analysis results supported the relevance, feasibility, and saliency of the planned intervention strategies. With the exception of a few items, employees and managers from the different occupational groups agreed on the interventions needed to prevent and manage violence against ED workers. Patients focused on improved staff communication and comfort measures. Discussion: Results support that violence in the emergency department is increasing, that violence is a major concern for those who work in and visit emergency departments, and that interventions are needed to reduce workplace violence. The Haddon matrix along with an action research method was useful to identify intervention strategies most likely to be successfully implemented and sustained by the emergency departments. © 2011 Emergency Nurses Association.
Anxiety Levels and Related Symptoms in Emergency Nursing Personnel in GreeceHariklia Stathopoulou | Maria N K Karanikola | Fotini Panagiotopoulou | Elizabeth D E Papathanassoglou
Volume 37, Issue 4, July 2011, Pages 314-320
Several studies provide evidence for the association between work stress and mild psychiatric morbidity among emergency nurses. These symptoms have not been explored in Greek nursing personnel employed in emergency departments. The aim of this descriptive correlational study was to investigate the presence of anxiety and stress symptoms among emergency nursing personnel in Greece. Methods: The sample was composed of nursing personnel employed in emergency departments of 8 adult General hospitals in Greece (N = 213). The Hamilton Anxiety Scale was applied for the quantitative assessment of anxiety symptoms, along with demographic, vocational, and educational data. Descriptive statistics were explored, and nonparametric comparisons, as well as correlational tests, were performed. Results: Anxiety levels were found to be mild (1.102 ± 0.53), with women (P = .021, Mann-Whitney U test) and nursing personnel employed in public sector hospitals (P = .029, Mann-Whitney U test) having higher anxiety level scores. In addition, a statistically significant mild correlation was observed between work experience in the emergency department and anxiety states (Τ = 0.178, P = .011). The most commonly reported manifestations of mild psychiatric symptomatology were sleep disturbances (2.32 ± 1.2), anxious mood (1.57 ± 1.1), and depressed mood (2.38 ± 1.2), with 24.8% of the participants reporting very severe sleep disturbance, 23.9% reporting very severe depressive mood, and 10.7% reporting very severe anxious mood. Discussion: Hospital administrators need to be aware of the extent of workplace stress and subsequent anxiety symptoms that exist in emergency nurses. Staff counseling, continuing professional education, and empowerment strategies may need to be implemented to prevent psychiatric morbidity, as well as job dissatisfaction and resignations. © 2011 Emergency Nurses Association.
Early Detection and Treatment of Severe Sepsis in the Emergency Department: Identifying Barriers to Implementation of a Protocol-based ApproachMara Burney | Joseph Underwood | Shayna McEvoy | Germaine Nelson | Amy Dzierba | Vepuka Kauari | David Chong
Volume 38, Issue 6, November 2012, Pages 512-517
Introduction: Despite evidence to support efficacy of early goal-directed therapy for resuscitation of patients with severe sepsis and septic shock in the emergency department, implementation remains incomplete. To identify and address specific barriers at our institution and maximize benefits of a planned sepsis treatment initiative, a baseline assessment of knowledge, attitudes, and behaviors regarding detection and treatment of severe sepsis was performed. Methods: An online survey was offered to nurses and physicians in the emergency department of a major urban academic medical center. The questionnaire was designed to assess (1) baseline knowledge and self-reported confidence in identification of systemic inflammatory response syndrome and sepsis; (2) current practices in treatment; (3) difficulties encountered in managing sepsis cases; (4) perceived barriers to implementation of a clinical pathway based on early quantitative resuscitation goals; and (5) to elicit suggestions for improvement of sepsis treatment within the department. Results: Respondents (n = 101) identified barriers to a quantitative resuscitation protocol for sepsis. These barriers included the inability to perform central venous pressure/central venous oxygen saturation monitoring, limited physical space in the emergency department, and lack of sufficient nursing staff. Among nurses, the greatest perceived contributor to delays in treatment was a delay in diagnosis by physicians; among physicians, a delay in availability of ICU beds and nursing delays were the greatest barriers. Despite these issues, respondents indicated that a written protocol would be helpful to them. Discussion: Knowledge gaps and procedural hurdles identified by the survey will inform both educational and process components of an initiative to improve sepsis care in the emergency department. © 2012 Emergency Nurses Association.
Incidence and cost of nurse workplace violence perpetrated by hospital patients or patient visitorsKaren Gabel Speroni | Tammy Fitch | Elaine Dawson | Lisa Dugan | Martin Atherton
Volume 40, Issue 3, January 2014, Pages 218-228
Introduction: Workplace violence against nurses is a serious problem. Nurses from a US urban/community hospital system employing more than 5,000 nurses researched the incidence of workplace violence against nurses perpetrated by patients or visitors in their hospital system. Methods: Survey research and retrospective database review methods were used. Nurse participants (all system-employed nurse types) completed a 34-item validated survey in electronic format. Retrospective database review provided annual nurse workplace violence injury treatment and indemnity charges. Institutional review board approval was received. Results: Survey research participants (N = 762) were primarily white female registered nurses, aged 26 to 64 years, with more than 10 years of experience. Over the past year, 76.0% experienced violence (verbal abuse by patients, 54.2%; physical abuse by patients, 29.9%; verbal abuse by visitors, 32.9%; and physical by visitors, 3.5%), such as shouting or yelling (60.0% by patients and 35.8% by visitors), swearing or cursing (53.5% by patients and 24.9% by visitors), grabbing (37.8% by patients and 1.1% by visitors), and scratching or kicking (27.4% by patients and 0.8% by visitors). Emergency nurses (12.1%) experienced a significantly greater number of incidents (P < .001). Nurses noted more than 50 verbal (24.3%) and physical (7.3%) patient/visitor violence incidents over their careers. Most serious career violence incidents (n = 595, 78.1%) were physical (63.7%) (60.8% by patients and 2.9% by visitors), verbal (25.4%) (18.3% by patients and 7.1% by visitors), and threatened physical assault (10.9%) (6.9% by patients and 4.0% by visitors). Perpetrators were primarily white male patients, aged 26 to 35 years, who were confused or influenced by alcohol or drugs. Per database review, annual workplace violence charges for the 2.1% of nurses reporting injuries were $94,156 ($78,924 for treatment and $15,232 for indemnity). Discussion: Nurses are too commonly exposed to workplace violence. Hospitals should enhance programs for training and incident reporting, particularly for nurses at higher risk of exposure, caring for patients with dementia or Alzheimer disease, patients with drug-seeking behavior, or drug- or alcohol-influenced patients. © 2014 Emergency Nurses Association.
Do Patients Understand Discharge Instructions?Sandra Zavala | Carol Shaffer
Volume 37, Issue 2, March 2011, Pages 138-140
Introduction: Adherence to aftercare instructions following an emergency department visit may be essential for facilitating recovery and avoiding complications, but conditions for teaching and learning are less than ideal in the ED. The objective of this study was to identify and describe areas of patient confusion about ED discharge instructions. Methods: Follow-up telephone calls were made to 50 ED patients on the day after discharge to inquire how they were doing and whether they had any questions about their instructions. Results: Fifteen subjects (31%) requested information about their aftercare instructions that required further clarification by the investigator, and 15 subjects (31%) described a diagnosis-related concern that revealed poor comprehension of instructions. Discussion: This study demonstrated that patients commonly remain confused about aftercare information following treatment in an ED. Follow-up telephone calls may be useful for identifying and addressing ongoing learning needs. © 2011 Emergency Nurses Association.
Interruptions Experienced by Registered Nurses Working in the Emergency DepartmentLisa Kosits | Katherine Jones
Volume 37, Issue 1, January 2011, Pages 3-8
Introduction: A descriptive, observational study was performed to determine (a) the frequency (number of interruptions per hour) that a typical ED nurse experiences interruptions, (b) the type of interruptions a typical ED nurse experiences, and (c) the percentage of interruptions that take place during medication related activities. Methods: A convenience sample of 30 nurses from 3 emergency departments of a major metropolitan academic medical center were each observed for 120 minutes to determine how many interruptions per hour the ED nurse experienced, the type of interruptions and what percentage of these interruptions took place during medication-related activities. A data collection tool was developed to record tasks performed by the nurses and the type of interruptions experienced. Interrater reliability was established with a Kappa of 0.825. Results: A total of 200 interruptions occurred during the 60 hours of observation, or 3.3 interruptions per hour per RN. Of the 20 possible types of interruptions that were identified a prior to the observation period, 11 different types of interruptions were actually observed. The majority of interruptions (95%) were related to face-to-face communications with others in the ED. The total number of interruptions related to medication activities was 55 (27.5% of the total number of interruptions). Discussion: The results of this study can serve as the basis for subsequent, larger studies that examine more closely the relationship between interruptions and errors in the ED, with the ultimate goal of developing interventions to reduce medication errors and other adverse events that occur due to nurse interruptions. © 2011 Emergency Nurses Association.
"It's Just What We Do": A Qualitative Study of Emergency Nurses Working with Well-Established Family Presence ProtocolElinar Lowry
Volume 38, Issue 4, July 2012, Pages 329-334
Introduction: ENA has supported family presence at the bedside during resuscitation of a loved one since 1993. Limited support from health care institutions has resulted in research that includes few data from hospitals with long-term family presence experience. The study objectives were to (1) describe the benefit and harm of being present during resuscitation to family members, using perceptions of nurses who work in an emergency department with a well-established family presence protocol; and (2) define family presence using perceptions of nurse participants. Methods: A descriptive qualitative study was conducted in an emergency department that has had a written family presence protocol since 1992. Fourteen emergency nurses described their experience with family presence in face-to-face interviews using an investigator-developed, open-ended tool. Transcribed interviews were evaluated using conceptual content analysis. Results: Nurses perceived benefits to family members in that 1) the family is able to see evolving events, described as a family member's ability to see a loved one's condition change over time, and 2) is able to validate efforts to save the life of their loved one. Nurses also indicated that family members' appreciation that everything possible was done increased nurses' confidence that they did everything they could during the resuscitation event. No nurses described observing actual harm to family members who were present during resuscitation. Discussion: Emergency nurses can embrace family presence and influence benefits for family members when the practice is well established. Behavior modeling rather than written protocol may affect acceptance of family presence during resuscitation efforts among emergency nurses. © 2012 Emergency Nurses Association.
Barriers and Perceived Needs for Understanding and Using Research Among Emergency NursesGarrett K. Chan | Susan Barnason | Cynthia L. Dakin | Gordon Gillespie | Mary C. Kamienski | Stephen Stapleton | Jennifer Williams | Altair Juarez | Suling Li
Volume 37, Issue 1, January 2011, Pages 24-31
Introduction: Nurses are involved in conducting research and incorporating evidence into their practice. However, barriers exist at the individual, unit, and organizational level related to understanding, conducting, and evaluating the evidence. The Emergency Nurses Association (ENA) conducted a study to understand levels of education in research, the extent of experience, and needs and barriers to research at the individual and organizational levels in emergency nursing. Methods: A cross-sectional survey design was used to poll members of the ENA. A 62-item survey instrument was designed to assess five areas: 1) nurses' research values, skills, experience, and awareness; 2) organizational settings' opportunities, barriers, and limitations to research; 3) nurses' understanding and comprehension of research and evidence; 4) presentation and accessibility of research; and 5) continuing educational topics to improve knowledge of the research process. Results: Respondents (n = 948) identified barriers at the individual level that included lack of knowledge about critiquing research studies and familiarity with the research process. Barriers at the unit level included obtaining help from administrators and other staff in starting a project or having the authority to change practice. Barriers at the institution level included lack of support systems such as protected time to conduct research or implement changes in practice. Discussion: Emergency nurses are highly motivated and interested in learning more about conducting and utilizing research to improve practice. Perceived personal, unit-based, and organizational barriers were identified through this research in an effort to highlight areas for improvement at the local and national levels. © 2011 Emergency Nurses Association.
An Australian Audit of ED Pain Management PatternsMargaret Fry | Scott Bennetts | Sue Huckson
Volume 37, Issue 3, May 2011, Pages 269-274
Introduction: Timely and appropriate pain management is an important quality indicator of ED performance. Emergency health care workers are well positioned to become active leaders and innovatively responsive in reducing human suffering. A pain management audit was conducted to determine Australia practice patterns. Methods: A 12-month retrospective descriptive cohort audit was undertaken. Through the randomization process a medical record audit tool was completed for each record identified. Ethical approval for the study was obtained. Results: Seventy-four hospitals agreed to conduct the audit, 36 (48%) provided data. The total number of patient notes reviewed was 2,066. Ninety-five percent (1,966) of patients arrived by ambulance. Of the patients (n=547; 56.4%) with a documented triage pain score the majority arrived in severe pain (n=300; 41.3%). Of the total number of patients (1,966) documented arriving in pain 1,473 (74.9%) received an analgesic. Six hundred and forty-four (32.7%) patients received an opioid. From time of emergency department arrival, the median time for analgesic administration was 70 minutes (IQR 58 minutes to 92 minutes). Twenty-five emergency departments (69.4%) had pain management policies that enabled nurses to initiate a pharmacological analgesia without medical consultation. Discussion: The Australian pain management audit highlighted current practices and potential areas for further research. While the audit demonstrated that nurse initiated pain management interventions promoted better analgesic response, greater consistency of triage pain assessment, code allocation, and documentation of pain scores may go some way to improving the timeliness of analgesia. © 2011 Emergency Nurses Association.
The Impact of Education on Provider Attitudes Toward Family-Witnessed ResuscitationLori M. Feagan | Nancy J. Fisher
Volume 37, Issue 3, May 2011, Pages 231-239
Introduction: The majority of acute care facilities have not developed policies or guidelines to facilitate family presence during cardiopulmonary resuscitation. Prior studies have shown that the personal beliefs and attitudes of hospital personnel involved in resuscitation efforts are the primary reasons family presence is not offered. Methods: This 2-phase, before/after study was conducted in a 388-bed academic trauma center, and in a 143-bed community hospital in eastern Washington State in 2008. In phase I, a convenience sample of physicians and registered nurses from both facilities were surveyed about their opinions and beliefs regarding family-witnessed resuscitation (FWR). Spearman's rho and independent t-tests were used to compare support of FWR between and within roles and practice location subgroups. In phase II of the study, clinician subgroups in the community hospital were re-surveyed following an educational program that used evidence-based information. Independent t-test and one-way ANOVA were used to compare pre and post-education mean scores of subgroups on indicators of effective teaching strategies and improved FWR support. Results: Opinions on FWR vary within and between practice roles and locations, with the strongest variable of support being prior experience with FWR. Following FWR education, mean scores improved for survey variables chosen as indicators of FWR support and teaching effectiveness. Discussion: When CPR providers are presented with FWR education, their opinion-based beliefs may be modified, decreasing barriers to family witnessed resuscitation and improving overall support of FWR as an extension of family-centered care. © 2011 Emergency Nurses Association.
How Do Emergency Department Patients Store and Dispose of Opioids After Discharge? A Pilot StudyPaula Tanabe | Judith A. Paice | Jennifer Stancati | Michael Fleming
Volume 38, Issue 3, May 2012, Pages 273-279
Introduction: Opioid abuse and overdose have increased drastically in recent years. Diversion of opioids used to treat pain, either through theft or sharing, is increasing and may contribute to this misuse. Based on these trends, we designed a study to investigate opioid storage and disposal practices of patients who were prescribed these agents in the emergency department. Methods: A prospective cohort pilot study was conducted. All adults (aged ≥18 years) with a chief complaint of either minor musculoskeletal trauma, renal colic, or acute back pain who were discharged home with an opioid prescription were eligible for inclusion; persons with chronic pain were excluded. Patients were asked to participate in two home interviews in which the research assistant viewed the storage location of the opioid prescription. Safe storage was defined as being stored in a locked container or cabinet. Safe disposal was defined as returning the drugs to a designated location or mixing unused pills with an undesirable substance, placing in a sealable container, and then in the trash. Patients self-reported disposal methods. Feasibility of study methods evaluated the ability to conduct home interviews after the ED visit. Descriptive statistics were used to analyze the data. Results: Twenty-five subjects consented to participate; 20 patients completed both home interviews. None of the medications were safely stored. Only 1 patient disposed of the medication, yet did so improperly. Conclusion: This pilot study revealed widespread improper storage and disposal of opioids. The study has major implications for education for ED physicians, nurses, and residents. © 2012 Emergency Nurses Association.
Reducing Blood Culture Contamination Rates in the Emergency DepartmentAndrew D. Harding | Susan Bollinger
Volume 39, Issue 1, January 2013, Page
Introduction: Routine monthly monitoring of blood culture (BC) contamination rates detected a spike (>3%) in false-positive BCs drawn in the emergency department. This triggered an ad hoc quality-improvement team to develop and implement a corrective action plan in our 230-bed urban community hospital with 58,000 ED visits annually. Methods: Both phlebotomists and nurses draw BCs in the emergency department; therefore all interventions were directed at both groups. These included private conversations with individual staff members associated with higher numbers of contaminated draws compared with peers, ensuring availability of necessary BC collection supplies, re-education of all phlebotomists and ED nursing staff surrounding BC collection best practices, monthly feedback to staff on BC contamination rates, and continuing private conversations as necessary, regardless of the contamination rate. Results: Before the spike in the emergency department, the average rate of BC contamination for the hospital as a whole was 1.82% (January-July 2011). Excluding 3 months when ED contamination was greater than 3% and the hospital contamination rate was 2.65% (August-October 2011), the average rate of BC contamination for the hospital dropped to 1.01% after the interventions (November 2011-June 2012). This represents a 44% decrease moving from 1.82% to 1.01% in hospital-wide BC contamination rates and an annualized cost avoidance of approximately $614,000. Discussion: The ED BC contamination rate spike occurred over a 3-month period during which the emergency department was transitioning into a new facility on the same campus. The total hospital BC contamination rate never rose above the 3% benchmark, which illustrates the importance of tracking ED-specific data. © 2013 Emergency Nurses Association.
Theory development for situational awareness in multi-casualty incidentsSteven Busby | Janet Witucki-Brown
Volume 37, Issue 5, September 2011, Pages 444-452
Introduction: Nurses and other field-level providers will be increasingly called on to respond to both natural and manmade situations that involve multiple casualties. Situational Awareness (SA) is necessary for managing these complicated incidents. The purpose of the study was to create new knowledge by discovering the process of SA in multi-casualty incidents (MCI) and develop substantive theory with regard to field-level SA for use by emergency response nurses and other providers. Methods: A qualitative, grounded theory approach was used to develop the first substantive theory of SA for MCI. The sample included 15 emergency response providers from the Southeastern United States. One pilot interview was conducted to trial and refine the semi-structured interview questions. Following Institutional Review Board approval, data collection and analysis occurred from September 2008 through January 2009.The grounded theory methods of Corbin and Strauss (2008) and Charmaz (2006) informed this study. Transcribed participant interviews constituted the bulk of the data with additional data provided by field notes and extensive memos. Multiple levels of coding, theoretical sampling, and theoretical sensitivity were used to develop and relate concepts resulting in emerging theory. Multiple methods were used for maintaining the rigor of the study. Results: The process of SA in MCI involves emergency responders establishing and maintaining control of dynamic, contextually-based situations. Against the backdrop of experience and other preparatory interval actions, responders handle various types of information and manage resources, roles, relationships and human emotion. The goal is to provide an environment of relative safety in which patient care is provided. SA in MCI is an on-going and iterative process with each piece of information informing new actions. Analysis culminated in the development of the Busby Theory of Situational Awareness in Multi-casualty Incidents. Conclusion: SA in MCI is a growing need at local, national and international levels. The newly developed theory provides a useful model for appreciating SA in the context of MCI thereby improving practice and providing a tool for education. The theory also provides a catalyst for further research refining and testing of the theory and for studying larger-scale incidents. © 2011 Emergency Nurses Association.
Under-triage as a significant factor affecting transfer time between the emergency department and the intensive care unitIrina Yurkova | Lisa Wolf
Volume 37, Issue 5, September 2011, Pages 491-496
Introduction: The purpose of the study was to identify factors that affect transfer times between the emergency department and the intensive care unit (ICU) in a community hospital. Patients who are transferred from the emergency department to the ICU are usually in critical condition and in need of prompt treatment by qualified personnel. As a result of delayed transfers, a patient may experience complications, such as increased mortality rates and longer hospital stays. Methods: A quantitative descriptive correlational design was used in this study. Data were collected from the charts of 75 patients who were transferred from the emergency department to the ICU of a 142-bed community hospital in the eastern United States. "Delayed patients" were identified as those who were transferred after more than 4 hours. Results: Forty-four patients (58.7%) spent more than 4 hours in the emergency department. Nineteen out of 25 patients (76%) with an Emergency Severity Index designation of 3 were identified as delayed. Delayed status and an Emergency Severity Index designation of 3 showed a significant correlation (r = -339, P = .004). Eleven patients (64.7%) diagnosed with sepsis were delayed, compared with 6 who were not delayed. A total of 70.4% of female patients were delayed, compared with 52.1% of male patients. Discussion: This study provides a more comprehensive view of the factors involved in delayed patient transfer and provides data needed for effective interventions to be developed. The results suggest significant problems with the under-triage of critically ill patients, specifically patients with sepsis. Future research should include a larger group of subjects and a multifactorial analysis. © 2011 Emergency Nurses Association.
Assessing Emergency Nurses' Geriatric Knowledge and Perceptions of Their Geriatric CareCourtney Roethler | Toby Adelman | Virgil Parsons
Volume 37, Issue 2, March 2011, Pages 132-137
Introduction: Persons aged 65 years or older have up to a 45% increased functional dependence and a 10% mortality rate within the first 3 months after being discharged from the emergency department. It has been demonstrated that when elderly individuals are cared for by nurses with specialized training in geriatrics, their outcomes improve. However, few registered nurses have this specialized training. This study was designed to conduct a needs assessment of an emergency department concerning registered nurses' knowledge and self-assessment of geriatric emergency care. Methods: A quantitative, descriptive study utilizing a survey tool was conducted at a large, acute-care teaching hospital in northern California during a 2-week period. The questionnaire consisted of 2 separate sections, a knowledge section with 15 questions and 16 self-evaluated practice assessment questions utilizing a Likert scale. Results: Thirty-two emergency nurses participated in the study. The knowledge section scores ranged from 4 to 12. The mean score was 8.53 (SD ± 1.866). More than 80% of the participants rate themselves as either "very good" or "good" in the self-assessment section in 13 of the 16 categories. No participants rated themselves as "very poor" in any category. Discussion: The high ratings in the self-assessment section demonstrate a perception among the sample of being very capable in geriatric care. In contrast, the knowledge section revealed low scores throughout. This study revealed a clear lack of consistency between the nurses' knowledge about geriatric care and their perception of their ability to provide this care. © 2011 Emergency Nurses Association.
The Impact of Time from ED Arrival to Surgery on Mortality and Hospital Length of Stay in Patients With Traumatic Brain InjuryYoung Ju Kim
Volume 37, Issue 4, July 2011, Pages 328-333
The previous studies examining the benefits of timely surgery in patients with traumatic brain injury (TBI) have yielded inconsistent conclusions. This study examined how time from ED arrival to surgery in patients with TBI influenced two patient outcomes: hospital mortality and length of hospital stay. Methods: Using a multivariate and cross-sectional research design, the study sample included 493 patients from the 17 level I and II trauma centers that met inclusion criteria in the National Trauma Data Bank 4.0. The patient characteristics (eg, age, Glasgow Coma Scale score, Injury Severity score, and ED arrival time) and trauma center characteristics (eg, ownership, designation type, and center level) were examined. Student t test, x 2 test, analysis of variance, and multilevel regression models were used to analyze data. Results: Patients who underwent craniotomy or drainage of hematoma within 4 hours of arrival had half the likelihood of mortality when compared with those who underwent surgery more than 4 hours after ED arrival (odds ratio = .49; 95% confidence interval = .24 to .99). When patients had surgery within 4 hours of arrival, they had a significantly shorter length of hospital stay than did patients who had surgery more than 4 hours after arrival in the emergency department (Estimate = -10, 95% confidence interval = -19 to -01). Discussion: Based on the results of this study using a large sample from multiple centers and advanced statistics, benefits of early clinical assessment and quick access to neurosurgical surgery are substantiated in patients with TBI. © 2011 Emergency Nurses Association.
Palliative and End-of-Life Care in the Emergency Department: Guidelines for NursesColleen K. Norton | Gwen Hobson | Elaine Kulm
Volume 37, Issue 3, May 2011, Pages 240-245
Emergency nursing resource: Family presence during invasive procedures and resuscitation in the emergency departmentDarcy Egging | Melanie Crowley | Terri Arruda | Jean Proehl | Gayle Walker-Cillo | AnnMarie Papa | Suling Li | Jill Walsh | Marlene L. Bokholdt
Volume 37, Issue 5, September 2011, Pages 469-473
Implementation of a Successful Registered Nurse Peripheral Ultrasound-Guided Intravenous Catheter Program in an Emergency DepartmentGayla Miles | Alberto Salcedo | Dave Spear
Volume 38, Issue 4, July 2012, Pages 353-356
A "Back to Basics" Approach to Reduce ED Medication ErrorsFidela S J Blank | Judith Tobin | Sandra Macomber | Marcia Jaouen | Myra Dinoia | Paul Visintainer
Volume 37, Issue 2, March 2011, Pages 141-147
Introduction: Medication error is the most frequently reported error in the emergency department. Nationally, 36% of medication errors occur in the administration phase. The purpose of this study is to reduce medication administration errors in the emergency department by reinforcing basic medication administration procedures. Methods: This study examined a 3-month educational intervention using a nonrandomized, single group comparing pre-post outcome variables. The educational intervention, titled "Preventing Medication and IV Administration Errors," described current medication errors in the emergency department, and recommended practices for reducing medication administration errors. Of 127 nurses, 75% participated. Three measures used pre- and post-intervention were: a) knowledge of medication administration procedures assessed by tests; b) behaviors reflecting recommended medication practices assessed by surveys; and c) medication administration errors, identified via chart review and voluntary error reports. Results: In the post-test, 91% achieved perfect scores vs. 69% on the pre-test (P = 0001). In the post-survey, the proportion responding that they follow recommended practice "all" or "most" of the time increased in 8 of the 10 survey questions, but the changes did not reach statistical significance (P = .98). Reviews of charts (299 pre-test and 295 post-test) revealed little change in total medication errors: 25% vs. 24% (P = .78). Voluntarily reported medication errors dropped from 1.28 to .99 errors/1000 patients. Discussion: This educational intervention successfully improved knowledge of recommended medication administration practices. However, improved knowledge did not translate to a significant change in practice. More research is needed to identify interventions that can modify behavior in clinical settings. © 2011 Emergency Nurses Association.
Reducing false-positive peripheral blood cultures in a pediatric emergency departmentMichelle A. Marini | Amy W. Truog
Volume 39, Issue 5, September 2013, Pages 440-446
Introduction: False-positive peripheral blood cultures due to contamination pose clinical and financial consequences for patients, families, and hospitals. Educating staff who draw peripheral blood cultures about hospital policy, using a blood culture-drawing kit, having a dedicated team obtaining peripheral blood cultures, and following up with staff who draw a contaminated peripheral blood cultures have been shown to reduce the rate of false-positive peripheral blood cultures. The objective of this study was to reduce the rate of false-positive peripheral blood cultures in a pediatric emergency department using the previously mentioned measures. Methods: This quality-improvement initiative used a retrospective chart-review approach to examine false-positive peripheral blood cultures drawn in 2009. In June 2010 a month-long education campaign about the initiative was conducted for nurses and clinical assistant staff to reduce false-positive peripheral blood cultures. From July 2010 through June 2011, monthly retrospective chart audits of false-positive peripheral blood cultures were completed in conjunction with bimonthly e-mail communication about the study, development of a blood culture-drawing kit, and follow-up with staff who drew the false-positive cultures. Results: In 2009 the false-positive peripheral blood culture rate in the emergency department was 2.1%. After educational interventions and use of a blood culture-drawing kit, the rate of false-positive peripheral blood cultures decreased to 1.4%. Discussion: The decline in contaminated blood cultures shows that the interventions described significantly reduced the rate of false-positive peripheral blood cultures in the emergency department. © 2013 Emergency Nurses Association.
Responding to mental health emergencies: Implementation of an innovative telehealth service in rural and remote New South Wales, AustraliaEmily Saurman | David Perkins | Russell Roberts | Andrew Roberts | Martyn Patfield | David Lyle
Volume 37, Issue 5, September 2011, Pages 453-459
Introduction: Mental health is a national priority in Australia, and the need is greatest where access to specialist care is poorest, in the rural and remote regions of the nation. The Mental Health Emergency Care-Rural Access Project (MHEC) was developed to provide 24-hour access to mental health specialists in rural and remote New South Wales using video conferencing equipment. Method: An evaluation of the service activity of MHEC using a concurrent mixed methods approach. Results: Use of the service increased from a low base to around 60 video assessments per month at the end of the study period. Use of video assessments was greatest in the remote zone (30.7 video assessments/10,000 population/year). The number of people referred to a mental health inpatient unit declined (50 fewer patients, representing a decrease from 73% to 52% of all admissions between 2008 and 2009). Both patients and providers found the service helpful. Most patients (81%) stated that they would recommend or use the service again. Discussion: This service is well positioned to have an increasing effect on emergency nursing and patient outcomes, as well as potentially on transportations. Continued use of MHEC suggests that video conference technology is acceptable and offers responsive specialist emergency mental health care to rural and remote communities. © 2011 Emergency Nurses Association.
Nonpharmacologic Pediatric Pain Management in Emergency Departments: A Systematic Review of the LiteratureSarah J K Wente
Volume 39, Issue 2, March 2013, Pages 140-150
Introduction: Children account for numerous ED visits each year, with the majority of children reporting pain or requiring painful procedures. The fast-paced, noisy environment, varying resources, and staff trained in taking care of pediatric patients make the ED a unique place to care for children in pain. Nonpharmacological interventions are an essential part of pain management. The purpose of this review was to examine what nonpharmacological interventions EDs are using for pain management in children ages birth to 18 years. Methods: A systematic literature search was conducted to examine nonpharmacological interventions used for pain management of children in EDs. Results: Fourteen articles met the inclusion/exclusion criteria. Ten studies used distraction, 2 examined the use of sucrose, 1 explored cold application, and 1 looked at parental holding and positioning. Benefits of using nonpharmacological methods included decreased pain, distress, and anxiety reported by the parent, child, and/or observer. Discussion: Findings suggest nonpharmacological interventions such as distraction, positioning, sucrose, and cold application may be helpful in pediatric pain management in the ED. Nurses can implement these methods independently when caring for children and their families. In addition, nonpharmacological methods are relatively inexpensive to organizations. © 2013 Emergency Nurses Association.
Nurses' knowledge and attitudes toward pain in the emergency departmentJoane T. Moceri | Denise J. Drevdahl
Volume 40, Issue 1, January 2014, Pages 6-12
Introduction: The purpose of this study was to investigate emergency nurses' knowledge and attitudes about pain. Methods: A descriptive design was used for this study. A validated tool, the Knowledge and Attitudes Survey Regarding Pain (KASRP), was administered to nurses working in 5 U.S. emergency departments. Demographic data also were collected from each participant. Results: Ninety-one emergency nurses completed the survey. The mean total KASRP score was 76%. No significant differences were found in mean total scores by age, education level, years of nursing experience, or years of ED experience. Eight questions were answered incorrectly by more than 50% of participants. Five of these questions were related to opioid pharmacology and dosage, 2 concerned understanding of addiction and dependence, and one was linked to nurse assessment and patient report of pain level. Analysis of these 8 questions revealed that higher education levels had a weak positive association with correct answers. Discussion: Participants taking the survey scored comparably or better than participants in other reported studies using the KASRP. Years of nursing experience was not correlated with correct responses. Findings from this study underscore the Institute of Medicine's Pain in America recommendation to increase pain management education for all providers. © 2014 Emergency Nurses Association.


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Posts Tagged 'iris'
Best Documentaries of 2015Rounding up the nonfiction film achievements of the past year.
Kristian Lin
You may have noticed that I didn't include any documentaries when I ran my list of 2015's best movies last week. I'm never sure how to evaluate documentaries alongside fiction films — comparing fiction movies to one ano...
Two Weeks in Another TownComedy takes a vacation in the holiday movie called The Holiday.
Kristian Lin
No less than The New York Times recently dubbed Nancy Meyers "the queen of chick flicks."


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Leonardo Da Vinci Milan 1482 1499
A selection of articles related to leonardo da vinci milan 1482 1499.
Original articles from our library related to the Leonardo Da Vinci Milan 1482 1499. See Table of Contents for further available material (downloadable resources) on Leonardo Da Vinci Milan 1482 1499.
- Yina'mna'u and Yina'milan
- (Fog-Woman and Fog-Man) Yakut A pair of animistic spirits associated with mists and fogs....
Deities & Heros >> Siberian
- Everyday Earth
- When you think of "Earth" what comes to mind? Perhaps you feel the stable element of solidity and grounding. Or maybe you see Earth as the third planet from the Sun. Or for you, is Earth the rich brown soil in your own backyard? Earth is all these...
The Elements >> Earth
- Tarot Cards Overview
- Tarot is made up of four suites of regular playing cards, each having 14 pieces of cards. What distinguishes a deck of tarot cards from conventional playing cards is a single card called the Fool.
Divination >> Tarot Cards
- An Overview: What is Atheism?
- Atheism is non-belief in the existence of god or deities. It originated from the Greek word "atheos" which means 'without god'.
Religion & Philosophy >> Philosophy
Leonardo Da Vinci Milan 1482 1499 is described in multiple online sources, as addition to our editors' articles, see section below for printable documents, Leonardo Da Vinci Milan 1482 1499 books and related discussion.
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- He painted the Mona Lisa but did he invent the bicycle? Here's a brief life of
- In old age Leonardo spent much of his time in the Vatican serving Pope Leo X. After Milan was recaptured by the French under King Francis I, Leonardo was commissioned to make him a mechanical lion. He and the monarch reportedly became friends.
- Ludovico Sforza, Duke of Milan from Grove Art Online
- About 1482 Leonardo da Vinci arrived in Milan, where he remained as an intimate member of Ludovico's household for 18 years. As court painter ... Ludovico's plans were destroyed by the invasion of Louis XII, King of France, in August 1499.
- Leonardo da Vinci from the Benezit Dictionary of Artists
- In any case, the Sforza monument was never cast, and the largest clay model that Leonardo completed suffered serious damage when French troops entered Milan in September 1499 and archers elected to use it for target practice. However, many drawings ...
- Leonardo da Vinci
- In 1482, Florentine ruler Lorenzo de' Medici commissioned da Vinci to create a silver lyre and bring it as a peace gesture to Ludovico Sforza, who ruled Milan as its regent. After doing so, da Vinci lobbied Ludovico for a job and ....
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Malmö mayor in new row with Sweden's Jews
23 Mar 2012, 16:18
Published: 23 Mar 2012 16:18 GMT+01:00
- Malmö mayor in new 'anti-Semitism' row (18 Mar 11)
- US Jewish centre meets Malmö mayor (14 Mar 11)
- Jews still struggle to feel at home in Malmö (16 Feb 11)
"With this letter, we want to point out that Ilmar Reepalu no long has any credibility among us Jews in Sweden," reads a letter signed by the heads of the Jewish communities in Malmö, Stockholm, and Gothenburg.
"Regardless of what he says and does from now on, we don't trust him."
The letter comes following an interview published on Thursday in the liberal-leaning magazine NEO in which Reepalu discussed the "strong ties" between the Jewish community and the Sweden Democrats, a political party with a clear anti-immigrant and anti-Muslim line which has its roots in Sweden's neo-Nazi movement.
According to Reepalu, "Sweden Democrats have infiltrated the Jewish community in order to push their hate of Muslims".
The statements were immediately dismissed by Fred Kahn, chair of the Jewish Community in Malmö (Judiska församlingen) as "pure fantasy".
Reepalu, a Social Democrat, quickly backtracked on Thursday, admitting to the Dagens Nyheter (DN) daily that he "had no basis" for his claims and that he "shouldn't have said it that way".
But the back tracking came too late for the Official Council of Swedish Jewish Communities (Judiska centralrådet i Sverige – JC), which on Friday penned a letter to Social Democrat head Stefan Löfven blasting Reepalu's claims.
According to the Jewish leaders, the Malmö mayor has "crossed all boundaries" with his comments, especially considering that Reepalu previously laid blame on Sweden's Jews for the threats, violence, and harassment to which they've been subjected.
"We are more than upset when we today read the interview in the magazine NEO where he flagrantly accuses Jews for ties with the Sweden Democrats," they write.
"We're all too familiar with these types of conspiracy theories."
The Jewish community leaders also warned Löfven that the Social Democrats risk losing support among Sweden's Jews, many of whom are members of the party, because of Reepalu's comments.
"Many of them have recently expressed their dismay, but also sadness, about no longer being able to support a party represented by someone whose rhetoric is clearly anti-Semitic," they write.
Speaking with the TT news agency following the release of the Jewish community's letter, Reepalu once again defended himself.
"I've never been an anti-Semite and never will be," he said.
"I've been in Israel with my children several times and explained to them the importance that Jewish culture has Europeans."
However, Reepalu ruled out taking any extraordinary measures to make amends with the Jewish community.
"What can I do? They don't listen," he said.
TT/David Landes


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Average ISO Coordinators in the United States make around $47K per year. Not all workers are lucky enough to have benefits; in fact, just under one in four are without coverage. Medical insurance is claimed by a fair number and dental insurance is reported by more than half. Job satisfaction is high and work is enjoyable for most ISO Coordinators. Women account for the majority of ISO Coordinators who responded to the questionnaire — 67 percent to be exact. Respondents to the PayScale salary survey provided the data for this report.
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ISO coordinators are responsible for quality compliance and adhering to ISO standards in all their company products. They are in charge of verifying that all processing follows strict regulations to prevent issues. They possess strong verbal and written abilities to coordinate quality control activities. They interact well with other coordinators in a team environment to share important ISO related information and reach all crucial objectives within a given time-frame.Read More...
Some of their main responsibilities include creating extensive reports based on their observations, results to comply with licensing, and verification rules for production. These individuals are organized and pay close attention to detail. They use a personal computer to communicate with other internal departments. They also participate with business meetings in order to share ideas and suggest how to modify the quality process and make it more efficient.
ISO coordinators are well-versed in office applications such as word processing and spreadsheet software to run calculations and make detailed reports. They also stay specialized through training and become certified in different ISO quality standards. These individuals also take part in keeping an inventory count and ordering new material as required. They can multitask with ease in a variety of projects. Their other main duties include participating in quality inspections, following up on responsibilities, and executing new company procedures as needed. ISO coordinators review procedures and suggest ideas to increase productivity with less company resources. A bachelor's degree in quality control processes, or related field is required for this job. Previous years of experience in a coordinating or quality control capacity can be helpful. Additional ISO certifications are a plus.
ISO Coordinators typically list a handful of skills they use on the job. Most notably, skills in Windows Operating System General Use, Microsoft Office, Microsoft Excel, and Microsoft Word are correlated to pay that is above average. Skills that are correlated to lower pay, on the other hand, include Microsoft Word. Most people experienced in Microsoft Excel also know Microsoft Office.
Median of all compensation (including tips, bonus, and overtime) by years of experience.
ISO Coordinators with more experience do not necessarily bring home bigger paychecks. In fact, experience in this field tends to impact compensation minimally. During the first five years of their careers, ISO Coordinators see a median income of $40K. Survey respondents with five to 10 years of experience report an only modestly higher median of $42K. After working for 10 to 20 years, ISO Coordinators make a median salary of $47K. Old hands boasting more than twenty years of relevant experience report pay that is more or less commensurate with that extensive experience; average earnings for this group come out to approximately $54K.
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EarSonics SM3 Universal Fit IEM
"Remember those essays you had to write in grade school? Well I do even if you don't. In honor of that memory, I am going to write: What does the EarSonics SM3 mean to me? Back in March I was going to order the EarSonics SM3 based off the few things I have read about them, even though it wasn't much. But then something stopped me. Could they really be that good, and the shipping cost was as..." --average_joe
EarSonics SM64
"I've now had these earphones for over a year and I remain breathless at how versatile they are. The below list should give readers of this review a good idea of the kind of sound I have been used to in the past as I have owned the following. IEM's: - Westone W40 - Shure 530/535 SE (Red) - Sennheiser IE8/IE80 - Etymotic ER-4S HEADPHONES: - Sennheiser HD 650 - Sennheiser HD 580 - Audio..." --gregaus
EarSonics Velvet
"It was a long time since I orignally intended to write this review as I wanted to check black Velvet in addition to the Crystal velvet I've had. You can find a lot of impression on Head-fi thread and there are several good reviews which are very detailed so you can get an average impression of what to expect so this is going to be not so huge review but I try to cover most important..." --LMka
EarSonics SM3 v2 universal in-ear monitors
"http://www.earsonics.com/SM3%20engl.htm v2 page. Aside from the cable and new body, my impressions match what I had in my v1 review. http://www.head-fi.org/products/earsonics-sm3-universal-fit-iem/reviews/4422 Otherwise, these sound about the same as v1/the new ear-piece body shape is a lot more ergonomic(seems to be a bit smaller as well, but not as easy to get a good seal... At the same..." --svyr
EarSonics EM32
"EarSonics has made its last flagship for the guigs, but the EM32 can without a doubt satisfy audiophile who are looking for the "neutrality" with a reinforcement in the sub and the highs. The main characteristic is the same as for the EM3pro/EM4/EM6 : musicality and body ! But here you have all in one, that's the improvement. 3 transducers, 3 ways, two bores, no one on the market is..." --Rollk2
Earsonics - S-EM9 in-ear Earphones
"Introduction EarSonics (ES), a French company with their roots in custom monitors for the musician market, has been around for a while. They might not be as known as popular brands as Ultimate Ears, JH Audio or Westone, but they have made their mark and earned the respect of the audiophile community. Most seasoned Head-Fi'ers will know them and have come across one of their iems along the..." --flinkenick
Fischer Amps FA-4E XB
"I'm going to write a new, proper, monster review of these later on. Just HAD to write something now. This is sort of in between my old review and my upcoming one. Useful iem tips; Comply TS400/500, Auvio tips, Meelec Balanced tips. (All of these are better than the stock tips imo.) The bass: Depending on tips, it hits hard, harder or very hard. My preferred tips are Meelec..." --MoonYeol
EarSonics EM4
"EarSonics is a french CIEMs and IEMs manufacturer that is based in the south of France, near from Montpellier. All the prices are also in €uros. The EM4 are based on Franck Lopez thoughts after the EM3pro. They gain in width, clarity, separation and precision. But they are not made for guigs, you can use it for but it's not especially done for. I would advice to take the EM6 for...." --Rollk2
EarSonics SM2 v2
"The sound is one of a kind for BA, bass heavy sound signature. These are some of the bassiest BA you can find, with good instrument separation and soundstage. IMO really good for metal music, vocals are a bit far, v shape frequency responds. Build quality for the earphone body is just fine, but cable and tips have lots of flaws. Update: these phones sounds so much better after..." --10shot9miss
Earsonics - S-EM6 in-ear Headphone with 6 Drivers (devil)
"This is an edited version of a Headfonics review, focusing on sound impressions. Full version is available here: http://headfonics.com/2016/02/the-s-em6-by-earsonics/ Introduction Released two years ago, the S-EM6 was the first universal iem with 6 BA drivers. Having owned the SM64, Velvet, EM32, S-EM9 and now S-EM6, I've had my fair share of experience with EarSonics' products. So..." --flinkenick


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2 October 2003
Stark Investments plans a November start for its convertible arb product.
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In the past, many women used menopausal hormone therapy (MHT) to relieve hot flashes and other symptoms of menopause. MHT is also known as postmenopausal hormone use and hormone replacement therapy.
Although MHT is approved for the short-term relief of menopausal symptoms, the U.S. Food and Drug Administration (FDA) recommends women use only the lowest dose that eases symptoms for the shortest time needed [180].
There are two main types of MHT used today:
Estrogen alone raises the risk of uterine cancer, so it is only used by women who no longer have a uterus (those who have had a hysterectomy). Women who still have a uterus most often use estrogen plus progestin.
Estrogen plus progestin increases the risk of both developing and dying from breast cancer [19,181-185]. When women take these hormones, their risk of having an abnormal mammogram increases within the first year of use [186]. And, their risk of breast cancer increases within the first five years of use [184-186].
The risk of breast cancer goes up slightly with each year a woman takes estrogen plus progestin [182]. Small yearly increases in risk can add up over time. One large study found women who use estrogen plus progestin for five or more years (and are still taking it) more than double their breast cancer risk [184].
When women stop taking MHT, the risk of breast cancer starts to decline. After about five to 10 years, the risk returns to that of a woman who has never used MHT [19,183-184,186].
MHT also has a negative impact on other aspects of women's health. Results from the Women's Health Initiative, a large randomized clinical trial, showed that taking estrogen plus progestin for more than five years does more harm than good [187].
Although using estrogen plus progestin may lower the risk of endometrial cancer and hip (and other bone) fractures, these benefits are outweighed by increased risks of breast cancer and [187]:
Study findings also show that the use of estrogen plus progestin increases the risk of other conditions, such as cognitive decline (in women older than 65) and urinary incontinence (at least once a week) [187].
Figure 2.2 below shows the absolute risks and relative risks of some health conditions with the use of estrogen plus progestin compared to placebo.
Figure 2.2: Risks of select diseases with about six years of estrogen plus progestin (E+P) use versus placebo
Absolute risk
Relative risk
Extra cases seen per 10,000 women who take E+P for a year:
Breast cancer
9 extra
Deep vein thrombosis
12 extra
Pulmonary embolism
Fewer cases seen per 10,000 women who take E+P for a year:
Endometrial cancer
1 fewer
Hip fracture
6 fewer
Adapted from Women's Health Initiative findings [187].
Some studies have suggested estrogen alone increases the risk of breast cancer by about 30 percent [19,182,184-185]. However, the Women's Health Initiative trial showed a decreased risk of breast cancer with estrogen alone compared to placebo after an average of seven years of use [187].
The results from two large cohort studies raise the question of the safety of longer-term use of estrogen alone.
Researchers continue to follow the women in these studies to better understand how estrogen alone might affect breast cancer risk.
Some findings have suggested estrogen alone MHT may lower the risk of heart disease [190]. However, findings from the Women's Health Initiative showed the use of estrogen alone MHT for up to seven years had almost no impact on risk [187].
Researchers continue to study this issue.
If you are considering taking MHT (estrogen plus progestin or estrogen alone), discuss the risks and benefits with your health care provider.
For short-term relief of menopausal symptoms, estrogen plus progestin is an approved MHT. However, the FDA recommends that it be used only at the lowest doses for the shortest time possible [180].
Because MHT may increase the risk of breast cancer recurrence, it is usually not given to breast cancer survivors [191].
Learn about alternatives to menopausal hormone therapy for the relief of menopausal symptoms.
For a summary of research studies on menopausal hormone therapy and breast cancer, visit the Breast Cancer Research Studies section.
Susan G. Komen's breast self-awareness messages
1. Know your risk
2. Get screened
3. Know what is normal for you and see a health care provider if you notice any of these breast changes (see images):
4. Make healthy lifestyle choices
Facts for Life: How Hormones Affect Breast Cancer
Discover the different ways you can help


text:
Fiscal 2013 Financial Guidance of Local Corp:
Revenue - The company expects 2013 revenue of between $93 million and $95 million, which at the mid-point, is an increase of 12 percent, over the fourth quarter 2012 exit run rate.
Adjusted Net Income – Adjusted Net Income for 2013 is expected to be at least $5 million, which would result in approximately $1 million in debt-free cash flow. The company defines debt-free cash flow as cash provided by operating activities, less capital expenditures
Local Corp has the double of business-listing than Google Place - Local Corp has 18 million Business Listings against only 9 million of Google Place: "Google would be at about 9.5 million +/- claimed pages now — still below what Facebook is reporting today."
Source: SMALL BUISINESS SEARCH MARKETING
A sensation is, that Facebook has only two third of business-listings of Local Corp: 11 million business listings against the 18 million of Local Corp.
Information was given from Facebook COO Sheryl Sandberg, who told investors and listeners on the call that 11 million businesses are using Facebook Pages.
Source: SMALL BUISINESS SEARCH MARKETING
Local Corp is THE pioneer in local technology
• Proprietary platform and know-how
»Real time business, product and services data integration
»Large scale local/commercial content production and syndication
»Very large scale CPC ad-serving and distribution
»Web indexing and local search relevance
»Very large scale SEO, SEM campaign expertise
»Local display ad production and syndication
»Web hosting and local/commercial domain name acquisition
•12 patents issued, 8 pending
»Key patents
–Local web indexing (for indexing local web sites across the web)
–Pay per call for local and commercial searches via a mobile device (multiple patents)
•The billion dollar industry question: How do we monetize mobile?
–Dynamic cascading menu search (for product search on tablets and smart phones)
–Bulk domain registration and content management (for very large scale SEO)


text:
The Maine
Im having a Dickens of a time figuring out what would compel this Arizona quintet to give itself such a frosty moniker as the Maine. Its just like this whole Twilight Saga bullshit about Aryan vampires and Native American werewolves. Like, why the hell does Bella, whos supposed to hail from sunny Arizona, look like shes never set foot outside the dampest cellar in Norway? Ive never read the Twilight books, but I saw the first flick, and Im confused. OK, so now Ive paused for a second and Googled why this band calls itself the Maine, and its because these Arizonians decided to name themselves after an Ivory song. Whatever.
The Maine blends youthful savvy with what its members may or not remember of the 90s music scene with a polished pop punk sound that is all the rage among Twilight readers. Which I think is great, especially with the disposable income that bracket wields and these dudes look like they need a lot of SPF 1000 to keep them going. Joining onstage will be the equally pasty and youthful This Century. Doors open at 7 p.m. Saturday at the Culture Room, 3045 N. Federal Highway, Fort Lauderdale. Show is for those 18 and up, and tickets cost $14.99. Call 954-564-1074, or visit cultureroom.net.
Sat., Aug. 14, 7 p.m., 2010
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text:
Simon Cowell has extracted light-hearted revenge on his former protegee Cheryl Cole.
Cowell was upset that his 52nd birthday last year was revealed to the world by Cole.
The Fight For This Love hitmaker famously sought revenge on her former boss after he axed her from the US X Factor, by sending a plane to fly over his Los Angeles home along with a banner saying, "Simon Cowell is 52 today! Ha ha ha! Love Cheryl".
The move angered Cowell, who didn't want anyone to know he was celebrating the milestone age - but he made sure the pop star was aware of her own advancing years as she celebrated her 29th birthday in Las Vegas on Saturday.
Cowell sent a plane over her hotel in Sin City and paid for the pilot to write a vapour message, which said, "Cheryl - Congratulations you're 30 next year! ha ha ha Love Simon".


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all the expressive, creative, and inspirational personalities of our community!
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You'll look as fresh and lovely as a lily in these elegant earrings. Intricately adorned with a golden floral filigree pattern, these exquisite earrings are wrapped foxglove-style around a faceted, mint-colored bead. You'll adore pairing these with a pastel, flowered frock and schoolgirl-sweet Mary Janes for a look that's as chic as it is charming!
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Ever seen peppers like these ? They are tiny, very colourful and SPICY AS HECK !!!
You get their juice in your eye and - good luck.
You can buy these at some grocery stores or at indian or african supermarkets sometimes.
In my house, these are boiled in hot water, after the stem is removed, then put to be blended in the blender. Later some olive oil is added and this is put in a jar.
We use it as pepper for our food, so we add this meals like sauce and rice, or sometimes pizza.
Many people would think that think these would be bad, that someone could give themselves ulcers by eating such spicy food - however, this isn`t true !!
These detoxify you and they create a lining in your stomach that protects you against the toxins in painkillers which cause ulcers in the stomach overtime. These peppers stop that from happening, not to mention that they keep you.... regular...
Hope you enjoyed this post !!! and keep in mind that many food can help you fight cancer, ulcers etc. Like palm oil is anti-cancer, so are shitaki mushrooms and certain spices like tumeric. Colour fruits are sometimes antioxidants. etc.
Happy healthy Luuuxing !!!
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How a Holocaust memoir was saved in translation
Henry Lew enlisted a global army of Yiddish speakers to bring a moving Shoah story to a wider audience.
Henry Lew with the original Yiddish version of Rafael Rajzner's book
Like Nobel laureates Primo Levi and Elie Wiesel, Rafael Rajzner was one of the few Holocaust survivors who wrote about his traumatic experience in the immediate post-war years. But unlike them, his harrowing, 324-page eye-witness account of the liquidation of Bialystoker Jewry, published in Australia in Yiddish in 1948, was never translated into English - until now.
Rajzner was one of only 1,000 Jews who survived when the Nazis destroyed the 60,000-strong community in the city of Bialystok, near Poland's eastern border. He was sent to Auschwitz and Sachsenhausen concentration camp, where he became one of the currency counterfeiters coerced by the Nazis into the famous plot to undermine the economies of the Allies.
But when he died in 1953 aged 56, all hopes evaporated that Der Umkum Fun Byalistoker Yidntum (The Annihilation Of Bialystoker Jewry), scribbled from memory into notebooks at the end of the war, would ever be translated.
Sixty years on, an English translation has been published, thanks to the determination of Henry Lew, a child of Bialystok refugees who was born in Melbourne around the exact time Rajzner's original Yiddish version was brought out in 1948.
"I have no doubt that had Rajzner still been alive and had it been translated in 1960 or 1961, it would have become a very famous book," Lew says. "Nobody looked at Primo Levi or Elie Wiesel until the 1960s."
Lew was introduced to Rajzner's book in 2001 by his 95-year-old father, Leo, a Bialystoker survivor who regretted that it did not have a wider audience. "When he died in 2002, I found the book," recalls Lew.
His Yiddish was not good enough to translate it, but the idea percolated at the back of his mind for a few years until he stumbled across Aaron Lansky's book, Outwitting History, which describes how this secular Jewish student devoted his life to retrieving Yiddish books.
"I was very inspired by Lansky's book," says Lew, who emailed the author in 2004 for names of Yiddish translators. Lansky provided 55 names, all of whom received a letter from Lew asking if they would translate 10 pages of Rajzner's book. Lew amassed an army of 22 "righteous translators" from the United States, Canada and Australia.
The book, which Lew self-published under the title The Stories Our Parents Found Too Painful to Tell, has been described by eminent historian Sir Martin Gilbert, as "a valuable memoir, which adds to our knowledge and understanding of the fate of the Jews of Bialystok, a city of importance in the life of pre-war Polish Jews".
He says he believes it should "receive the widest possible circulation and publicity" .
Lew, an opthalmologist who has written three other books, says the project took him four years. "I started another book on Bialystok based around my family," he says. "But I put it aside because I wanted the translators to be still alive by the time Rajzner's translation was finished."
The Stories Our Parents Found Too Painful to Tell is available at www.abebooks.com or www.readings.com.au


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Pathfinder Society Scenario #8-01: Portent's Peril (PFRPG) PDF
The Colossal Creatures Bestiary (PFRPG) PDF
Pathfinder Society Scenario #8-05: Ungrounded but Unbroken (PFRPG) PDF
Pathfinder Society Scenario #8-05: Ungrounded but Unbroken (PFRPG) PDF
Letters from the Flaming Crab: Coins & Credit (PFRPG) PDF
Wings of Glory: 3x3 Fokker E.III Display (9)
Ares Games
Wings of Glory is a game system that allows players to recreate aerial combat during World War I and II, using cards and miniatures to represent the airplanes and their maneuvers. In Wings of Glory players will control one or more airplanes, taking to the skies to engage their opponents in aerial duels, or trying to carry out a specific mission, such as recon, escort, or bombing.
The Fokker E.III was a German single-seat monoplane fighter, the first aircraft armed with a synchronized, forward firing machine gun. This airplane was also used by the Austro-Hungary Empire and Turkey during World War One. The Fokker E.III was the definitive version of the Eindecker, with larger, newly designed wings than the original Fokker and was piloted by Aces as Max Immelmann, Hans-Joachim Buddecke and Oswald Boelcke.
Designed to be used with the popular air combat game system created by Andrea Angiolino and Pier Giorgio Paglia, each WW1 Wings of Glory Airplane Pack is a ready-to-play model, painted and assembled, 100% compatible with any other WW1 Wings of Glory game product.
In each pack you will find all you need to play with the airplane: a special base with gaming stats, a variable altitude flying stand, and a specific deck of maneuver cards.
***NOTE: This is not a complete game. You must own a WW1 Duel Pack or WW1 Rules and Accessories Pack to play.
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Big Finish and Paizo Announce the Launch of Curse of the Crimson Throne Audio Series!,
Pathfinder Adventures: Now Available on Phones and Tablets!,
Cthulhu Mythos Comes to Pathfinder's World of Golarion,


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100 years after inventing hair colour, L'Oréal Paris introduces the latest technology in permanent, home hair colour: micro-oil technology. Our NEW micro-oil system perfectly diffuses a blend of colour reflects into the heart of the fibre, revealing ultra-fine colour full of highs & lows. Each shade is made of a luxurious blend of multiple tones for an extraordinary natural-looking colour, all without ammonia.
The new vision of colour by L'Oréal Paris. Extraordinary natural-looking colour: the hair colour you wish you were born with. Ultra-fine colour full of highs & lows - our new micro-oil technology perfectly diffuses a blend of colour reflects into the heart of the fibre, revealing subtle, natural-looking colour. Beautiful, lively, multi-tonal colour - the colour particles are diffused from root to tip, reflecting light to reveal an extraordinary natural-looking colour. Improved hair texture & radiant shine - the micro-oil technology leaves each strand feeling smoother and cared for. Hair looks enhanced: improved visible condition, with healthy radiant shine. All this without ammonia. Up to 100% grey coverage - strand by strand up to 100% grey coverage that always looks natural.
We advise, and it is stated on the product instructions, everyone should perform a strand test before dyeing their hair, even if they have used the product before, as that ensures they will achieve the right result. Wait at least 2 weeks after using a relaxer, a perm or a straightening process on the hair.
1122744 – Colourant:
Paraffinum Liquidum / Mineral Oil, Aqua / Water, Ethanolamine, Steareth-20, Caprylyl/Capryl Glucoside, Polysorbate 21, Steareth-2, P-Aminophenol, M-Aminophenol, Ascorbic Acid, Sodium Metabisulfite, Argania Spinosa Oil / Argania Spinosa Kernel Oil, Thioglycerin, Toluene-2,5-Diamine, Polyquaternium-67, 2-Methyl-5-Hydroxyethylaminophenol, 2-Methylresorcinol, Carthamus Inctorius Oil / Safflower Seed Oil, Resorcinol, Edta, Parfum / Fragrance, (F.I.L. C161722/2)
1071397 – Developer:
Aqua / Water, Paraffinum Liquidum / Mineral Oil, Cetearyl Alcohol, Hydrogen Peroxide, Steareth-20, Peg-4 Rapeseedamide, Tocopherol, Sodium Stannate, Polyquaternium-6, Pentasodium Pentetate, Phosphoric Acid, Tetrasodium Pyrophosphate, Hexadimethrine Chloride, Glycerin, (F.I.L. C42424/1)
1087475 – Conditioner:
Aqua / Water, Cetearyl Alcohol, Behentrimonium Chlorid, Cetyl Esters, Lactic Acid, Trideceth-6,Chlorhexidine Digluconate, Limonene, Linalool, Benzyl Salicylate, Benzyl Alcohol, Amodimethicone, Isopropyl Alcohol, 2-Oleamido-1,3- Octadecanediol, Butylphenyl Methylpropional, Potassium Hydroxide, Cetrimonium Chloride, Hexyl Cinnamal, Parfum / Fragrance, F.I.L. C159703/2)
Size (0) Unit (EA) Height (17.3) Width (10.1) Depth (8.8)
Product code: 314502
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IEEE SoutheastCon 2016 was held in Norfolk, VA March 30 - April 3, 2016
Officer election results:
Co-Chairs: Kate Bollinger and Brian McGinnis
Vice Chair: Melissa Dollar
Secretary: Trey McGinnis
Treasurer: Colson Sutton
Webmaster: Elizabeth Hayes
Mathcounts occurred Saturday, February 28, 2015. 7th through 9th graders gathered at Southwest Tennessee Community College at the Macon campus from 8 am to 2 pm to compete in a math competition. It was a great experience not only for the students, but also for the volunteers who made it happen. Thanks to everyone involved for your hard work!
The Tennessee Society of Professional Engineers annual banquet occurred Thursday, February 26, 2015. CBU's Dr. Siripong Malasri was awarded by the Memphis Chapter of the Tennessee Society of Professional Engineers with its 2015 Distinguished Service Award. It was a great night with several great speakers and awards. Thank you to everyone who attended.
Officer election results:
Chair: Trey McGinnis
Vice Chair: Melissa Dollar
Secretary and Webmaster: Brian McGinnis
Treasurer: Kate Bollinger
IEEE SoutheastCon 2015 takes place at Ft. Lauderdale, FL April 9th to 12thLink to Website
ECE Senior Presentations occurred Saturday, January 24, 2015. The graduating seniors did a splendid job of showing off their hard work and research. Great job to everyone who presented, and thank you to all the friends and family who came to support them.
Officer elections will be held Thursday, Feb. 12th 2015 in Nolan. Room: IEEE Room.
Positions: Chair, Vice-Chair, Treasurer, Secretary
S-PAVe occurred Saturday, December 6. Mike Zurkamer of CT Groups did a wonderful job in his presentation of Interviewing Skills workshop and the group interviews gave valuable experience to the participating students. Thanks to everyone who came by!
S-PAC 2014 occurred Friday, November 21 in the KROC center. IBM's Dr. Ben Amaba spoke on the topic of "The Practice of Innovation". AT&T's Maria Lensing spoke on the topic of "How to Define Yourself". Both were highly inspirational and gave the students and professionals who attended the event plenty to think about as they talked over dinner.


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|Key Info
La Maison Pijot is a very comfortable and fully equipped holiday home with it's own private 10 x 5m swimming pool and large terrace with sun loungers and parasols. There is also a petanque pitch (French boules), table football and table tennis if you fancy a little competition with your family or friends. With a BBQ area and another large furnished terrace there is plenty of space for relaxing and alfresco dining. Situated only a five minute drive from the local town of Tonneins and twenty minutes from the larger towns of Marmande and Casteljaloux, you won't be stuck finding somewhere to shop or eat, not to mention the lake at Casteljaloux with it's own beach, great for children and adults alike.
|Sleeps up to 7, 3 bedrooms
|3 bedrooms, 2 bathrooms of which 1 family bathroom and 1 en suite
|Nearest beach
|Casteljaloux (lake and beach), Arcachon, Biscarros 80 km
|Car essential
|Nearest Amenities
|4 km
|Nearest travel links
|Nearest airport: Bergerac and Bordeaux 60 km
|Family friendly
|Great for children of all ages
|No pets allowed, No smoking at this property
|Fireplace, Internet access, DVD player
|Private outdoor pool (unheated)
|TV, CD player, Table tennis, Satellite TV, Wi-Fi available
|Kettle, Toaster, Iron
|Cooker, Microwave, Fridge, Freezer, Washing machine
|Double Beds (2), Single Beds (3), Cots available (1), Dining seats for 7, Lounge seats for 7
|Linen provided, Towels provided, High chair available
|Private outdoor pool (unheated), Balcony or terrace, Private garden, Shared garden, BBQ
|Parking, Not suitable for wheelchair users
The peace, tranquillity and lovely summers of rural France, The French people are warm, friendly and welcoming. The Garonne river is quite literally a stones throw from our gite.
Great location. We are surrounded by farm land and in summer the fields are full of sunflowers.
We are just a 2 hour drive away from the Atlantic coast and 3.5 hours from the Med. There is a large lake at Casteljaloux with a clean sandy beach, Go Ape (rope climbing and zip lining through the trees) and pedalo boat hire, a great way to keep all the family entertained.
18 hole golf course at Casteljaloux, 25 minutes drive.
9 hole golf course at Tombeboeuf, 30 minutes drive.
9 hole golf course at Marmande, 20 minutes drive.


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ISO issues software licence management standard
The International Standards Organization (ISO) has published a standard for software asset management to help companies avoid legal action from using improperly licensed software.
This Article Covers
Risk management
The International Standards Organization (ISO) has published a standard for software asset management to help companies avoid legal action from using improperly licensed software.
Your exclusive guide to CIO trends
A collection of our most popular articles for IT leaders from the first few months of 2016, including: - Corporate giants recruit digitally-minded outsiders to drive transformation - Analytics platforms to drive strategy in 2016 - Next generation: The changing role of IT leaders.
By submitting your personal information, you agree that TechTarget and its partners may contact you regarding relevant content, products and special offers.
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The new standard, called ISO/IEC 17990-1, has been jointly published by the ISO and the International Electrotechnical Commission.
IT supplier group Business Software Alliance (BSA), which campaigns against illegal software, has welcomed the new standard. The UK's Federation Against Software Theft (FAST) is also expected to support it.
Investors in Software, one of the organisations involved in the development of the standard, said, "The underlying justification for software asset management is the need to apply good governance to software assets. Without it, organisations could be subjected to significant risks, including legal and financial exposure."
So far, ISO has published part 1 of the standard, which covers processes and areas such as risk management and cost control.
The second part of the standard, covering tools, is expected later this year.
Enjoy the benefits of CW+ membership, learn more and join.
Reinventing Bahrain's Kanoo Group through digital technology
Read more on IT risk management
Security Think Tank: Five tips for creating a patch management strategy
Security Think Tank: Security patching an essential element of outsourcing contracts
Security Think Tank: Allocate maintenance processes to each piece of key software
Security Think Tank: Using vulnerability management to support the patching process
Lancaster and Newcastle researchers tackle Met Police email challenge
InfoSec Europe 2012: A look at IT security skills in the current climate
Tim Wilson, deputy head of ICT at NHS City & Hackney, on ISO 27000 compliance
Input from the business vital to risk management in infosec, says CISO for Steria UK


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Hotel Midama places you within a 15-minute drive of Cuenca Cathedral and Cuenca Museum. This 30-room hotel welcomes guests with conveniences like free in-room WiFi, an arcade/game room, and free newspapers in the lobby. San Pablo Footbridge and Castile-La Mancha Science Museum are also within a 15-minute drive.
For your convenience, a continental breakfast is available for a fee.
All 30 rooms feature phones and desks. Guests can enjoy TVs and stay connected with free WiFi. Bathrooms offer hair dryers, free toiletries, bathrobes, and bidets.
Property features
Hotel Midama features free WiFi in public areas, a meeting room, and an arcade/game room. If you drive, take advantage of free offsite parking. Front-desk staff can help secure valuables, and provide local restaurant recommendations. Additional amenities include free newspapers, a terrace, and a TV in a common area.
- Free WiFi in rooms and public areas
Hotel MidamaCalle Real, s/n Chillaron de Cuenca Cuenca 16190
Hotel Amenities
Hotel Amenities
Hotel Midama features a terrace, an arcade/game room, and complimentary newspapers in the lobby. High-speed wireless Internet access is complimentary. This Chillaron de Cuenca hotel also offers a safe deposit box at the front desk, a television in a common area, and an elevator (lift). Parking is available onsite for a surcharge.
- Arcade/game room
- Total number of rooms - 30
- Number of floors - 3
- Breakfast available (surcharge)
- Free newspapers in lobby
- Elevator/lift
- Front desk (limited hours)
- Free WiFi
- One meeting room
- Terrace
- Safe-deposit box at front desk
- Self parking (surcharge)
- Free parking nearby
- Television in common areas
Family Friendly Amenities
- Family Hotel
- Free Wi-Fi
- Rollaway/extra beds available
- Arcade/game room
- Cribs/infant beds (complimentary)
Available in all rooms: Free WiFi
Available in some public areas: Free WiFi
Self parking (surcharge), Free parking nearby
Room Amenities
Hotel Midama offers 30 accommodations with bathrobes and hair dryers. Guests can surf the web using the complimentary wireless high-speed Internet access.
Bathrooms include showers, bidets, and complimentary toiletries. Business-friendly amenities include desks and phones. Housekeeping is provided daily.
- Phone
- Daily housekeeping
- Private bathroom
- Bathrobes
- Free toiletries
- Hair dryer
- Bidet
- Shower only
- Television
- Desk
- Rollaway/extra beds available
- Free WiFi
- Free cribs/infant beds
Where to Eat
Continental breakfasts are available for a surcharge.
Nearby Things to Do
The recreational activities listed below are available either on site or nearby; fees may apply.
- Mountain biking nearby
- Hiking/biking trails nearby
To make special requests for accessibility needs, please note them at check-out when you book your room.
- In-room accessibility
Hotel Policies
Check-in time ends at 7 PM
Check-in time starts at 1 PM
Special check-in instructions:
Check-out time is 11 AM
Payment types
- Pets allowed
You need to know
Extra-person charges may apply and vary depending on hotel policy.
Government-issued photo identification and a credit card or cash deposit are required at check-in for incidental charges.
Special requests are subject to availability upon check-in and may incur additional charges. Special requests cannot be guaranteed.
- Resort fee
Optional extras
- Fee for continental breakfast: EUR 4.50 per person (approximately)
- Self parking fee: EUR 14 per night
- Rollaway beds are available for an additional fee
Hotel Name
- Hotel Midama
- Hotel Midama Chillaron de Cuenca
- Midama Chillaron de Cuenca
- Hotel Midama Province Of Cuenca, Spain - Chillaron De Cuenca
We should mention
Cash transactions at this property cannot exceed EUR 2500, due to national regulations. For further details, please contact the property using information in the booking confirmation. A resort fee is included in the total price displayed.