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Peripherally inserted central catheters (PICCs) have become an important means of central venous access. PICCs originally were designed to be placed at the bedside, into visible antecubital veins.1 Today, they often are placed by a radiologist in patients without any visible arm vein.2,3 As radiologists become more involved in the placement of PICCs, they should be aware of the indications and proper technique for PICC placement, knowledgeable of the pitfalls to be avoided, familiar with the various characteristics of the multiple PICCs that are available, cognizant of the complications associated with PICCs, and able to manage patients once they have had a PICC placed. With these skills, radiologists will be able to provide safe, comfortable, and reliable venous access for a very large population of patients.
Venous anatomy
The veins of the upper extremity are grouped into superficial and deep components (figure 1). The two main superficial veins of the upper arm are the cephalic and basilic veins. The cephalic vein is a superficial vein which extends from the radial side of the wrist along the lateral aspect of the upper arm, traversing the pectral-deltoid groove to insert into the axillary vein. The basilic vein arises along the ulnar side of the forearm and extends to the shoulder, where it is joined by the deep brachial veins to form the axillary vein. The large superficial antecubital vein connects the cephalic and basilic veins at the elbow.
The brachial vein is the main deep vein in the upper arm and it is often paired. These veins course in a common fascial sheath with the brachial artery. The brachial vein is formed from the confluence of the radial, ulnar, and interosseous veins of the forearm. Normal brachial veins usually are small, as most of the blood flow is via the superficial veins.
The indications for placement of a PICC are broad (table 1). PICCs greatly improve patient comfort by avoiding the need for frequent vein punctures to maintain peripheral IV access or to draw blood.
Referring physicians appreciate the reduced risk of placing a PICC compared to placing a temporary subclavian or internal jugular line. PICCs are safe, reliable, and easy to care for, making them ideal for home IV therapy.
Though almost every patient is able to have a PICC, alternative access becomes necessary when a patient has no continuous arm vein, or has extensive burns or a diffuse dermatological disorder involving the upper extremities (table 2). Acute upper extremity deep venous thrombosis also is an important contraindication to PICC placement. Placement of a PICC in a paralyzed extremity or in the arm ipsilateral to a mastectomy is associated with an increased risk for developing severe thrombophlebitis. Chronic central venous occlusion is only a relative contraindication to placement of a PICC. Although superior vena cava (SVC) or subclavian vein occlusion may be present, a PICC can still be placed with its tip positioned just peripheral to the level of the occlusion.
Many patients referred for vascular access suffer from severe thrombocytopenia or anemia. In these patients, PICC placement may be the only reasonable option for venous access. Because most PICCs are placed into superficial veins in the arm, these catheters can be placed safely despite a moderate anemia or coagulopathy. However, a prothrombin time within 3 seconds of control, a hematocrit of 30%, and a platelet count of 100 K/uL is preferred.
Whenever possible, avoid using an upper extremity vein as an access site in patients with end-stage renal disease. Damaging an upper extremity vein may reduce the number of sites available for creation of hemodialysis fistulas.
All central lines can be a source of cellulitis, sepsis, or air embolization. These serious complications are less likely to occur if patients have a good support system at home. Therefore, it is important to determine who will be caring for the PICC prior to its placement.
Pre-procedure preparation
A good history and a directed physical examination are essential prior to PICC placement. A recent complete blood count, serum chemistries, prothrombin time, partial thromboplastin time, and electrocardiogram are helpful prior to placement of any central line, including PICCs.
The most important part of the pre-procedure evaluation is determining the indication for line placement and the planned duration of use. Choosing the correct type of line also is a very important component of the preparation process.
Types of PlCCs
There are a wide variety of PICCs available. No single design has been found to be clearly superior; rather, the catheter selection must be tailored to each individual patient.4
The catheter tips have two basic designs: end-hole and valved (Groshong-type) (figure 2). The most common style of catheter tip is the end-hole design. Its primary advantage is that it can be advanced coaxially over a guidewire. A staggered-tip, dual lumen end-hole catheter has one lumen exiting the catheter proximal to the catheter tip. This design allows for simultaneous infusion of incompatible substances. However, these catheters cannot be trimmed without sacrificing the staggered-tip.
The Groshong valve-tip (Bard, Salt Lake City, UT) has no end-hole but rather a slit near its tip that functions as a valve to prevent spontaneous back-flow of blood into the catheter. This design only requires saline to flush the catheter, thereby simplifying line care.5 Groshong-tip catheters also are valuable for patients with a known heparin allergy or heparin-induced thrombocytopenia.
One of the most important considerations in selecting a PICC is the minimum number of lumens required. Single lumen catheters are easier to maintain and provide a larger lumen, which allows for more rapid infusions or infusion of more viscous solutions (i.e., blood products). Whenever possible, a single lumen catheter should be placed. However, most of the PICCs placed are dual lumen because of the requirement for multiple, simultaneous infusions.
The larger the catheter, the better the flow rates; however, larger catheters are more difficult to place and more likely to occlude small arm veins. Sizes for pediatric patients typically vary from 2 to 4 French (F), while most adults receive either a 4 to 5-F single lumen or a 5 to 6-F dual lumen PICC.
Almost all the PICCs available today are made from either silicone or polyurethane (PU). Each of these materials has distinct advantages. PU provides a stronger, thinner-walled catheter. Thus, a 5-F PICC made of PU has a bigger inner diameter (ID) than a 5-F PICC made from silicone (figure 3). The potential disadvantage to PU is that it is stiffer, and there is a theoretical concern that PU catheters are more likely to cause vascular injury. There are also some formulations of PU that have been known to become brittle on long-term exposure to blood. Despite these concerns, many patients have had PU PICCs in place for over a year without any clinical problems.
Silicone is biocompatible, non-thrombogenic, and is associated with a low infection rate.6 Silicone is not as strong as PU, which necessitates silicone catheters having thicker walls to provide adequate rigidity and resistance to rupture. Their thicker walls mean smaller IDs and lower flow rates than for PU catheters of the same outer diameter.
One of the greatest drawbacks to PICCs is their limited flow rate, due to their small inner diameters. Whether the catheter is single or dual lumen, silicone or PU, or 4, 5, 6, or 7-F will greatly affect the ID of the catheter lumens. PICC flow rates also are limited by their long length (typically 50 to 60 cm). These factors together make PICCs unreliable for infusing blood products.4 The viscosity of packed red blood cells (PRBCs) varies greatly from one unit to the next. Therefore, one unit of PRBCs may infuse well, but another may not infuse at all. Because a unit of PRBCs must be completely infused within four hours or the remaining blood must be discarded, placement of a PICC in a patient that needs frequent transfusions is not recommended. If these patients must be infused through a PICC, a single lumen PU catheter is recommended.
The pressure required to generate the 1 to 3 cc/sec of contrast injection for chest and abdomen computed tomography (CT) is too great for most PICCs. Single lumen PU catheters are the most reliable to use for power injection.4,7 The flow rates, at a given pressure, are better for a shorter catheter than a longer one. Therefore, trimming the PICC to remove excess catheter length prior to its placement will improve flow rates.
Overall, the single lumen catheters are easier to manage, provide better flow rates, and appear to plug less frequently. For these reasons, placement of a single lumen catheter should be encouraged whenever possible.
Placement technique
For PICC placement, the patient is situated with the arm positioned at about 45 degrees of abduction. Careful sterile preparation and draping of the arm is the key to achieving a low infection rate.8 A 10 minute betadine scrub is performed, followed by application of a betadine solution. Once this is dry, alcohol should be used to remove all the residual betadine. Sterile drapes are placed to provide a sterile field centered on the upper arm.
Placement of a PICC into the forearm or antecubital fossa requires a catheter that is unnecessarily long and is exposed to kinking caused by flexion at the elbow and, therefore, placement in the upper arm is preferred. Patients also find it more comfortable to have their catheter placed in the upper arm.
There are 4 different methods for visualizing the arm veins during PICC placement: (1) direct visualization or palpation; (2) IV contrast; (3) IV carbon dioxide (CO2); and (4) ultrasound. A number of manufacturers package PICCs in a kit that provides the components needed to place the line using the Seldinger technique (table 3).
A small percentage of patients have a visible or palpable basilic or cephalic vein in the upper arm. In these cases, a tourniquet, placed high on the upper arm, allows direct puncture of the vein using a 22 G angiocatheter (Johnson & Johnson Medical, Arlington, TX). Once the angiocatheter is in the vein, an 0.018" guidewire is advanced, as described below.
Unfortunately, the large majority of patients referred for a PICC have no visible or palpable superficial vein. However, an upper arm vein can easily be opacified by injecting one-third strength iodinated contrast into a more peripheral IV line. This method requires some type of peripheral IV access; a small gauge IV in the forearm or hand usually can be introduced in most patients. The excellent opacification provided by IV contrast allows most of PICCs to be placed using less than 10 cc of contrast material. A tourniquet should not be used when using IV contrast, as there is marked leakage of contrast at the puncture site when the vein is distended. In patients with a contrast allergy or renal insufficiency, intravenous CO2 also can be administered in order to visualize the veins (figure 4). The patient is given a slow injection of approximately 10 to 20 cc of CO2 via a peripheral IV. It is best to use a tourniquet to slow the passage of the gas. The image contrast may be poor and, thus, several punctures may be needed to gain access into the vein.
The majority of PICCs can be placed using ultrasound guidance. Use of a 5 to 7.5 MHz linear array transducer and a tourniquet facilitates visualization of arm veins. Many of our patients have had multiple peripheral IVs and their superficial veins are sclerosed, making access via the brachial vein necessary. However, when the brachial vein is punctured using IV contrast guidance, the needle may inadvertently traverse the brachial artery.
An important advantage of ultrasound guidance is that it allows clear location of the arteries. When using ultrasound, a puncture site that keeps the vein superficial to, or beside, the artery can be chosen. The needle is then advanced into a suitable vein using real-time imaging (figure 5). If needed, the arm can be rotated internally or externally to facilitate the vein puncture.
Following localization of the vein and prior to the puncture, 1% lidocaine, without epinephrine, is used to raise a dermal wheal at the intended site of puncture. The 25 G needle should not be advanced so deep as to enter the vein of interest and cause spasm of the vein or a perivenous hematoma. When using fluoroscopic or ultrasound guidance, a 7 cm, 21 G needle is used to puncture the vein. This needle is large enough to accept an 0.018" guidewire.
The veins are compliant, thus a double wall puncture is frequently performed when using fluoroscopic guidance. It also is helpful to have the orientation of the needle parallel to the course of the vein (figure 6). The technique for ultrasound guided puncture is similar, but often a single wall puncture of a distended vein is sufficient because a tourniquet is in place. Once the ultrasound-guided puncture into the vein is made, fluoroscopy is used to visualize passage of the guidewire.
Whatever method is used to access the vein, the remaining portion of the procedure is always performed in a standard fashion. The 0.018" guidewire is gently advanced through the needle. If it does not pass easily into the vein, the needle is slowly withdrawn during fluoroscopic visualization. The vein is then gently probed with the guidewire, which should advance easily once the needle tip is in the vein. After guidewire access into the vein is gained, a small incision with a number 11 blade and blunt dissection of the puncture site greatly facilitates the advancement of the peel-away sheath and the PICC. A peel-away sheath should then be advanced over the guidewire. Once the sheath is in the vein, the guidewire and dilator are removed. Some manufactures provide a long 0.018" guidewire that can be used to size the length of PICC that will be needed. The catheter is then advanced through the peel-away sheath, without a guidewire, into the SVC. The tip of the PICC is positioned in the SVC at the caval-atrial junction (figure 7). As with most conventional central lines, retraction of the catheter tip can be expected after placement.9 The position of the catheter is documented using a tightly collimated chest radiograph. All PICCs have adequate radiopacity to identify the tip of the catheter.4
Next, the catheter is affixed to the skin, sutured in place with 2 to 4 stitches of a non-resorbable material (3-0 Prolene, Ethicon Inc., Somerville, NJ), as tape is not reliable for fixation. Although the ideal dressing is debatable, we prefer to place a clear plastic adhesive dressing over the PICC site. Both ports are flushed with heparinized saline (2 cc of 100 units/cc heparin), clamped, and then capped. Instructions for catheter care are reviewed with, and a copy given to, the patient. A copy of the instructions are also placed in the chart. These instructions include a phone number to call should any questions arise.
The most common pitfall encountered is the inability to puncture the vein of interest or an inability to advance a guidewire into the vein. If the first pass of the 21 G needle is unsuccessful, intense spasm of the vein often will occur. Administration of 100 ug of nitroglycerin through the peripheral IV, with simultaneous compression of the other outflow veins may be helpful for relieving the venospasm. If the spasm persists, or a hematoma develops, then a more central puncture in the same vein, or puncture of a different vein is often necessary.
Central venous stenoses or occlusions are other common pitfalls. The small size of PICCs allows them to be advanced into the SVC in almost all patients-even those with central venous stenoses. However, if the catheter cannot be advanced into the SVC, an upper extremity venogram should be performed. If the subclavian vein is occluded in one arm, the PICC should be placed in the contralateral arm. In patients with bilateral central venous occlusions, the PICC tip can be positioned peripheral to the occlusion and still be a valuable venous access site.
While advancing the PICC, the veins usually are not opacified. Rarely, the catheter will exit the main venous channel and pass into a small parallel collateral channel. When this occurs, it may be necessary to pull the catheter back and perform a contrast injection. Advancing a small torqueable guidewire through the PICC may be necessary on occasion to facilitate placement of the line in the main venous channel, or to successfully advance it into the SVC.
A PICC should not be placed in a persistent left SVC (figure 8) because the left SVC drains into the coronary sinus, and pericatheter thrombosis can lead to coronary sinus thrombosis. The left SVC may be mistaken for the descending aorta and the operator may pull out the PICC assuming it has inadvertently been placed into the brachial artery. A contrast injection should be made to confirm the PICC position prior to removing it.
Overall, the complication rates associated with PICCs are similar to or less than those associated with other central lines. PICC complications can be generally divided into early (less than three days) and late (greater than three days) types.
Early complications include bleeding, hematomas, nerve or arterial injury, acute thrombophlebitis, and arrhythmias. Puncture site problems are the most common early complications. Using a peel-away sheath for PICC placement can lead to pericatheter bleeding immediately after catheter placement and sheath removal. This oozing of blood around the catheter at the insertion site can persist for minutes or hours. Light pressure for 10 minutes usually will control the bleeding. Otherwise, a gelfoam sponge can be placed on the puncture site.
If bleeding is persistent and coagulopathy is not present, an arterial injury should be suspected. Arterial injury is often due to inadvertent through-and-through puncture of the brachial artery when performing brachial vein puncture using fluoroscopic guidance. It also may occur when the brachial artery is mistaken for the brachial vein while attempting an ultrasound-guided puncture. However, ultrasound guidance usually allows continuous visualization of the artery during puncture of the brachial vein. A color duplex examination also can be performed prior to the puncture to insure that the vein is correctly identified.
If there is any question about the possibility of a transarterial venous puncture, a pull-back test can be performed. After the peel-away sheath is introduced over the guidewire, the dilator is removed. The sheath is then slowly withdrawn over the .018" guidewire. If the needle traversed the artery, a sudden flash of arterial blood from the peel-away sheath will be seen. If no flash of arterial blood is seen, the dilator and peel-away sheath can then be re-advanced over the 0.018" guidewire, and the PICC is placed.
Nerve injury is rare and is most likely to occur during brachial vein punctures. Symptoms of nerve injury include immediate pain or numbness radiating to the hand. If these symptoms occur, the puncture needle or the catheter (if the PICC has already been placed) should be removed immediately. A new line should then be placed in the other arm. The symptoms usually will resolve within several hours.
Arrhythmias are associated with advancing the PICC into the right heart. These will usually resolve when the catheter is withdrawn into the SVC.10
Acute superficial thrombophlebitis is another complication. It usually is associated with pain and tenderness, and perhaps mild erythema, along the course of the accessed vein. This problem usually resolves within 24 to 48 hours following conservative therapy with arm elevation and moist local heat. If symptoms persist despite adequate conservative therapy, a superimposed infection should be excluded, and it may be necessary to remove the line.
Late complications include line plugging, catheter dislodgement, line fracture, venous thrombosis, exit site infection, and sepsis. Line plugging is the most frequent late complication and is best prevented by meticulous maintenance flushes using heparinized saline. The second most common late complication is catheter dislodgement, which can occur despite suturing the catheter to the skin. Dislodgement is common in uncooperative patients, and for them, a port may be preferable. Fortunately, almost all the line fractures occur in the portion of the catheter external to the puncture site, and are seen more frequently with silicone catheters.
Thrombophlebitis occurs in approximately 1 to 10% of patients with PICCs.11,12 There are 2 distinct presentations. Most cases of phlebitis appear in the first few days after placement, as previously discussed. These cases are probably due to the manipulation of the veins with catheters and guidewires, or to the presence of a PICC in a relatively small arm vein.
Late presentations (greater than 3 days) are related to either a line infection or significant venous thrombosis. Infected lines usually are removed immediately, and the catheter tip is
then cultured. Patients with severe thrombophlebitis symptoms should be systemically heparinized. Fortunately, instances of central venous thrombosis are rare (approximately 1%) with PICCs. This is an important difference from conventional chest-wall venous access catheters, where symptomatic central thrombus forms in up to 8% of patients.13 The rate of sepsis associated with PICCs is similar to that of tunneled central lines (1 to 3%).11-14 Approximately 2% of patients with PICCs develop local cellulitis.11
Findings will include insertion site erythema, tenderness, induration, purulent drainage, and fevers. These lines should be removed and cultured. If venous access is still needed, a new PICC should be placed in the opposite arm and antibiotics initiated pending results of the catheter tip culture. The main differential diagnosis for exit-site erythema is an allergic reaction to the tape used on the dressing or the catheter itself.
Post-procedure care
Starting a PICC service means a large investment of personnel and time into care of these lines. The following instructions are given to a patient or their care providers in order to minimize the occurrence of problems: (1) The lumens should be flushed after the completion of any infusion; (2) for end-hole catheters, each lumen must be flushed at least once every 12 hours (the flush consists of 10 cc of saline followed by 2 cc of 100 unit/ml heparin); (3) the dressing must be changed every 3 days; and (4) the catheter is to be kept sutured to the skin with non-resorbable sutures.
Another potential care issue is preventing contamination of the lumen of the line and preventing entry of air into the line. Most of the manufactures of PICCs include a clamp on the catheter near the hub, which is used in addition to an injection cap on the hub.
When a patient presents with a plugged PICC, the external portion of the catheter is inspected for kinks or occlusive sutures. Clearing the plugged PICC using a 10 cc syringe filled with saline should be attempted. The small size of PICCs makes them prone to plugging, and the thin wall of these lines also makes them easy to rupture. About
9 ATM of pressure can be generated with a 10-cc syringe, whereas a 3-cc syringe can generate about 21 ATM.15 Generally, the catheters made from PU are stronger than the silicone catheters. Silicone catheters have been shown to rupture or leak with pressures of 3 to 11 ATM, whereas the pressure required to induce rupture or leakage in PU catheters is at least 19 ATM. Therefore, with plugged PU catheters, a 3 or 5-cc syringe can be used when attempting to clear these lines. If simple flushing fails, an attempt will be made to clear the line with 5000 units of urokinase (UK) (Abbott Laboratories, Chicago, IL). If the line is completely plugged, it can be difficult to get the UK into the catheter. In this situation, a three-way stopcock and a 60-cc syringe on the side-arm of the stopcock should help get the UK into the catheter. The three-way stopcock is connected to the PICC. The syringe containing the UK (5000 units in 2 cc of saline) and an empty 60-cc syringe are attached to the 2 side-arms of the three-way stopcock. By generating a negative pressure in the PICC with the 60-cc syringe and then turning the stopcock handle open to the UK syringe, some of the UK will be drawn into the plugged PICC. It may be necessary to repeat this maneuver several times to facilitate transfer of the full 5000 units (2 cc) of UK into the plugged PICC lumen. The UK should be left in place for 10 minutes, and the catheter is then flushed with saline. This process should be repeated if needed. PICCs with a leak or only one plugged lumen can often be safely rewired over a 0.018" Teflon-coated guidewire.
One of the main advantages of having PICCs placed in the interventional suite is the greater than 99% technical success rate. This compares with bedside insertion success rates of approximately 74%.11 The average duration of catheter usage is extremely variable, ranging from a day to greater than a year. In a study by Cardella et al, the catheters remained in for an average of 72.7 days.11 In 73.4%, catheters were removed because they were no longer needed. In 22.6% of the patients, the lines were replaced at least once to allow completion of the planned therapy. These line exchanges occurred when the PICC became partially dislodged, fractured, or partially plugged. In the remaining 4%, a new line had to be placed at a different site to complete the therapy, due to site infection, phlebitis, or suspicion of systemic infection.
Although the number PICCs placed is increasing, there are several important alternative venous access devices to consider (table 4). As interventional radiologists, we must provide a good venous access service, of which PICCs are just one component. Consultation should be provided to the referring physicians regarding the most appropriate type of access device for their patients.
Peripheral IVs -Peripheral IVs, although certainly cheaper in the short term, require frequent replacement, are inappropriate for infusions of vein-sclerosing infusates, and do not allow for blood draws.
Conventional central lines -Conventional central lines introduced through the subclavian or jugular vein have a higher infection rate than PICCs. Traditional temporary central lines also carry the additional risks of pneumothorax or arterial injury.
Permanent central lines -Tunneled central lines with a dacron cuff that becomes incorporated into the subcutaneous tissues are considered a permanent type of venous access. These lines are more costly to place than PICCs, but they are still the most practical choice if long-term therapy is needed. Patients who have had multiple central lines or who have bulky mediastinal disease may have central venous stenoses or occlusions. Tunneled catheters are large diameter catheters and are more prone to inducing venous thrombosis if the central veins are narrowed significantly. The small diameter of PICCs allows placement in many patients with central venous stenoses in whom a tunneled central line may be hazardous.
Other cuffed silicone catheters -A Hohn catheter16 is a non-tunneled silicone catheter with an antimicrobial cuff (Bard Access, Salt Lake City, UT or Cook, Inc., Bloomington, IN). Use of these catheters is an important alternative to conventional central lines, tunneled central lines, and PICCs. These
5-F single or 7-F dual lumen catheters are placed via the subclavian or jugular vein and are designed for intermediate-term access. They are introduced through a peel-away sheath, and have a cuff attached to the catheter near the hub which is advanced into the subcutaneous tissue at the puncture site. Infection rates are similar to those of tunneled lines but the placement procedure is easier.16 Unfortunately, patient satisfaction is not high when this line is placed in the neck.
Arm ports -Arm-port catheters are similar in size and length to PICCs but are particularly intended for long-term (greater than 6 month) usage. Placement is similar to PICCs, except that a pocket is made for the port at the puncture site in the upper arm.17 The initial cost for placement of an arm port is significantly more than that of a PICC.
PICCs have all the capabilities of a multi-lumen, tunneled central line (blood sampling, simultaneous infusions of incompatible agents, and delivery of infusates directly into the central venous system) except for infusion of blood products. Placement of PICCs is an outpatient procedure and can be performed in about 20 minutes. There is no need for a prolonged recovery time. Placement of PICCs by interventional radiologists provides the safety of fluoroscopic guidance and a technical success rate that is approximately 100%. Immediate complications are rare when PICC placement is performed in the interventional suite.
The success rate for bedside insertion of PICCs is approximately 74%. The lower cost of bedside insertion by nurses has created a two-tier system at some institutions: patients who fail bedside insertion are then sent on to the interventional radiologist. Unfortunately, what is lost in this two-tier system is the concept of a venous access consultation service. A PICC is not for everyone (i.e., the dialysis patient). In addition, the added cost of having a PICC placed in the interventional suite is more than offset by the savings associated with the potential delays in starting intravenous therapy and higher complication rates associated with bedside insertion. Just as important is the continuity of care that occurs after line placement when all PICCs are placed by one service center.13,18
The placement of PICCs in the radiology suite has been found to be more reliable and more comfortable. This is because the antecubital fossa is a common insertion site for lines placed at the bedside. These lines can be uncomfortable and are prone to fracture, dislodgement, and kinking, when compared to PICCs placed in upper arm veins.
Calculating the actual expense of placing and maintaining a PICC is difficult, and the true cost-effectiveness of providing a PICC service remains uncertain.
There are many indications for PICC placement, and the radiologist can provide successful placement in nearly all patients referred for the procedure. PICCs are associated with a very low morbidity rate. Procedure planning must include a careful selection of the appropriate type of venous access device for the clinical situation. Perhaps most important to creating a viable PICC service in the department of radiology is the development of an effective post-placement care system. With appropriate organization and attention to detail, creating a PICC service can be a rewarding and productive activity. AR
1. Hoshal VL: Total intravenous nutrition with peripherally inserted silicone elastomer central


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Starbury Gets Clowned By The Swiss
Things are going from stupid to ridiculous for Stephon Marbury. Not only has he been banished by his team but now he's getting punked by the Swiss who are known for their humor.
Several people claiming to be Swiss bankers with connections to Real Madrid attempted to recruit Starbury to play for the Spanish giants. It turns out they were fakers. He didn't find this out before he returned calls and emails on Saturday. Now he's considering turning their information over to the law.
The pranksters also contacted the Post, AP and the New York Times to promote Starbury's imminent move to Real and Real president Ramon Calderon's contacts with Donnie Walsh. Too bad none of it was true. Starbury playing in Spain would make for great reality TV. We might get a Kwame Brown moment where he blows up when he can't get Spanish Fly at a restaurant.
Filed under: NBA • New York Knicks • Starbury • Stephon Marbury • Switzerland
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Our latest cold front sagged into the Brazos Valley today. While it took a bit for that cooler air to get here, after the initial wind shift, we starting cooling off pretty rapidly by 4pm this afternoon.
Light rain was found sprawled out across the Brazos Valley this evening, but is slowly pushing south and should be out of the area by midnight. Cloud cover should begin to decrease from north to south, leaving clear skies by sunrise Saturday morning. Clear skies and...
Watch the Pets & Tender Plants:
Scattered freezing temperatures will likely be found across parts of the Brazos Valley by first thing Saturday morning. For those that aren't officially down to freezing, you'll be close as lows sink into the low-to-mid 30s. Frost will be possible in a few locations, along with some cars covered in frozen water droplets after tonight's light rain.
While we don't expect a hard freeze this weekend, you'll want to make sure that the furry friends have a warm spot to cuddle up for the night and cover / bring in any tender vegetation that you may have started working on in advance to Spring.
Here's our expected lows for Friday night / early Saturday morning:
Sunny Weekend Ahead:
High pressure will help clear out the clouds that are on hand this evening. Sunshine and a mildly cool day is expected on Saturday. Highs are expected to top off in the upper 50s to extremely low 60s:
By Sunday, southerly winds return and turn breezy (10-15mph, with gusts upwards of 20mph). That should help crank afternoon highs back up around the 70° mark to wrap up the weekend. Moisture will start to collect again which will set us up for the weather story of next week -- scattered rain chances.
Progressive Weather Pattern:
We've got two cold fronts on schedule for next week. As of this evening, we'll pin those down for Monday afternoon / evening and then again on Thursday.
Monday's cold front will be a shot of re-reinforcing cool air. Ahead and along of that front, we'll hold a 30% chance of scattered showers / isolated thunderstorm. The downside to rain chances with this front is that there will be a bit of a CAP in the atmosphere (hindering shower / storm development) along with the fact that the upper-level support for this front will be well to the north of Texas.
Thursday's cold front looks a bit more promising for bringing a line of rain / thunderstorms to the area. We'll currently call it a 50% chance (pending changes to the forecast over the next several days). The upper-level support with this front should slide across Kansas / Oklahoma, which is a bit more promising for rain development.
We will have to monitor this system as the latest extended computer models brings this system through with a negative tilt. When storm systems are tilted to the left, they typically can create scenarios for a round of severe weather. Nothing set in stone, but something to monitor through the weekend and into the beginning of next week.
Enjoy the weekend and the upcoming sunny days. Don't forget you can keep up with the latest in the forecast by checking back to the weather page, twitter (@KBTXWeather or @KBTXShel) along with our Facebook page.


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Christmas cards. Some people love 'em, some people hate 'em.
Personally, I like for the Christmas cards I receive to include a photo. Regular cards do nothing for me. Yes, I get it that the thought is nice, but let's face it – no one keeps them. They're usually thrown right in the trash once the new year rolls in. Unless, that is, there's a photo. The photo usually hangs around longer, maybe on your fridge, maybe in your office – for us, the photos sit on the bar area on our kitchen counter for months to come.
That's right – I like Christmas cards with photos. Family photos are totally cool in my book, and further – I think they are pretty imperative if you have growing children. What's not super-cool in my book? When a couple has their photo taken for a Christmas card. Believe me – I'm just as vain as the next person, and there's nothing more I love than a great photo of Daniel and I…but the thought of us sending out a Christmas card capturing one of our precious moments – and believe me, there are plenty of them – makes me gag.
So, I suppose I don't need to tell you not to hold your breath for one of those this year. I'll be saving that for the day we have a beautiful family of our own – because in my book, that's something worth showing off. And when that day arrives, I'd love to do something over-the-top like the portrait the Kardashian's had taken this year. I love that they switch up the theme each year, and I am particularly smitten with the dramatic vibe of this super-glam edition. I love the solemn faces, and of course – I'm positively dying over the fashion. I mean, just look at little Mason – I die.
I'm also dying to know what YOU think about Christmas cards. Are you into the photos, or would you rather go without altogether? Are you obsessing over this glam-ed out photo op from the Karsdashian clan, or is it a little too haute for the holidays?


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Booklet aimed at helping Headteachers cope with the pressures of the job whilst trying to maintain their work/life balance.
Hard copies available £3.00 + VAT per booklet.
HCC Customers requesting in excess of 20 copies £3.00 + VAT per booklet.
Headfirst available online (PDF 404kb)
For further details please complete our enquiry form.


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CAPP Workshop
All adjunct instructors and liaison professors are expected to participate in the annual CAPP Workshop that occurs during the academic year.
Mark you Calendars: 2013 Spring Workshop is Wednesday, April 24!
8:00-8:30 am Registration and Breakfast - Reeve 227
8:30-9:00 am Opening and Welcome from Chancellor Wells
9:00-9:30 am Welcome from CAPP Director
9:30-11:30 am Morning Workshop Sessions
11:30 am - 12:45 pm Lunch and Keynote Speaker: Kalpana Srinivas from Syracuse University
12:45-1:00pm Break
1:00-2:00 pm Afternoon Workshop Sessions
Parking will be free in lots 15, 32, and 13 (Tennis court side) from 7:30am to 5:00pm that day. Map of UW Oshkosh


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The thought of keeping your children occupied this summer might seem like a daunting prospect, so we've put together a list of fun free activities to inspire you and your family.
1. Nature walks
Embark on a countryside expedition at your local park or woodland and captivate your kids with the magic of wildlife. Hunt for 'treasure' such as pine cones, acorns and wildflowers or investigate what insects you can spot. Take a magnifying glass for seeking out animal footprints, or go foraging for blackberries in the hedgerows.
2. Kite flying
Make a kite with recycled materials and watch it soar through the sky! All you need are some sticks, tape, string, scissors and plenty of fabric or paper. Be creative with diamond or box shapes and crazy colourful designs.
3. Get active!
There are hundreds of sports activities that will keep your family fit this summer. Why not try rounders, back garden bowling, frisbee or hide and seek? Splash about with water fights and bubble chasing, or build your own obstacle course in the garden.
4. Make the most of your garden
Kids love the excitement of waiting for a seed to sprout, and gardening is a great way for them to learn about plants. Herbs, vegetables and sunflowers are perfect for first-time growers, and if you don't have a garden, try a window box.
5. Get creative in the kitchen
Have some culinary fun making summer foods, like homemade ice-cream, fruit juice lollies or fresh fruit salad. Then enjoy your picnic feast in the sunshine!
6. Catch your own dinner
Take a net down to your local riverbank or harbour to see what's biting. Don't forget to take a picture of your first big catch! Or for a truly British seaside pastime, try crabbing – all you need is string and some bait, but watch out for nasty nips!
7. Summer sledging
Why wait for winter? All you need is a flattened cardboard box and a hillside and you're all set for some summer tobogganing. Budding adrenaline-junkies will go crazy for the thrills, and it'll channel some of that endless energy into a fun-focused activity.
8. Build a den
Have a holiday in your own backyard by pitching a tent in your garden, or simply hang sheets over the washing line to create your very own teepee. Have a barbecue, tell stories, play games and have a campfire sing-along – it's the perfect way to spend some quality time together as a family.
9. Beach-combing
Scour the seashore for some littoral loot such as seaweed, shells, interesting pebbles, driftwood or sea-smoothed glass and then use your treasures to make a sea-themed collage. Or have a sandcastle-building competition to see who can sculpt the finest fortress.
10. Fossil-hunting
Find your local sedimentary rock spot and search for ancient dinosaur relics! Coasts, quarries and farmland are the best places to look, and all you need is a keen pair of eyes.


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Release Date: June 28, 2010
DOE-Sponsored Field Test Demonstrates Viability of Simultaneous CO2 Storage and Enhanced Oil Recovery in Carbonate Reservoirs
Washington, D.C. — A field test conducted by a U.S. Department of Energy (DOE) team of regional partners has demonstrated that using carbon dioxide (CO2) in an enhanced oil recovery method dubbed "huff-and-puff" can help assess the carbon sequestration potential of geologic formations while tapping America's valuable oil resources.
The huff-and-puff method of enhanced oil recovery proceeds in three phases: injection (the huff stage), "soaking" for a short period of time, and production (the puff stage). Compared to other huff-and-puff operations, the PCOR Partnership test was unique for several reasons:
The test was conducted utilizing a producing oil well in the Mission Canyon Formation, part of the Madison Group of Mississippian-age carbonate rocks in the western United States. During the test, 440 tons of liquid CO2 were injected into the well to a depth at which CO2 is miscible and blends with residual in-place oil. Following 2 weeks of "soaking," the well was placed back into production.
Production more than doubled over the course of a 3-month period, increasing from a baseline rate of 1.5 stock tank barrels (STB) per day to 3-7 STB per day. The percentage of oil in the produced fluid, commonly referred to as the "oil cut," also increased, more than doubling from less than 3 percent to 6 percent.
In addition to demonstrating the feasibility of combining CO2 storage along with enhanced oil recovery in carbonate rocks deeper than 8,000 feet, the test determined that two Schlumberger technologies—a reservoir saturation tool (RST) and vertical seismic profiling (VSP)—may be effective tools for detecting and monitoring small-volume CO2 plumes in deep carbonate reservoirs to ensure safe and permanent sequestration. Project outcomes may be applicable to many other sites in the PCOR Partnership region and in similar settings globally.
The Regional Carbon Sequestration Partnerships initiative is a government-industry effort that is determining the best approaches for capturing and storing gases that can contribute to climate change. The PCOR Partnership brings together more than 80 partners—consisting of public agencies, utilities, oil and gas companies, engineering firms, nonprofit organizations, and universities—in a region that includes all or part of nine U.S. states and four Canadian provinces. Led by the Energy and Environmental Center in Grand Forks, North Dakota, the PCOR Partnership has completed four small-scale validation tests and is currently conducting two large-scale development tests.
The Regional Carbon Sequestration Partnerships initiative is managed by the Office of Fossil Energy's National Energy Technology Laboratory.


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You're watching...
Suspect's Aurora apartment booby-trapped
Soda bottles filled with chemicals, trip wires near door
Jul 20, 2012
You're watching...
Soda bottles filled with chemicals, trip wires near door
Jul 20, 2012
Also in this playlist...
Auto-advance: ON
Auto-advanceThis transcript is automatically generated
Fox News alert for you now for those just joining us let's get you up to speed on the latest breaking developments in this tragedy out of Aurora Colorado.
-- just wrapped up a news conference following the horrific.
Shooting of dozens of innocent moviegoers at that packed premiere of the latest bat man film last night.
At least twelve people will twelve people at the moment are dead but more than three dozen others were injured.
Listen to the police chief from -- he just gave his heart wrenching description of the events inside that theater.
Our best available counts on injuries as of right now.
Is that 71 people.
Where shots.
And that twelve are deceased.
Two died at area hospitals.
And ten.
Are deceased.
In the crime scene at this time and we are making best efforts to to identify and remove those ten.
-- while the investigation continues with federal state and local officials there is an explosive situation still unfolding.
At the suspect's apartment a bomb robot is being sent into the suspect's apartment.
After investigators -- in the window and they spotted trip wired booby traps.
And large bottles filled with an unidentified liquid Fox's Chris Gallagher is tracking the latest from our breaking news -- in Los Angeles what -- do we know about -- -- They're actually called bottles Alison these Coke bottles are filled with some unknown liquid and they're kind of strung up around the door as if you would see in a movie kind of like trip wires.
And apparently the way that that police and fire department.
Authorities have described this to us.
Is if you pushed in the front door that would be kind of the trigger to set up these explosives -- which is why you can see the firefighters are actually doing all their work.
From the other side of the apartment so they can get a direct view.
Of that contraption the front door they call it very sophisticated.
The first point of business is to go in there with a small robot and either take a sample of this liquid to find out what it is is -- gasoline is at some type of chemical.
Or to see if they can detonate this but in case something goes wrong which you can't see offscreen.
Is the fact they've got firefighters with hoses at the ready in case this blows up there are no people inside this apartment.
They evacuated the entire thing early this morning and those people could be out for the foreseeable future because the police and firefighters said.
This could take some days to resolve.
We have also learned that he just rented this apartment we're talking about the shooting suspect James Holmes and on his rental -- -- application.
He wrote that he was quoting here.
Quiet and easy going.
And this morning shortly after police arrived on scene one of the neighbors said that.
While this shooter was apparently at the theater.
There was music in his apartment that was playing over and over again it appeared to be the same song playing on re -- We have also learned from the University of Colorado that he recently dropped out of the medical school there again he was studying.
To get his Ph.D.
in neuroscience he got his undergrad degree in neuroscience neighbors and San Diego where he grew up.
Said that he always seemed like a nice -- don't they always out.
-- they we often hear that of those new details.
About the application and the music playing -- obviously chilling Trace thank you for that so again.
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Hi, we (family of 4) plan to stay in Alesund early March and drive car to Oppdal. How are the road conditions in that time period?
what train to catch from oslo gardermoen to reach porsgrunn, final destination is quality resort hotel skjaergarden stathellevn, langesund
We are going to Tromso in the end of february / beginning of march. We live in Spain and never make it further north tan Hamburg, so we probably have to face buying a lot of warm clothing we'll never need again! Having learnt that most of the businesses that take tourists on "Northern Light Chases" provide extra warm clothes & even boots, there remains the question:What do people wear for just walking around in the city? Or, for taking a bus to somewhere else, or a ferry ... etc etc. For instance. are warm shoes with warm socks enough, or does it have to be moon boots? Pants, coats?I'd be really grateful for some advice!Thanks Angelaibiza
Coming to Oslo Thursday. Do I need a huge ski/mountain coat or can I bring a lighter weight ski coat? Trying to fit everything! Advice?
We are planning on going to Tromso for seeing the NL. We are NOT good and dedicated fotographers, on our "normal" trips we just take simple fotos as a souvenir with a simple digital camera. So, when (and if) we are going to see the Lights, we'll probably just want to look, and stare, and look more ... However, a few fotos would be nice to have this documented!Can anybody advise us with what kind of camera we can get by without spending a fortune on equipment and weeks of learning?Thanks a lot!
how is night life in bergen?
How much does the Airport shuttle bus cost into the centre of Molde cost?
Hi, I would like to find out if you can visit Stavenger Fjords in winter? will be very greafull for any tips


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Enterprise Physical-to-Virtual Server Virtualization Project Saves Company over $10M Annually.
This $13billion, multi-national business information company has over 55,000 employeesin more than 100 countries. In the last five years, revenues were increasing7 to 8% annually. While this is great news, the company was experiencing storage capacity doubling annually, servers crawling across the datacenter taking up space and an enormous power and cooling expense every month.


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Tag Archives: Daggerdale
Fri, Apr 29, 2011 | 23:52 BST
Friday Shorts: L.A. Noire, EQII, Mario Chucks, Disciples III, Civ V, D&D, sales
We're all just working for the weekend, ya know. Let these shorts do some of it for you so your clicker fingers can be saved for something more useful.
Wed, Apr 20, 2011 | 22:32 BST
Wednesday Shorts Late Edition: DiRT 3, Kotick, Earthrise, D&D, iOS, sales
Is hump day over with yet? No? Sorry about that, trooper. How about more minuscule headlines to help you pass the time?


text: I know there had to be a Mrs. Monroe. It's kind of hard to have a son without one. HA! Bill was great, but that would have been a flat-out miracle! Anyhow, whats the story? Why isn't she ever mentioned in the history write ups about bill? This Enquiring mind would like to know!


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Posted: Feb 6, 2013 7:04 AM by ASSOCIATED PRESS
LAS VEGAS (AP) - Police are trying to find who's responsible for a shooting at a Las Vegas movie theater lobby that left two people critically injured.
Authorities say the incident happened a little after midnight Wednesday morning at the UA Showcase Theater, near the MGM Grand casino on the Las Vegas Strip.
Police say a fight that happened in the foyer escalated into a shooting. Officer Bill Cassell says one person fell in the lobby, while the second victim fell into an elevator and ended up on the fifth floor.
Details about the victims and suspect information were not immediately available Wednesday morning.
(Copyright 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.)
Offensive or inappropriate comments are subject to removal. To report a comment, please e-mail us at email@example.com, and include the name of the story and information on the comment.
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Bethlem Royal Hospital Archives and Museum
Bethlem Royal Hospital Archives and Museum
The Bethlem Royal Hospital
Monks Orchard Road
Education and Outreach
General enquiries
Head of Archives and Museum
020 3228 4307
020 3228 4053
Education and Outreach
020 3228 4537
Secretary/General Enquiries
020 3228 4227
020 3228 4045
Founded in 1247, Bethlem Royal Hospital is now located in Beckenham, South London, as part of the wider South London and Maudsley NHS Foundation Trust. The Archives and Museum service is dedicated to the history of mental health treatment, and includes historical and archival material as well as a large art collection. De-stigmatising mental illness is one of its major roles. The current museum is limited in space, but we are currently fundraising for a new museum.
Venue Type:
Archive, Museum
Additional info
Archives and reference library open to the public by appointment only. Museum opening hours cannot be guaranteed at all times. Please telephone to check before planning a visit.
Collections illustrate aspects of mental health and mental healthcare. They include archives of Bethlem Hospital (the original 'Bedlam') and the Maudsley Hospital (founded in the 20th century, influential in psychiatric teaching and research). Historical objects relate mainly to Bethlem. The unique art collection contains works by artists, past and present, who have suffered from mental health problems. It comes from many sources, not only from the Bethlem and Maudsley Hospitals.
Collection details
Archives, Fine Art, Medicine, Personalities, Social History
Key artists and exhibits
- Richard Dadd
- Louis Wain
- William Kurelek
- Jonathan Martin
- Vaslav Nijinsky
- Cynthia Pell
- Caius Gabriel Cibber's statues of 'Raving and Melancholy Madness' from 17th century Bedlam
Back from Holiday
- 11 October 2013 — 31 January 2014 *on now
In the last few years many of our paintings have been out on loan to museums and galleries around the world. This display features some of these temporary absentees, now back home in Beckenham, including Vaslav Nijinsky, Jonathan Martin, Richard Dadd and Louis Wain.
Getting there
Nearest Station: Eden Park / East Croydon
London Transport Travel Zone 5
Full Details
By car:
From Central London, via Streatham or Crystal Palace to the A214. This passes the north end of Monks Orchard Road.
From further south, via the A232 Croydon to Orpington Road. This passes the south end of Monks Orchard Road just west (the Croydon side) of West Wickham.
By train:
From Cannon Street, Charing Cross, Waterloo East or London Bridge to Eden Park, via trains travelling to Hayes (Kent). Four trains per hour from London Bridge: journey time 30 minutes. Walking time from Eden Park Station, 15 minutes, or take the 356 bus from outside the station to Bethlem Royal Hospital.
From Victoria, frequent fast trains to East Croydon: journey time about 15 minutes. Buses from outside the station, travelling towards West Wickham, Nos. 119, 194 and 198, pass the south end of Monks Orchard Road. Walking time from the bus stop, 5 minutes.
By bus:
Bethlem Royal Hospital is at the Shirley end of the 356 route, which runs to Forest Hill.
The Bethlem site:
Bethlem Hospital occupies a large site and the buildings are widely scattered, but it is easy to find the Archives and Museum, which is close to the entrance. If you are on foot, turn right just inside the gate, and you will find our building a little way down the road on the right hand side. It is well signed. This is a service road, and the traffic barrier is opened only for Heavy Goods Vehicles: so if you are driving you will have to turn left and follow the signs, working your way round until you are nearly back where you started. You may find it easiest to park in the visitor's car park near the gate, or outside in Monks Orchard Road, and walk the short distance to our building.
- About
- | Collections
- | Exhibitions
- | Map


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text: Boston Herald -- Can an automobile be too safe?It's a strange concept to contemplate, but in reviewing Volvo's new XC60 crossover, that thought crossed my mind. Volvo made its reputation creating some of the safest cars on the road and in some ways this compact SUV could be considered its crowning achievement.To say this is a safe car is an understatement. It offers parking assist with rear camera, ready-alert brakes that stop the car for you in near-collision conditions, pedestrian detection, driver-alert control that detects fatigue or distraction on the part of the driver, stability and traction control, distance alert, speed-dependent steering control, both crash warning alarm and light, lane-departure warning, a blind-spot information system and a whiplash protection system.As much as I applaud Read the Full Article


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Welch Allyn's Green Series (GS) 900 procedure light combines outstanding durability, extraordinary maneuverability, unparalleled spot quality and multiple mounting options. The Welch Allyn GS 900 is perfect for both minor procedures and standard procedures whether you are in the hospital, ambulatory care center, outpatient facility or physician's office.
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,,It's a little too late for you to come back,
Say it's just a mistake, think I'd forgive you like that;
If you thought I would wait for you, you thought wrong..." It's because girls dont waste their time on these boys.
Lyrics submitted by Ian-sama
Log in now to tell us what you think this song means.
Don't have an account? Create an account with SongMeanings to post comments, submit lyrics, and more. It's super easy, we promise!


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Opportunities and Connections for All
The School District of Menomonee Falls, Community Education & Recreation Department will use this blog to share information relative to upcoming events, classes, programs, workshops and seminars for people of all ages, from preschool to older adults. Jason Husslein, Recreation Supervisor, will post information and maintain this blog, along with contributions from other staff members. Residents are encouraged to e-mail questions of interest to firstname.lastname@example.com. Your questions may be answered in our blog.
ABC's of Community Education
From A to Z, the Menomonee Falls Community Education & Recreation Department has you covered.
Adult Sports
Babysitting Classes
Cookie Decorating
Driver's Education
Educational Associates Adult and Youth Educational Programs
Fitness Programs
Golf - Youth and Adult Programs
High School Recreational Sport Leagues
Internet Real Time On-line Registration
Journaling Programs
Learn to Skate
Microsoft Office Classes
New Programs
Older Adult Programs
Preschool Playgroup
Quality Programs
Rock Climbing
Social Dance
Teen Center
Understanding Elementary Math
Variety of Programs
Xcellent Instructors
Youth Help Fight Hunger
Students in grades K-12, who participate in programs offered through Menomonee Falls Community Education & Recreation, are going to do their part to help fight hunger here in Menomonee Falls.
Help the Hunger Challenge
Students in grades K-5 enrolled in the Kids INC Program at any one of the four elementary schools in Menomonee Falls (Ben Franklin, Riverside, Shady Lane, Valley View), are encouraged to collect non-perishable food items from friends, family, neighbors, classmates and teachers. The items will then be dropped off in the designated areas at the Kids INC sites November 10 - 14. The Kids INC site with the most items collected per student will win a freshly popped popcorn party. All items will be donated to the Menomonee Falls Food Pantry.


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Hi, this is my first post. I wanted to share something with you guys. If you use Windowblinds, you can set individual themes for applications. So I did that for MM, got a couple of tiles, a winamp skin.
It's been my second day using this program, and I love it. If anyone needs help on how I created this look, or need the name of the skins, then ask right ahead.[/img]


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Note: this is a slightly revised version of a talk titled "Geopolitics 2.0″ that I gave in Madrid in 2009, shortly after the mass protests in Iran. It is published here on this blog given recent events in Tunisia and Egypt. - MF
In the aftermath of Iran's massive street protests in June 2009, that country's authoritarian regime blamed the unrest on Western intelligence agencies and big media organisations. This time, however, the ruling mullahs lashed out at a new list of Western enemies: Twitter, Facebook, and YouTube.
Web-based social networks indeed played a powerful role during the uprising – not only as tools for mobilising action inside Iran, but also for influencing global opinion. The global media described the turbulent events in Iran as a "Twitter Revolution" due to the widespread use of tweets to organise spontaneous protests and disseminate information about what was happening in the country. The viral power of the Web came into poignant focus when a young Iranian woman called Neda became a tragic martyr for the Iranian protest: seconds after she was shot during the bloody repression, smartphone video images of her bleeding to death in the streets of Tehran were posted on YouTube, provoking horror and outrage throughout the world.
While the Iranian regime was not toppled, the "Twitter Revolution" marked a turning point in global politics that – as recent events in Tunisia and Egypt demonstrate — no government can afford to ignore.
The sudden explosion of Web-based networks has brought a new lexicon to the emerging geopolitical realities of digital diplomacy. Just as Wikipedia has toppled the authority of established intellectual elites, online social networks have diffused the power of mobilisation to the periphery. This diffusion of power is reshaping geopolitics as the vertical logic of states is challenged by the viral dynamics of online social networks.
Broadly speaking, what we call Geopolitics 2.0 is characterised by three significant power shifts: (1) from states to individuals; (2) from hard power to cyber power; and (3) from old media to new media.
1. States towards Individuals
The first power shift is from states towards individuals. Or expressed more formally, from a state-centric approach in international relations towards a new dynamic involving a widely disparate number of non-state actors, even individuals, who can instrumentalise the Web to exert influence by mobilising protest or inflicting violence.
This shift has been occurring for some time, as states lose their monopoly as exclusive actors in global politics, but is now rapidly accelerating due to the elimination of entry barriers via Web-based social networks. It should be underscored that this shift by no means signifies that states are no longer the main actors in international affairs. States however are today confronted with radically new challenges as power shifts not only towards non-state actors, but towards individuals. Online social networks can empower individuals with virtually no resources to act and exert influence on the same playing field as powerful states that control massive political, economic and military resources. Today a lone hacker can play cyber David against Goliath states.
This was dramatically demonstrated in 2009 when the Russian government allegedly inflicted a denial-of-service attack on Twitter in order to neutralise a single blogger in the neighbouring state of Georgia. Twitter users worldwide faced a paralysing brownout because the Kremlin had launched a cyber attack against one individual. More recently, the destabilising impact of WikiLeaks, and its diplomatic fallout, demonstrated how a single Web-based source of information can exert influence on global politics.
The Web-based empowerment of individuals marks a major shift from previous models of geopolitics, where the main actors have been either states or other easily identifiable non-state actors, including terrorist groups like al-Qaeda. Today, the identity of individual actors in the global system is frequently not apparent, and sometimes a baffling mystery. When hackers and cyber-spies strike, governments may accuse China or Russia, but the origins of these attacks and their perpetrators are never verified with total certainty. In short, it's possible to be a significant actor in the global system, and inflict major damage on states, without ever becoming known, let alone getting apprehended and punished.
This shift has powerful implications — as we have seen in North Africa and the Middle East — for network-based political mobilization. Individuals with access to the Web can easily instrumentise online networks to organise and mobilise action – notably against states. In Iran, the authoritarian regime, perplexed by the origins of the organized protest, was completely taken by surprise when the "Twitter Revolution" erupted. Only physical repression – as the death of Neda poignantly demonstrated – saved the Iranian regime from overthrow. In Tunisia, circumstances – notably the attitude of the army — favoured the protest movement and the regime fell.
It's possible, to be sure, to exaggerate the role of the Web in overthrowing authoritarian regimes, for in the final analysis protest movements inevitably must physically confront state instruments of coercion. There can be no doubt, however, that social media have played a powerful role in organising and mobilising action. In liberal democracies, social networks like Facebook, YouTube and Twitter have become indispensible tools of electoral mobilisation and civic organisation. Governments are now acutely aware that their citizens can use these tools to voice their views and organise action. And as we have seen in Tunisia and Egypt, these tools can potentially be used to challenge authority and overthrow regimes.
2. Hard Power towards Cyber Power
Online mobilization is effective precisely because the nature of power is being transformed. We are witnessing a shift from military "hard power" towards virtual "cyber power". Again, this shift does not signify that traditional forms of hard power are irrelevant or unnecessary, but that new forms of virtual power are emerging and can produce serious consequences for states.
Much has been written about "soft power" in international affairs. Cyber power is different from "soft power" in one important aspect: whereas the latter conveys values through culture, consumer behaviour and lifestyle (from Mickey Mouse to McDonald's), cyber power is located in cyberspace.
States now have no choice but to master, and instrumentalise, Web-based forms of coercion. Make no mistake, states are using the Web to in cyber attacks against other states. North Korea, for example, is widely suspected of being at the origin of cyber attacks against neighbouring South Korea and other countries. Another example occurred in April 2007, when the normally tranquil nation of Estonia came under a cyber attack – targeting government, banks and media – following the relocation in that country of a Soviet war memorial. The Estonian government blamed the Kremlin for the sudden and unexpected cyber attack. While the Kremlin denied any direct involvement, the incident prompted the NATO military alliance to step up its readiness for cyber warfare.
America is a soft-power superpower, but is more vulnerable in the sphere of cyber power. This explains why the American government has invested massively in programmes that strengthen the U.S. arsenal of cyber weaponry –- both offensively and defensively. Lt.-Gen. William Shelton, the US Air Force's chief of warfighting integration, has said that in the past the Pentagon relied too heavily on industry efforts to respond to cyber threats. This industry-led approach, he added, failed to keep pace with the threat from cyber space.
"Threats in cyberspace move at the speed of light, and we are literally under attack every day as our networks are constantly probed and our adversaries seek to exploit vulnerabilities", General Shelton told the House Armed Services Committee in May 2009. A US National Security Council report concluded meanwhile that the American government's policies on waging cyber warfare have been ill-informed. While these statements may be motivated by a desire to obtain more substantial budget allocations, it cannot be doubted that they reveal how states –- with their traditional institutional bias in favour of hard power -– have been slow to understand the velocity and significance of the cyber war threat.
Today the military-industrial complex may need to rely less on giant arms manufacturers and four-star generals and more on computer geeks with formidable skills on videogames like World of Warcraft. That assertion may seem outlandish, but it is actually a fact. The US Army is using Web networks like Facebook and YouTube as recruitment tools and, what's more, is looking specifically for certain skills sets that include familiarity with virtual worlds and online videogames. As the new generation of so-called 'millennials' move into positions of responsibility in government and the military, they will bring with them powerful cyber skills that will be instrumentally useful in espionage and warfare.
The threat of cyber warfare is not new. In fact, the Internet itself – a product of the Cold War – was built in the 1960s by US military scientists to protect American communications infrastructure against a Soviet nuclear strike. A half-century later, those threats remain. But with one major difference: cyber weapons are not only in hands of enemy and rogue states, but can be deployed by isolated individuals ranging from bored teenagers to wild-eyed terrorists. Or, as recent events in Tunisia and Egypt demonstrate, they can also be deployed by organizers of mass protest. It should be no surprise that regimes in this region have responded to mass protest by shutting down Internet access.
3. Old Media towards New Media
The third shift is from old media towards new media like as effective platforms of global diplomacy, communication and opinion shaping – or a shift form the "CNN Effect" to the "YouTube Effect".
In the past, governments have used mass media to conduct diplomacy and wage information warfare. Prominent statesmen, including Presidents and Prime Ministers, have been willing to appear on CNN and the BBC to convey their positions and policies to other states and world opinion. Non-state actors, too, have exploited the global media to stage events –- and sometimes to pull off publicity stunts -– to attract attention to their causes. Old media have been the privileged forum of global diplomacy and opinion shaping.
Once again, this shift does not signify that old media such as television news networks are irrelevant, but that media power has shifted towards the Web. Today the era of old media dominance, while not over, is coming to an end with the rapid emergence of Web-based forms of journalism, information and propaganda. The explosion of online networks like Facebook, Twitter and YouTube has also challenged the traditional function of established media by diffusing media power towards individuals. These networked Web platforms are powerfully effective tools for "digital activism" by non-state actors, including individuals; but are also being deployed by states to exert influence in the theatre of global diplomacy.
The Gaza crisis in 2008 provided an excellent example of this shift towards new media. Shortly after Israel launched its military operation, a pro-Israel individual created a Facebook page called "I Support the Israel Defense Forces in Preventing Terror Attacks from Gaza". At the same time, a pro-Palestinian individual created a Facebook page called "Let's Collect 500,000 Signatures to Support the Palestinians in Gaza". Intrigued by the leveraging of social media on both sides of the crisis, Time magazine published a story under the headline "Facebook users go to war over Gaza".
Most of these Facebook initiatives were the work of individuals. But states joined the Web-based propaganda campaign to get out their message. The Israeli Army, for example, launched its own YouTube video channel in an effort to win the global PR battle by uploading videos showing carefully pinpointed strikes against terrorist targets.
As more recent events in Tunisia and Egypt have dramatically demonstrated, people turn to the Web for "live" information and commentary about what is happening on the ground. Indeed, traditional media outlets, including global news networks, frequently broadcast Web-based information and video captured by individuals, instead of relying on their own correspondents. Old media journalists once scorned the Web as "amateur"; today, they source many of their sources via the Web.
These three shifts have forced states to radically rethink their approach to global diplomacy. States are alternately censoring the Internet or deploying Web platforms to achieve their goals and assert influence. In many cases, they are doing both.
It would be simplistic to argue that authoritarian regimes are hostile to the Web while states in Western liberal democracies are embracing these technological ruptures. The United States, for example, denounced WikiLeaks and arrested alleged perpetrators. Authoritarian states, resorting to more repressive forms of coercion, routinely imprison so-called "cyber-dissidents".
In the Middle East, Syria has jailed bloggers and blocks websites (including Facebook and YouTube) deemed a security threat. In Egypt, an Arab country that enjoys open diplomatic relations with the West, the government has punished online criticism of the state. Beyond the Middle East, the Chinese regime has imprisoned cyber-dissidents and shut down websites including YouTube, particularly over sensitive issues such as Tibet. Indonesia has banned both YouTube and MySpace. Other states that have banned websites or imprisoned cyber-dissidents include Iran, Saudi Arabia, Libya, Belarus, Burma, North Korea, Tunisia, Turkmenistan, Uzbekistan and Vietnam.
Liberal democracies, while doubtless developing their cyber war capabilities, have been focused on the potential danger of Web-based forms of terrorism. It is believed that terrorists are using Web platforms like Google Earth to locate potential targets, especially in countries like Israel. This may explain why Google has pixillated sensitive zones in Israel and elsewhere in the world that could come under a terrorist attack. The findings of a "Dark Web" research project at the University of Arizona tracked Jihadist extremist groups using Web 2.0 media. The study, published in 2008, came across an alarming number of Jihadist blogs and YouTube uploads.
In the aftermath of events in Tunisia and Egypt, it is critical for experts in international affairs to understand how Web-based social networks are impacting the new dynamics of global politics. We have outlined here three important power shifts that are reshaping geopolitics – from states to individuals, from hard power to cyber power, and from old media to new media.


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zorak ramone, on 18 April 2012 - 01:54 PM, said:
My first observation would be that the Hunchback has both it's energy weapons in it's arms while the Dragon has them split between an arm and torso. That means that the hunchback has both energy weapons on a single reticule and can easily fire them together, while the Dragon's energy weapons will be on seperate reticules and likely fired seperately. This would offer a huge game play difference.
Second, if you set both of these mechs up with PPCs then it's likely the Dragon will be somewhat more expensive to buy and repair offering economy as a balancing factor between them.


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Zoe Hip Skirt with Garters
You'll feel like a starlet of olden days in this hip skirt, which fits like a second skin with lace around the hemline. Animal print mesh runs around the waist and down the entire front in a V-shape to provide a little coverage. This is bordered by several inches of regular fishnet, which offer just a bit more of a view to your thighs. The animal print returns in panels on either side of the thighs for a one-of-a-kind look. By Jezebel.
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Amanda Skirt
Perfect by itself or under your skirt suit, the Amanda skirt by Jezebel is a sexy little secret you'll have trouble keeping. A spandex blend sits along your hips and thighs like a second skin, while feminine lace on either hip provides visual detail with contrasting colors and helps to minimize your thighs.
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Daphne Thong
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Posh Teddy
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Desire Baby Doll
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Dazzled Bustier w/Push Up Pads & Removable Garters
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Jezebel Provocative Chemise
Jezebel Provocative Chemise
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Muslim Architecture, Dune Bashing, and other Great Tourist Spots in Dubai
Posted: June 29th, 2009 | Author: TwB | Filed under: Dubai, Middle East | Tags: Dubai, Dune Bashing, Middle East | No Comments »
If you are tired of your list of usual vacation spots, fly to Dubai and explore the many wonders of this Muslim county. Dubai has about 200 mosques bearing the grandness of Muslim architecture. Sadly, non-Muslims are not allowed to enter most mosques in the United Arab Emirates, but the Jumeirah Mosque allows non-Muslims to see the mosque's interior.
The Sheikh Mohammed Centre of Cultural Understanding offers educational tours for non-Muslims who visit the country. Take note, however, that one should dress appropriately for such tours. The Jumeirah Mosque, located along Jumeirah Beach Road, is the most famous mosque in Dubai with its attractive façade and one central big dome. It looks spectacular during nighttime.
The horse race at Nad Al Sheba is quite famous, but there are also camel races being held. The admission is free for these races. "Dune bashing" is another common past time in the country. It's simply driving into the dessert on a four-wheel-drive vehicle and enjoying the unusually bumpy and hot trip. If you're interested in trying dune bashing, make sure you book a tour operator because going into the dunes unaccompanied very risky.
Famous Dubai attractions include: Dubai Museum, Grand Mosque, Bastakiya District, S Sheikh Saeed Al-Maktoum House, the Al Fahidi Fort, Dubai Creek, Hatta Town, Palm Island, Heritage Village, Jumeirah Beach Park, Burj Al Arab Hotel, and the Jumeirah Archaeological Site.
Veteran tourists know that the best places to visit and the best experiences to enjoy are not in the guidebooks you buy in bookstores or airports. So before you fly to distant Dubai, try to read a few interesting articles about this country and have a blast exploring the rich culture and history of Dubai with your family and friends.


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Mix of the Day Mix of the Day: Kris Menace December 11, 2013 in Mix of the Day with Kris Menace by EB Team Fresh from the release of his 'The Entirety of Matter' LP, German producer and remixer Kris Menace supplies a mix of expansive house and techno. – more Mix of the Day: Kris Menace Mix of the Day: Ron Flieger Mix of the Day: COMA Mix of the Day: Discodeine
Columns Videodrome 127 – This week's best videos December 11, 2013 in Videodrome with Planningtorock by Moritz Gayard New, cool videos from around the world - this week featuring Rainer, Tinashe, Rebecca Black, Black Deer, Gold Skull, and many – more Audioccult Vol. 84: The D Word Editors' Choice: November 29th, 2013 Dis-track-ed Vol. 4: Baroque of Ages Eastern Haze: November 2013
Reviews Pete Kember recommends My Bloody Valentine's m b v December 11, 2013 in Reviews with My Bloody Valentine, Sonic Boom by A.J. Samuels Pete Kember aka Sonic Boom is a founding member of British neo-psych legends Spacemen 3 and the creative force behind Spectrum and Experimental Audio Research (EAR). In this piece taken from the Spring 2013 issue of Electronic Beats Magazine he recommends My Bloody Valentine's 2013 release 'm b v'. – more DJ Richard recommends Heatsick's Re-Engineering "Everything is not OK": An interview with MGMT "Where's your Lord?": Glenn O'Brien talks to Panda Bear Chris Bohn recommends Scott Walker's Bish Bosch
Live Video MS MR live at Electronic Beats Festival Zagreb 2013 December 10, 2013 in Live Concert Footage with MS MR by EB Team Watch the Brooklyn art pop duo perform "Fantasy", "Think Of You", and the single that kicked it all off, "Hurricane", at EB Festival Zagreb. – more Fritz Kalkbrenner live at Electronic Beats Festival Zagreb 2013 Random Access Memories: MS MR Efterklang live at Electronic Beats Festival Zagreb 2013 Perfect Ten: MS MR answer ten questions
PSB Listen and Learn: Mark Reeder on Pet Shop Boys' Electric December 10, 2013 in Reviews with Pet Shop Boys by Mark Reeder The key member of Berlin's experimental scene for 30+ years assesses the new Pet Shop Boys album and and recalls his role smuggling their music over the Wall. – more Track by Track: Pet Shop Boys and Stuart Price on Electric Revolution to Revelation: Pet Shop Boys and politics "Anything can be pop nowadays": Max Dax talks to Pet Shop Boys Watch Pet Shop Boys' 45 minute Elysium live show from Berlin
Keep it 100 Glenn O'Brien recommends $100 of Books December 10, 2013 in Monologues by Glenn O Brien Have an extra hundred to blow? The former member of Andy Warhol's factory, TV Party-host and ex-editor-in-chief of Interview Magazine tells us what you should be reading. – more How Steffi spends €100 "Where's your Lord?": Glenn O'Brien talks to Panda Bear How Holly Herndon spends $100 Glenn O'Brien recommends The Art of William S. Burroughs: "A way to cut through the straitjacket of language"
Interviews "Where's your Lord?": Glenn O'Brien talks to Panda Bear December 9, 2013 in Interviews with Panda Bear by Glenn O Brien Noah Lennox talks influences, collaboration, and why Animal Collective is not as pompous as their name implies with The Style Guy. – more Animal Collective live at EB-Festival Cologne (May 19th, 2011) "Pythagoras saw the cosmos similarly" – Hans Ulrich Obrist talks to Björk "Testing things to destruction is probably the best way to test things" – Max Dax talks to Squarepusher Blackened Blue: Daniel Jones on Xiu Xiu's Nina
Live Report: Scooter Journey into the Heart of Darkness: Scooter live at Uebel & Gefährlich, Hamburg December 6, 2013 in Reviews by Max Dax As Hurricane Xaver raged outside, Scooter—Germany's most polarising band—were busy raising their own hell within the concrete walls of Hamburg's Uebel & Gefährlich club. But, as Electronic Beats' editor-in-chief Max Dax found out firsthand, there's more to the band than just thunderous volume. – more Rick Jordan of Scooter recalls his Depeche Moment "Popularity is a currency of its own": H.P. Baxxter meets Albert Oehlen Style Icons: H.P. Baxxter on The KLF Exclusive Preview: An extract from Scooter: Always Hardcore
Festivals Electronic Beats Spring Festivals 2014 dates announced! December 5, 2013 in Events by EB Team Save the date! It's time to break open your shiny 2014 diaries with the announcement of next year's Electronic Beats festival fixtures. – more Live Report: Electronic Beats Festival Vienna 2013 Live Report: Electronic Beats Festival Dresden 2013 Live Report: Electronic Beats Festival Zagreb 2013 Live Report: Electronic Beats Festival Budapest 2013
Essays Pattern Recognition Vol. 8.5: The Year in Vaporwave December 5, 2013 in Pattern Recognition with Eyeliner, Infinity Frequencies, Saint Pepsi by Adam Harper In this accompaniment to his Year in the Online Underground piece, Adam Harper—the premier writer on new, emergent, underground music—reflects on the year in vaporwave and selects his favorites. – more Pattern Recognition Vol. 8: The Year in the Online Underground The Man Who Has Everything: Mark Fisher on Drake's Nothing Was the Same Adam Harper's Pattern Recognition Vol. 1: The New Online Weird James Pants recommends 情報デスクVIRTUAL's 札幌コンテンポラリー
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Slices/Tech Talk: Chopstick Tech Talk: Chopstick (Slices DVD Feature) November 29, 2013 in Slices with Chopstick by EB Team Slices pokes around Chopstick's studio and finds out about the producer's methodology and love of outboard gear. Originally featured on Slices issue 3-13. – more Club Special: La Machine du Moulin Rouge (Slices DVD feature) Andre Bratten (Slices DVD feature) New Faces: Chasing Kurt (Slices DVD feature)


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For ages 2 and up, this interactive book helps develop learning skills. Sturdy doors to slide hidden surprises and questions encourage learning.
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Manufacturer #: 0031249909
Product Weight:1 pounds
Product Dimensions (in inches):8.2 x 8.2 x 0.8
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Great book ! easy for a 2 yr old to use
By Grandma for Max
from Glendale, CA
About Me Bookworm
Comments about MacMillan Childrens 1011547 Slide and Find Trucks Board Book:
My 2 yr old grandson loved it ! Looked at the book with me-- it was put down a couple of times-- he always went back to get the book to show someone the trucks.
Comment on this review
not for little hands
By jess
from san francisco, ca
About Me Everyday Reader
My 2 year old son loves the pictures. It's just too hard for his little fingers to move the boxes & he ends up tearing them. Honestly, I have a hard time sliding the boxes too.
I would buy this product again and again
By momof2
from Lonsdale,MN
About Me Rarely Read
My little one Just Loves this Book!!He has it with him at all times & never lets go!!I will be stocking up on the book
Hard to move windows
By dmoore66047
from Lawrence, KS
See all my reviews
The book's windows are hard to move. Returned book.
I would buy his item again.
By Medzie
from East Greenwich, RI
The book I ordered was wonderful, [...]
Great truck book!
By Mom of two under two!
from Topanga, CA
My two year old son LOVES this book! The sliding windows and questions are brilliant for learning all about trucks and the people who drive them.
Excellent visual concept for a 2 yr old
By Grammy
from Escondido, Ca
About Me Casual Reader
Just right for a little boys who loves any toy with wheels on it
My son just loves this book
By Busy Mom
from Lakewood, Colorado
About Me Parent
everything that I got is wonderful, my kids just love it.
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The two Pit Bulls involved in Wednesday's dog attack will be put down, according to Liberty Animal Control. Workers say the dogs can't be adopted out for liability reasons. The Pit Bulls' owner voluntarily gave the dogs up Thursday morning. Wednesday afternoon they reportedly mauled a 10 pound Dachshund named "Starlight."
Caged at Liberty Animal Control, CBS47 finds the two pit bulls that mauled a Dachshund. The dogs apparently broke through the fence separating two backyards.
"There was blood underneath the jaw of one of the dogs, which was clear because the dog was white," said Daniel Bailey of Liberty Animal Control.
Starlight is greatly missed by his owner.
"Still very upset. He was my little baby," said Lavonne Reger, Starlight's owner.
Reger had just let Starlight and her other dogs outside when the attack happened. She wishes her neighbors would have kept a closer eye on their pit bulls.
"High risk dogs, I guess is a good way to call them, to make sure they stay in their yard," said Reger.
A man who lives in the neighborhood says he sees dogs off leash all the time. He blames their owners.
"They do not care. They don't care. They think it's a free world and they can do what they want," said John Hannan.
Animal control says the Pit Bulls' owner tearfully signed the dogs over to its custody on Thursday. They'll likely be euthanized within 48 hours. Liberty would be liable if it tried to find new owners for the dogs.
"Having it occur to a child or somebody else, we wouldn't take that risk," said Bailey.
CBS47 did try to reach the owner of the Pit Bulls, but no one was at home.


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The rent at Alta at Regency Crest Apartments ranges from $1,550 for a one bedroom to a $2,575 three bedroom. Apartments in this building are about 38% more expensive than the Ellicott City average. This is a pet-friendly apartment.
This apartment is in Ellicott City. Nearby parks include Patapsco State Park, Roger Carter Neighborhood Park and Ellicott City Historic District.
Alta at Regency Crest Apartments has a Walk Score of 55 out of 100. This location is Somewhat Walkable so some errands can be accomplished on foot.
Nearby schools include St Johns Parish Day School, St. Johns Lane Elementary School and Linwood Center.
The closest grocery stores are Roman Food Market, Roso & Pakula Food Brokers and International Food Market.
Nearby coffee shops include Dunkin' Donuts, Tea On the Tiber and Coffee World. There are eight restaurants within a 15 minute walk including Tigi's Ethiopian Restaurant And Market, Ledo Pizza - Ellicott City and Tian Chinese & Korean Restaurant.
Pets allowed: