text:
Chuck's Buy More and CIA worlds are colliding, finally and inevitably, and you've gotta love the way they handled it. I've never found Morgan to be an especially appealing character compared to the rest of the "Chuck" roster, but he really shone in this episode.
Chuck vs. The Best Friend: Chuck is frustrated to find out that he's been benched until he can flash again, leaving him stuck minding the Castle while the rest of the team tries to intercept a CIA agent the Ring will supposedly try to turn. Shaw quickly discovers that not only is the supposed agent actually Captain Awesome, but that he's being used as a decoy while the Ring storms the Castle.
Back at the Buy More, Morgan confronts Chuck about his secretiveness lately, even to the point of dumping Hannah with no explanation. And (sniff) he fires Chuck … as his best friend. You can tell it just kills Morgan to do this, but also that he's forcing himself to man up and take a stand. When a team of suits arrives to interview employees at the Buy More before deciding whether to purchase the store, Chuck sweetly talks Morgan up, still calling him his best friend.
Unfortunately, the potential buyers are not only played by Diedrich Bader and Cedric Yarbrough (cast in serious roles even though they're best known as comic actors, which threw me off momentarily), they're also Ring agents attempting to infiltrate the Castle and retrieve and destroy Shaw's files. And they're pretty sure Chuck is Agent Charmichael. What follows is pure, outstanding "Chuck"-ness.
Morgan spots the Ring agents breaking into the Castle and is obviously dumbfounded. As one would tend to be after seeing the Buy More break room lockers open into a secret CIA base. Not sure I'd follow the guys with explosives into the base, but then I'm not Morgan. Thank goodness. He describes what he thinks is an unbelievable situation to Chuck, begging him not to freak out. It's really cute until he insists on fighting, because the Buy Morons are "the store's — no, America's last line of defense."
Sadly, his "Red Dawn"-style offensive, armed with what I believe to be electric carving knives, is immediately quashed when it turns out the Ring agents have weapons that aren't found in the home goods section of the Buy More. Darn. When the Ring agents threaten to torture Morgan, knowing he's Chuck's best friend, Chuck confesses to being a spy. But not before Morgan gives a big, impassioned speech about how Chuck could never possibly keep something like that from him, because they've been best friends forever and ever. Ouch.
But after briefly freaking out, Morgan is psyched that his best friend is a spy and just stopped hanging out with him because he was out saving the world. It's definitely pretty cool if you look at it that way. Interestingly, the Ring agents are concerned when Casey arrives at the Buy More, and more than in a "CIA help just arrived" way. They try to kill him, but he fights them off with the help of a dazed Jeff (and his chloroform). When Shaw decides to destroy the Castle rather than let the Ring get hold of his data, Sarah convinces him to hold off for five minutes to give Chuck a chance to save the day.
Chuck, meanwhile, tells Morgan the whole story. After realizing that Sarah was Chuck's beard, Morgan sympathizes: "It's awful that you had to pretend to be in a relationship with someone you clearly love." I love that Morgan can just completely take you by surprise sometimes. Chuck reflects, and acknowledges the truth in that statement, even though he'd been trying to tell himself he didn't love her. After getting all this off his chest, he finally flashes!
And it's GREAT. Does anyone remember that scene from "Alias" where Sydney busts in to rescue Will, and after seeing her get all butt-kicky he's all, "WHAT?!?!" This reminded me of that. Morgan just can't believe it, and then pitches in and helps! The Castle is saved just as Shaw is readying the self-destruct orders, of course. Best part: Morgan emerging from the smoke as the door opens. "Bag 'em and tag 'em, Sarah. Excuse me: Agent Walker."
Even though Awesome is awesome and Morgan is "a moron," they agree to a similar scenario in which Morgan is entrusted with the secret and doesn't have to go into witness protection, after Chuck insists on his loyalty and Sarah backs him up. Chuck: "I'm a spy again because I have my best friend back." Casey: "God help us."
We're left with a couple loose ends, though. The Ring agents never got a chance to tell their superiors what they found, but it's unclear why they didn't kill Shaw when they had the chance, which worries him. And more interestingly, Casey! We end with a Ring phone ringing in the Castle, and Casey answering it cautiously. Mysterious man: "Hello, Colonel Casey. It's been a while." Dun dun duuuuunnnnn! I can't wait to delve into the mystery that is John Casey next week!
The Buy Morons vs. The Man: When the Buy Morons hear that their store is being sold, and Lester misinterprets an overheard Ring order to "terminate" them, they stage a revolution to save their jobs, complete with an Iwo Jima-inspired flag-planting. Casey is only able to get into the store (after being attacked with a barrage of Nerf projectiles) when he asks to join the cause because "the only thing I hate more than hippie neo-liberal fascists and anarchists are the hypocrite fat-cat suits they eventually grow up to become." Could I love Casey any more? No, no I couldn't.
Equally awesome is Jeffster!'s inspiring performance of "Fortunate Son" to rally the troops. Outstanding. Jeffster! is totally filling the "Glee" void during its absence. After reclaiming control of the Castle, Shaw calls Big Mike, cutely pretending to be Buy More Corporate canceling the sale and lauding them for their incredible display of store loyalty. Man, every time I get steamed at Shaw, he lets a little of his soft side show and I just can't stay mad at the guy!
Quotes and Odds and Ends:
- Jeff can fit an entire apple in his mouth. Yes. That happened.
- With Awesome freaking out and insisting he and Ellie join Doctors Without Borders, I wonder if we'll be seeing much less of them. It'd make sense, with the budget cuts and all. I'll miss them, though! Hopefully they'll pop in from time to time.
- I love that Morgan accuses Chuck of flashing when he gets a perfect score on Duck Hunt. It says a lot about their friendship that things could go back to being that normal, with the spy world casually incorporated, after all that's happened.
- Chuck: "I'm not a machine! Okay, I am a machine. But I'm also a person!"
- Casey: "When we get back, I expect this place to be exactly as I left it."
- Your director for this episode: None other than Chuck himself, Zachary Levi.
I really loved this episode…how about you? Are you excited to potentially find out more about "Alex Coburn" next week? How are you feeling about Shaw these days?


text:
Eucharistic sharing is call to mission, to feeding the poor, pope says
The Eucharist calls people to give all they are and have to God, seek his blessing and then take his love to the world, Pope Francis said in Bolivia.
The Eucharist calls people to give all they are and have to God, seek his blessing and then take his love to the world, Pope Francis said in Bolivia.
Pope Francis also praised Bolivia's efforts to include all its citizens in the country's economic, political and social life.
Belfries and spires poke the sky in this ramshackle city of impromptu developments, rutted roads and brick buildings, billed by locals as one of the highest in the world at more than 13,000 feet above sea level.
In the Villa Adela neighborhood, an onion dome towers over the Cuerpo de Cristo parish -- easily visible from the runway of the nearby international airport, where Pope Francis is scheduled to land Wednesday for a brief visit to El Alto and nearby La Paz.
"Those who choose the path of service ... are always at others' service. Not a moment belongs to them," the pope told a gathering of clergy in Ecuador.
The outcome of May's same-sex marriage referendum in Ireland and the decision of the U.S. Supreme Court on the same issue clearly show the extent to which Western society is abandoning many of its Christian legal foundations, said Australian Cardinal George Pell, prefect of the Vatican's Secretariat for the Economy.
In his address at the Fota VIII International Liturgy Conference in Cork, Pell called the Irish referendum "a victory for John Stuart Mill and utilitarianism."
A well-intentioned argument is developing among some Westerners, urging the evacuation of Christians from the Middle East. These Westerners reason that because no one will defend the Middle Eastern Christians, they should be resettled elsewhere.
Pope Francis tied together the Christian proclamation of faith with Ecuadoreans' centurieslong struggle to stop exploitation of their resources and their very selves.
Residents of Villa 21-24, a slum on the south side of the Argentine capital, hold fond memories of Pope Francis.
Priests and laypeople in Osorno are angry and bewildered at the way their local church has been steamrollered and their appeals ignored.
Pope Francis told more than a million people gathered at a park in Ecuador that despite economic hardships across the region, things can and will improve.

subset: commoncrawl


text:
More Videos...
Audi S4 vs Porsche turbo
Racing a 2001 stock 911 turbo, he got the jump on the start, but I caught him. Stage 3 2001 Audi S4 running an aggressive pump tune with shell V-power 356WHP.
Cruisin up to H2Oi 2011
Moggah's Bmw M5 Turbo 913whp
S38B36 turbo 913Whp /1088nm
Mallorca car parking
4 africans in a BMW parking out, I made this Video during my Holiday on Mallorca from the balcony of my appartment in 28-08-2004


text:
71 Responses.
[…] Autor : SCF […]
[…] Last Scenario is a Japanese-style RPG made in RPG Maker XP. This game is actually a bit special to me, because it was the first RPG Maker XP game (and one of the first RPG Maker games, period) I ever played, so it really introduced me to the concept in a lot of ways. […]
Hey there Im currently uploading a video walkthrough on my youtube channel , the link: https://www.youtube.com/user/TNewGabriel/featured
The parts will be uploaded on every Monday, Thursday and Sunday
It will be 44 parts and will be finished on May 12th,


text:
Memorex Portable Boombox
Catalog #: 1400254
Sold out online
Find a store near you
FREE shipping & returns
The Memorex® Portable Boombox allows you to easily find your favorite stations or listen to your music collection.
- Play all your MP3 files burned to a disk or attach your MP3 player and listen to your tunes through the boom box speakers.
- This boombox offers full, rich sound. Listen at home, or take your music on the go.


text:
This "Infrared" Air Max 90 Isn't An Anniversary Release
April 30, 2015 BY Patrick Johnson / 4.11 / 5
This Air Max Lunar 90 BR has strayed so far away from the original Air Max 90 design that it's hard to pinpoint what advancements stand out more – the lunarlon tooling on t...Read More
Black and White Options For Two New Nike Air Max Lunar Releases
April 18, 2015 BY Patrick Johnson / 3.88 / 5
Nike continues to release new takes on their classic Air Max models. This duo of the Nike Air Max Lunar 1 BR and the Nike Air Max Lunar 90 BR stray so far away from the traditional con...Read More
Blue Camo Hits The Nike Lunar Janoski
April 16, 2015 BY Patrick Johnson / 4.61 / 5
We've entered a phase where camouflage isn't even a trend anymore – it's just persistent as far as aesthetics go. The option to have a silhouette grace the mili...Read More
- $520.00 3 bids 0hr 16mins
- $644.99 BUY IT NOW 0hr 26mins
- $485.00 36 bids 0hr 57mins
- $500.00 0 bids 1hr 32mins
The CLOT x Nike Lunar Force 1 Releases This Friday
April 14, 2015 BY Patrick Johnson / 4.02 / 5
We've been patiently waiting for the CLOT x Nike Lunar Force 1 for almost a year now. Rumors have this pair dating all the way back to CLOT's actual 10th anniversary back i...Read More
Nike Lunar Force 1 Low "Perf" Pack
April 12, 2015 BY Patrick Johnson / 3.64 / 5
The Nike Lunar Force 1 has occupied an interesting space since debuting all the way back in fall of 2012. The shoe has showcased that the addition of a slimmed down lunarlon outsole h...Read More
NikeLab Lunar Huarache Light – Available
April 2, 2015 BY Patrick Johnson / 4.4 / 5
The NikeLab Lunar Huarache Light is now available via Nike.com. The Nike Huarache Light is perhaps the most tinkered with model in the long Huarache lineage. Instead of giving us the t...Read More
Nike Sportswear's "White Hot" Pack With Gum Soles
March 18, 2015 BY Patrick Johnson / 4.25 / 5
Nike Sportswear is already gearing up for summer with the introduction of their "White Hot" Pack. The collection re-introduces the Nike Lunar Force 1 Low, this time returni...Read More
NikeLab Lunar Huarache Light "White"
March 6, 2015 BY Patrick Johnson / 4.52 / 5
The Nike Air Huarache Light returns with a brand new lunarlon outsole. This isn't the first time that the Huarache Light has switched out its original base for Nike's lates...Read More
Nike Flyknit Lunar 3 – March 2015 Releases
March 3, 2015 BY Patrick Johnson / 3.88 / 5
Runners are constantly looking for a shoe lightweight enough to feel like a second-skin, and they may have found just that with the Nike Flyknit Lunar 3. Dressed in an all Flyknit cons...Read More
Nike Lunar Internationalist "Stingray"
February 22, 2015 BY Zack Schlemmer / 4.25 / 5
Nike Sportswear goes exotic with the upcoming editions to the "Stingray" pack, featuring the Free OG '14, Air Huarache, and the shoe we're here to look at, the ...Read More


text: ×Close Product Image 1 of 1 The Famous Stanley Kidnapping Case See image The Famous Stanley Kidnapping Case By Zilpha Keatley Snyder For Ages: 8 - 12 × Added to Cart List Price $10.99 Your Cart ( items) Cart total Continue Shopping CHECKOUT NOW Choose a format: Trade Paperback eBook More Formats Hardcover Trade Paperback Choose a format: Trade Paperback Hardcover Trade Paperback Trade Paperback eBook Atheneum Books for Young Readers | 216 pages | ISBN 9781442484467 | September 2012 | Grades 3 - 7 | Lexile ® 1060L List Price $10.99 This title is temporarily out of stock, please check back soon. Browse Related Books 3rd Grade | 4th Grade | 5th Grade | 6th Grade | 7th Grade Age 4 - 8 | Age 9 - 11 | Age 12 and Up Lexile ® 991 - 1090 Children's Fiction > Family > GeneralChildren's Fiction > Mysteries & Detective Stories Buy from another retailer Amazon Barnes & Noble Books-a-Million IndieBound Walmart Get a FREE eBook when you join our mailing list. Plus, receive updates on new releases, recommended reads and more from Simon & Schuster. Email Address Free eBook available to NEW subscribers only. Offer redeemable at Simon & Schuster's ebook fulfillment partner.Offer expires in three months, unless otherwise indicated.See full terms and conditions and this month's choices. More Books from this Author Blair's Nightmare Blair's Nightmare By Zilpha Keatley SnyderBy Zilpha Keatley Snyder William's Midsummer Dreams William's Midsummer Dreams By Zilpha Keatley SnyderBy Zilpha Keatley Snyder William S. and the Great Escape William S. and the Great Escape By Zilpha Keatley SnyderBy Zilpha Keatley Snyder The Witches of Worm The Witches of Worm By Zilpha Keatley SnyderBy Zilpha Keatley Snyder See more by Zilpha Keatley Snyder About the Author Zilpha Keatley Snyder Zilpha Keatley Snyder is the author of The Egypt Game, The Headless Cupid, and The Witches of Worm, all Newbery Honor Books. Her most recent books include The Treasures of Weatherby, The Bronze Pen, William S. and the Great Escape, and William's Midsummer Dreams. She lives in Mill Valley, California. Visit her at ZKSnyder.com. BECOME A FAN BOOKS


text:
Joseph Huppert's seen exceptional places where you might commission an artist to make something, in some of the chicest locales: Los Angeles, New York, Paris, London. Clients there seek out his boss, Robert Irwin, who's earned international renown for decades of artwork.
So Huppert stared at the mushrooms spilling from the ceiling in an abandoned ice factory in North Park earlier this year, repulsed by the dingy, moldy storefront. But when it comes time to create his own artwork, Huppert doesn't have his run of an atrium at the Getty in L.A. He's never made art specifically inspired by and conditioned to a particular space before, à la his boss — so who would commission him?
He had to try his ideas somewhere. In this kind of art, the space comes first. So, the ice factory it was.
This juxtaposition is normal life for a young artist testing his wings on the fringes of San Diego's art scene at night, but spending his days in rarified air. And it's been Huppert's reality since befriending Irwin a few years ago.


text:
Nurofen Cold & Flu Tablets 24s can help to relieve you of the symptoms related to colds and the flu. Containing Ibuprofen and Pseudoephedrine hydrochloride, this dual action tablet offers powerful, effective relief in clearing a blocked nose and sinuses, curing headaches and migraines. Nurofen tablets also help in removing pain, lowering your temperature and easing the discomfort of a sore throat. You're left feeling brand new and ready to get on with your day.
Cheapest price we found
|Visit Store
More results for this product
|Visit Store
|Visit Store
Prices are updated periodically, the prices quoted here were correct at the time of last update.
Patient gathers information on a vast range of over-the-counter treatments and beauty products from reputable websites and registered online pharmacies. We perform a price comparison so that you can see who offers the best price.


text:
The three of them stood there, not moving an inch. The other classmates saw the whole thing, and stared in disbelief, even the teacher had his mouth wide open. Snapping out of it, Daniel rushed to Jennifer's side and blocked Kevin away. \"You...\" Said Daniel, with anger in his face. \"Why'd you do that...\"
\"Why...?\" Said Kevin. He stood for a while. \"I guess I like her?\" He grinned widely, while the other two just stood there and stared at him. \"Ah, don't tell me!\" Yelled Kevin. \"You two are dating?!\"
Both of them blushed. Jennifer looked up at Daniel, hoping he'd reply for the two of them. \"Don't be silly...that wouldn't happen...\" Daniel paused for a while. \"We're...just friends...\" Replied Daniel. Jennifer felt disappointed, why is that?
\"Then I have the right to go out with her!\" Screamed Kevin. Jennifer was sure the whole class was able to hear that. She couldn't help but blush.
\"But as her friend, I will help her if she doesn't want to go out with you.\" Replied Daniel. He turned his head to face Jennifer's. \"Do you want to go out with him?\" Asked Daniel. Jennifer rapidly shook her head.
\"Ouch...well I got rejected...but I won't give up!\" Said Kevin. He turned his head to face directly into Daniel's eyes. \"Well, if your her little knight, you wouldn't mind having a contest with me!\"
\"A contest?\" Asked Daniel. He looked at Jennifer still standing behind him. She had a worried look on her face, so she really didn't want to go out with him. Kevin smirked.
\"Yes! A race!\" Said Kevin happily. \"If you win, I'll stop bothering Jennifer, of coarse goes the same if you back out! But if I win, I'll get to go out with her!\"
\"What? Hey, wa-\". Started Daniel.
\"Deal!\" Yelled Jennifer. \"Daniel won't lose!\"
\"D-Deal?!\" Said Daniel, very worried. \"Are you crazy? If I lose, you'd have to go out with him!\" Jennifer looked up at him.
\"But you won't lose, I know you won't.\" Replied Jennifer. \"I don't want him to go out with me, and I know for sure you won't lose!\"
Daniel was extremely worried. Kevin was fast, and if challenging him to a race, he must be up to something! \"How can you be so sure of yourself?!\"
\"Because I trust you!\" Said Jennifer.
\"Then it's settled.\" Said Kevin. In two days, right here, we'll race.
© Copyright 2017 SakuraAngel. All rights reserved.
Status: Finished
Genre: Romance
Book / Romance
Short Story / Romance
Paste the link to picture in the entry below:
Paste the link to Youtube video in the following entry:
Cannot annotate a non-flat selection. Make sure your selection starts and ends within the same node.
An annotation cannot contain another annotation.
There was an error uploading your file.


text:
Choose Between Two Options
- $19 for one month of weekly beginners Irish-dancing classes (a $50 value)
- $39 for two months of weekly beginners Irish-dancing classes (a $100 value)
- All classes are 60 minutes long.
- Click here to see the schedule.
Hirten Irish Dance School
Despite being affected by Hurricane Sandy, Nancy Hirten did not let the storm break her spirits or her passion to teach students at the Hirten Irish Dance School. Nancy—an accredited teacher by the Irish Dancing Commission in Dublin and an experienced dancer who has performed for the Today show and Mayor Bloomberg—continues to teach students of all ages the fine art of traditional Irish dance.
3 Araca Rd.
Babylon, NY 11702Get Directions


text:
Do Spells in Brisbane, Australia
In light and in love, enter! My name is Phelan. I am an eclectic white witch practitioner, located in Atlanta, GA. I have helped clients in Brisbane, Australia and Anaheim, CA in all areas of their love life, if you are in need of help with psychic phone readings in person or by phone to increase your awareness about the condition of your life, please feel free to create an account or give me a call at 678-918-3333 today, if you live within the Atlanta area we can setup an appointment in person to discuss your situation or to schedule a psychic reading.
I can also provide magical help with Do Spells or Do White Magic, just about any situation can be dealt with magic. My specialty is customizing the energy needed for Do Witch Craft and performing rituals on behalf of my clients.
Hidden secrets and truths untold are often revealed to me about a client through the art of candle gazing, a candle reading is a valid esoteric art used by the few practitioners who understand its value, get a candle reading today and experience the art of true divination.
I look forward to assisting you in any manner that I can, please note that I am a Witch who practices White Magic, magic is pure energy and it is the intent of the practitioner that decides whether a spell casting is black, white, good, bad or indifferent, my belief is that magic is best kept pure as not to reap any negative backlash and to avoid incurring any negative karma! Remember, I am located in Atlanta but even if you are Brisbane, Australia my magic can and will help you in any aspect of your life.
Blessed Be, Phelan
Do Spells | Reunite Soulmate | Brisbane, Australia


text:
Contact/Find Us
This used Peugeot 208 3 door registration LX63FYR (2013) has a 1.4 Diesel engine with a Manual gearbox and boasts impressive fuel consumption of 74.3 mpg and is finished in Virtual Blue. The CO2 emissions are extremely low at just 98 g/km which in turn offers FREE road tax!
Learn more about Hire Purchase:
Learn more about Personal Contract Plan:
Learn more about Dealer Finance:


text:
Welcome to Little Shingwedzi Safaris
In the heart of the South African Bushveld is where you will find Little Shingwedzi Safaris. Situated on the border of Kruger National Park, in the sunny and lovely city of Phalaborwa.
Little Shingwedzi Safaris will make anyone's dream come true by booking a day safari or an overnight safari into Kruger National Park. We also offer transfers outside Kruger National Park to surrounding areas of Phalaborwa, Tzaneen, Hoedspruit, Mica and Nelspruit. Or just a transfer from anywhere to anywhere.
The name Little Shingwedzi describes the love for Kruger Park from up in the North from the Shingwedzi River to wherever an Elephant roams. Shingwedzi was one of the famous Magnificent 7 Tuskers of Kruger National Park.
The Little Shingwedzi Team is here to make each and everyone's experience in the African Bush an everlasting memory. Our passion and love for Kruger, wildlife and the whole South African Bushveld is what is driving us to ensure that every person that uses Little Shingwedzi Safaris, falls in love with each and every aspect of the Bushveld.
Our qualified and registered field guides will pass on all valuable knowledge of the bush, whether it is a tree, lion, snake or a bird it doesn't matter. You as a client will love it and also pick up a lot of knowledge on our world class safaris.
Come and experience a world class safari with us in Kruger National Park. Relax, sit back and we will cater for you in the Bush, whether we do a breakfast, lunch or dinner in Kruger, you will always have that African Bush feeling.


text:
It wasn't so much a "something for everyone" weekend as it was "multiple things for the same general audience," as four wide releases aimed at thrill-hungry moviegoers and/or adults debuted on the same day, creating a clear case of mutually assured destruction. The top three movies are basically tied, but as always, rank is irrelevant next to the actual hard numbers (why rank doesn't matter). For the moment, the top debut of the weekend may be End of Watch, a "found footage"-style LA cop drama, parlayed strong reviews into a solid $13 million opening, which is the second-biggest debut for Open Roads outside of The Grey ($20 million) back in January. The $7 million film (purchased for $2 million) had a marketing and distribution cost of around $20 million, so even a $40 million final total will get this film in the black before home video. It also proves that Jake Gyllenhaal is a decent mid-range opener. He's useful when the film you're selling doesn't cost $200 million ala Prince of Persia. End of Watch is yet another installment in writer David Ayers' "two volatile men in a car" sub-genre, which includes the likes of The Fast and the Furious, Training Day and Harsh Times (an underrated Christian Bale vehicle that he also directed). He wrote but did not direct the the LA Riots-set cop melodrama Dark Blue while directing but not writing the frankly mediocre Keanu Reeves cop melodrama Street Kings. Among films he directed, End of Watch should easily top the $26 million gross of Street Kings while it will be fifth (out of seven) if it can merely surpass the $9 million gross of Kurt Russell's Dark Blue. Fourth place is the $76 million-grossing Training Day, which is too far a bridge to cross at this point.
For holdover news, read the rest of this article at Mendelson's Memos.
HuffPost Entertainment is your one-stop shop for celebrity news, hilarious late-night bits, industry and awards coverage and more — sent right to your inbox six days a week. Learn more


text:
Keep in mind we don't always restock. This is just for popular items that may come back due to high demand! Customer care can't provide any information about items that are sold out.
See our
Privacy Policy.
Super soft chunky knit single loop gray infinity scarf. Looks perfect tucked up all cozy over a denim jacket!
*100% Acrylic
*25"/63.5 length
*12"/30.5cm width
*Wash cold
All sales are Final. No price matching. Nasty Gal will no longer accept returns and exchanges as of 12:00 a.m. PST February 8, 2017.


text:
production of a Radio Advert / Commercial
This project was awarded to Belizky for $100 USD.Get free quotes for a project like this
Project Budget$30 - $250 USD
Total Bids6
Project Description
I need a professional freelancer to produce a professional Radio Commercial / Advert of 30 to 45 seconds, with music in background and a voice of a professional native english speaker. I will provide the text for that. If you want to bid, please provide me with sample of your work.
Awarded to:
Skills Required
Looking to make some money?
- Set your budget and the timeframe
- Outline your proposal
- Get paid for your work
Hire Freelancers who also bid on this project
Looking for work?
Work on projects like this and make money from home!Sign Up Now
- Forbes
- The New York Times
- Time
- Wall Street Journal
- Times Online


text:
San Domenico House
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this hotel rated in the past?
- Suites
- Room service
- Breakfast Available
- Multilingual staff
- Babysitting service
- Bar/lounge
Travelers also recommend:
- Bar/lounge
- Breakfast Available
- Family rooms
- Suites
- Multilingual staff
- Babysitting service
- Room service
- Laundry
TripAdvisor Reviews San Domenico House London
Travel Blogs from London
Finding Neverland
... It was a rainbow of colour, alluring to the eye but then it is chocolate. The third thing was the tall man. I swear Raluca was half his size and I don't think I am exaggerating there. The weirdest thing about him was that I didn't even notice how tall he was. Stella had to point him out to me. I mean I noticed he was tall and that was it. I sometimes don't seem to pay attention to the world in that way-like the time one of my friends lost 90 kilos. My ...
Exploring other England
... When we arrived back, the three of us picked up the map from our hotel then headed to get some quick dinnera before going into the city to see the lights. From previous post everyone has probably worked out the sun sets pretty later, so it was 10:30 by the time we caught the train into the city. We went to Tower Bridge first and it looked fantastic. As we were crossing it we had to stop for it to be raised to let a boat in. This was great to see as it ...
Busy, Busy London
... the call. It turns out the gift cards some of my students generously gave me at the end of the school year work in London! They converted our dollars to pounds and our lunch and drinks were free. A nice treat in an expensive city.
With lunch out of the way, we made our way back to the bus and moved on to the Tower of London. There we toured the castle and its many rooms of armor, the Crown Jewels, the Bloody Tower, The ...
Sightseeing in London, Part 1
... opening, we were able to see them at our leisure (they have an ingenious moving walkway to keep everyone from just posting up in front of them and never moving -- they also have a no pictures rule which we can totally understand as people would just take countless numbers of pictures that they'd never look at but would grind the flow of people to a halt). Seeing a royal crown up close was pretty impressive. We can't imagine what type of person have to ...
Day 3 in London
... best part really. The different sandwich flavors were a little odd but we at least took a nibble of each one, the pesto chicken was the best. the other flavors were egg, salmon, and cucumber. after tea we stopped in the Kensington area at a pub called the champion, we sat outside a nd had a glass of wine and a pint. we tried to head to the ! picadily circus / oxford street area but it was rush hour and SO MANY PEOPLE! so we hopped off the bus and went down to the underground ...


text:
- Welcome to Cash Liqidations,Inc.
Cash Liquidations, Inc. is a premier resource in the warehousing, liquidation, and installation of furniture, fixtures, and equipment for hotels, resorts, condominiums, and timeshares alike. With the ability to warehouse new FF&E anywhere in the country as well as timely, discreet installation on renovations and new builds, CLI is a sole provider for all FF&E hospitality needs. After liquidation, the salvaged product is sent back to the 220,000 sq. ft. facility at the retail operation in Forsyth, GA and is sold piece by piece to the public.
Furniture Showcase
We sell top quality hotel furniture from 4 and 5-star hotels & resorts across the country. For the budget minded homeowner, college bound student, rental property owner, vacation condo owner and anyone who enjoys the thrill of finding a true bargain, this is the shopping experience for you.
Register now
I'm a small Introtext for the Register Module, I can be set in the Backend of the Joomla WS-Register Module.


text: Increase Your Memory's CapacityTamar Weinberg8/27/07 7:30amFiled to: How ToMemoryMind HacksStudentsStudy Tips22EditPromoteShare to KinjaToggle Conversation toolsGo to permalink Finding a surefire memorization technique can be challenging, but it doesn't have to be. By applying some quick tricks, you can become well-read in any information-heavy subject just by putting your mind to it. Tutor John Place writes: Advertisement 1. First, use a pencil or word processor (I prefer the latter because it's faster) to type, in complete sentences, any fact you think might appear on the test. Use short sentences because they're easier to remember. 2. Take your printed notes into a quiet room, shut the door, and eliminate all distractions. 3. Look at the first sentence in your notes and read it out loud. Then, close your eyes and say the sentence without looking at it. 4. Repeat the step above, this time with the first two sentences. 5. Next, try it with three sentences. Then four. Repeat until you have memorized every sentence in your notes.After applying these techniques to his studies, John was able to memorize seven chapters (or 23,000 words) of his psychology textbook and surpassed his professor's expectations. What memorization techniques do you find most valuable? Let's hear it in the comments. Advertisement How to Memorize Anything [John Place Online]Reply22 repliesLeave a reply


text:
The veteran Ukraine energy explorer, Paul Davies, said his JKX Oil & Gas business would continue its investment push into the country this year despite the Russian crisis.
He said JKX's Ukranian operations had been unaffected so far, and was optimistic about revenues from a new fracking project there.
Mr Davies said: "We have operations in Ukraine and Russia, so we are trying to keep as much up to speed on what is going down, but for our operations, life goes on as normal," he said. "They've announced presidential elections on 25 May. Any delay on that is not generally going to be a good thing. It would appear to me to be sensible to get the election done and take it from there."
However, the impact of the Russian incursion on local currencies is having an impact on the company's business, which sells its gas on both sides of the border.
One of the biggest shareholders at JKX is the Ukrainian oligarch Igor Kolomoisky , who was recently made governor of a province in the country by the temporary government.
Within days of that appointment, Russia's central bank put the Russian subsidiary of Kolomoisky's Privatbank into temporary administration. President Vladimir Putin declared Mr Kolomoisky "a unique imposter", and accused him of violating a contract with Chelsea FC owner Roman Abramovich.
JKX is currently in a legal dispute with Mr Kolomoisky, who, with the London-based Ukrainian oligarch Gennadiy Bogolyubov, last year attempted what JKX claimed was a raid on the company. That resulted in a legal action that is still rumbling through the courts with an appeal scheduled for next week.
Another Ukranian oligarch formerly associated with JKX is Dmitry Firtash, who was arrested and bailed for €125m in Vienna earlier this month on the orders of the FBI under suspicion of corruption. However, Mr Davies stressed Mr Firtash's business had sold its stake in JKX back in 2006. Mr Firtash is said to have been introduced to JKX by Viscount Raymond Asquith, reported to have been a former Moscow MI6 bureau chief. Asquith remains a non-executive director of JKX.
Profit from operations after exceptional items jumped to $9.2m for the year ended 31 December from $5.8m a year earlier.
Revenue fell about 11 percent to $180.7m. The Ukrainian currency fell 25 per cent against the dollar during the unrest, hitting dollar revenues in the last quarter. However, JKX said it did not anticipate any reduction in the contractual prices it has for its gas with the Ukrainian or Russian authorities.
The current investment programme at JKX is backed by the company's raising of a $40m bond last year.
Ukrainian energy debts are one cause of its strife with RussiaReuse content


text:
What is Wenger going to do to with all those quality midfielders? During the first half of yesterday's game against Viking FK I was salivating over the midfield brilliance of both Santi and Eln... [Read More]
50 goals from our first choice attackers and nr10: surely enough to win the title?! I reckon we lost the league last year because it was the Foxes' year. Leicester Cinderella City became ... [Read More]
We will do a proper match preview tomorrow but let's do a bit of tactics on our mega encounter with Barcelona on Tuesday night. We are lucky to have a large squad available, although it would ha... [Read More]
All are fit against Barcelona in Nou Camp…. Who would you play? Arsene announced today that Coquelin and Rosicky are available again and that Jack, Santi and Danny are a few weeks away ... [Read More]
I know you are all scanning the Newsnow Arsenal news aggregator and other media to find out whether we have finally signed Elneny now or any other new players. I must admit to also look regularly eve... [Read More]
Alexis CF, Mesut nr.10… with Jack and Aaron 'Mid-wings': Discuss! :) Regular readers know that I am a great believer in Giroud and that I do not see a need to buy a CF anytime soon.... [Read More]
Please forgive me if I end up jinxing the outcome of today's game, but this match today feels very much like the Swansea game of a few weeks ago, in which we had some very difficult moments but ... [Read More]
That was a decent enough weekend we've just had, by my reckoning, don't you think? The Manchester derby was the only real concern for us and as the two sides cancelled each other out, it e... [Read More]
I hope that whatever team is chosen tonight, we see more energy and urgency than our last outing in this competition, because anything other than a win against Olympiakos would be nothing short of a d... [Read More]
I really hope the team are riding high today after Wednesday's North London Derby victory. Today is the last of our back-to-back-to-back-to-back away games and a win today feels like it could be... [Read More]


text:
Rihanna Hairstyle – 45 Of The Best Haircut Rihanna
Rihanna Hairstyle – Rihanna hairstyle elegant and roll and adapted hair in a short time, it is hard to remember exactly how many haircuts, which is carried throughout his career.
This post will give an overview of the most popular hairstyle, it is:
Rihanna wore many short hair styles different neural and world famous singer loves spending from one court to another in the regime shortcuts. She looked beautiful with volume at the crown and strands framing her face.
In 2006, he brought a super-smooth tape with perfect hair smoothing and straightening. Sidescan hair gave him the look beautiful.


text:
"I've been trying to incorporate a variety of vitamin-packed, fiber-rich vegetables and legumes into our diets, and this dish meets both criteria." -Colette Russo, Barboursville, VA
6 servings (serving size: 1 cup)
Nutritional Information
Calories 109
Caloriesfromfat 19 %
Fat 2.3 g
Satfat 0.8 g
Monofat 0.7 g
Polyfat 0.5 g
Protein 5.8 g
Carbohydrate 18.1 g
Fiber 3.9 g
Cholesterol 3 mg
Iron 1.8 mg
Sodium 451 mg
Calcium 111 mg
Cooking spray
2 cups finely chopped red onion
1/4 cup chopped pancetta (about 1 ounce)
3 garlic cloves, minced
11 cups chopped kale (about 1 1/4 pounds)
1/2 teaspoon freshly ground black pepper
1/4 teaspoon salt
1 (15-ounce) can pinto beans, rinsed and drained
1 (14-ounce) can less-sodium beef broth
Heat a large Dutch oven over medium-high heat. Coat pan with cooking spray. Add onion, pancetta, and garlic; sauté 5 minutes or until pancetta browns. Stir in kale, pepper, and salt. Add beans and broth; bring to a boil. Cover, reduce heat, and simmer 15 minutes or until kale is tender. Uncover and cook 10 minutes or until liquid almost evaporates.
November 2005


text:
Hotels in Coignieres, France
Search & Compare Coignieres Hotels
Get Secret Prices on select hotels
These prices aren't available to everyone.
Trending now in Coignieres
Hotels in Coignieres
- Most bookedFasthotel Paris Ouest Coignieres
16 people looked at this hotel in the last hour
15 people looked at this hotel in the last hour
Most recent review
"Rooms small but adequate for short stay We stayed for eleven nights, visiting eldelry relative in CARE HOME in the next village We were able to come and go as we pleased."
A Traveller, Jul 2015, GB
14 people looked at this hotel in the last hour
11 people looked at this hotel in the last hour
Hotels within 5 miles of Coignieres
31 people looked at this hotel in the last hour
Most recent review
"Was looking for somewhere close to Versaille for visit to palace following morning. Arrived late and was pleasantly surprised by standard of accommodation. Very good sized room, comfortable and fittings were recent and to a high standard."
A Traveller, Aug 2015, GB
31 people looked at this hotel in the last hour
Most recent review
"Hotel was OK for 1 night business stay. Outside is dated and reception and restaurant area need a bit of refresh. But new part of the hotel which is recently refurbished is clean and comfortable. Part of the hotel is currently being refurb'ed."
A Traveller, Sep 2016, GB
24 people looked at this hotel in the last hour
Most recent review
"Location of this hotel is very convenient for me and my high school reunion group . Short distance to chateau de Versailles and France Miniature park . Very friendly and helpful staffs . Room is clean and the bed is comfortable ."
A Traveller, Jul 2014, US
24 people looked at this hotel in the last hour
Most recent review
"We absolutely loved this place. It was so very beautiful. Service was great and dinner in the dining room was one of the most memorable experiences. We plan on coming back and spending much more time. Excellent value, service, so beautiful!"
A Traveller, May 2016, US
16 people looked at this hotel in the last hour
Most recent review
"clean, quiet and in the perfect suburban location if your travels take you to this distant part of greater Paris. Excellent bar and restaurant on site and plenty of off site to choose from. Good friendly atmosphere and caring staff"
A Traveller, Apr 2014, US
8 people looked at this hotel in the last hour
Most recent review
"WE wanted to visit Versaille (about 20km from hotel). Room wasn't ready but staff made us coffee whilst it was finished (15 mins). Stayed in room Thetis which had wonderful views, staff carried luggage to room, 2nd floor up winding stairs (no lift). Hotel a little tired and restaurant menu very ..."
A Traveller, Jul 2016, GB
Best hotels in Coignieres
You can compare all of our Coignieres hotel rooms including the major Coignieres hotel chains using our genuine Hotels.com guest reviews as well as TripAdvisor Coignieres hotel reviews to help find the perfect hotel room when booking your accommodation in Coignieres. We also feature Expedia Coignieres hotels and reviews.
When you book your Coignieres stay with Hotels.com you may also earn free nights on participating hotels by joining the Hotels.com Welcome Rewards program. It's free to join and only takes 2 minutes to sign up and when you stay 10 nights you receive 1 night free*. So even a short weekend break in Coignieres can get you on your way to a free night.
Why use Hotels.com to book your Coignieres lodging & accommodation?
We can help you to find the perfect Coignieres hotel room for almost any occaision. With our fast and secure hotel search you may compare different Coignieres hotels by:
- - Price
- - Location within Coignieres
- - Neighborhoods in Coignieres
- - Nearby Coignieres attractions
- - Hotels in different areas of France
- - Genuine Hotels.com guest reviews for Coignieres
- - Star rating
- - Amenities
- - Hotel name & chain
- - Theme
For every hotel in Coignieres France we provide:
- - Up to the minute hotel rates & availability
- - In depth hotel information and photos
- - Detailed Coignieres maps showing the locations of your hotel in Coignieres and the nearest transport and landmarks
- - TripAdvisor Coignieres hotel review score
And when you make a hotel reservation in Coignieres with Hotels.com we'll send you email and text confirmations with the reservation details of your Coignieres hotel booking along with contact details, directions, information on nearby Coignieres attractions, restaurants and even the weather - and if you get stuck, we're only a phone call away.
To make the most of our service, download our mobile & tablet apps and sign up to our newsletter or follow us on Facebook, Google+ or Twitter to receive the latest deals and Hotels.com Coignieres discount codes.


text:
Lower tidal volume at initiation of mechanical ventilation may reduce progression to acute respiratory distress syndrome: a systematic review
- Brian M Fuller1Email author,
- Nicholas M Mohr2,
- Anne M Drewry3 and
- Christopher R Carpenter4
DOI: 10.1186/cc11936
© Fuller et al.; licensee BioMed Central Ltd. 2013
Received: 24 September 2012
Accepted: 18 January 2013
Published: 18 January 2013
The most appropriate tidal volume in patients without acute respiratory distress syndrome (ARDS) is controversial and has not been rigorously examined. Our objective was to determine whether a mechanical ventilation strategy using lower tidal volume is associated with a decreased incidence of progression to ARDS when compared with a higher tidal volume strategy.
A systematic search of MEDLINE, EMBASE, CINAHL, the Cochrane Library, conference proceedings, and clinical trial registration was performed with a comprehensive strategy. Studies providing information on mechanically ventilated patients without ARDS at the time of initiation of mechanical ventilation, and in which tidal volume was independently studied as a predictor variable for outcome, were included. The primary outcome was progression to ARDS.
The search yielded 1,704 studies, of which 13 were included in the final analysis. One randomized controlled trial was found; the remaining 12 studies were observational. The patient cohorts were significantly heterogeneous in composition and baseline risk for developing ARDS; therefore, a meta-analysis of the data was not performed. The majority of the studies (n = 8) showed a decrease in progression to ARDS with a lower tidal volume strategy. ARDS developed early in the course of illness (5 hours to 3.7 days). The development of ARDS was associated with increased mortality, lengths of stay, mechanical ventilation duration, and nonpulmonary organ failure.
In mechanically ventilated patients without ARDS at the time of endotracheal intubation, the majority of data favors lower tidal volume to reduce progression to ARDS. However, due to significant heterogeneity in the data, no definitive recommendations can be made. Further randomized controlled trials examining the role of lower tidal volumes in patients without ARDS, controlling for ARDS risk, are needed.
2013 Fuller et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Close to 200,000 cases of acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) occur annually in the United States [1, 2]. It remains a leading cause of death in critically ill patients, with a mortality rate of approximately 30%, but as high as 60% in the elderly [1, 3, 4]. ARDS also represents a large societal burden, accounting for 3.6 million hospital days annually and significant long-term sequelae in survivors [1, 3]. These include various neuropsychological impairments (e.g. depression, cognitive decline), persistent weakness and pulmonary dysfunction, and decreased quality of life [3, 5].Unfortunately, the number of ARDS trials demonstrating improved clinical outcomes are far outnumbered by those that have not [6–21]. In patients with ARDS, the current body of evidence supports a lower tidal volume strategy as best practice [6].
In contrast, the optimal tidal volume in patients without ARDS is uncertain [22, 23]. Historically, it was thought that high tidal volume not only was safe, but also was preferred to avoid the hypoxia, atelectasis, and acidosis associated with mechanical ventilation with lower tidal volumes [24–26]. This led to the common use of tidal volumes in the 12- to 15-ml/kg range [27]. However, experimental data suggest that tidal volume is a major contributor to the development of lung injury [28]. Clinical data in intensive care unit (ICU) patients also suggests that larger tidal volume may contribute to the development of ARDS [29–31], suggesting that this syndrome may in part be preventable. However, this evidence has been inconclusive, because of observational trial design, small sample sizes, and lack of reproducibility in different patient populations [32, 33]. In patients without lung injury at the time of endotracheal intubation, progression to ARDS can occur over the course of hours and may increase mortality by >30% [30, 34, 35]. This has led to increased interest in ARDS prevention and the examination of a lower tidal volume strategy to prevent its development in patients without lung injury.
We therefore aimed to systematically review the evidence regarding the role of tidal volume as a contributor to ARDS progression in patients without ARDS. The objectives of this study were to perform a systematic review of the literature comprising a comprehensive search strategy and standardized analysis techniques to determine whether lower tidal volumes, compared with higher tidal volumes, are associated with a decreased incidence of ARDS in mechanically ventilated patients. We hypothesized that lower tidal volume ventilation is associated with a decrease in progression to ARDS in mechanically ventilated patients, but the existing literature lacks the methodologic quality to provide definitive recommendations for the best tidal volume in patients without ARDS.
Materials and methods
This systematic review was designed, conducted, and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines [36, 37]. It did not require ethical approval from Washington University Human Research Protection Office. It is recognized that ALI and ARDS have undergone recent definitional change [38]. Although the definitional criteria in place during the systematic search for clinical trials, as well as the conduct of each study, was the American-European Consensus Conference (AECC) criteria, for consistency in reporting according to the new Berlin definition, we use the term ARDS to refer to both ARDS and ALI (as reported in previous literature) [2, 38].
Search for and identification of studies
We followed a written protocol (see Additional file 1) that was finalized before beginning the search. We initiated our timeline from 1967 (first description of ARDS) through 2011 and searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library, by using a combination of standardized search terms and keywords covering the basic concepts of acute lung injury, acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury, prevention, outcomes, and clinical trial. A trained information professional experienced in systematic reviews assisted in designing the search strategy and in conducting the search. Two authors (BMF, NMM) also manually screened the reference lists of the articles selected for inclusion to identify additional studies. To identify potential unpublished data from clinical trials that have completed enrollment, BMF and NMM also (a) manually searched abstracts from the Society of Critical Care Medicine, European Society of Intensive Care Medicine, American Society of Anesthesiology, American Thoracic Society, CHEST, and the Society of Academic Emergency Medicine from 2008 to 2011; and (b) searched online for details of clinical trials registration (http://ClinicalTrials.gov). BMF also contacted principal investigators of published and unpublished studies for clarification of potential data for inclusion, as needed.
Inclusion criteria
Studies were eligible for review regardless of language or publication type. We included randomized controlled trials, prospective and retrospective cohort analyses, cross-sectional studies, and before-and-after trials of adults (older than 17 years) undergoing invasive positive-pressure ventilation without ARDS at the time of initiation of mechanical ventilation, and in which tidal volume was independently studied (either retrospectively or prospectively) as a predictor variable for outcome. We excluded studies involving patients with established ARDS by consensus criteria [2], studies of nonintubated patients (e.g. noninvasive positive-pressure ventilation), studies of one-lung ventilation, studies in which tidal volume was not the only ventilator variable studied or manipulated (e.g. tidal volume and positive end-expiratory pressure), and studies in which the development of ARDS was not a primary or secondary outcome measure. We also excluded articles that were reviews, correspondence, editorials, and nonhuman studies. We screened the reference list of all review articles to identify additional studies for inclusion. Corresponding authors were contacted, where appropriate, for clarification of data or study type.
Study selection and data abstraction
Two reviewers (BMF and NMM) independently screened the titles and abstracts of identified studies for potential eligibility. After this relevance screen, full text articles were assessed for eligibility, and the two reviewers compared their exclusion logs to determine whether there was disagreement. All studies deemed potentially relevant after the screen were obtained, and the full manuscripts were reviewed for further exclusion. In cases of disagreement, a third reviewer (AD) assessed the study, and a consensus was reached between the three reviewers. Any disagreements in this collection were resolved with a consensus among the reviewers.
Assessment of study quality
We assessed the quality of clinical trials selected for inclusion by using the Cochrane Collaboration's tool for assessing the risk of bias in clinical trials, evaluating four domains: random sequence generation, concealment of allocation, blinding, and selective outcome reporting [39]. High quality was defined as a grade of A in at least three of the four methodology domains. For studies of observational design, each was assessed for its reporting of adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement [40].
Assessment of publication bias
Because detecting publication bias is difficult, we sought to minimize bias through a medical librarian assisted comprehensive search strategy and the use of study registries. We planned to use a graphic display (funnel plot) of the size of the treatment effect against the precision of the trial to evaluate for potential publication bias [41].
Data analysis
Our original intent, after conducting the systematic review, was to conduct a meta-analysis of the data by using Review Manager (RevMan, Version 5.1, Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011). However, because of qualitative heterogeneity between the studies with respect to the patient populations studied and the baseline risk for ARDS development, this was not possible. RevMan was used to generate the funnel plot.
Search and selection
Study characteristics
Randomized controlled trial
Author, year
Primary patient population
High-quality RCT?a
Primary outcome
Secondary outcome
Determann, 2010
VT 6 ml/kg PBW vs. 10 ml/kg PBW
Medical/surgical ICU
Cardiac arrest, neurologic disease
Cytokine levels in BAL and plasma
Development of ARDS
Could be randomized up to 36 hours after mechanical ventilation
Observational studies
Cohort studies
Author, year
Study design
Primary patient diagnoses
High quality c
Primary outcome
Secondary outcomes
Gajic, 2004
Medical/surgical ICUs
Shock, sepsis
Development of ARDS
Hospital mortality, ventilator-free days
Excluded patients ventilated <48 hours
Gajic, 2005
Multicenter registry of medical/surgical ICUs
Postoperative, coma, pneumonia
Development of ARDS
None mentioned
Excluded patients ventilated <48 hours
Kahn, 2006
Neuro ICU
Aneurysmal subarachnoid hemorrhage
Development of ARDS
Incidence of lung-protective ventilation
Tidal volume obtained from author contact.
Mascia, 2007
Four European ICUs
Severe traumatic brain injury
Development of ARDS
ICU LOS, VF days, ICU mortality
Excluded patients with ARDS <24 hours from admission
Yilmaz, 2007
Prospective, before-after
Medical/surgical ICU
Sepsis, pneumonia
Development of ARDS
Hospital mortality, duration of ventilation, ICU LOS, VF days
Excluded patients ventilated <48 hours
Plurad, 2007
Surgical ICU
Development of late ARDS
Not mentioned
Defined late ARDS as >48 hours after admission
Iscimen, 2008
Medical ICU
Septic shock
Development of ARDS
Hospital mortality, hospital length of stay
Jia, 2008
Medical/surgical/cardiac ICUs
Development of ARDS
Not mentioned
Excluded patients ventilated <48 hours. 341 patients had data missing on VT/PBW
Pasero, 2008
Cardiac ICU
Patient status after cardiopulmonary bypass
Development of ARDS
Not mentioned
Abstract only
Hughes, 2010
Abdominal, orthopedic, vascular surgery within 24 hours of ICU admit
Development of ARDS
Not mentioned
Assessed outcomes for 7 days.
Excluded many risks for ARDS development
Blum, 2011
OR: all noncardiothoracic and nontransplant procedures
Development of ARDS
Not mentioned
Abstract only
Case-control study
Author, year
Study design
Primary patient diagnoses
High quality
Primary outcome
Secondary outcomes
Fernandez-Perez, 2009
Prospective, nested
OR with general anesthesia for ≥3 hours
Elective operations
Postoperative respiratory failure due to ARDS
Length of stay, 60-day survival, 1-year survival
Excluded patients with "prevalent" risk factors for ARDS. 1st hour ventilator variables were primary predictor variable
Study characteristics and outcomes reporting
The 13 studies were published over a 7-year period (2004 through 2011). One study was a randomized controlled trial (RCT), and 12 were of observational trial design. On the methodologic quality assessment, the RCT was rated as high quality by Cochrane Collaboration's tool for assessing the risk of bias in clinical trials. In this trial, Grade A was given for random-sequence generation (sequence adequately generated), concealment of allocation (performed concealment allocation), and selective outcome reporting (free of suggestion of selective outcome reporting). For clinical trials in which blinding is not feasible at the point of intervention (potential methodologic issue for mechanical ventilation trials), high quality can still be assigned if the investigator collecting the primary outcome is blinded to the treatment allocation. This was unclear in the included RCT; therefore, a grade C was given for blinding (unknown whether investigators collecting the primary outcome were blinded to allocation). None of the 12 observational trials reported any adherence to the STROBE guidelines [40]. Two of the trials were multicenter studies (one retrospective registry and one prospective observational trial), and 11 were performed at a single center. Ten trials involved interventions and patients in medical, surgical, neurologic, trauma, or cardiac ICUs. Three trials were from the operating room. No studies examined mechanical ventilation in the Emergency Department (ED). Two of the studies were presented in abstract form only.
Clinical outcomes
Study results
Randomized controlled trial
Author, year
Time of ARDS onset
Incidence of ARDS
Experimental ARDS rate
Control ARDS rate
Determann, 2010
1.9 days
8% (n =12)
2.6% (n = 2)
13.5% (n = 10)
5.1 (1.2-22.6)
Trial stopped early for safety, due to ARDS in control.
Observational studies
Cohort studies
Author, year
Time of ARDS onset
Incidence of ARDS
VT ARDS Group
VT No-ARDS Group
OR b
Gajic, 2004
2.5 days
24% (n = 80)
1.29 (1.12-1.51)
Proportion of ARDS increased as VT increased.
Gajic, 2005
6.2% (n = 205)
670 ml ± 220c
620 ml ±110 c
1.26 (1.12-1.40)
Proportion of ARDS increased as VT increased.
Kahn, 2006
3 days
27% (n = 170)
9.1 ml/kg PBW ±1.8
9.4 ml/kg PBW ±1.5
ARDS development associated with transfusion, SAH severity, and PRBC transfusion.
Mascia, 2007
2.8 days
22% (n =18)
10.4 ml/kg PBW ± 1.1b
9.5 ml/kg PBW ±1.0c
5.54 (1.54-9.24)
Proportion of ARDS increased as VT increased.
Yilmaz, 2007║
28% (n = 60) before protocol; 10% (n = 17) after protocol
1.31 (1.16-1.50)
Proportion of ARDS increased as VT increased.
Plurad, 2007
8.2% (n = 192)
8.6 ml/kg PBW ± 1.7
8.8 ml/kg PBW ± 2.3
ARDS associated with fluid balance and PRBC transfusion
Iscimen, 2008
5 hours
44% (n = 71)
6.9 ml/kg PBW (6.1-7.8)
7.0 ml/kg PBW (6.5-7.9)
Delayed antibiotics and resuscitation associated with ARDS
Jia, 2008
3.3 days
19% (n = 152)
650.5 ml ± 119.7c
616.9 ml ± 112.8c
1.33 (1.09-1.62)
Proportion of ARDS increased as VT increased. Transfusion, fluid balance, airway pressures also associated with ARDS. Mean VT in patients that developed ARDS, 623.5 ml
Pasero, 2008
3.7 days
7% (n = 14)
2.04 (1.03-4.05)
Time of surgery and PEEP also associated with ARDS
Hughes, 2010
28% (n = 25)
9.0 ml/kg PBW (8.3-10.0)
9.3 ml/kg PBW (8.3-10.1)
1.0 (0.3-3.2)
Intraoperative fluid >20 ml/kg/h associated with ARDS
Blum, 2011
0.2% (n = 102)
9.2 ml/kg PBWc
9.1 ml/kg PBWc
0.77 (0.62-0.95)
PRBC transfusion strongest predictor of ARDS
Case-control study
Author, year
Time of ARDS onset
Incidence of ARDS
VT ARDS Group
VT No-ARDS Group
OR d
Fernandez-Perez, 2009
1.9% (n = 83)
8.9 ml/kg PBW ±1.6
8.7 ml/kg PBW ±1.7
1.03 (0.84-1.26)
Time of surgery, transfusion, and fluid balance associated with ARDS
The time of ARDS onset was reported in seven studies, and occurred between days 2 and 4 (5 hours to 3.7 days). The incidence of ARDS was very low in the two operating room studies involving primarily elective procedures: 0.2% and 1.9%. This is in contrast to a much higher incidence in ICU patients, ranging from 6.2% to 44%.
Clinical outcomes comparing ARDS and non-ARDS groups
Author, year
No ARDS
Kahn, 2006
Fernandez-Perez, 2009
Mascia, 2007
Hospital mortality
Gajic, 2004
Gajic, 2005
Iscimen, 2008
Fernandez-Perez, 2009
ICU mortality
Iscimen, 2008
ICU LOS (days)
Mascia, 2007
Kahn, 2006
15% increase
Hospital LOS (days)
Kahn, 2006
7% increase
Fernandez-Perez, 2009
VF days
Gajic, 2004
Mascia, 2007
Duration of MV (days)
Kahn, 2006
Renal failure
Kahn, 2006
In patients who do not have ARDS at the time of endotracheal intubation, the preponderance of evidence implies an association between lower tidal volume and subsequent progression to ARDS. However, this systematic review could yield no definitive recommendations regarding the most appropriate tidal volume strategy in patients without ARDS. Several important caveats exist. An overall lack of data appears in the existing body of literature, as well as a lack of methodologic quality in the data that do exist. Of the 13 trials included in this review, only one was a high quality RCT, whereas the remainder were of observational trial design. None of the observational trials referenced the STROBE guidelines, which are endorsed by 110 journals worldwide [50]. Publication guidelines like STROBE were designed to standardize the reporting of medical research to enhance transparency and minimize variability [51]. An increasing body of evidence indicates that the guidelines do improve the overall quality of research reporting [52].
There was also substantial heterogeneity appeared in the patient populations examined, each carrying perhaps vastly different risk for ARDS progression. For example, relatively healthy patients with a finite exposure to tidal volume risk (operating room cases) are inherently different in risk for progression compared with critically ill ICU patients [53]. Furthermore, even among the studies restricted to patients with longer exposure to tidal volume (ICU patients), the diagnoses leading to mechanical ventilation (Table 1) also carry very different risk for ARDS (e.g. septic shock versus postoperative). Funnel-plot inspection for the assessment of publication bias revealed asymmetry suggestive of publication bias. However, asymmetric funnel plots are not sufficient proof of publication bias. Other potential explanations for asymmetry include study-to-study heterogeneity with the intervention fidelity or outcome assessment. Also, improvement in the usual care in the "control" treatment groups as routine management evolves over time may reduce the observed effect size. It is also possible that an asymmetric funnel plot is the result of chance alone [41]. Finally, differences were noted between studies in how a patient was classified as having developed ARDS, even though each study required fulfillment of accepted consensus criteria [2].
The results of this systematic review do reveal some important trends in the data. First, each study that reported ARDS onset showed that it occurs early in mechanically ventilated at-risk patients. This may reflect the difficulty in defining the precise onset of ARDS retrospectively, but also that many mechanically ventilated patients may have early ARDS that has yet to manifest clinically. This suggests that prevention trials should target the most immediate time after initiation of mechanical ventilation (e.g. in the ED, interhospital transport, and/or the first 24 hours of ICU admission). Endotracheal intubation and initiation of mechanical ventilation is a common occurrence in the ED, yet the effect that ED-based mechanical ventilation may have on outcome has not been studied [54]. However, preenrollment data from ARDS clinical trials showed that early tidal volume did not influence mortality, further highlighting the equipoise on this topic [55].
Second, the incidence of ARDS is very low when tidal volume is studied in low risk patients in the operating room (<2%). This is in contrast to the ICU, where the progression to ARDS appears to be a significant problem (as high as 44%). However, in a cohort of higher-risk surgical patients, higher tidal volumes have been associated with other clinical outcomes, including greater nonpulmonary organ failure and an increase in duration of mechanical ventilation and ICU length of stay [56].
Third, although no definitive conclusions between tidal volume and progression to ARDS can be made, based on this systematic review, several findings in this body of evidence suggest a link between higher tidal volumes and progression to ARDS. Although almost all of the data are observational trials, consistent findings across trial design suggest a cause-effect relation [57]. In the only RCT examining this topic to date, tidal volume was predictive of progression to ARDS. Additionally, the majority of the observational data demonstrate an increased ARDS incidence with larger tidal volumes, which also suggests a causal link [57]. A dose-response relation (seen in five studies), with the proportion of ARDS patients increasing with higher tidal volumes, suggests cause-effect, as does the fact that no findings appeared in the opposite direction (no study showed lower tidal volumes to be harmful).
Fourth, the development of ARDS was associated with many other factors across these trials. These include patient-related (e.g. restrictive lung disease [29]), ventilator-related (e.g. airway pressure [47]), and non ventilator-related (e.g. fluid balance and transfusion [35, 45, 47, 49]) factors. This further highlights that the development of ARDS reflects an interaction between patient risk and treatment variables, which was demonstrated before, and suggests that the most effective ARDS-prevention strategy may involve a multimodal approach (e.g. early resuscitation, fluid management and type, lower tidal volume, high transfusion threshold, and so on) [48, 53]. In addition, future ARDS-prevention trials will need to control for each of these confounding variables while assessing patient populations with similar baseline risk of progressing to ARDS.
Finally, the progression to ARDS is associated with significant increase in morbidity and mortality. In all trials directly comparing ARDS versus no-ARDS groups, mortality (up to fivefold increase), length of stay, and organ failure were all increased with the development of the syndrome. Although the best strategy to prevent the progression to ARDS has not been fully elucidated, it is clear that its prevention should be a high priority in clinical care and further research [58].
Important limitations exist in this systematic review. The only RCT was stopped early, after an unplanned interim analysis, because of safety concerns of ARDS development in the 10-ml/kg PBW group [44]. Clinical trials stopped early for benefit are increasing in prevalence, often lack information on why the trial was stopped, and routinely show larger than expected treatment effects [59]. The benefit of clinical trials stopped early, including the trial in this review, should therefore be viewed with caution. However, with 75% of the planned enrollment achieved, and a very significant between-group difference for the primary outcome (p = 0.01), confidence is increased that these results are indeed valid.
Second, relatively few studies have examined ARDS prevention and the role of tidal volume in the development of ARDS. Existing studies are limited by their observational trial design, and therefore any attempt to analyze these studies as a group is limited by their individual weaknesses.
Third, a meta-analysis of these data could not be conducted as planned a priori, which differs from another systematic review on this topic [60]. The patients were not qualitatively similar and represent a spectrum of patients from those with very little risk for ARDS (e.g. elective surgery patients) to those with very high risk (e.g. septic shock). When contemplating whether a systematic review should become a meta-analysis, heterogeneity is typically first addressed on a macroscopic level of the individual study's design, population, intervention(s), and outcome measures. If sufficient differences exist between individual studies such that lumping them together is comparing "apples and oranges," then a meta-analysis is not appropriate. Systematic review authors should proceed to meta-analysis only if this first level of heterogeneity is assessed and deemed unlikely, an approach that has been previously advocated [61]. We were therefore able to conduct only a qualitative analysis of the data, as conducting a meta-analysis would have served only to homogenize patients artificially. We recognize that these limitations make drawing recommendations difficult based on this systematic review, but with our inclusion of an additional 10 studies (and >7,000 ICU patients) and strict adherence to reporting guidelines, we believe this current review to be the most complete and methodologically sound assessment of the literature to date.
The focus on early mechanical ventilation and ARDS prevention is likely to increase. Recently the National Heart, Lung and Blood Institute (NHLBI) recommended the development of ARDS prevention trials, as well as observational trials of patients without ARDS undergoing prolonged mechanical ventilation [58]. Given the limited treatment options for ARDS, the period of mechanical ventilation immediately after endotracheal intubation is emerging as a critical time window of clinical care and an opportunity for clinical trials to improve outcome [58]. Our results are important in further highlighting knowledge gaps, which may serve in the future design of ARDS prevention trials, and not only call attention to the limitation of the literature, but also highlight potential solutions for clinical trials going forward. This includes RCTs targeting homogeneous patient groups with higher event rates for ARDS progression and early timing of trial enrollment (e.g. immediately after endotracheal intubation in the ED). Factorial trial design aimed at limiting more than one risk modifier for ARDS progression, such as tidal volume and fluid balance, should be considered to maximize efficiency in this research arena [62]. Future research should aim to minimize bias by incorporating publishing guidelines such as the Consolidated Standards of Reporting Trials (CONSORT) for RCTs and the STROBE for observational trials and should have clinically relevant end points, such as progression to ARDS or development of nonpulmonary organ failure as a surrogate for ventilator-associated lung injury [40, 63, 64]. Finally, to reduce efficiently the preventable heterogeneity and variability in research and clinical care in a sustainable fashion, interventions should be simple, and reproducibility should be enhanced with the aid of implementation science and electronic aids [65–69]. Knowledge of factors influencing a lack of adherence to beneficial therapy in ARDS may aid clinicians in translating research to routine care for prevention of the syndrome as well [65, 70]. These trials will ultimately influence clinicians and change practice. Therefore, analyzing critically what has and has not been done is of vital importance.
Currently, no definitive recommendations can be made on the most appropriate tidal volume strategy in mechanically ventilated patients without ARDS. Data suggest an increased incidence of ARDS with higher tidal volumes, but previous studies are limited by their heterogeneity and high variability in baseline ARDS risk among the patients included. Given the increased mortality and morbidity associated with progression to ARDS, a focus on prevention should remain a high priority for future research and clinical practice.
Key messages
The majority of data suggest that higher tidal volumes are causal in the development of ARDS.
An overall lack of quality data prevents a definitive recommendation for the most appropriate tidal volume in patients with ARDS.
ARDS occurs early in the course of mechanical ventilation, suggesting that ARDS-prevention trials should occur early in the course of mechanical ventilation, such as in the emergency department.
The development of ARDS is associated with significant increases in mortality and morbidity, suggesting that ARDS-prevention trials are needed.
American European Consensus Conference
acute lung injury
acute respiratory distress syndrome
Consolidated Standards of Reporting Trials
emergency department
intensive care unit
Meta-Analysis of Observational Studies in Epidemiology
National Center for Advancing Translational Sciences
National Center for Research Resources
National Heart: Lung and Blood Institute
National Institutes of Health
predicted body weight
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
randomized controlled trial
Strengthening the Reporting of Observational Studies in Epidemiology.
The authors thank Susan Fowler, medical librarian at Bernard Becker Medical Library at Washington University in St. Louis. We also thank the contacted authors of several of the manuscripts that were included and excluded in this review. Their time and generosity in responding to our inquiries is much appreciated.
Dr. Fuller acknowledges that this publication was made possible by the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through grant number UL1 TR000448. Dr. Carpenter received funding from the Washington University KM1 Comparative Effectiveness Award (1KM1CA156708-01). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Authors' Affiliations
- Rubenfeld G, Caldwell E, Peabody E, Weaver J, Martin D, Neff M, Stern E, Hudson L: Incidence and outcomes of acute lung injury. N Engl J Med 2005, 353: 1685-1693. 10.1056/NEJMoa050333View ArticlePubMedGoogle Scholar
- Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R: The American-European Consensus Conference on ARDS: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994, 149: 818-824.View ArticlePubMedGoogle Scholar
- Rubenfeld GD, Herridge MS: Epidemiology and outcomes of acute lung injury. Chest 2007, 131: 554-562. 10.1378/chest.06-1976View ArticlePubMedGoogle Scholar
- Bersten AD, Edibam C, HUNT T, Moran J: Incidence and mortality of acute lung injury and the acute respiratory distress syndrome in three Australian states. Am J Respir Crit Care Med 2002, 165: 443-448.View ArticlePubMedGoogle Scholar
- Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE: Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011, 364: 1293-1304. 10.1056/NEJMoa1011802View ArticlePubMedGoogle Scholar
- The Acute Respiratory Distress Syndrome Network: Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000, 342: 1301-1308.View ArticleGoogle Scholar
- Phua J, Stewart TE, Ferguson ND: Acute respiratory distress syndrome 40 years later: time to revisit its definition*. Crit Care Med 2008, 36: 2912. 10.1097/CCM.0b013e31817d20bdView ArticlePubMedGoogle Scholar
- The Acute Respiratory Distress Syndrome Network: Ketoconazole for early treatment of acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA 2000, 283: 1995-2002. 10.1001/jama.283.15.1995View ArticleGoogle Scholar
- The ARDS Clinical Trials Network: Randomized, placebo-controlled trial of lisofylline for early treatment of acute lung injury and acute respiratory distress syndrome Crit Care Med 2002, 30: 1-6.
- Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT: Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med 2004, 351: 327.View ArticlePubMedGoogle Scholar
- Steinberg KP, Hudson LD, Goodman RB, Hough CL, Lanken PN, Hyzy R, Thompson BT, Ancukiewicz M: Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med 2006, 354: 1671-1684.View ArticlePubMedGoogle Scholar
- Wiedemann H, Wheeler A, Bernard G, Thompson B, Hayden D, deBoisblanc B, Connors A Jr, Hite R, Harabin A, National Heart and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network: Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006, 354: 2564-2575.View ArticlePubMedGoogle Scholar
- Matthay MA, Brower RG, Carson S, Douglas IS, Eisner M, Hite D, Holets S, Kallet RH, Liu KD, MacIntyre N: Randomized, placebo-controlled clinical trial of an aerosolized beta-2 agonist for treatment of acute lung injury. Am J Respir Crit Care Med 2011, 184: 561-568.View ArticlePubMedGoogle Scholar
- Rice TW, Wheeler AP, Thompson BT, Steingrub J, Rock P: Enteral omega-3 fatty acid, γ-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA 2011, 306: 1574-1581. 10.1001/jama.2011.1435PubMed CentralView ArticlePubMedGoogle Scholar
- Esteban A, Alía I, Gordo F, de Pablo R, Suarez J, González G, Blanco J: Prospective randomized trial comparing pressure-controlled ventilation and volume-controlled ventilation in ARDS. Chest 2000, 117: 1690-1696. 10.1378/chest.117.6.1690View ArticlePubMedGoogle Scholar
- Gattinoni L, Tognoni G, Pesenti A, Taccone P, Mascheroni D, Labarta V, Malacrida R, Di Giulio P, Fumagalli R, Pelosi P: Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001, 345: 568-573. 10.1056/NEJMoa010043View ArticlePubMedGoogle Scholar
- Dellinger RP, Zimmerman JL, Taylor RW, Straube RC, Hauser DL, Criner GJ, Davis K, Hyers TM, Papadakos P: Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Crit Care Med 1998, 26: 15-23. 10.1097/00003246-199801000-00011View ArticlePubMedGoogle Scholar
- Wheeler A, Bernard G, Thompson B, Schoenfeld D, Wiedemann H, DeBoisblanc B, Connors A Jr, Hite R, Harabin A: Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006, 354: 2213-2224.View ArticlePubMedGoogle Scholar
- Perkins GD, McAuley DF, Thickett DR, Gao F: The β-Agonist Lung Injury Trial (BALTI): a randomized placebo-controlled clinical trial. Am J Respir Crit Care Med 2006, 173: 281-287. 10.1164/rccm.200508-1302OCView ArticlePubMedGoogle Scholar
- Domenighetti G, Suter PM, Schaller MD, Ritz R, Perret C: Treatment with N -acetylcysteine during acute respiratory distress syndrome: a randomized, double-blind, placebo-controlled clinical study. J Crit Care 1997, 12: 177-182. 10.1016/S0883-9441(97)90029-0View ArticlePubMedGoogle Scholar
- Abraham E, Baughman R, Fletcher E, Heard S, Lamberti J, Levy H, Nelson L, Rumbak M, Steingrub J, Taylor J: Liposomal prostaglandin E1 (TLC C-53) in acute respiratory distress syndrome: a controlled, randomized, double-blind, multicenter clinical trial. Crit Care Med 1999, 27: 1478-1485. 10.1097/00003246-199908000-00013View ArticlePubMedGoogle Scholar
- Hubmayr RD: Point: is low tidal volume mechanical ventilation preferred for all patients on ventilation? Yes. Chest 2011, 140: 9-11. 10.1378/chest.11-0825View ArticlePubMedGoogle Scholar
- Gattinoni L: Counterpoint: is low tidal volume mechanical ventilation preferred for all patients on ventilation? No. Chest 2011, 140: 11-13. 10.1378/chest.11-0827View ArticlePubMedGoogle Scholar
- Bendixen H, Hedley-Whyte J, Laver M: Impaired oxygenation in surgical patients during general anesthesia with controlled ventilation: a concept of atelectasis. N Engl J Med 1963, 269: 991. 10.1056/NEJM196311072691901View ArticlePubMedGoogle Scholar
- Hedley-Whyte J, Laver M, Bendixen H: Effect of changes in tidal ventilation on physiologic shunting. Am J Physiol: Legacy content 1964, 206: 891-897.Google Scholar
- Tobin MJ, Chadha T, Jenouri G, Birch S, Gazeroglu H, Sackner M: Breathing patterns. 1. Normal subjects. Chest 1983, 84: 202-205. 10.1378/chest.84.2.202View ArticlePubMedGoogle Scholar
- Gattinoni L, Chiumello D, Russo R: Reduced tidal volumes and lung protective ventilatory strategies: where do we go from here? Curr Opin Crit Care 2002, 8: 45-50. 10.1097/00075198-200202000-00008View ArticlePubMedGoogle Scholar
- Dreyfuss D, Soler P, Basset G, Saumon G: High inflation pressure pulmonary edema: respective effects of high airway pressure, high tidal volume, and positive end-expiratory pressure. Am J Respir Crit Care Med 1988, 137: 1159-1164.Google Scholar
- Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, Rana R, StSauver JL, Lymp JF, Afessa B: Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 2004, 32: 1817-1824. 10.1097/01.CCM.0000133019.52531.30View ArticlePubMedGoogle Scholar
- Gajic O, Frutos-Vivar F, Esteban A, Hubmayr RD, Anzueto A: Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med 2005, 31: 922-926. 10.1007/s00134-005-2625-1View ArticlePubMedGoogle Scholar
- Mascia L, Zavala E, Bosma K, Pasero D, Decaroli D, Andrews P, Isnardi D, Davi A, Arguis MJ, Berardino M: High tidal volume is associated with the development of acute lung injury after severe brain injury: an international observational study*. Crit Care Med 2007, 35: 1815. 10.1097/01.CCM.0000275269.77467.DFView ArticlePubMedGoogle Scholar
- Koner O, Celebi S, Balci H, Cetin G, Karaoglu K, Cakar N: Effects of protective and conventional mechanical ventilation on pulmonary function and systemic cytokine release after cardiopulmonary bypass. Intensive Care Med 2004, 30: 620-626. 10.1007/s00134-003-2104-5View ArticlePubMedGoogle Scholar
- Wrigge H, Zinserling J, Stüber F, von Spiegel T, Hering R, Wetegrove S, Hoeft A, Putensen C: Effects of mechanical ventilation on release of cytokines into systemic circulation in patients with normal pulmonary function. Anesthesiology 2000, 93: 1413. 10.1097/00000542-200012000-00012View ArticlePubMedGoogle Scholar
- Iscimen R, Yilmaz M, Cartin-Ceba R, Hubmayr R, Afessa B, Gajic O, Farmer J: Risk factors for the development of acute lung injury in patients with septic shock: an observational cohort study. Crit Care 2008,12(Suppl 2):P487. 10.1186/cc6708PubMed CentralView ArticleGoogle Scholar
- Kahn JM, Caldwell EC, Deem S, Newell DW, Heckbert SR, Rubenfeld GD: Acute lung injury in patients with subarachnoid hemorrhage: incidence, risk factors, and outcome. Crit Care Med 2006, 34: 196. 10.1097/01.CCM.0000194540.44020.8EView ArticlePubMedGoogle Scholar
- Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis J, Clarke M, Devereaux P, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009, 62: e1-e34. 10.1016/j.jclinepi.2009.06.006View ArticlePubMedGoogle Scholar
- Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB: Meta-analysis of observational studies in epidemiology. JAMA 2000, 283: 2008-2012. 10.1001/jama.283.15.2008View ArticlePubMedGoogle Scholar
- The ARDS Definition Task Force: Acute respiratory distress syndrome: the Berlin definition. JAMA 2012, 307: 2526-2533.Google Scholar
- Higgins J, Altman DG: Assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series. Edited by: Green JHaS. Chichester, UK: John Wiley & Sons; 2008.View ArticleGoogle Scholar
- Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull WHO 2007, 85: 867-872.PubMed CentralPubMedGoogle Scholar
- Sterne J, Egger M, Smith G: Investigating and dealing with publication and other biases. In Systematic Reviews in Health Care: Meta-analysis in Context. 2nd edition. Chatham, UK; 2001.Google Scholar
- Blum J, Stentz M, Park P: Predictors of postoperative acute lung injury in a low incidence surgical population [abstract]. Anesthesiology 2011, 115: A790.View ArticleGoogle Scholar
- Hughes CG, Weavind L, Banerjee A, Mercaldo ND, Schildcrout JS, Pandharipande PP: Intraoperative risk factors for acute respiratory distress syndrome in critically ill patients. Anesth Analg 2010, 111: 464-467. 10.1213/ANE.0b013e3181d8a16aView ArticlePubMedGoogle Scholar
- Determann RM, Royakkers A, Wolthuis EK, Vlaar AP, Choi G, Paulus F, Hofstra JJ, de Graaff MJ, Korevaar JC, Schultz MJ: Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial. Crit Care 2010, 14: R1. 10.1186/cc8230PubMed CentralView ArticlePubMedGoogle Scholar
- Fernández-Pérez ER, Sprung J, Afessa B, Warner DO, Vachon CM, Schroeder DR, Brown DR, Hubmayr RD, Gajic O: Intraoperative ventilator settings and acute lung injury after elective surgery: a nested case control study. Thorax 2009, 64: 121. 10.1136/thx.2008.102228View ArticlePubMedGoogle Scholar
- Pasero D, Guerriero F, Rana N, Merigo G, Mastromauro I, Viberti S, Mascia L, Rinaldi M, Ranieri M: High tidal volume as an independent risk factor for acute lung injury after cardiac surgery [abstract]. Intensive Care Med 2008,34(Suppl 1):398.Google Scholar
- Jia X, Malhotra A, Saeed M, Mark RG, Talmor D: Risk Factors for ARDS in patients receiving mechanical ventilation for >48 h. Chest 2008, 133: 853-861. 10.1378/chest.07-1121View ArticlePubMedGoogle Scholar
- Yilmaz M, Keegan MT, Iscimen R, Afessa B, Buck CF, Hubmayr RD, Gajic O: Toward the prevention of acute lung injury: protocol-guided limitation of large tidal volume ventilation and inappropriate transfusion*. Crit Care Med 2007, 35: 1660. 10.1097/01.CCM.0000269037.66955.F0View ArticlePubMedGoogle Scholar
- Plurad D, Martin M, Green D, Salim A, Inaba K, Belzberg H, Demetriades D, Rhee P: The decreasing incidence of late posttraumatic acute respiratory distress syndrome: the potential role of lung protective ventilation and conservative transfusion practice. J Trauma 2007, 63: 1. 10.1097/TA.0b013e318068b1edView ArticlePubMedGoogle Scholar
- STROBE Statement:Strengthening the reporting of observational studies in epidemiology. [http://www.strobe-statement.org/index.php?id=strobe-endorsement]
- von Elm E, Altman D: Reporting guidelines: looking back from the future. Chest 2008, 134: 682-684. 10.1378/chest.08-1671View ArticlePubMedGoogle Scholar
- Plint A, Moher D, Morrison A, Schulz K, Altman D, Hill C, Gaboury I: Does the CONSORT checklist improve the quality of reports of randomised controlled trials? A systematic review. Med J Australia 2006, 185: 263-267.PubMedGoogle Scholar
- Gajic O, Dabbagh O, Park P, Adesanya A, Chang SY, Hou P, Anderson III H, Hoth JJ, Mikkelsen ME, Gentile N: Early identification of patients at risk of acute lung injury. Am J Respir Crit Care Med 2011, 183: 462-470. 10.1164/rccm.201004-0549OCPubMed CentralView ArticlePubMedGoogle Scholar
- Sagarin M, Barton E, Chng Y, Walls R, National Emergency Airway Registry Investigators: Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med 2005, 46: 328-336. 10.1016/j.annemergmed.2005.01.009View ArticlePubMedGoogle Scholar
- Checkley W, Brower R, Korpak A, Thompson BT: Effects of a clinical trial on mechanical ventilation practices in patients with acute lung injury. Am J Respir Crit Care Med 2008, 177: 1215-1222. 10.1164/rccm.200709-1424OCPubMed CentralView ArticlePubMedGoogle Scholar
- Lellouche F, Dionne S, Simard S, Bussières J, Dagenais F: High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery. Anesthesiology 2012, 116: 1072. 10.1097/ALN.0b013e3182522df5View ArticlePubMedGoogle Scholar
- Hill AB: The environment and disease: association or causation? Proc R Soc Med 1965, 58: 295.PubMed CentralPubMedGoogle Scholar
- Spragg R, Bernard G, Checkley W, Curtis J, Gajic O, Guyatt G, Hall J, Israel E, Jain M, Needham D, Randolph A, Rubenfield G, Schoenfield D, Thompson B, Ware L, Young D, Harabin A: Beyond mortality: future clinical research in acute lung injury. Am J Respir Crit Care Med 2010, 181: 1121-1127. 10.1164/rccm.201001-0024WSPubMed CentralView ArticlePubMedGoogle Scholar
- Montori V, Devereaux P, Adhikari N, Burns K, Eggert C, Briel M, Lacchetti C, Leung T, Darling E, Bryant D: Randomized trials stopped early for benefit: a systematic review. JAMA 2005, 294: 2203. 10.1001/jama.294.17.2203View ArticlePubMedGoogle Scholar
- Neto AC, Manetta JA, Pereira VGM, Esposito DC, Damasceno MCT, Schultz MJ: Association between use of lung protective ventilation with lower tidal volumes and clinical outcomes among patinets without acute respiratory distress syndrome. JAMA 2012, 308: 1651-1659. 10.1001/jama.2012.13730View ArticleGoogle Scholar
- Thompson S: Why sources of heterogeneity in meta-analysis should be investigated. BMJ 1994, 309: 1351-1355. 10.1136/bmj.309.6965.1351PubMed CentralView ArticlePubMedGoogle Scholar
- Montgomery AA, Peters TJ, Little P: Design, analysis and presentation of factorial randomised controlled trials. BMC Medical Res Methodol 2003, 3: 26. 10.1186/1471-2288-3-26View ArticleGoogle Scholar
- Schulz K, Altman D, Moher D, for the CONSORT Group: CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med 2010, 152: 726-732.View ArticlePubMedGoogle Scholar
- Equator Network[http://www.equator-network.org/index.aspx?o=1032]
- Needham DM, Colantuoni E, Mendez-Tellez PA, Dinglas VD, Sevransky JE, Himmelfarb CRD, Desai SV, Shanholtz C, Brower RG, Pronovost PJ: Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ 2012, 344: e2124. 10.1136/bmj.e2124PubMed CentralView ArticlePubMedGoogle Scholar
- Morris AH, Orme J Jr, Truwit JD, Steingrub J, Grissom C, Lee KH, Li GL, Thompson BT, Brower R, Tidswell M: A replicable method for blood glucose control in critically ill patients. Crit Care Med 2008, 36: 1787-1795. 10.1097/CCM.0b013e3181743a5aView ArticlePubMedGoogle Scholar
- Morris AH, Orme J Jr, Rocha BH, Holmen J, Clemmer T, Nelson N, Allen J, Jephson A, Sorenson D, Sward K: An electronic protocol for translation of research results to clinical practice: a preliminary report. J Diabetes Sci Technol (Online) 2008, 2: 802.View ArticleGoogle Scholar
- Blagev DP, Hirshberg EL, Sward K, Thompson BT, Brower R, Truwit J, Hite D, Steingrub J, Orme JF, Clemmer TP: The evolution of eProtocols that enable reproducible clinical research and care methods. J Clin Monitor Comput 2012, 26: 305-317. 10.1007/s10877-012-9356-yView ArticleGoogle Scholar
- Pronovost PJ, Murphy DJ, Needham DM: The science of translating research into practice in intensive care. Am J Respir Crit Care Med 2010, 182: 1463-1464. 10.1164/rccm.201008-1255EDView ArticlePubMedGoogle Scholar
- Walkey AJ, Wiener RS: Risk factors for underuse of lung-protective ventilation in acute lung injury. J Crit Care 2012, 27: 323, e1-323.e9.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
Construction on The Irish Cultural Center's Research Library Delayed After Death of General Contractor
Officials behind the scenes at the Irish Cultural Center announced today that the construction of its new research library will be delayed due to the recent death of a "key figure" involved in the project.
Ahern says that Double AA Builders of Scottsdale will now oversee the project. The 15,000-square-foot research library, originally scheduled to be completed in January, will house more than 6,000 books and be used for those of Irish descent to research their genealogy.
While Ahern says that a revised timetable for the building's opening hasn't been determined, he's hoping that "the library will be substantially complete by Saint Patrick's Day" in time for the center's annual festival and parade.
"It won't be done by then, but it should look like a library," Ahern says.
Related Location
1106 N. Central Ave.
Phoenix, AZ 85004
Get the Arts & Culture Newsletter
Find out about upcoming performances, exhibitions, openings and special events happening in the Phoenix art and theater scene.
In Case You Missed It
Upcoming Events
Colin & Brad
TicketsFri., Mar. 3, 7:30pm
It's So Learning
TicketsSat., Mar. 4, 7:00pm
Brian Regan
TicketsSat., Mar. 4, 8:00pm
"Photograph 51"
TicketsThu., Mar. 2, 7:30pmpowered by goldstar
Sponsor Content


text:
Loure(tm) Tumbler Decorative accessories in the bathroom not only add functionality, but also offer a means to bring design cohesiveness and personal style to the space. Loure accessories offer a...More
Find, Compare, Read Reviews & Buy the Kohler K-11598-FRG Frosted Glass Loure Loure Tumbler K-11598 Online @ Yahoo Shopping Want to see your products in Yahoo Shopping? Advertise with us. Sitemap All Brands
Terms | Privacy | About Our Ads | Help


text:
Is this you? Claim your profile today!
Gabriel Martinez
Gabriel Martinez is a professional in the game industry.
Voice Acting Roles ( 1 )
Grand Theft Auto IV (2008) ()
|Voiced character
|Referenced in end credits as
|The Crowd of Liberty City
|Gabriel Martinez - The Crowd of Liberty City
Last updated on


text:
Reviewed By Brian P (Tucson, AZ) Reviewed for a 1994 Isuzu Rodeo —5/20/2009 9:09 AM
It plugs in and the adhesive pad holds it in place with a wire tie to help. Took less than 1 minute to put on the vehicle.
Reviewed By Wilbur T (GREAT FALLS, MT) Reviewed for a 1978 Ford F-250 —11/14/2016 9:50 AM
My truck already has a 4-way flat, so this made the installation easier and cleaner. Splicing into wires is a necessary evil at times and this avoids that unpleasantness. The bracket needed a small bend to allow the door to open all the way so the plug-in will fit. This is the one with the LED lights that indicate which pins are working, but I wish I had purchased a separate tester instead. One LED light always stays on. Battery drain isn't a concern, but unnecessarily attracting attention is.
Isuzu Rodeo LS Hitch Wiring
Isuzu Rodeo LSE Hitch Wiring
Isuzu Rodeo S Hitch Wiring


text:
Top Linksmain detailsbiographyby votesphoto galleryquotes
Filmographiesby yearby typeby ratingsby votesby TV seriesby genreby keyword
Did You Know?photo galleryquotes
Guy Germaine (Character)
from The Mighty Ducks (1992)
|Photos (See all 8 | slideshow)
FilmographyEdit Credits
- D3: The Mighty Ducks (1996) Played by Garette Ratliff Henson
- D2: The Mighty Ducks (1994) Played by Garette Ratliff Henson
- The Mighty Ducks (1992) Played by Garette Ratliff Henson
Additional Details
Plot Keywords:
Fun Stuff
[the kids aren't thrilled about being named the Ducks]
Gordon Bombay: I didn't have a choice, we're being sponsored.
Les Averman: By who, Donald and Daisy?
Gordon Bombay: Hey, you don't wanna be Ducks? You'd rather be District Five? Some stupid number?
Peter Mark: Better than some stupid animal.
Gordon Bombay: I'll have you know, Peter, that the Duck is one of the most noble, agile and intelligent creatures in the animal kingdom.
Connie Moreau: But they're wimpy!
Guy Germaine: They don't even have teeth.
Gordon Bombay: Neither do hockey players. Have you guys ever seen a flock of ducks flying in perfect formation? It's beautiful. Pretty awesome the way they all stick together. Ducks never say die. Ever seen a duck fight? No way. Why? Because the other animals are afraid. They know that if they mess with one duck, they gotta deal with the whole flock. I'm proud to be a Duck, and I'd be proud to fly with any one of you. So how about it? Who's a Duck?
Fulton Reed: [pause] I'll be a duck.
See more »
You may correct errors and omissions on this page directly. Clicking the 'Update' button will take you through a step-by-step process.