text:
New Mexican Refried Beans
|3 (Thick Cut, Homestyle)
|1⁄2 Bunch (50 gm) (Or 1 Medium)
|Minced garlic
|2 Tablespoon
|Pinto beans
|2 Cup (32 tbs) (With Liquid)
|Freshly ground pepper
|To Taste
|Grated monterey jack cheese
|1⁄4 Cup (4 tbs)
|Grated monterey cheddar cheese
|1⁄4 Cup (4 tbs)
|To Taste
1) Cube bacon into 1/2-inch squares.
2) Chop scallions to measure 1/4 cup plus 2 tablespoons.
3) Line serving plates with paper towels.
4) In large heavy skillet cook bacon over medium heat stirring for 5 minutes. Shift bacon to plate.
5) To the skillet, mix 1/4 cup scallions and garlic and saute over medium heat until till golden.
6) Mix beans and liquid and stir. With potato masher or back of spoon mash beans till liquid is absorbed. 7) Stir in bacon, salt and pepper.
8) Put beans to medium-size serving bowl and sprinkle grated cheese and remaining scallions on top.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size: Complete recipe
Calories 1680 Calories from Fat 288
% Daily Value*
Total Fat 36 g55.4%
Saturated Fat 17.8 g89.2%
Trans Fat 0 g
Cholesterol 101.7 mg33.9%
Sodium 1119.2 mg46.6%
Total Carbohydrates 237 g79%
Dietary Fiber 57.4 g229.5%
Sugars 9 g
Protein 103 g206.2%
Vitamin A 29.4% Vitamin C 69%
Calcium 114.1% Iron 108.8%
*Based on a 2000 Calorie diet


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Which Joe gave his name to 'sloppy joes'? We look at five interesting sandwiches and their lexical origins.
Definition of electrolysis in English:
Chemical decomposition produced by passing an electric current through a liquid or solution containing ions.
- 'This is related to their behavior during electrolysis where the ions move to the two opposite electrodes.'
- 'During electrolysis an anion is attracted to the anode (positive electrode).'
- 'Perhaps the best known example of electrolysis is the electrolytic decomposition of water to produce hydrogen and oxygen.'
- 'The technique that he developed, electrolysis of potassium fluoride in anhydrous liquid hydrogen fluoride, is still used today, with some modifications.'
- 'The free element sodium was first produced in 1807 by the English chemist Humphry Davy by electrolysis of molten sodium hydroxide.'
2The removal of hair roots or small blemishes on the skin by the application of heat using an electric current.
- 'It is appropriate to institute permanent methods of hair removal by way of electrolysis or laser ablation after suppression of hyperandrogenism has been achieved.'
- 'We also refer patients for mechanical control measures of hair growth including electrolysis and laser therapy.'
- 'However, electrolysis is considered to be a permanent method of hair removal.'
- 'It's relatively cheap compared to electrolysis and laser hair removal.'
- 'They don't get rid of hair forever; you'd need to get electrolysis or laser hair removal for that.'
Further reading
6 punctuation marks you might be using incorrectlyRead more
We take a look at several popular, though confusing, punctuation marks.
An A-Z of country name originsRead more
From Afghanistan to Zimbabwe, discover surprising and intriguing language facts from around the globe.
How brothers became buddies and brosRead more
The definitions of 'buddy' and 'bro' in the OED have recently been revised. We explore their history and increase in popularity.

subset: commoncrawl


text:
- Home
- Accommodation
- See & Do
- What's On
- Dining Out
- Canterbury District
- Plan My Visit
The Marlowe Theatre Box Office
01227 787787
The Friars,
|Tue 28 Feb
|Andy Zaltzman: Plan Z
|Tue 28 Feb - Sat 4 Mar
|Million Dollar Quartet
|Fri 3 Mar
|The Monstrum
|Sat 4 Mar
|The Monstrum
|Mon 6 - Sat 11 Mar
|The Curious Incident Of The Dog In The Night-Time
|Fri 10 Mar
Peter James' Not Dead Enough. Three murders, one suspect, no proof.
Following the huge sell-out success of The Perfect Murder and Dead Simple, the thrilling work of multi-million selling author Peter James returns with the world premiere production of Not Dead Enough.
On the night Brian Bishop murdered his wife, he was 60 miles away, asleep in bed. At least that's what he claims. But as Detective Superintendent Roy Grace continues to deal with the mysterious disappearance of his own wife, he starts to dig a little deeper into the chilling murder case and it soon becomes clear that love can be a dangerous thing...
Olivier Award winner Ian Talbot directs Not Dead Enough – the third novel in Peter James' award-winning Roy Grace series and the third play in his box office smash hit and critically-acclaimed stage franchise.
Contains adult themes.
|Mon 10 - Sat 15 Apr 2017
TICKETS (bkg fees apply*)
Fri & Sat performances:
Premier Seats: £34
£29.50, £27.50, £24.50, £22.50
Mon-Thu performances:
Premier Seats: £32
£27.50, £24.50, £22.50, £19.50
Concessions: £2 off Price Band A & B (Mon-Wed)
The Marlowe Friends: £5 off top three prices (Mon-Thu)
Discovery Tickets (for 16-26yrs & full-time students): £10 (Tue & Wed, limited availability, price includes bkg fee)
Groups: Bring 10 or more people and get 10% off. Bring 25 or more people and get 15% off
*Booking Fees Apply. By phone & in person: £1 per ticket booking fee. Online: 75p per ticket booking fee. The Marlowe Friends: 75p per ticket booking fee (by phone, in person & online). The maximum fee you will be charged when booking by phone or in person is £8. Booking fees are unlimited online.
An extra charge of £1 applies if you would also like your tickets posted. Marlowe Friends do not pay a postage charge. There is no booking fee made for group bookings of 15 tickets or more or customers with access needs, when booking by phone or in person.
Centre of Canterbury, nearest car park is Pound Lane. Disabled parking on forecourt.
: 2 miles from Canterbury West station


text:
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Asian Cards
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(011) 26933903 9811521597 www.asiancardsindia.com
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text:
Peppers Gallery Hotel, Canberra
- Free WiFi
Main amenities
- 85 smoke-free guestrooms
- Restaurant and bar/lounge
- Breakfast available
- Fitness centre
- Self parking
- Spa services
- Business centre
- 24-hour front desk
- Air conditioning
- Daily housekeeping
- Garden
- Lobby fireplace
For families
- Cribs/infant beds (surcharge)
- Rollaway/extra beds (surcharge)
- Refrigerator
- Private bathroom
- Free toiletries
- Garden
What's around
- In Northern Canberra
- National Museum of Australia (1 mi / 1.6 km)
- Old Parliament House (1.5 mi / 2.4 km)
- Australian National Botanic Gardens (1.6 mi / 2.6 km)
- National Gallery of Australia (1.7 mi / 2.7 km)
- Australian War Memorial (1.8 mi / 2.9 km)
Peppers Gallery Hotel, Canberrafrom £85
- Deluxe Room - Stay 2 Nights and Save 15%
- Deluxe Room with Breakfast
- Premier Room - Book Early and Save 15%
- Premier Room - Stay 3 Nights and Save 20%
- Deluxe Room - Book Early and Save 10%
- Apartment, 3 Bedrooms
- Premier Room, Bathtub
- Premier Room
- Deluxe Room
- Deluxe Room
- Deluxe Room
- Hotel Room
- Deluxe Room
- Deluxe Room, Bathtub
- Apartment, 3 Bedrooms
- Apartment, 2 Bedrooms
- Apartment, 1 Bedroom
- Peppers Suite
- Premier Room with Bath
- Premier Room
- Deluxe Room with Bath
- Apartment, 2 Bedrooms
- Shoebox
- Apartment, 1 Bedroom
- Suite (Diamant)
- Apartment, 1 Bedroom
- Room, 1 Extra large Double Bed
- Premier Room - Floriade Package
- Deluxe Room + 2 Tickets to Gold and the Incas Exhibition
- Apartment, 3 Bedrooms
- Apartment, 2 Bedrooms
- Room, 1 Large Double Bed
- Standard Room
More great choices
At a glance
Key facts
Hotel size
- This hotel has 85 rooms
- This hotel is arranged over 2 floors
- Check-in time starts at 3 PM
- Check-out time is 11 AM
Required at check in
- Credit card or cash deposit required
- Government-issued photo ID required
- Minimum check-in age is 18
Travelling with others
- Pets not allowed
- Free WiFi in public areas
- Free WiFi and wired Internet access in rooms
- Self parking (limited) *
Other information
- Smoke-free property
Nearby Four Star Canberra hotels
In the hotel
- Continental breakfast (surcharge)
- Restaurant
- Bar/lounge
- Room service (during limited hours)
- Fitness facilities
- Spa services on site
- Spa treatment room(s)
- Free use of nearby fitness center
- Business center
- Number of meeting rooms - 2
- 24-hour front desk
- Tours/ticket assistance
- Elevator/lift
- Garden
- Fireplace in lobby
- Accessible bathroom
- In-room accessibility
- Roll-in shower
In the room
- In-room climate control (air conditioning)
- Air conditioning
- Minibar
- Coffee/tea maker
- Slippers
- Iron/ironing board
- Blackout drapes/curtains
- Private bathroom
- Rainfall showerhead
- Shower only
- Free toiletries
- Hair dryer
- 27-inch plasma TV
- Digital TV channels
- MP3 docking station
- DVD player
- Desk
- Free newspaper
- Free WiFi
- Phone
- Refrigerator
- Daily housekeeping
- In-room safe
Top Canberra hotels
Recently reviewed hotels in Canberra
- Sundown Motel ResortFrom
"LOVELY HOTEL QUITE LOCATION LARGE ROOMS. IDEAL LOCATION FOR VISITING CANBERRA AND SURROUNDING AREAS"Jan 15, 2017
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"Not happy with limited internet cover provided --/limited data"Nov 20, 2016
- The Pommy TreeFrom
"A little way out of Canberra but it's certainly worth being in the suburbs to stay here. The owners are warm and welcoming and the cooked breakfast in the morning is certainly…"Nov 20, 2016
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"Stayed for three nights and enjoyed the surrounding attractions which were walkable, even the Mint. Plenty of restaurants and bars to choose from within walking distance."Nov 19, 2016
Nearby hotels
Also popular with travellers from the UK
Special features
DiningBicicletta Restaurant – This restaurant specialises in Italian cuisine and serves breakfast and dinner. Guests can order drinks at the bar and enjoy al fresco dining (weather permitting). Reservations are required.
Peppers Gallery Hotel, Canberra's small print
Also known as
- Peppers Gallery Hotel Canberra
- Peppers Gallery Canberra
- Peppers Gallery
- Peppers Gallery Hotel
- Peppers Gallery Canberra
- Peppers Gallery
- Hotel Diamant Boutique
- Diamant Hotel Canberra - By 8 Canberra
- Diamant Boutique Canberra
- Peppers Gallery Hotel Canberra
- Peppers Gallery Hotel
Guests must contact this hotel in advance to reserve onsite parking. Contact the office using the information on the reservation confirmation received after booking.
This property's policy is to refuse certain bookings for the purpose of group events or parties, including pre-wedding stag and hen parties.
Parking height restrictions apply.
Optional extras
Self parking is available for an extra charge
Rollaway beds are available for AUD 50 per night
Continental breakfast is offered for an extra charge of AUD 20 for adults and AUD 20 for children (approximately)
Cribs/Infant beds are available for AUD 10 per night
We have included all charges provided to us by this hotel. However, charges can vary, for example, based on length of stay or the room you book.
Recent reviews
Excellent 4.1 /5 from 342 reviews
Nice updated hotel, plenty of restaurants onsite and in the surrounding area. Free wifi and central location in Canberra.
We got a great deal on this place... But it was a rough start when they put us in a lower room looking onto a street. They wouldn't move us or give us two beds until I paid for an upgrade. It was OK after that, but probably would try others next time.
We booked parking, which is at a neighboring location, so we had to unload in the foyer. There was no parking in front of the hotel as the drive through area, was filled with parking. No assistance was offered to unload luggage. So not a good start. Room was nice and has a great bathroom, with bath and rainfall shower. However Room 126 was opposite the housekeeping cupboard, so despite having a late checkout, we were awoken to knocking of housekeeping on the rooms next door.
A good stay. Small room but clean and good decor. Nice bathroom.
Great bed and shower, nice toiletries and lounge but shower stall needing a bit more cleaning, hallways dark and tired. Restaurant great, lovely setting. Nice staff and entrance area
Is the description of this hotel not correct? Tell us


text:
Forbidden love seems to be the theme of this edition of "True Blood" news bites – onscreen and off. Check out the latest news headlines and a couple sneak peek clips that will make you scream, "Waiting sucks!"
- Sam Trammell has crush on 'True Blood' make-up artist [ContactMusic.com]
- Fresh 'Blood': Meet the new addition to Merlotte's main menu [New York Post]
- HBO's 'True Blood' ad for apps video [Wall Street Journal]
Note: Spoilers below!
- HBO released the finale episode description. [Press Release]
Episode #36: "Evil Is Going On" (season finale)
Debut: SUNDAY, SEPT. 12 (9:00-10:00 p.m. ET/PT)
Eric (Alexander Skarsg�rd) grapples with his conscience while plotting his perfect revenge against Russell (Denis O'Hare). Fed up with being "vampire crack," Sookie (Anna Paquin) considers a new life without Bill (Stephen Moyer) – or any other vampire. Tara (Rutina Wesley) discovers some surprising news about Sam (Sam Trammell), whose rage resurfaces upon learning of Tommy's (Marshall Allan) latest transgression. Jason (Ryan Kwanten) finds a new calling after warning Crystal's (Lindsay Pulsipher) family about an impending drug raid. Plagued by visions, Lafayette (Nelsan Ellis) turns to Jesus (Kevin Alejandro) for help, and learns his boyfriend has more to offer than companionship. Hoyt (Jim Parrack) hopes for a future with Jessica (Deborah Ann Woll), spurning Maxine's (Dale Raoul) pleas to wed Summer (Melissa Rauch).
Written by Alan Ball; directed by Anthony Hemingway
- Sneak peaks for Sunday's (August 8) episode, "Night On The Sun." [HBO.com]
Follow Zap2it and TheRealJethro on Twitter and Zap2it on Facebook for the latest TV, movie and celebrity news.
Video credit: HBO


text:
This is your resource to discuss support topics with your peers, and learn from each other.
Hi people,
working on widget javascript extension, I'm trying to execute some javascript from Java side, and it's ok.
In particular, I'm trying to load this javascript from a file.
In my class extension.example.loader.SampleExtension try to load the file javascript.js which is located under the same package (extension.example.loader) using getResourceAsStream:
This operation returning a null InputStream.
Is there any issue about compiling? Does widget packager remove not code file?
Thank you very much!
Hi Scarex,
You may want to take a look at the source code for the widget templates. It should give you an idea on how we are pulling out the embedded resources.
The full source code for the widget templates is in a "device_templates" directory in the Widget SDK install dir. This is the full Java Code that gets wrapped around BrowserField and runs a widget.
Thanks tneil,
I looked in the code for a solution to my problem, but according to my understanding the found method (which use BrowserFieldRequest obejct) is related to resource packed in the widget itself (it should be declared in config.xml).
What I need is to load a text file attached to java sources used to compile the javascript extension; in other words I put this file in the source code under device_template folder trying to load it at runtime from java code.
Probably this is not possible...
Thank you very much.
Yeah.. I don't think you will be able to include it as a resource the way you are trying.
You may have to simply include the contents of the .js file in a string variable in your code. Not nearly as flexible that way, but it may be your only option.


text:
There is no doubt the auto forward spy has provided the consumer market with more than was expected with the cell phone spy software. The auto forward has been in the market for more than 5 years and there with no say, has provided the best to the needs of the consumer. So many are the times that consumers have limited the functions of the cell phone monitoring software, this could be a disputable topic in the consumer market because truly some of the cell phone monitoring software have functions that are either limited to the internet monitoring of just call and message forwarding. Look at the net nanny. Although vary competitive, simple cheap and easy to use, it is very relevant to the parents whose monitoring is limited to online activities but may not do so much to those that may want to monitor all the cell phone activities including texts and photos.
What the auto forward gives its consumers is more than the internet monitoring. It has surely gone beyond the text and call monitoring. In the current generation where the technology is controlling its creator the human being; the children are exposed to too much that influences their lives both positively and negatively. Therefore parents also should be very vigilant in their monitoring so as to bring up a generation that can be leaders and that which can be look upon by the coming generations. A scholar once said that the parents are the makers of tomorrow's world and this is obviously true. The auto forward therefore give the parents and the interested persons more than just the ordinary.
Talk about the remote locking and installation. What does it mean? This simply means that you can monitor in every way without having the targeted phone. The remote installation will enable you to install the software in the targeted phone without having it or without them knowing because there is no physical; contact with the phone. Talking about the remote blocking, this is a feature that will make you appreciate the auto forward spy. This feature will enable the consumer to block any person or site that the targeted person is accessing yet may not be of befit to them. Talk about the pornographic site, the contacts of predators and others that may cause more harm than good to the targeted person.
The stealth camera that secretly takes photos of the targeted person and their surrounding is another additional feature that the auto forward spies have more than the other spy software. After these pictures are taken secretly and are forwarded to your phone, you can be sure that you will never miss any photo that is taken by the targeted phone. The picture and videos that were taken previously can also be forwarded to your cell phone that may be used as very important information.
Another additional feature that gives the auto forward more advantage than the spy software is the GPS location. This gives you more than just the texts and the internet monitoring by allowing the consumer to locate the place where the phone holder is. It gives you an opportunity to be able to monitor the movements of the targeted person. In such situations where the child or the targeted person is sneaking out, the GPS location is the best feature that the auto gives you that will help you know where they are.
Those are just but a few not mentioning the browser history that although is leaned to the internet gives you more as it can forward the conversations and allows you to block the unwanted site in the targeted person's phone.


text:
Alan Gilbert Conducts Bach's B Minor Mass
Thursday, April 17, 2014
Alan Gilbert conducts Bach's Mass in B minor with soprano Dorothea Röschmann, mezzo-soprano Anne Sofie von Otter, tenor Steve Davislim, bass-baritone Eric Owens, and the New York Choral Artists directed by Joseph Flummerfelt. This performance was part of The Bach Variations: A Philharmonic Festival in 2013.
Program details:
J.S. Bach: Mass in B-minor
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Common Places.Editions Rodopi 2011; US$ 84.50
While a great deal of postcolonial criticism has examined how the processes of hybridity, mestizaje, creolization, and syncretism impact African diasporic literature, Oakley employs the heuristic of the commonplace to recast our sense of the politics of such literature. Her analysis of commonplace poetics reveals that postcolonial poetic... more...
Hello Darling!Allen & Unwin 2006; US$ 34.53
The definitive biography of one of Australia's best loved stars of stage and screen, the fabulous and inimitable Jeanne Little. more...
Anne Frank TRGSaddleback Publishing 2008; US$ 10.95
Born in Germany in 1929, Anne Frank was a teenager during World War II. Because Anne was from a Jewish family, she and her family were forced to escape the terror of the Holocaust that swept the continent. Beginning in 1942, Anne kept a diary of the difficult journey of her family. See how Annes family tried to escape the horror of war, and how... more...
Strenthening Crisis Prevention Through Early Warning SystemsInternational Labour Office 2005; US$ 5.00
Focuses on ways of coping with socio-economic and employment challenges of responding to crises arising from natural disaster, man-made catastrophe, or war. Reports on best practices and new avenues for crisis response and early warning, with examples from 14 developing countries around the world. more...
NS-Raubgut, Reichstauschstelle und Preussische StaatsbibliothekDe Gruyter 2008; US$ 68.95
The book describes the control exercised by the National Socialist state over academic libraries and analyses their collaboration, in particular in the theft of books and the identification of 'Enemies of the Reich'. In addition, it deals with aspects of the identification and restitution of books stolen and confiscated between 1933 and 1945.... more...
In the Shadow of the Rising SunMarshall Cavendish International (Asia) Ptd Ltd 2010; US$ 11.19
When Mary Thomas left the shores of England for Singapore in December 1939 to live a leisurely life of an Englishwoman in a colonial outpost, she did not expect to soon find her circumstances greatly changed. After the Japanese bombs fell on 8 December 1941, Mary chose not to rush for the first boat out of Singapore and instead stayed on to serve in... more...
A Lucky ChildProfile Books 2010; US$ 6.65
Thomas Buergenthal is unique. Liberated from the death camps of Auschwitz at the age of eleven, in adulthood he became a judge at the International Court in The Hague. In his honest and heartfelt memoirs, he tells the story of his extraordinary journey - from the horrors of Nazism to an investigation of modern day genocide. Aged ten Thomas Buergenthal... more...
Les six mois qui ont ébranlé le mondePresses de l''niversite du Quebec 1991; US$ 24.75
Comment marier l'ancien et le nouveau ? - Gorbatchev a-t-il encore une importance essentielle pour l'avenir de la politique étrangère soviétique ? - L'URSS et l'Europe de l'Est en 1989-1990 - Europe de l'Est : ensemble ou chacun tous azimuts ? - Chronologie des événements en Europe de l'Est et en... more...
Saint PraftuGrosvenor House Publishing 2011; US$ 6.20
Part 1 of 'Saint Praftu' describes the author's early childhood in India, his wartime service in the RAF, and twenty years of civil flying in Burma, India and Nepal. At one period during the War, he belonged to the select group of pilots who undertook the hazardous operation of flying Lysanders to France at night during the moon periods, to land and... more...
Prison Break - True Stories of the World's Greatest EscapesJohn Blake Publishing 2012; US$ 5.99
In the folklore of World War II, the memory of those heroes who staged 'Great Escapes' from POW camps still endures. But what of the other side of the coin: the villains and jack-the-lads who painstakingly plan their escapes and await their moment at great personal risk? For the first time, Prison Break, tells the stories of all the most ruthless and... more...


text:
Who Do I See?
Looking into the mirror, behind the wrinkles and aged eyes, I can almost make out the happy young man I used to be. The man who was ignorant to pain and oblivious to how cruel and unfair the world really is. Back then, I thought my life would be so much different. I never expected to end up alone and unimportant.
My life doesn't really have any meaning any more. Everyone who has been affected by me is dead and gone by now. My war time had the most affect on me, however. That is when I really lived. When I really had a life.
Enlisting, I thought I was doing the best thing for my country, and myself. I always pictured myself as a war hero. World War Two was worse than I had imagined, though. The front lines were dangerous and the living conditions were rough. I watched so many of my fellow soldiers die those first two months there that I never even tried to become friends with anyone there again.
The worst memory from there, however, didn't have anything to do the guns or the heat. It was of an explosion, and a girl. This girl worked in the town I was stationed near and for months we saw each other. She was the most beautiful woman I had ever laid my eyes on. We were dating and she was intending on coming back to the states with me when my time was up. But then the bomb was dropped.
The explosion wasn't a large one. It blew up half of the town, but that was nothing compared to what could have happened. I saw the planes coming over and tried to run to her in time to warn her and save her. But the bomb dropped just before I made it. She was killed instantly, and my leg was almost taken off from the blast. I spent months in rehab and never fully regained the use of it, but it's still there at least.
But Elizabeth, poor Elizabeth, she never got the promise of a better life. She died right there in that little town at the young age of twenty-five. I loved that girl and, though I tried, I never found anyone else like her. So I stayed single for my whole life.
For a while there when I came back, I had a dark stage. I just couldn't see myself going on. I had no love and I couldn't even walk anymore. This was not the life I had expected. I was no war hero, just an old man with a bum leg with a war story, and those were a dime a dozen.
I drank way too much way too often. I would go out to bars and get so drunk I was blind. I don't even remember most of my time after the war. The years that followed were lost in a drunken haze that I called my life.
Now, I am rotting away in a nursing home. The pain comes every day and my liver is failing from my alcoholic days. I take so much medicine, I feel like nothing in my body works on its own. I am a waste of a life. I left no great thing for the future generation, I have no family living to come visit me and all of my friends here are dying off slowly.
Looking in the mirror, I see the sad life for the last time. I reach for the pain pills by the sink and take a few. Then a few more. And a few more. No amount seems to be efficient to get rid of the pain. After a little while, though, I see the world around me getting darker. It's no longer the cruel pathetic thing I once thought it was. Even though I know I am caught up in a drug haze, I like it. This is a nice way to go out, painless for once.
I feel my legs go weak and myself falling, I hope someone will find my body soon. I hope my funeral is nice, maybe one or two people will show. Maybe someone will miss me.
© Copyright 2017 PeaceLoveLingleton. All rights reserved.
Status: Finished
Genre: Literary Fiction
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I will just let you read this and come to your own conclusion…BUT it is scary when someone grabs you and you are not sure what their intention is…HMMMM lose lose if you ask me. Hiring a lawyer…very typical. No one was seriously injured in the incident. TJ
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text:
Mild hypothermia after near drowning in twin toddlers
DOI: 10.1186/cc2926
© Vargas Hein et al.; licensee BioMed Central Ltd. 2004
Received: 28 January 2004
Accepted: 24 July 2004
Published: 2 September 2004
We report a case of twin toddlers who both suffered near drowning but with different post-trauma treatment and course, and different neurological outcomes.
Methods and results
Two twin toddlers (a boy and girl, aged 2 years and 3 months) suffered hypothermic near drowning with protracted cardiac arrest and aspiration. The girl was treated with mild hypothermia for 72 hours and developed acute respiratory dysfunction syndrome and sepsis. She recovered without neurological deficit. The boy's treatment was conducted under normothermia without further complications. He developed an apallic syndrome.
Although the twin toddlers experienced the same near drowning accident together, the outcomes with respect to neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.
Keywordschildren mild hypothermia near drowning twins
Of drowning and near drowning victims who are younger than 20 years, 63–68% are 0–5 years old [1, 2]. Of submersion events in the age group 1–4 years, 56% occurred in artificial pools [3]. Death from drowning is the second leading cause of accidental death in children [4], and one-third of all survivors have neurological damage [4]. Hypothermia frequently accompanies submersion accidents, especially in children with a relatively large ratio of surface area to body mass [3]. Mild hypothermia (32–34°C) reduces oxygen consumption by 7% per 1°C decrease in temperature, and reduces cerebral blood flow and cerebral intracranial pressure [5–7]. Temperature under 28°C leads to cardiocirculatory depression and finally cardiac arrest [3]. Hypoxaemia and capillary leak develop due to apnoea, regardless of whether aspiration occurs [3]. The degree of cerebral protection that can be expected due to hypothermia depends, among other factors, on the amount of time that elapses before induction of mild hypothermia [1, 3, 6]. Induced mild hypothermia for cerebral protection after near drowning accidents has yielded controversial results in terms of mortality and neurological outcome [1, 3, 8]. However, induced mild hypothermia after cardiac arrest has led to improved neurological results, whereas life-threatening complications such as infections and resultant sepsis may counter these neurological benefits [9].
We report here a case of twins who both suffered near drowning, but with different post-trauma treatment and different neurological outcomes.
Case report
The twins (a girl and boy, aged 2 years and 3 months old) were found lifeless by their father in the neighbours' garden pond. It was early spring, and the toddlers had been unattended for at least 10 min. Bystander cardiopulmonary resuscitation (CPR) was performed. The emergency doctor could not palpate any pulse, the children were hypothermic, and the pupils were dilated and pupil reflexes absent. Both children had aspirated. Under CPR the children exhibited pulseless bradycardia on the electrocardiogram.
The girl
Parameters at the scene and on admission in the twins
At the scene
Time to bystander CPR (min)
> 10
> 10
Pulseless bradycardia under CPR
On admission
Pupils dilated, nonreactive to light
Corneal reflex
Temperature on admission (°C)
pH on admission
Arterial CO2 tension (torr)
BE on admission (mmol/l)
Oxygenation index (torr)
CPR time (min)
Under differentiated pressure controlled ventilation, oxygenation did not improve. Because it was unclear at this time whether extracorporeal membrane oxygenation would be required, 5 days after the accident the child was transferred by helicopter to another university hospital because of limited capacity at our hospital. Under high-frequency oscillatory ventilation and nitric oxide inhalation, oxygenation improved and extracorporeal membrane oxygenation was not necessary. Conventional pressure controlled ventilation could be restored 7 days after the accident, and at the same time the multiple organ failure improved. Sedation was reduced and the girl was extubated 11 days after the accident, with no neurological deficit. Twenty-three days after the accident she was transferred to the community hospital where her brother was initially hospitalized, and she was discharged 1 day later completely restored to health.
The boy
The brother was transported to a community hospital. Admission parameters are presented in Table 1. Haemodynamic stability was achieved 150 min after admission to the hospital under dopamine and dobutamine therapy. The pupils were slightly dilated with reaction to light and the corneal reflex was present. He was rewarmed and normothermia was achieved 5 hours after admission. Continuous catecholamine therapy was stopped 4 days after the accident. The boy was sedated with fentanyl and midazolam, and ventilated to achieve normocapnia using a pressure-controlled mode. With improvement in oxygenation, he was extubated 6 days after the accident. The initial chest X-ray films showed bilateral infiltrations of the lung as a sign of aspiration pneumonia, which improved within the next few days. Liver and kidney function remained normal.
After the end of sedation, an apallic syndrome with extension posturing developed. The initial cranial CT obtained 36 hours after admission was normal, and fundoscopy did not show signs of papillary congestion. A cranial CT obtained 32 days after the accident showed marked expansion of the internal and external cerebral fluid interspaces with marked cerebral atrophy. At discharge from hospital, 41 days after the accident, the little boy remained in an apallic state, with flexion and extension posturing.
We present a case of twin toddlers with different neurological outcomes after near drowning with severe hypothermia and protracted cardiac arrest. Hypothermia at the scene has yielded controversial results with respect to cerebral protection. Factors such as time to achieve hypothermia (e.g. water temperature), the degree of hypothermia, the time of submersion, and other effects such as cardiocirculatory depression or arrest have various influences on the cerebral protection conferred [3, 8]. Some of these factors are unclear in this case report. The two institutional approaches to management of the twins were optimal because both hospitals have paediatric departments with paediatric ICUs. In addition, the community hospital is a training hospital and part of the university hospital.
Lavelle and Shaw [8] described three patients with body temperature under 28°C on arrival at the emergency department. All three patients had a good neurological outcome, but they fell into icy water. The use of prolonged or induced mild hypothermia for cerebral protection after near drowning has yielded controversial results [4, 8]. Bohn and coworkers [6] reported on 40 children aged under 15 years who suffered severe near drowning accidents with submersion time longer than 5 min and need for CPR. Twenty-four children were treated with hypothermia (30–33°C) for 24–36 hours, and 14 survived but three of these children had permanent neurological damage. Sixteen children were kept normothermic, and 13 survived but four had permanent neurological damage. Nussbaum and Maggi [10] investigated 31 children aged under 6 years who had undergone near drowning and were in a flaccid state of coma. All children were treated with hypothermia (32–34°C) for 48 hours (half of them received additional barbiturate therapy). Twelve children recovered completely, 12 children had brain damage and seven died.
Two recently published studies, conducted in patients who had suffered out-of-hospital cardiac arrest, compared induced mild hypothermia for 12–24 hours with normothermic management [7, 9]; they found that a significantly greater percentage of patients in the groups treated with mild hypothermia had good neurological outcomes. In patients affected by brain injury with a Glasgow Coma Scale score from 3 to 8, induced mild hypothermia for 24–48 hours yielded controversial findings [11, 12]. In these patients hypothermia on admission correlated with poor outcome, suggesting that spontaneous hypothermia may be a result of major brain injury [11].
In the present case report, hypothermia on the scene and on admission was probably the result of external factors such as water and air temperature and the children's age, suggesting cerebral protection from hypothermia. Up until the arrival of the twins at hospital, the treatment was identical. The boy was passively warmed to achieve normothermia, and the girl underwent prolonged (72 hours) mild hypothermia (32–34°C). The different neurological outcomes could have been influenced by these different treatments. However, some factors remain uncertain. For example, was the boy the first to go into the water, with resulting longer submersion and hypoxaemia times? How effective was bystander CPR in the two children? Was the time to achieve hypothermia the same in both children? Excluding bystander CPR, the remaining factors are considered strong predictors of outcome after near drowning [1, 3, 8]. The girl developed ARDS and septic shock, whereas the boy recovered from aspiration pneumonia without further complications.
There is concern that prolonged mild hypothermia has adverse effects on cardiac and lung function, coagulation and the immune system [3, 5, 7]. In a series of 41 patients with submersion injury (temperature on admission >32°C, no induced mild hypothermia), 32% developed pneumonia and one person ARDS [8]. Significantly higher infection rates, predominantly pneumonia, were described in patients treated with induced mild hypothermia as compared with patients treated under normothermic conditions [5, 13, 14]. However, other investigations evaluating patients following out-of-hospital CPR and with brain damage did not identify any differences in the incidence of infection between normothermic and hypothermic groups treated. just for 12–24 hours [7, 9, 15]. It seems posssible that the duration of mild hypothermia has an impact in the incidence of infection and sepsis. Among the 41 normothermic patients described by Lavelle and Shaw [8], after submersion 14% developed sepsis. In experimental animal models it was shown that hypothermia under 29°C leads to a reduced neutrophil response to endotoxin [16]. Leukocytopenia has been described to be significantly more frequent in patients with induced mild hypothermia [13, 14].
The girl was highly catecholamine dependent in the first 7 days after the accident. It has been reported that, in patients with mild hypothermia, significantly higher doses of catecholamines are required in comparison with normothermic patients after acute brain injury [11]. Vasopressor requirements have been described as having a significant impact on outcome [2]. The rate of other organ dysfunctions (liver, kidney) has also been found to be significantly higher in patients under induced mild hypothermia. The girl also developed transient liver dysfunction. Together with sepsis syndrome, coagulopathy developed. Disturbances of this system with resultant bleeding complications are known to occur during therapy with mild hypothermia [5, 13, 14, 17].
Although the twin toddlers experienced a near drowning accident together, the outcomes in terms of neurological status and postinjury complications were completely different. One of the factors that possibly influenced the different postinjury courses might have been prolonged mild hypothermia.
Key messages
Two twin toddlers suffered hypothermic near drowning with protracted cardiac arrest and aspiration.
The girl was treated with mild hypothermia and developed acute respiratory dysfunction syndrome and sepsis, but recovered without neurological deficits.
The boy was treated under normothermic conditions and developed an apallic syndrome.
One of the factors that possibly influenced the different postinjury course might have been prolonged mild hypothermia.
acute respiratory dysfunction syndrome
cardiopulmonary resuscitation
computed tomography
intensive care unit.
Authors' Affiliations
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- Holzer M: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002, 8: 549-556.Google Scholar
- Nussbaum E, Maggi JC: Pentobarbital therapy does not improve neurologic outcome in nearly drowned, flaccid-comatose children. Pediatrics 1988, 5: 630-634.Google Scholar
- Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR Jr, Muizelaar JP, Wagner FC Jr, Marion DW, Luerssen TG, et al.: Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 2001, 8: 556-563. 10.1056/NEJM200102223440803View ArticleGoogle Scholar
- Clifton GL, Allen S, Barrodale P, Plenger P, Berry J, Koch S, Fletcher J, Hayes RL, Choi SC: A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 1993, 3: 263-271.View ArticleGoogle Scholar
- Ishikawa K, Tanaka H, Shiozaki T, Takaoka M, Ogura H, Kishi M, Shimazu T, Sugimoto H: Characteristics of infection and leukocyte count in severely head-injured patients treated with mild hypothermia. J Trauma 2000, 5: 912-922.View ArticleGoogle Scholar
- Shiozaki T, Hayakata T, Taneda M, Nakajima Y, Hashiguchi N, Fujimi S, Nakamori Y, Tanaka H, Shimazu T, Sugimoto H: A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. J Neurosurg 2001, 1: 50-54.View ArticleGoogle Scholar
- Marion DW, Penrod LE, Kelsey SF, Obrist WD, Kochanek PM, Palmer AM, Wisniewski SR, DeKosky ST: Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 1997, 8: 540-546. 10.1056/NEJM199702203360803View ArticleGoogle Scholar
- Biggar WD, Bohn D, Kent G: Neutrophil circulation and release from bone marrow during hypothermia. Infect Immun 1983, 2: 708-712.Google Scholar
- Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA: Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 2001, 9: 2033-2035.View ArticleGoogle 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.


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David Corvo, CBS News' VP for public affairs, will be the new executive producer on Fox's upcoming, prime time magazine program, Fox News president Van Gordon Sauter confirmed late yesterday. The broadcast will originate from Los Angeles.Corvo is one of Sauter's first major hires and is viewed within the industry as a totem for the kind of journalism the Clearasil Network will practice. Since 1990, Corvo has overseen CBS newsmagazines "60 Minutes,""48 Hours" and "Street Stories," and the web's in-house documentary and specials unit. Aside from screening and signing off on pieces, he also handles some of the day-to-day personnel and business affairs matters that arise on these programs. Sauter and Corvo have a long history, working together on-and-off since the 1970s. It was Sauter who brought Corvo from California to New York when the former headed CBS' news division. Within the news division, Corvo developed a reputation for being among a select group of up-and-comers known as "Van's Nerds."MDRV Sources familiar with the two men suggest that Sauter was anxious to have a Sancho Panza on the payroll at his new shop. Also, considering that Fox News is still in the start-up phase, Corvo's administrative talents are widely viewed as a plus. Said one Fox source, "We need an executive producer who is also an adult." Corvo's first order of business will be putting together a production staff that can produce a lucrative, cutting-edge newsmagazine by spring. The proposed program is considered one of the three major building blocks in Fox News' development strategy. Aside from trying to bring news capability to its 140 affiliates, Sauter also wants to build the weblet's wire service into a global news feed. The majority of Corvo's career has been spent at CBS, both in L.A. at KNXT (now CBS O&O KCBS) and in New York at CBS News. Corvo, who joined KNXT in 1975 as a producer, helped launch the station's investigative reporting unit. In 1980, he became the executive producer for news. Two years later, he became CBS News' L.A. bureau chief. Corvo has worked as an assignment editor and producer on "The CBS Evening News: Weekend Edition,""CBS Morning News" and "CBS This Morning." He first came to national attention in 1987 when he became executive producer of "CBS This Morning," which replaced the "CBS Morning Program"–an ill-fated Mariette Hartley vehicle that received a 1.9 Nielsen rating. Under Corvo's leadership, the morning show shifted gears to a more news-driven, less infotainment-heavy format. Sources at CBS News characterize Corvo as a gifted and warm-hearted administrator. Yet several CBS colleagues described him as more of an editor than a visionary. Sources at CBS suggest that Corvo was drawn to Fox because he had grown tired of bench-sitting administrative duties.
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August 23, 2011
Staff at Earthwatch's Regional Climate Center (RCC) in Brazil is celebrating after receiving a brand-new Land Rover Defender 110 in July
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1. In a large bowl, pour in 2 tbsp. of olive oil. Season with salt, pepper, lemon juice and half of lemon zest. Mix well and add in the salmon. Rub the dressing over the salsa generously.
2. In a sauté pan, add in the olive oil and heat on high. Place the salmon and cook for 5 minutes on each side.
3. Into the left-out dressing, add in the remaining lemon zest, onion, tomatoes and coriander. Toss well.
4. In a serving plate, place the salmons and top with salsa. Serve and enjoy!
Serving size Per servingComplete recipe
Calories 443 Calories from Fat 287
% Daily Value*
Total Fat 32 g49.6%
Saturated Fat 4.6 g23.1%
Trans Fat 0 g
Cholesterol 82.5 mg27.5%
Sodium 232.4 mg9.7%
Total Carbohydrates 9 g3%
Dietary Fiber 3.1 g12.5%
Sugars 3 g
Protein 31 g62.1%
Vitamin A 12.6%
Vitamin C 63.7%
Calcium 5.7%
Iron 10.1%
*Based on a 2000 Calorie diet


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