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We are looking for hotels between the fairgrounds and Crowne Plaza hotel. We have a big NSRA SE Nationals there in Oct. They will probably cruise Martin Luther King and we want a hotel on this street so we can sit out and watch the cars. Great show...all come!!
Thanks in advance,
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The Kitchen Salon LLC is one of the most trusted resources in natural hair. We provide natural hair care resources to the public through our meetups, workshops and The Ohio Natural Hair, Health & Beauty Expo. This website, features comprehensive natural hair care, styling and maintenance information. Established in 2007, The Kitchen Salon was established to educate individuals on becoming their own DIY expert so that they may embrace their texture and wear their natural hair with confidence.
The Kitchen Salon also provides private workshops and presentations for church groups, schools or community organizations and sponsors some events with natural hair information or product samples. These services should be requested in advance. Please include the date, time and location of your event as well as the theme and the number of expected guests. Please send all email inquiries to email@example.com


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Brahma Bhuta Guest House
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Heading to Trinidad - Last Country of Tour
... a bit closer to the other country than said country would approve so mishaps do happen.
We show up at our hotel, Hotel Kapok, about 3 p.m. We have to fill in a form with our passport numbers and such and give it to the desk clerk to get our room key. I have no clue what they were doing but a good many of the rooms were not ready and we were all tired and needing showers and such. Some people got ...
1903. First Impressions of the Caribbean
... and presidents of their own countries and destinies. I'm not saying that everything is fine here, and what happened in the past is all OK--but I do think that this makes it a lot easier for a society to move forward without that weight of unsolved injustices among the races and social classes... old wounds that just keep popping up again and again in other parts of the Americas. "Trinidad is the least racist place in the world" my host, a South African later ...
Trinidad Part 1
I was at the airport by 10.30 on the 28th ready to fly to Trinidad. The flight went to plan and, after almost a 2 hour wait at immigration, I finally got out and met Jabal (a Trinidadian friend from uni who I'm spending the next 2 weeks with). I went to get some money out before leaving the airport and for absolutely no reason the machine ate my card... ****** off was an understatement and once the necessities of food and a couple of beers was out of the way, ...
Trouble in Trinidad
... come back into the airport. To enable all of that, we filled out our immigration forms, much to our dismay.
Leaving immigration, we went to customs. Since we did not have any checked baggage, we made it through very quickly.
We picked up our boarding passes and made our way back to the concourse. The passes we had indicated that boarding would begin at 23:25. In ...
Port of Spain
... anyone, though one of yesterday's was still smoking! Had gone past one yesterday on the bus, a quite a lavish shindig, and at least 2 corpses judging by the Vegas style hearses and roaring flames!
Walked back along the road to try and find a good local roti – met a friendly older lady and talked for about 1km until the roti shop where I had a quick, but very uninspiring, roti ...


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Berghaus Remote 30 Daysack
Next working day UK* delivery
The Berghaus Remote 30 Daysack, is a fantastic all round rucksack for grabbing to take away for a weekend, for commuting to and from work, for going to the gym and for taking with you for a long walk in the countryside or along the coast!
The Remote Daysack offers an incredibly comfortable wear thanks to the combination of the flow back system, adjustable chest strap and detachable waist belt so whether you are off for a hike or rushing to catch the bus this bag will quickly become a trusted companion.
There are plenty of storage options including a zipped main pocket, bottle pockets, mesh front pockets, internal organiser and zipped internal pockets so that you can keep all your essentials organised and easy to access. It also features a laptop sleeve perfect for if you need to take your laptop with you and don't want to have to carry a cumbersome laptop case!
Berghaus has always been well known for their range of versatile daysacks and this one certainly does not disappoint as it has just the right combination of comfort, durability and storage options that it will quickly become an essential part of your outdoor gear!
- Capacity: 30 Litre
- Esdura 210D Tremble Ripstop fabric
- Flow back system with vented foam for improved airflow
- Height adjustable chest strap
- Detachable waist belt
- Reflective detail for visibility and safety
- Side compression straps
- Hydration system compatible
- Bottle pockets
- Mesh front pockets
- Internal organiser
- Zipped internal pockets
- Walking pole attachment
- Key clip
- Laptop sleeve
- LED attachment point
- Zipped front pocket
- Size: H51 x W30 x D29 cm
- Weight: 680g (approx.)
- Berghaus Remote 30 Daysack
Delivery Charges
Just £1.95 next working day UK delivery - Free on orders over £50
Delivery Times Explained
Next working day delivery - stock is available from our warehouse and will normally be despatched the same day if you order by 3pm.
All items are sent on a next working day service (large/expensive items DPD Monday-Friday, smaller items Royal Mail Monday-Saturday). If you require Saturday delivery on larger/more expensive items (over about £50) there will be an additional charge, please give us a call for a quote.
Northern Ireland, Highlands and Islands will take 2 working days.
14 day delivery* - Stock will be ordered from our supplier. *Estimated
Very low stock - Please call to check availability
Delivery Method
Small items may be sent by Royal Mail 24h, larger or more expensive items with DPD Next Day may require a signature on delivery. In the event that no one is available, the parcel will be taken to your local depot and a note will be left with instructions for redelivery.
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Our "no quibbles" guarantee means that if for any reason you are unhappy with the item you have purchased just return it in its original condition within 28 days and we will issue a full refund or exchange.
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Items purchased between 1st November and 25th December can be returned anytime until the 31st January 2017 as part of our extended Christmas guarantee! Normal terms and conditions apply
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Supplier Code: 4-21425C33


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Loving Father, I entrust myself to your care this day; guide with wisdom and skill the minds and hands of the medical people who minister in your Name, and grant that every cause of illness be removed, I may be restored to soundness of health and learn to live in more perfect harmony with you and with those around me. Through Jesus Christ. Amen.
Into your hands, I commend my body and my soul. Amen.
Four things to know about your candle on Catholic Online:
In the centuries old Catholic tradition, holy cards or prayer cards are small, devotional cards for the use of the faithful. Prayer cards have an endless amount of use and make wonderful gifts and keepsakes.


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We do not regard it as acceptable that those of us who regard it as our duty to challenge any legislation which may have the effect of detracting from the civil rights and individual liberties if any citizen if the UK should be traduced in this way.Sir Menzies Campbell
These findings underscore the need to pass legislation in the US that makes electronics producers responsible for managing their products at disposal time and bans the exporting of e-waste to developing countries.Ted Smith
Prohibition goes beyond the bounds of reason in that it attempts to control a man's appetite by legislation and makes crimes out of things that are not crimes.Abraham Lincoln
A good compromise, a good piece of legislation, is like a good sentence; or a good piece of music. Everybody can recognize it. They say, 'Huh. It works. It makes sense.Barack Obama
And then of course, obviously as far as issues such as global warming, something has to be done on the corporate side, there has to be some mandate or some legislation.Daryl Hannah
Every proper exertion has been made and will be continued to carry out the wishes of Congress in relation to the tobacco trade, as indicated in the several resolutions of the House of Representatives and the legislation of the two branches.Martin Van Buren
Eastern Washington has experienced a number of deadly forest fires this season, and it is crucial that we have bipartisan legislation that will expedite the research and restoration process.Cathy McMorris
Congress should pass legislation to remove from the federal courts their jurisdiction to hear these outrageous challenges to the Ten Commandments and the Pledge of Allegiance.Phyllis Schlafly
Awareness has changed so that every act for children, every piece of legislation recognizes that children are part of families and that it is within families that children grow and thrive or don't.Bernice Weissbourd
For many of those who had historically supported welfare programs in the broadest sense, it was perfectly reasonable to enact legislation in which poor people were the objects of efforts to assist them.Barney Frank
If the president is failing to disclose material facts with regard to legislation being presented to the Congress on a question as important as war and peace, I think it does impair the level of trust that the House and the Senate have for this administration.John Dingell
If the tenth of the population that is gay became visible tomorrow, the panic of the majority of people would inspire repressive legislation of a sort that would shock even the pessimists among us.Jane Rule
If the Union is once severed, the line of separation will grow wider and wider, and the controversies which are now debated and settled in the halls of legislation will then be tried in fields of battle and determined by the sword.Andrew Jackson
Internet safety begins at home and that is why my legislation would require the Federal Trade Commission to design and publish a unique website to serve as a clearinghouse and resource for parents, teachers and children for information on the dangers of surfing the Internet.Mike Fitzpatrick
It is very difficult to get legislation passed. But then the danger always is that you have no power at all if you do not exercise constant power.Major Owens


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Modern technologies elevate the prestige of engineering.
We train not just professionals but also successful entrepreneurs focused on independent business development and new jobs creation.
These are of particular importance in conditions of economic upheaval.
The strategy of D.Serikbayev EKSTU is straightforwardly directed to being an innovative and entrepreneurial university.
We cultivate optimal conditions to study, to conduct innovative scientific research, and to develop as a person in our university.
Zhassulan Shaimardanov
Rector of D. Serikbayev EKSTU
Doctor of biological sciences, professor
Greetings! Welcome to East Kazakhstan State Technical University, one of the major universities of the 9th largest country on earth.
Here, you will find a diverse menu of academic specialties, professors who care about students like they care about their own children, an active student body, opportunities for international engagement way beyond Central Eurasia, and plenty of opportunities for launching meaningful careers either here or abroad.
The challenges of the 21st century will require a skilled workforce, covering the spectrum from energetic managers to focused problem-solvers in traditional and emerging disciplines. The technical aspects of these disciplines need to be informed as well by complementary coursework and research in the humanities. All can be found in abundance here. You are cordially invited to check us out and find your niche, right here in Ust-Kamenogorsk.
Stuart S. Chen, Ph.D., P.E.
Fulbright Senior Scholar and Visiting Professor,
East Kazakhstan State Technical University"
- D. Serikbayev EKSTU influenced to unlock my potential. I am very grateful to my University, because it gives a very good knowledge of the basic disciplines. Also, I would like to note there are good established English language teaching and translation studies at University.
D. Serikbaev EKSTU always will be the best and the most reliable University that has given me a quality education!
Michael Tokovarov, engineer-master of electrical engineering of Lublin University, Poland
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Greenville Gold & Silver, Gold Jewelry, listed under "Gold Jewelry" category, is located at 1607 Woodruff Avenue Suite A Greenville SC, 29607 and can be reached by 8649017975 phone number. Greenville Gold & Silver has currently 0 reviews.This business profile is not yet claimed, and if you are the owner, claim your business profile for free. If you are not the owner you can invite this business to join by email or by phone.Browse all Gold Jewelry in Greenville SC. Discover census data for Greenville, SC.
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GCN Lab review: Sonar-equipped Panasonic scanner handles any kind of document on any kind of paper
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8609 Westwood Center Drive, Suite 500
Vienna, VA 22182-2215
© 2017 1105 Media, Inc.
8609 Westwood Center Drive, Suite 500
Vienna, VA 22182-2215703-876-5100 © 1996-2016 1105 Media, Inc. All Rights Reserved.


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nishil from Kolkata, India recommends this hotel Posted: Room Quality: 3/5 Service Quality: 3/5 Dining Quality: 3/5 Cleanliness: 3/5
The property was quite average in terms of the quality. I stayed there for a day but I found bit inconvenience in check in as I had a wait for an hour or so. Room facilities and service was manageable but location was far from the station. I didn't taste any food in the hotel but it was a manageable stay altogether.


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Antibiotic prescription patterns in the empiric therapy of severe sepsis: combination of antimicrobials with different mechanisms of action reduces mortality
DOI: 10.1186/cc11869
© Dias-Martin et al.; licensee BioMed Central Ltd. 2012
Received: 30 July 2012
Accepted: 18 October 2012
Published: 18 November 2012
Although early institution of adequate antimicrobial therapy is lifesaving in sepsis patients, optimal antimicrobial strategy has not been established. Moreover, the benefit of combination therapy over monotherapy remains to be determined. Our aims are to describe patterns of empiric antimicrobial therapy in severe sepsis, assessing the impact of combination therapy, including antimicrobials with different mechanisms of action, on mortality.
This is a Spanish national multicenter study, analyzing all patients admitted to ICUs who received antibiotics within the first 6 hours of diagnosis of severe sepsis or septic shock. Antibiotic-prescription patterns in community-acquired infections and nosocomial infections were analyzed separately and compared. We compared the impact on mortality of empiric antibiotic treatment, including antibiotics with different mechanisms of action, termed different-class combination therapy (DCCT), with that of monotherapy and any other combination therapy possibilities (non-DCCT).
We included 1,372 patients, 1,022 (74.5%) of whom had community-acquired sepsis and 350 (25.5%) of whom had nosocomial sepsis. The most frequently prescribed antibiotic agents were β-lactams (902, 65.7%) and carbapenems (345, 25.1%). DCCT was administered to 388 patients (28.3%), whereas non-DCCT was administered to 984 (71.7%). The mortality rate was significantly lower in patients administered DCCTs than in those who were administered non-DCCTs (34% versus 40%; P = 0.042). The variables independently associated with mortality were age, male sex, APACHE II score, and community origin of the infection. DCCT was a protective factor against in-hospital mortality (odds ratio (OR), 0.699; 95% confidence interval (CI), 0.522 to 0.936; P = 0.016), as was urologic focus of infection (OR, 0.241; 95% CI, 0.102 to 0.569; P = 0.001).
β-Lactams, including carbapenems, are the most frequently prescribed antibiotics in empiric therapy in patients with severe sepsis and septic shock. Administering a combination of antimicrobials with different mechanisms of action is associated with decreased mortality.
Sepsis is a prevalent disorder and one of the main causes of death among hospitalized patients. Treating sepsis is associated with high costs; however, despite advances in medical practice, the mortality rate of sepsis has not declined in recent decades [1]. In Spain, the incidence of severe sepsis is 104 cases per 100,000 adult residents per year, and related in-hospital mortality is 20.7%; the incidence of septic shock is 31 cases per 100,000 adult residents per year, and related in-hospital mortality is 45.7% [2]. Sepsis present at intensive care unit (ICU) admission and ICU-acquired sepsis clearly differ in the types of patients affected, the sources of infection, the microorganisms responsible, and the prognosis [3].
Diverse studies have confirmed that the prompt institution of antimicrobial therapy active against the causative pathogen is lifesaving in patients with severe sepsis [4, 5]. The Surviving Sepsis Campaign strongly recommends initiating antibiotic therapy within the first hour of recognition of severe sepsis, after suitable samples have been obtained for cultures [6].
Nevertheless, although antibiotic therapy is the cornerstone in the treatment of sepsis, the optimal antimicrobial strategy has not been defined. Few data are available about antibiotic prescription patterns used most in severe sepsis.
Furthermore, the advantages and disadvantages of combination therapy compared with monotherapy are controversial, and studies comparing the two approaches have mainly been limited to bacteremia, pneumonia, or serious Pseudomonas aeruginosa infections [7–9]. Importantly, a recent retrospective study concluded that certain combinations of antimicrobials, including antimicrobials with different targets, improve survival in patients with septic shock [10].
We present a secondary analysis of the Edusepsis study, which enrolled all patients with severe sepsis and septic shock admitted to the participating ICUs during 2 months in 2005 and 4 months in 2006. Our aims are (a) to describe the patterns of empiric antimicrobial therapy, analyzing the differences between community-acquired and nosocomial infections; and (b) to compare the impact on mortality of combination therapy, including at least two antimicrobials with different mechanisms of action, with that of monotherapy and other combinations of antimicrobials.
Materials and methods
Design of the study
We conducted a secondary analysis of the Edusepsis study, a Spanish national multicenter before-and-after study involving 77 ICUs [11]. In this study, carried out between November 2005 and 2007, data were collected before and after a 2-month educational intervention based on the Surviving Sepsis Campaign guidelines; this approach to improving treatment of severe sepsis is cost-effective [12]. Each participating centers' research and ethical-review boards approved the study, and patients remained anonymous. The need for informed consent was waived in view of the observational and anonymous nature of the study.
The study included all patients in these ICUs with severe sepsis or septic shock. The study design is described in detail elsewhere [11]. In brief, severe sepsis was defined as sepsis associated with organ dysfunction unexplained by other causes. Septic shock was defined as sepsis associated with systolic blood pressure <90 mm Hg, mean arterial pressure <65 mm Hg, or a reduction in systolic blood pressure >40 mm Hg from baseline despite adequate volume resuscitation. Patients in whom the onset of severe sepsis could not be determined were excluded from the analysis. The approach to data collection and the quality-control measures to assure data reliability also are described elsewhere [11, 12].
The following variables were recorded: demographic characteristics (age and gender), types of patients (medical, trauma, emergency surgery, elective surgery), sources of infection, location at sepsis acquisition (community-acquired or nosocomial infection), and baseline lactate level and organ dysfunction at sepsis diagnosis. Severity of illness was evaluated by the Acute Physiology and Chronic Health Evaluation (APACHE) II score, considering the worst reading in the first 24 hours in the ICU [13]. All patients were followed up until death or hospital discharge. The primary outcome variable was in-hospital mortality.
Antimicrobial therapy
The antimicrobial therapy prescribed at the diagnosis of severe sepsis and the time from severe sepsis presentation to antibiotic administration were recorded. To facilitate subsequent analysis, antimicrobial agents were grouped into eight antibiotic families: β-lactams (except carbapenems), carbapenems, quinolones, macrolides, aminoglycosides, anti-gram-positive antibiotics (vancomycin, teicoplanin, and linezolid), antifungal agents, and other antimicrobial agents (including antiviral and tuberculostatic agents). Data for community-acquired and nosocomial infections also were analyzed separately. We also compared the clinical characteristics of patients that received different-class combination therapy (DCCT) with those of patients that received any other antimicrobial therapy (non-DCCT).
DCCT was defined as the concomitant use of two or more antibiotics of different mechanistic classes, as recently defined by Kumar et al. [10], specifically β-lactams or carbapenems with aminoglycosides, fluoroquinolones, or macrolides/clindamycin. Monotherapy or any other combination therapy was considered non-DCCT for this analysis.
To assess the impact of DCCT on mortality, we analyzed only patients who received the first dose of antimicrobial within the first 6 hours after severe sepsis presentation.
Statistical analysis
Discrete variables were expressed as frequencies (percentage), and continuous variables, as means and standard deviations (SDs), unless stated otherwise; all statistical tests were two-sided. Differences in categoric variables were calculated by using χ2 tests or Fisher Exact test, and differences in continuous variables were calculated by using the Mann-Whitney U or Kruskal-Wallis test, as appropriate.
Backward logistic regression was used to assess the factors independently associated with in-hospital mortality. To avoid spurious associations, variables entered in the regression models were those with a relation in univariate analysis (P ≤ 0.05) or a plausible relation with the dependent variable. SPSS for Windows 20.0 (SPSS, Chicago, IL, USA) was used for all statistical analyses.
Results and discussion
Descriptive analysis
Demographic and clinical characteristics of the patients
n= 1,372
n= 1,022 (74.5%)
n= 350 (25.5%)
General data
Sex (male)
837 (61%)
623 (61%)
214 (61%)
Age (years)
62.24 ± 16.22
62.00 ± 16.65
62.93 ± 14.87
21.44 ± 7.54
21.09 ± 7.49
22.45 ± 7.61
Lactate (mM)
35.56 ± 26.94
36.76 ± 27.68
32.06 ± 24.37
Diagnosis on admission
893 (65.4%)
734 (72%)
159 (45.8%)
25 (1.8%)
8 (0.8%)
17 (4.9%)
Emergency surgery
382 (28%)
256 (25.1%)
126 (36.3%)
Elective surgery
66 (4.86%)
21 (2.1%)
45 (13%)
Type of infection
502 (36.6%)
362 (35.4%)
140 (40%)
390 (28.4%)
270 (26.4%)
120 (34.3%)
182 (13.3%)
163 (15.9%)
19 (5.4%)
50 (3.6%)
47 (4.6%)
3 (0.9%)
54 (3.9%)
46 (4.5%)
8 (2.3%)
24 (1.7%)
6 (0.6%)
18 (5.1%)
138 (3.1%)
108 (10.6%)
30 (8.6%)
More than one focus
32 (2.3%)
20 (2.0%)
12 (3.4%)
Organ failure
1,129 (82.3%)
845 (82.7%)
284 (81.1%)
880 (64.1%)
641 (62.7%)
239 (68.3%)
,1006 (73.3%)
754 (73.8%)
252 (72.0%)
238 (17.3%)
176 (17.2%)
62 (17.7%)
344 (25.1%)
266 (26.0%)
78 (22.3%)
502 (36.6%)
394 (38.6%)
108 (30.9%)
526 (38.3%)
356 (34.8%)
170 (48.6%)
The most frequent sources of sepsis were pneumonia (n = 502; 36.6%), followed by abdominal infection (n = 390; 28.48%), urinary tract infection (n = 182; 13.3%), central nervous system infection (n = 50; 3.6%), skin or soft-tissue infection (n = 54; 3.9%), and catheter-related infection (n = 24; 1.7%).
Antimicrobial treatments prescribed
Antibiotic distribution in the entire cohort and in patients with community-acquired and nosocomial sepsis
n= 1,372
n= 1,022 (74.5%)
n= 350 (25.5%)
902 (65.7%)
708 (69.3%)
194 (55.4%)
345 (25.1%)
218 (21.3%)
127 (36.3%)
282 (20.6%)
241 (23.6%)
41 (11.7%)
183 (13.3%)
114 (11.2%)
69 (19.7%)
60 (4.4%)
54 (5.3%)
6 (1.7%)
161 (11.7%)
96 (9.4%)
65 (18.6%)
38 (2.8%)
20 (2.0%)
18 (5.1%)
151 (11.0%)
111 (10.9%)
40 (11.4%)
The distribution of the antibiotics prescribed for community-acquired infections was similar to that for the overall group, with predominance of β-lactams (n = 708; 69.3%), quinolones (n = 241; 23.6%), and carbapenems (n = 218; 21.3%), , whereas in the group with nosocomial infections, although β-lactams were also the most-used treatment (n = 194; 55.4%), carbapenems were second (n = 127; 36.3%), followed by aminoglycosides (n = 69; 19.7%) and anti-gram-positive agents (n = 65; 18.6%). Macrolides and quinolones were more frequently used in community-acquired sepsis than in nosocomial sepsis (see Table 2).
DCCT and non-DCCT groups
Comparisons of patients treated with DCCT or non-DCCT
DCCT group
n= 388 (28.3%)
Non-DCCT group
n= 984 (71.7%)
General data
Sex (male)
247 (63.7%)
590 (60%)
Age (years)
60.88 ± 16.79
62.78 ± 15.96
21.35 ± 7.43
21.47 ± 7.58
Lactate (mM)
36.37 ± 26.99
35.22 ± 26.93
Diagnosis on admission
310 (79.9%)
583 (59.6%)
3 (0.8%)
22 (2.2%)
Emergency surgery
59 (15.2%)
323 (33%)
Elective surgery
16 (4.1%)
50 (5.1%)
Type of infection
56 (14.4%)
334 (33.9%)
44 (11.3%)
138 (14%)
5 (1.3%)
45 (4.6%)
Skin and/or soft-tissue
6 (1.5%)
48 (4.9%)
4 (1%)
20 (2%)
31 (8%)
107 (10.9%)
More than one focus
13 (3.4%)
19 (1.9%)
Organ failure
Number of organ failures
2.98 ± 1.26
2.98 ± 1.25
319 (82.2%)
810 (82.3%)
289 (74.5%)
591 (60.1%)
264 (68%)
742 (75.4%)
61 (15.7%)
177 (18%)
94 (24.2%)
250 (25.4%)
131 (33.8%)
371 (37.7%)
132 (34%)
394 (40%)
Significant differences between the two groups were found in diagnosis at admission and source of infection. In the DCCT group, the percentage of patients with medical diagnoses was higher (79.9% versus 59.6%; P < 0.001) and the percentage with emergency surgical diagnoses was lower (15.2% versus 33%; P < 0.001). The most common source of sepsis was pneumonia in the DCCT group (59% versus 27.7%; P < 0.001) and abdominal infection in the non-DCCT group (14.4% versus 33.9%; P < 0.001).
Although the median number of organ failures was the same in both groups, significant differences were noted in the organ-failure distribution: respiratory failure was more common in the DCCT group (74.5% versus 60.1%; P < 0.001) and renal failure was more common in the non-DCCT group (68% versus 75.4%; P = 0.007).
Antibiotic prescription in patients treated with DCCT or non-DCCT
Non-DCCT group
n= 984 (71.7%)
DCCT group
n= 388 (28.3%)
582 (59.1%)
320 (82.5%)
269 (27.3%)
76 (19.6%)
96 (9.8%)
186 (47.9%)
25 (2.5%)
158 (40.7%)
7 (0.7%)
53 (13.7%)
120 (12.2%)
41 (10.6%)
21 (2.1%)
17 (4.4%)
121 (12.3%)
30 (7.7%)
Predictors of mortality
Univariate analysis of factors associated with in-hospital mortality
n= 1,372
n= 846 (61.7%)
n= 526 (38.3%)
General data
Sex (male)
837 (61.0%)
489 (57.8%)
348 (66.2%)
Age (years)
62.2 ± 16.2
59.80 ± 16.81
66.16 ± 14.39
21.4 ± 7.5
19.20 ± 6.86
25.09 ± 7.17
Lactate (mM)
35.6 ± 26.9
31.09 ± 22.54
43.09 ± 31.69
Type of infection
502 (36.6%)
289 (34.2%)
213 (40.5%)
390 (28.4%)
228 (27%)
162 (30.8%)
181 (13.3%)
142 (16.8%)
40 (7.6%)
50 (3.6%)
40 (4.7%)
10 (1.9%)
Skin and soft-tissue
54 (3.9%)
37 (4.4%)
17 (3.2%)
24 (1.7%)
15 (1.8%)
9 (1.7%)
138 (10.1%)
78 (9.2%)
60 (11.4%)
More than one focus
32 (2.3%)
17 (2%)
15 (2.9%)
Community acquired
1,022 (74.5%)
666 (78.7%)
356 (67.7%)
388 (28.3%)
256 (30.3%)
132 (25.1%)
Multivariate analysis of risk factors for mortality
Age (years)
Sex (male)
Focus of infection
Skin and soft-tissue
More than one focus
For the DCCT-combination treatments associated with reductions in mortality, the results of the analysis, excluding patients who died within the first 6 hours, were similar to the results including these patients; hence, no evidence of immortal bias was found in our results.
This secondary analysis of the Edusepsis study reveals interesting data about the patterns of antibiotic prescription in patients with severe sepsis and septic shock and about the characteristics of patients receiving combination therapy, including antimicrobials, with different mechanisms of action (DCCTs) versus those receiving either monotherapy or any other combinations of antimicrobials (non-DCCTs). Our study confirms the increased survival in patients administered DCCTs (β-lactams plus aminoglycosides, quinolones, or macrolides/clindamycin) within the first 6 hours of severe sepsis presentation. We excluded patients that received antimicrobial therapy after 6 hours of severe sepsis diagnosis from this analysis, because strong evidence indicates that early administration increases survival in patients with severe sepsis or septic shock [4, 5, 10].
Appropriate empiric antimicrobial therapy is crucial for the survival of sepsis patients [4, 5]. Formerly, multidrug-resistant pathogens were found almost exclusively in nosocomial infections. However, community-acquired infections are now often caused by antibiotic-resistant bacteria (for example, extended-spectrum β-lactamase-producing Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, or methicillin-resistant Staphylococcus aureus) [14, 15]. This striking change in epidemiology may explain why the initial therapy frequently includes a combination of different antimicrobial agents [16].
β-Lactams, including carbapenems, are the most commonly used antibiotics in the critical care setting [17]. Likewise, this antibiotic family constitutes the mainstay of empiric treatment in patients with severe sepsis or septic shock, whether administered alone or in combination with other antimicrobials. Carbapenems are more frequently prescribed in patients with nosocomial sepsis, although it is worth mentioning that one in five patients with community-acquired sepsis is treated empirically with a carbapenem. This may reflect the increase in multidrug-resistant gram-negative pathogens in the community [14]. Carbapenems might have been analyzed in conjunction with the rest of β-lactams. However, we decided to analyze them separately from other β-lactams because of the broader-spectrum, major role in empiric antibiotic therapy and the widespread use in the ICU.
Quinolones are used mainly in community-acquired infections and in combination therapy [18]. The extended use of quinolones in combination therapy in patients with severe community-acquired pneumonia may explain the increasing rate of quinolone resistance among nosocomial gram-negative pathogens [18, 19].
Numerous studies have evaluated the likely superiority of combination therapy in patients with diverse types of infections. A French multicenter study of critical patients with acute peritonitis found no difference in the rate of therapeutic failure or length of antibiotic treatment when β-lactams were administered alone or in combination with aminoglycosides, concluding that aminoglycosides should be added only when an infection by Pseudomonas spp or Enterococcus spp is suspected [20]. Two randomized clinical trials found no benefits of combination therapy over monotherapy in patients with ventilator-associated pneumonia [21, 22]. Moreover, in one trial, monotherapy was associated with lower rates of therapeutic failure, superinfection, and side effects [22].
Conversely, diverse studies have demonstrated lower mortality and length of stay in patients with pneumococcal bacteremia or with community-acquired pneumonia receiving combination therapy, including a β-lactam plus a macrolide or a quinolone, than in those receiving monotherapy [23–25]. In these studies, the benefits seem to be restricted to more-severe patients or to those in septic shock [18, 23]. Conversely, a recent retrospective study concluded that, in bacteremia caused by gram-negative bacilli, combination therapy with β-lactams and fluoroquinolones was associated with a reduction in 28-day crude mortality only among less severely ill patients [7].
Two meta-analyses of studies performed in patients with gram-negative bacteremia or sepsis found no benefit of combination therapy over monotherapy, except when bacteremia was caused by multidrug-resistant bacteria or Pseudomonas spp [26, 27]. Moreover, higher rates of side effects (mainly nephrotoxicity) were reported in the group of patients treated with β-lactam antibiotics plus aminoglycosides. More recently, a meta-analytic/meta-regression study that included 50 studies found that combination antibiotic therapy improves survival, particularly in septic shock patients, but may be harmful to less severely ill patients [28].
Nevertheless, few data are available about the impact on the outcome of combination therapy in large cohorts of patients with severe sepsis or septic shock. A recent propensity-matched analysis concluded that, in patients with septic shock, the use of combination therapy with two or more antibiotics of different mechanistic classes was associated with lower 28-day mortality, shorter ICU stay, and lower in-hospital mortality [10].
Our results confirm that combination therapy, including two or more antimicrobials with different mechanisms of action (β-lactams in combination with aminoglycosides, fluoroquinolones, or macrolides/clindamycin), administered within the first 6 hours of sepsis presentation is an independent protective factor against in-hospital mortality. Interestingly, severity of illness measured by APACHE II score, basal lactate levels, and the presence of hemodynamic failure did not differ between patients receiving DCCTs and those receiving non-DCCTs.
The choice of empiric antimicrobial therapy is based on the clinical presentation of the infection, the characteristics of the patient, the local ecology, and previous antibiotic exposure. Reducing the antibiotic pressure and side effects are the main reasons for choosing monotherapy. Conversely, the main reason for prescribing combination therapy for critically ill sepsis patient is to broaden the antimicrobial spectrum in an attempt to ensure the coverage of all likely pathogens. Our results permit us to speculate that the synergistic mechanisms of different antimicrobial combinations, or the immunomodulatory effects described with macrolides and quinolones, may be of clinical transcendence in patients with severe sepsis or septic shock [29–31].
Our study has several limitations. First, a major limitation in our study is the lack of microbiology data due to the initial study design. Accordingly, no data are available on antibiotic susceptibility, appropriateness of antimicrobial therapy, or the presence of bacteremia. Appropriate antimicrobial therapy based on culture results was an important determinant of survival in a large cohort of patients with severe sepsis [32].
Second, because of the absence of microbiology data, we cannot explore whether the positive impact on mortality observed with DCCTs is related to a synergistic effect of two mechanistically distinct antibiotics or a broader range of coverage with two or more agents.
Third, we did not evaluate source control and other important measures included in the Surviving Sepsis Campaign care bundles.
Fourth, this is a secondary analysis of an observational study. Nevertheless, properly designed observational studies with the appropriate analytic approach can provide valuable information on treatment effectiveness [4].
However, our study has also important strengths. We prospectively enrolled a large cohort of ICU patients with severe sepsis and septic shock in a short time and monitored them until death or hospital discharge, resulting in a homogeneous database with high quality-control measures that assure data validity [4]. Finally, our conclusions are strengthened by absence of immortal bias.
β-Lactams, including carbapenems, are the mainstay of empiric therapy in patients with severe sepsis and septic shock. Carbapenems are more frequently prescribed in patients with nosocomial sepsis, although up to one in five patients with community-acquired sepsis is treated empirically with a carbapenem. Our study supports the hypothesis that early administration of antimicrobials with different mechanistic targets is associated with decreased in-hospital mortality. Our findings extend those of the propensity-matched analysis in patients with septic shock published by Kumar et al. [10] because we also included patients with severe sepsis, underlining the urgent need for well-designed randomized controlled trials to evaluate the clinical benefit of DCCTs in critically ill sepsis patients.
Key messages
β-Lactams, including carbapenems, are the antibiotics most usually used in the critical care setting.
Although carbapenems are more frequently prescribed in patients with nosocomial sepsis, one in five patients with community-acquired sepsis is treated empirically with a carbapenem.
Urologic focus of infection is associated with the lowest mortality rate in patients with severe sepsis or septic shock.
In our series, the mortality rate was significantly lower in patients receiving DCCTs than in those receiving non-DCCTs.
A DCCT in empiric therapy is a protective factor for mortality in patients with severe sepsis or septic shock.
Acute Physiology and Chronic Health Evaluation II
different-class combination therapy
intensive care unit.
We received statistical support from David Suarez, MSc from Unidad de Epidemiologia, Fundación Parc Tauli, Universidad Autónoma de Barcelona. Barcelona, Spain; and data monitoring from Gemma Gomà, research nurse from Centro de Críticos, Hospital de Sabadell. Sabadell, Spain.
The Edusepsis Study Group included Ana Navas, Ricard Ferrer, Antonio Artigas (Hospital de Sabadell, Consorci Hospitalari Parc Tauli); María Álvarez (Hospital de Terrassa); Josep Maria Sirvent, Sara Herranz Ulldemolins (Hospital Universitari Josep Trueta de Girona); Pedro Galdós, Goiatz Balziscueta (Hospital General de Móstoles); Pilar Marco, Izaskun Azkarate (Hospital de Donostia); Rafael Sierra (Hospital Universitario Puerta del Mar); José Javier Izua (Hospital Virgen del Camino); José Castaño (Hospital Universitario Virgen de las Nieves); Alfonso Ambrós, Julian Ortega (Hospital General de Ciudad Real); Virgilio Corcoles (Complejo Hospitalario Universitario de Albacete); Luis Tamayo (Hospital Río Carrión); Demetrio Carriedo, Milagros Llorente (Hospital de León); Paz Merino, Elena Bustamante (Hospital Can Misses); Eduardo Palencia, Pablo García Olivares, Patricia Santa Teresa Zamarro (Hospital Gregorio Marañon Madrid); Carlos Pérez (Hospital Santiago Apóstol); Ana Renedo (Hospital Morales Messeguer); Silvestre Nicolás-Franco (Hospital Rafael Méndez); María Salomé Sánchez (Hospital Vega Baja); Francisco Javier Gil (Hospital Santa Maria del Rosell); María Jesús Gómez (Hospital General Universitario Reina Sofía de Murcia); Enrique Piacentini (Hospital Mútua de Terrassa); Ana Loza (Hospital Universitario de Valme); Jordi Ibáñez (Hospital Son Dureta); Silvia Rodríguez (Hospital de Manresa); Jose Ángel Berezo, Jesús Blanco (Hospital Río Hortega Valladolid); Angeles Gabán, Mª Jesús López Cambra, Alec Tallet (Hospital General de Segovia); Miguel Martínez, Jose Antonio Fernández, Fernando Callejo, Mª Jesús López Pueyo (Hospital General Yagüe); Francisco Gandía (Hospital Clínico Universitario de Valladolid); Mª José Fernández (Hospital Santa Bárbara); Juan Carlos Ballesteros (Hospital Universitario de Salamanca); María Teresa Antuña, Santiago Herrero (Hospital de Cabueñes); Manuel Valledor, Mª Jose Gutierrez (Hospital San Agustín); Carmen Pérez (Hospital Universitario Insular Gran Canaria); Oscar Rodríguez (Hospital Clínico Universitario de Valencia); Rafael Dominguez (Hospital Alto Guadalquivir); Josefa Peinado (Empresa Pública Hospital de Poniente); María Victoria de la Torre, Cristina Salazar (Hospital Virgen Victoria de Málaga); Mª Cruz Martín, Joaquin Ramon (Centro Médico Delfos); Fernando Iglesias Llaca, Lorena Forcelledo Espina, Francisco Taboada Costa, José Antonio Gonzalo Guerra (Hospital Universitario Central de Asturias); Francisco José Guerrero, Felipe Cañada, Mª Milagros Balaguer, Isabel Mertín, Carmen López, Daniel Sánchez (Hospital Torrecardenas); Josep Costa, Calizaya (Hospital de Barcelona SCIAS); Angel Arenaza, Ana Mª Morillo, Daniel Del Toro, Tomás Guzman (Hospital Virgen de la Macarena); Antonio Blesa, Fernando Martínez, Alejandro Moneo (Hospital San Carlos); Mª Jesús Broch (Hospital de Sagunt); Jose Antonio Camacho (Hospital San Agustín de Linares); Francisco J. Garcia (Hospital de Montilla); Xosé Luis Pérez (Hospital Universitario de Bellvitge); Nieves Garcia (Hospital Universitario La Princesa); Juan Carlos Ruiz, Jesús Caballero, Esther Francisco, Tania Requena, Adolfo Ruiz, José Luis Bóveda (Hospital Universitari Vall Hebrón); José Miguel Soto, Constantino Tormo (Hospital Universitario Dr Peset); Rafael Blancas (Hospital La Mancha-Centro); Manuel Quintana, Miguel Ángel Taberna (Hospital Nuestra Sra del Prado); Jose Maria Añon, Juan B. Aranjo (Hospital Virgen de la Luz); Manuel Rodríguez (Hospital Juan Ramon Jiménez); José Maria Garcia (Hospital La Serrania de Ronda); Mª Isabel Rodríguez (Hospital General de Baza); Mª Jesús Huertos (Hospital Universitario Puerto Real); Carlos Ortiz (Hospital Virgen del Rocio); Mª Eugenia Yuste (Hospital Universitario San Cecilio); Juan Francisco Machado (Hospital Santa Ana-Motril); Dolores Ocaña (Hospital La Inmaculada); Ramón Vegas (Hospital Valle de los Pedroches); and Luis Vallejo (Hospital SAS La Linea).
Authors' Affiliations
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Real Estate in Pearland, TX
Pearland is located in Texas. Pearland, Texas has a population of 90,347. Pearland is more family-centric than the surrounding county with 46.9% of the households containing married families with children. The county average for households married with children is 39.32%.
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Skip to comments.For Newt after Santorum goes stark raving, March improving economy, Mad(ness)
Posted on 03/13/2012 2:32:04 AM PDT by Cincinatus' Wife
Thankfully, former Speaker Newt Gingrich is every bit a social conservative as the former senator from Pennsylvania, and so would have that historical advantage that, along with the Its the economy, stupid rule, regularly results in the election of Republican presidents and congressional majorities.
So how did the young whippersnapper who previously won our Super Tuesday endorsement by avoiding anti-Bain venture capitalism-pile-ons while also contrasting his unblemished record against individual health care mandates as opposed to Mitt Romneys Massachusetts RomneyCare and 2009 advocacy for the individual mandates in ObamaCare? Unprompted, he essentially took the economy off the table for the fall election against President Barack Obama based upon seasonally adjusted employment fictions from the administration:
You hear now the media starting to say, oh well, looks like the economy is getting better, Santorum told supporters in Missouri Saturday night after winning the Kansas caucuses. You know, the economy may be getting better and Republicans may lose their edge on that issue. Well, if that was the only issue in this race, that may or may not be the case, we dont know.
You heard that right. The man that pointed out the danger of a Romney candidacy that takes ObamaCare off the table against the Democrats, volunteers to take the economy off the table based upon the bogus hurrahs for a fictional economy built at the Bureau of Labor Statistics that changed decades of procedures last year by rejecting state employment statistics in favor of the federal governments own best estimates. One wonders what the senator would say if the MSM reported that Americans are happy with ObamaCare.
When asked about Young Ricks concessions yesterday, Senator Lindsey Graham (R-SC) yesterday recited economic reality:
Well, no, I dont think hes right at all. This is an anemic recovery as a pretty long recession, 37 months in a row over 8 percent unemployment for the people in the United States, the longest streak since the Great Depression. Last month in February, $229 billion monthly deficit, the highest deficit in the history of the nation. When you look at the stimulus package two years ago, they projected unemployment at 6.5 percent. Obamacare said that everybodys premiums would be lowered by $2,500; theyve gone up by $2,200. And were producing less oil on publicly held lands than any time in the nation.
So the economy is not is anemic at best, and the policies of the president are going to make it impossible for this country to recover. Big things havent happened very well on his watch.
Doesnt the man so well-informed about the evil details of ORomneyCares understand that:
1. the raw numbers of Americans working last month are nearly two million less than those working when the Democrat president was elected in November of 2008;
2. the 227,000 number of new jobs allegedly created last month is a fiction based upon seasonal adjustments;
3. the U-3 unemployment rate of 8.3% produced by bureaucrats in D.C. sans data from states was flatly contradicted earlier last week even by liberal Gallup (9.1%) and the week before by the Congressional Budget Office (10%);
4. 8.3%, in any event is unacceptably high after three-plus years of between 8-11% as Obama has presided over second the longest such period of high unemployment in American history; and
5. the Gross Domestic Product over the last year has been barely above a pulse at an average of less than 1%.
Yet, somehow because ABC, NBC, CBS, CNN and even Fox News Channel report government propaganda as fact, Republicans could somehow lose the edge on the economy this fall? Well yes, if we concede issues for incoherent reasons, we would lose the edge, not because the voters buy it (polls show that majorities reject the rosy scenarios and Obamas performance on the economy); but rather because too many voters would again see a cowardly Republican against a courageous Democrat and stay home.
Therefore, despite Newts personal and non-personal baggage (Cave-ins to Bill Clinton while betraying promises to republican colleagues, Couching Pelosi on the science fiction of man-made global warming, Bain attacks etc), we are satisfied with his mea culpas and are confident that he wont shift campaign strategy based upon what John King insists is a booming recovery, when the numbers rely upon writing off 1.2 million people that failed to file their 5th application for work at the corner McDonalds for four consecutive weeks.
We just hope that a Gingrich nominee would also not have to fight with some timid conservative websites that also seem to want to make Green Rooms at CNN more palatable by also faking a smile about fictitious improving economies.
We also hope that those anti-social conservatives dont pull their support when the media reminds of Newts very strong, you might say religious right-strength, social conservative views as expressed in his 2009 book, Rediscovering God in America; positions against judicial supremacy mainly on religious freedom issues; railings against the ABC TV show, Christian Bitches; and boldly and accurately describing then Illinois State Senator Barack Obamas opposition to the Born Alive Infant Protection Act as support for legalized infanticide.
Prior to Santorums weekend remarks conceding economic issues to the failed Democratic incumbent, we thought we had cast our Stone Mountain of Georgia precinct primary vote for the best candidate to evict the American economy wrecking machine, also married to Michelle, from the White House. Our trust was betrayed.
Hopefully, our present advocacy for Gingrich that we hope is heeded by Alabamians and Mississippians voting in Tuesdays next installment of Newts I-85 Primary, wont be betrayed before the sun sets on March Madness after the Kentucky Wildcats finally deliver a national championship to Coach Calipari.
But if Newt transgresses, he will be called on it by the DeVine Law Gamecock by rooster crowings before April Fools Day. Would tea partiers expect anything less? No, and while I think either of the top three could and would defeat Obama, we are interested in the issues and a mandate to fix what ails us. We will continue to hold our fellow conservative Republicans accountable.
From Redstate? Wow. That will leave a mark.
We should get the ' COST of Obamacare today".
Maybe the boy just ain't smart enough for politics?
Newt/Perry 2012
For Mr. Santorum will not initiate anything, Mr. Gingrich should do the followings:
1. Announce that HE WILL ONLY campaign in Louisiana, NY, Arkansas, TX, New Mexico, and Montana.
2. Encourage his avid supporters like myself to vote for Santorum in Missouri, Wisconsin, Penn., West Virginia, Cali., Kentucky, South Dakota, Nebraska.
3. Tell Ron Pauls supporters that he will make Dr. Paul the Secretary of Treasury in his administration to reign on the Fed if he get elected.
4. Tell Santorums supporters to see them and Mr. Santorum in the brokered convention if they work hard for him in the states he will campaign.
There is no chance both Mr. Gingrich and Mr. Santorum can force a brokered convention if they divide the conservative votes between them, in reality, divide delegates equally 3-way among them and Romney in all conservative states and yield all delegates to Romney in more liberal primaries. Please check the numbers here:
They have to take turn to beat up on Romney to force a brokered convention where they can have a chance to fight another day. Otherwise, it is all over soon as Romney will have more than enough delegates to clinch the nomination.
I cant stomach my priests having to give out Communion to lesbians or marry homosexuals in church and force my kids to sit there and watch, or to witness them kissing each others in public.
All the sexual promiscuities will take place if Romney nationalizes same-sex marriage as he did in Massachusetts.
I disagree. It is unwise to limit a campaign.
It's clear that Rick Santorum is working for the VP pick at this point.
Look at Kansas lesson, Newt declared not to go there, Santorum collected 33 and left 7 delegates for Romney.
If either Santorum or Newt reach >50% in the state level or congressional district levels, he will collect ALL the allocated delegates leaving none for Romney.
If they both campaign for the same delegates at the same CD or state, they will never achieve >50% votes, therefore, the allocated delegates at that particular CD or state will be awarded proportionally to all three candidates plus Ron Paul.
Unfortunate! Nobody listens.
I haven't even made it to the article—I'm still trying to understand what the h*** the headline means.
"All the sexual promiscuities will take place if Romney nationalizes same-sex marriage as he did in Massachusetts."
We should be fighting Obammay/Mittens.
Newt is best when he is Attacking Obammay.
However the Newt and Santorum camps keep fighting each other.
Obamma & Mittens are the enemy Hammer away guys.
VP to who? Certainly not Romney. I would hope Gingrich would pick Perry over Santorum. Santorum burned his VP bridges with his cheap shot campaign while pretending to have clean hands. He even took an uncalled for shot at Bush 41 yesterday.
March Madness = college basketball playoffs.
"Newt/Perry 2012"
Do you really think Perry is a good fit? I don't think he needs Perry for VP (I'd rather he be Homeland Security). I like Col. West.
Did you watch the speeches last night?
C-Span: Republican Candidates Campaign in Birmingham, Alabama
Roger that!
However the Newt and Santorum supporters keep fighting each other.
When Obama/Mittens is where we should be focused.
Yeah, I gathered that, but it still doesn't make any sense.
No, he wants to take an election season with the worst economy because of a Marxist ideologue and his Marxists administration's policies and turn it into an election about social issues. Because that's such a winning platform with our culture and a media painting him as the Church Lady from SNL.
I am watching Newt on Fox and Friends this morning. He physically looks horrible.
He needs to get his health checked out.
Newt March 12, 2012 -- Birmingham, Ala.
It was scarey. Could be exhaustion. He looked bad this morning.
Have you had your opportunity to vote for Mitt yet?
notice that he never really went after Mitt, not the way he went after Newt. His game is obvious- help Romney destroy Newt all the while presenting himself as the VP pick that will shore up Romney's conservative credibility issue. He's not going to be President and he knows it. also note that Romney never went after Rick the way he went after Newt.
LOL, I am in Indiana, you will have your opportunity to vote for Mitt before I will. /sarc
The top priorities of the current administration is to bankrupt USA with debt and impose so-called health care. When one's healthcare is controlled, his thoughts are censored.
The top priority of the next administration is to nationalize same-sex "marriage." Just look at the example of State of Washington which just passed Democrat-sponsored same-sex marriage law. Republican senators introduced 2 amendments, first to exempt Christian churches from marrying them in church; second to exempt business such as florist, DJ, cater services using conscience clause, and both amendments were defeated. The gay-practicing sponsor of the bill rejoiced in saying that he finally could get married in his own catholic church! The time for our pastors and priests to be martyred for Christ finally is arriving.
If it is to be the next administration then that leads me to believe that Obama or Mittens will win this Election. We may not make it that far.
Just don't see it in Newt or Santorum.
Newt seems to have a cold or sinus congestion this morning. Maybe allergy?
>> still trying to understand what the h*** the headline means <<
You and me both!
T think his face looked swollen.
Well for goodness' sake don't vote for him, he could have hay fever!
(But obviously you weren't going to vote for him anyway.)
Agreed. Santorum is angling to be Romney's VP pick, nothing more. At the convention, Romney comes up short and Santorum provides the needed delegates. Romney agrees because he needs the delegates and he needs help with the evangelicals. Even if Romney/Santorum loses, Santorum is the front runner for 2016.
Having Newt pick Perry would be worth the VP debate alone. Idiot Biden debating Idiot Perry. My gosh the thing might never end with their equal lack of intelligence. If Newt is the nominee, he cannot pick Perry when we have many intelligent candidates to chose from. I guess for comic relief, the debate would be a must see.
Is there a live thread for tonight's primaries in MS and AL?
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.


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Welcome to Kiss Futures
This site is dedicated to providing top quality education and information relating to the trading of stocks, futures, and forex products. With the recent advances in computing power and growing access to the internet, millions of users are now able to connect to financial markets all over the world. We hope that you will learn a few things and take the time to interact with other guests and members in our forum.
What are stocks, futures, and forex?
Lets start with stocks. Most of us are familiar with stocks which are basically a tiny piece of ownership in a company. I remember when I was little my friend told me he owned
stock in Disney. When I asked my parents what that meant they told me he owned a tiny portion of Disney and I pictured a little corner of Disney World that was his and his alone. Boy was I jealous! Of course that is not exactly how stock ownership works but its a figurative example. By owning stock you do indeed own a piece of the company and a tiny piece of any property or assets that company has. There are three ways you can make money (or lose) money by trading stock:
- Buy stock at low price and sell it at a higher price
- Hold onto your stock and the company may pay dividends which is a cash payout to you
- Short sell – if you think the stock price will go down you can essentially borrow the stock from your broker, sell it at a current price, and then re-buy the stock at a lower price and give it back to your broker. You pocket the difference.
Be careful of risk. Each of these options is extremely risky for short term (less than 1 year) of stock trading. The safest strategy to make money trading stocks is to buy stock in a solid company and hold onto it for at least several years. Read more about stock trading….
What are Futures? Futures are contracts between a buyer and a seller and they are yet another type of financial instrument that you can trade online. Unlike stocks, futures contracts are a promise to buy something in the future (that's how they got their name). Some examples of futures contracts are gold, oil, currency, and grain. A little history. The first futures
exchange market was the Dojima Rice Exchange in Japan in the 1730s, to meet the needs of samurai who—being paid in rice, and after a series of bad harvests—needed a stable conversion to cash. So you see, futures contracts can help people and companies reduce risk by allowing them to buy or sell a good (such as oil) at an agreed upon price in the future. Read more about futures trading…..
What is Forex? The foreign exchange currency market is also known as "forex". This is a highly liquid market that trades 24 hours per day 6 days per week. The forex market allows large organizations such as companies, banks, or even nations to exchange currency. Typically a buyer of one currency will pay for their transaction with another currency. The price of that transaction will become the exchange rate. If you do millions of transactions per day, the exchange rate will fluctuate. Investors have caught onto this and use the fluctuating rate as a method to make money. There are many brokers that will allow the average person (you and I) to trade in the forex market. Be careful – the amount of leverage that is used in forex can be very high. This means your broker may let you open a trade for 100 times more than what you have in your account. I suggest everyone use a good forex lot size calculator to determine a safe amount to trade. Leverage can be a double-edged sword allowing you to make or lose a great deal of money very quickly. Read more about forex…….
About the site owner: Besides being a business owner and investor, Brad is also a registered patent agent and has filed over 500 patents. Brad is the creator of the free patent template and the example for provisional patent on the PatenFile website.
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European eels (Anguilla anguilla) undertake a ~5000-kilometer (km) spawning migration from Europe to the Sargasso Sea. The larvae are transported back to European waters by the Gulf Stream and North Atlantic Drift. However, details of the spawning migration remain unknown because tracking eels in the Atlantic Ocean has, so far, eluded study. Recent advances in satellite tracking enable investigation of migratory behavior of large ocean-dwelling animals. However, sizes of available tags have precluded tracking smaller animals like European eels. Here, we present information about the swimming direction, depth, and migratory behavior of European eels during spawning migration, based on a miniaturized pop-up satellite archival transmitter. Although the tagging experiment fell short of revealing the full migration to the Sargasso Sea, the data covered the first 1300 km and provided unique insights.
↵† Present address: Aarhus University (AU), Department of Biological Sciences, Ny Munkegade 114, DK-8000 Aarhus C, Denmark.


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Honk: Everything might not be a loss
Q. Talk about your run of bad luck – I recently renewed my auto registration. Not two weeks after I put the sticker on my license plate, I was involved in an accident that totaled my car. Now I'm forced to buy a new car (new to me anyway). Is there any hope of recovering the registration fees I paid for a car that will never be on the road again? I though I remembered seeing a similar question in a past column, but I can't seem to find it now.
– Mike Hughes, Costa Mesa
A. Honk doesn't remember writing that one up. But look at that mug shot of him – he has more wrinkles than a good mystery novel. He might simply have forgotten that one.
Well, Mike, luck might be turning your way.
Honk chatted with Jessica Gonzalez, a spokeswoman for the Department of Motor Vehicles, and state law does allow a pro-rated refund of the Vehicle License Fee if your ex-ride was too damaged to repair.
Your insurance provider could be the one getting any cash, though, depending on the circumstances.
If you are entitled to the cash, you will need to fill out an application, which will set you back $19 (it would be deducted from your refund). Expect to round up some documentation.
For specifics: dmv.ca.gov/pubs/brochures/fast_facts/ffvr04.htm.
Q. In a recent Honk column, you mentioned that drivers must keep open booze in the trunk or in the bed of a truck. Would placing an opened wine bottle in an ice chest in the back of a van be legal?
– Mike Chiaramonte, Santa Ana
A. Shockingly – at least to Honk – yes, that would be fine, so long as the driver or a passenger is at least age 21.
State law says that for vehicles without trunks, open liquor can be placed in an area not normally occupied by the driver or passengers.
So make sure you stick the cooler – as Todd Kovaletz, a California Highway Patrol officer and spokesman in Santa Ana, puts it – in the "very, very, very, very back of the van."
No one should try and get cute – the good officer said sticking the cooler between the driver and the passenger, as an example, won't cut it.
And the law specifically spells out that glove boxes cannot hold open booze – so don't tell the cop, "Well, officer, my passenger and I don't normally occupy the glove box."
Got a question? Contact Honk at email@example.com. See Honk online: ocregister.com/honk.
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Kiddicouture Pushchair Liquorice Lane
Guide price: £100
Last updated on 6th Jul 2012
Kiddicouture Pushchair Liquorice Lane
This lightweight stroller is suitable for children from 3 months of age and has a 4 position back rest and adjustable leg support. The pushchair comes complete with a net shopping basket and also has a zipped pocket in the rear of the hood with viewing window. A co-ordinating foot muff and rain cover is included. Features: • Suitable from 3 months • Lightweight aluminium frame • Umbrella fold • Ergonomic handles • 5-point safety harness • Lockable / swivel front wheels • Adjustable leg rest • 4 recline positions • Viewing window • Linked brake • Zipped pocket in hood • Net shopping basket • Rain cover included • Co-ordinating footmuff included
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Silver Bear Ammunition 5.45x39mm Russian 60 Grain Full Metal Jacket (Bi-Metal) Case of 750
- Non-returnable item. We will not accept any returns on this item.
Silver Bear ammo is high quality ammo features distinctive, highly polished, zinc plating on the steel cartridge case; hence the name Silver Bear. Silver Bear offers you a high quality ammunition at reasonable prices. Silver Bear uses Berdan primers that are non corrosive. These primers offer long shelf life and sure-fire ignition. Silver Bear is loaded to exacting standards.
60 Grain Full Metal Jacket
Bi-Metal Jacket
Zinc Plated Steel Case
Berdan Primed
Muzzle Velocity 2821 fps
Uses: Target, Training, and Plinking
Note: The projectile is a lead core however the jacket is bi-metal and it may contain steel. As such a magnet would be attracted to the bullet.
750 round case
Ammo price is per case


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Watch how to make this recipe.
Preheat the oven to 350 degrees F. Coat a 9 by 13-inch baking pan with cooking spray.
Place all ingredients except the syrup and eggs in a food processor and pulse until the mixture is finely chopped. Add the syrup and eggs and pulse until the mixture is well combined. It will resemble a coarse paste.
Transfer to the baking pan and spread evenly. Bake until just done, about 20 minutes. Cut into 20 squares.
Copyright 2005, Ellie Krieger, All Rights Reserved
The best comfort food is comforting both to cook and to eat, like Ree's pork chops.


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Couldn't disagree more with the review. The critic must be some elitist arse, who'd be better off reviewing obscure restaurants with square plates or butcher's paper for a plate. Anyway, the three or four times I've eaten at Mother Muffs, the food has been great. Just what you'd expect after reading the menu. I've had BLT, fried raviolis, cheese sticks, and a burger. All were tasty. Service has been great. Prices are decent! Nice atmosphere in the front room. Olde school, pub feel!
The bar is a very fun place to relax and have a couple drinks. The staff is friendly. I like this place a lot. Robert this is a very safe bar.
I have always had the best of service here. Mindy and staff are helpful an caring. Product is always available and of good quality. Prices are very competitive. I have shopped many dispensaries and this is one I continue to go back too. They have gone above and beyond in my book getting product I have specifically requested. Good people, good product and good pricing. Cant go wrong. Check them out
Great bands and rockin' Halloween parties...
Never seen any cases of attempted murders or people getting tossed out on their a****.
Always had a good time..great staff and libations.
Old Town Plaza merchants have always been friendly over the last 5 years I have shopped with those merchants. FREE Parkignlot is maintian so clean. the side walks and wheelchair aprking with rmap up tho the sie walk is amazing for those in wheelchairs. Great variety in the shops with awesome food aat the deli and Egytian resturant.
Awesome product and prices! Great employees and member deals!
Benny's is my favorite bar in Colorado Springs. Also, in my opinion, Ashley is the best bartender in Colorado.
My observations are based on daytime visits since I do not go to bars at night (I am 71).
Dana the owner has an exceptional operation...
I am a vendor at ACM with three locations throughout the store. ("Mom & Me, Vintage Linens, Lace and Antiques") ACM gives me the best opportunity to Grow my business because they help. They are interested in our success and we are more than just a number here. Are we filthy rich? No, but we sure do have a lot of fun making a decent profit, doing what we love.
A must try!
Can I please please please get the recipe for the amazing shrimp tacos as I don't live in the area!! They were amazing!
ACM is great place to shop for a variety of reasons! Not only do they have antiques they also have great gift items for birthdays and holidays! They also have a wide selection of beautiful jewelry from vintage, native American and modern. The prices are great too! Why buy a piece of new furniture when you can get solid wood piece cheaper than pressed wood and the piece will last for generations to come. Looking for a present? don't just go to the mall and pick something everybody else has? You can find something unique like tea cups, jewelry, candles, stocking stuffer items, hostess gifts and new items! Make a gift basket to fit your recipients personality! There are lots of kids items and any collectable you can imagine! So when shopping for those holiday gifts you will find the items on your shopping list all in one place! Hint: Plan an entire day you cant possibly see everything in one day!
Tru, you can be on my list of those with bad behavior. You can see my list on this Independent site in various places. I do not criticize without cause and I use my real name. I will back up my comments with facts. I will ask who are you that you deserve special treatment and demand that someone lose their job. Bad service? I would spill drinks on you and I do not blame a bartender whose job is to serve glasses of angry, stupid, melancholy or however it affects you to everyone. Instant mood swings, fistfights and loudmouths- you name it and if you think your dollars are going to make or break anyone I say "think again".
Only place I shop. The employees are super nice to me. Texts for specials. Great meds!
Best quality for the price and the tenders are fantastic won't ever leave this store as my member store. Best store in town not just the westside
Awesome drinks and friendly staff. Best new drinks ever!
This is a great store. The staff is awesome and super friendly. They are always easy to talk to and definitely helpful with any questions you might have. I have never had a bad experience going in. My husband and I have bought several toys from this store and are always satisfied 😋
I love SEVL it's a great place to hang with friends
People are awesome and prices are cheap. I wouldn't go anywhere else!
The most outstanding place to be!!! Excellent Service, very entertaining, lots to do!
Some of the best deals in town. This is a one stop shop with outstanding buds.
The place is always busy but members can use the express bar to order ahead.


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Tara's journey started with her daughter's birth. play video


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Crepes Suzanne
|Sifted all purpose flour
|3⁄4 Cup (12 tbs)
|1 Tablespoon
|1⁄4 Teaspoon
|1 Cup (16 tbs)
|1 Tablespoon, melted
|Navel orange
|Peach preserves
|1⁄2 Cup (8 tbs)
|2 Tablespoon
|2 Tablespoon
|1⁄4 Cup (4 tbs)
1. Measure flour, sugar and salt 591 into a sifter. Beat eggs until thick in a medium-size bowl; sift dry ingredients over; beat just until smooth. Stir in milk and the 1 tablespoon melted butter or margarine. Chill batter at least 2 hours.
2. Heat a heavy, 8-inch skillet slowly; test temperature carefully by sprinkling in a few drops of water. When drops bounce about, temperature is right. Grease pan lightly with butter or margarine.
3. Pour batter, 1/4 cup at a time, into skillet, tilting to cover bottom completely. Cook over medium heat, 1 to 2 minutes, or until top is set and underside is golden; turn; brown other side. Stack crepes with sheet of foil between each, until ready to serve. Repeat with remaining batter, lightly buttering the pan before each crepe. (Batter makes 8 crepes.)
4. Grate the rind from the orange; reserve. Squeeze and reserve juice from orange.
5. Combine the peach preserves, the honey, the remaining 2 tablespoons butter or margarine and reserved orange rind and juice in same 8-inch skillet; heat, stirring constantly, until mixture bubbles for 1 minute; reduce heat to low.
6. Place a crepe in sauce in pan; turn gently with tongs to coat both sides lightly. Fold crepe in half once, then in half again to form a quarter circle. Pick up with tongs, allowing excess sauce to drain off into pan; place crepe on heatproof serving platter; repeat with remaining crepes. Pour remaining sauce over crepes in serving platter; keep warm.
7. Warm brandy slowly in a small saucepan until small bubbles appear around the edge. (Do not allow to boil.) Ignite carefully with a wooden match held at arm's length. Quickly pour over crepes, spooning sauce over crepes until flames die; serve immediately.
Rate It
Nutrition Rank
Nutrition Facts
Serving size: Complete recipe
Calories 1809 Calories from Fat 531
% Daily Value*
Total Fat 60 g92.3%
Saturated Fat 32.2 g160.8%
Trans Fat 0 g
Cholesterol 753.8 mg251.3%
Sodium 794.9 mg33.1%
Total Carbohydrates 255 g85%
Dietary Fiber 7 g27.8%
Sugars 167.5 g
Protein 38 g76.2%
Vitamin A 51.5% Vitamin C 195.8%
Calcium 44.7% Iron 42%
*Based on a 2000 Calorie diet


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Dustbags X3051p Hoover
Guide price: £6
Last updated on 29th Nov 2011
Tags: vacuum cleaner accessories
Dustbags X3051p Hoover
Don't forget the dustbags for your vacuum to keep it running conveniently and to it's maximum potential.
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Similar to Dustbags X3051p Hoover
Waterproof Bluetooth Shower Speaker
Wouldn't it be great if you sing along with the shower speaker and never miss incoming calls from the shower! With a clear stereo sound, this splash-proof device streams music instantly from any Bluetooth enabled device and doubles as a hand-free microphone, offering easy switch and handling. Just hook it up anywhere, connect it to a Bluetooth device and let the time roll.


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