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Newegg.com - A great place to buy computers, computer parts, electronics, software, accessories, and DVDs online. With great prices, fast shipping, and top-rated customer service - once you know, you Newegg.
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This review is from: Sedna PCIE 7 Ports USB 3.0 Adapter Card with SATA Power Connector
Pros: I am sure many, if the device worked, and had not been mishandled during manufacturing.
Cons: Firstly, this supposedly brand new item arrived to me physically dirty. The actual physical device, obviously after being taken out of the package, was dirty. Some sort of grime, along with sticky fingerprints were all over the back and components of the card. I cleaned most of it off with some methanol, but the fingerprints and a film of some kind remain.
Secondly, the internal SATA power socket on the card itself is, or rather was, attached to the PCB with very flimsy and tiny plastic mounts. Upon the very first insertion of a SATA power cable these mounts snapped. Now, the socket is being held onto the PCB only by the copper leads themselves. I have over 15 years of experience with electronics and computer hardware, so I certainly know what I am doing, and did not over-exert any force.
Thirdly, this card BSODs my Windows 7 Ultimate 64-bit system any time a device is plugged into it. The following is the last BSOD overview I captured before writing this. If you search the codes, you will find they all point towards faulty hardware:
Problem signature:
Problem Event Name: BlueScreen
OS Version: 6.1.7601.2.1.0.256.1
Locale ID: 1033
Additional information about the problem:
BCCode: 50
OS Version: 6_1_7601
Service Pack: 1_0
Product: 256_1
Lastly, with this card installed in my system, if I try to hibernate or sleep, Windows will fail to resume and report a corrupted restoration point. To resolve this, I have to reboot twice, delete the restoration point, and start Windows fresh.
I am not at all a satisfied customer, and find this product to be faulty, containing poor design features and component quality, and showing signs of poor handling and manufacturing.
This review is from: Vantec 4 Channel 6-Port SATA 6 Gb/s PCIe RAID Host Card Model UGT-ST644R with HyperDuo
Pros: This card has a solid physical design, and the inclusion of low-profile mounting brackets means you can use this is thin client, and 2U+ rack cases.
I am using the card to host an external backup drive, and an internal backup drive. Solid performance, no issues at all.
For those having issues with the drivers, make sure you get the Marvell 92xx drivers from Marvell's website. In Device Manager the the files are listed as mv91xx.sys, mvxxmm.sys, and mv91xxm.dll.
In regards to device compatibility, I have had no issues testing SATA I, II and III hard drives. As well, no issues with either DVD-RW or BR-RW drives, single and dual layer. Booting from all devices works fine, but this is actually dependent upon the motherboard BIOS.
Cons: There are a couple of items that buyers need to be made aware of:
- Firstly, this card is requires a PCI-e x4 or larger slot. It will not fit into x2 as the description indicates.
- Secondly, this card has four SATA channels, that means only four of the six ports are usable at once.
Other Thoughts: This is a great card, with solid compatibility and performance. I have never bought a bad Vantec product, and they are one of the few brand names I inherently trust.READ FULL REVIEW


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Wednesday, August 9, 2017 beginning at 6:15 p.m.
More than 200 floats, animal, marching bands and novelty and performing units will march from the State Capitol, west on Grand to 13th Street.
Start time: The 2017 Iowa State Fair Parade will begin at 6:15 p.m.
Route: The parade will travel west on Grand Avenue to 13th Street.
Television Coverage: Highlights of the parade will be re-broadcast throughout central Iowa on KDSM FOX 17.
An estimated 200 floats, animals, vehicles and novelty and performing units will parade down Grand Avenue to herald the start of Fair.
Questions? Contact Tonya Cook at email@example.com.

subset: commoncrawl


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Alan Ruck Net Worth: Alan Ruck is an American actor who has a net worth of $10 million. Alan Ruck was born July 1, 1956 in Cleveland, Ohio. His is best known for his roles as Cameron Frye in the 1986 film Ferris Bueller's Day Off, a film that achieved worldwide success along its way to becoming a classic, and Stuart Bondek on the television series Spin City (1996-2002). He made his Broadway debut in 1985 in Neil Simon's Biloxi Blues with Matthew Broderick. Alan Ruck's first big-screen film role was in the hard-hitting 1983 drama Bad Boys, also starring Sean Penn. That same year he played Roger Jackson in Class with Andrew McCarthy and John Cusack. After appearing in his memorable role in Ferris Bueller's Day Off, Alan Ruck settled into smaller film roles over the next decade. He appeared in the 1989 comedy film Three Fugitives then played Hendry William French in Young Guns II, the 1990 sequel to Young Guns. He also played Captain John Harriman in the 1994 film Star Trek Generations. Alan also had supporting roles in the blockbuster Keanu Reeves/Sandra Bullock film Speed and in the 1996 disaster film Twister. After Spin City wrapped up, Ruck made guest appearances on such television shows as Scrubs, The Bronx Is Burning, Stargate Atlantis and Cougar Town. He also appeared in many supporting roles in films such as Ghost Town; The Happening; I Love You, Beth Cooper; and Extreme Measures. When Ruck returned to the stage in 2005 for the Broadway revival of Absurd Person Singular, he and co-star Mireille Enos fell in love and later married. Enos gave birth to their daughter, Vesper Vivianne, on September 23, 2010. Also in 2010, Ruck landed a starring role on the TV summer mini-series Persons Unknown.
Alan Ruck Net Worth
Alan Ruck
Date of Birth
Jul 1, 1956 (60 years old)
United States of America
6 ft (1.83 m)
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All net worths are calculated by applying a proprietary algorithm. The results are then fact checked and confirmed by a team of editors. We scan all publicly available data and resources and work diligently to ensure that our numbers are the most accurate and up to date net worth data you will find anywhere on the internet.


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The Marine Protected Areas (MPA) Federal Advisory Committee advises NOAA and the Department of the Interior on ways to strength the nation's system of MPAs (see Committee charter). It includes representatives of diverse stakeholder groups, including scientists, academia, commercial fishermen, anglers, divers, state and tribal resource managers, the energy and tourism industries, and environmentalists, among others. MPA Federal Advisory Committee meetings are open to the public and provide opportunities for public comment.
NOAA and the Department of the Interior are currently calling for nominations for ten new MPA FAC members to represent diverse ocean interests. Nominations are due by October 11, 2016. For more information, click here.
Agendas, minutes, public comment, presentations and supporting documents.
List, contact information and bios for the 20 members, plus federal (non-voting) members
View Committee recommendations and reports.
For More Information


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Catania are preparing to face Fiorentina and the Elefantini reveal "Vincenzo Montella asked to be released from his contract."
Montella was the Coach in Sicily last season, but after Roma made a proposal to bring him back to the Olimpico, he did eventually move to Fiorentina over the summer.
"He had worked well here in Catania, even if he asked to be released from his contract so he'd be free to choose a new destination," said general manager Sergio Gasparin.
"We made him happy so that there would not be any ill feeling."
Montella faces his former club next weekend when the Sicilians play at the Stadio Franchi in Serie A.
"Next Sunday I hope to see Montella happy at the start of the game and sad at the end of it..."
Keep up to date with the latest news and action from Spain's Primera Division with Football Espana - from the team behind Football Italia. [12]


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11 October 2012
28 September 2013 Last updated at 18:14 BST
A man has been described as "lucky to be alive" after he slipped and fell while descending a 14,000-ft (4200 m) mountain in the Rockies.
Richard Walker's head hit the rocks when he plunged 50 feet (15 m) down the North Maroon Peak; he broke his back and his jaw in the fall.
He was bleeding heavily from his nose and mouth and gasping for breath.
The first attempt to rescue him by helicopter failed, but climbers managed to lower him to an area where he could be lifted to safety.


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Sand-based Batteries to Power Your Castle
Adding silicon dioxide, or quartz — a primary component in sand — to lithium-ion batteries improved performance threefold.
Adding silicon dioxide, or quartz — a primary component in sand — to lithium-ion batteries improved performance threefold.
Simon Battensby/Getty Images
What do smart phones, electric vehicles and solar panels have in common? They all demand more and more battery power to keep our homes, jobs and vehicles running. Lithium ion is still the "gold standard," but researchers are looking at the entire periodic table for new combinations of elements that can conduct and store electrons in smarter ways. And the sooner they find it, the sooner society can get off fossil fuels and use more sustainable energy sources. "With the combination of new materials, new design concepts, and new production and manufacturing methodologies, I believe we will get there," said Esther Takeuchim, professor of advanced power systems at SUNY Buffalo, Here's a look at five new battery techs – some ready for market in the next year, others just over the horizon:
Leyden Energy
Lithium Imide When Leyden Energy's Noam Kedem was at the Consumer Electronics Show in Las Vegas earlier this month, he was struck by the fact that almost nobody could talk on the phone after 3 p.m. "Everyone was running from charger to charger," Kedem said. To meet the demand for more power and longer life, Fremont, Calif.,-based Leyden is using a unique electrolyte salt solution with existing lithium ion technology. Kedem says that doubles the number of laptop or cellphone battery charges from 350 cycles to more than 800. Kedem says their batteries can also operate up to 140 degrees Fahrenheit without producing hydrofluoric acid or the swelling that can occur when batteries heat up as they run multiple applications. Canada's Dr. Battery retailer began selling Leyden's first rechargeable battery pack, and the firm is beginning mass production of tablet and cellphone batteries this year. Kedem says the firm is testing a prototype electric vehicle battery using the same electrolyte platform.
Aquion Energy
Sodium Ion Pittsburgh-based Aquion Energy is betting on simple, non-toxic materials for their grid storage battery system. "It's made out saltwater, cotton, charcoal and dirt, actually lithium manganese oxide," said Ted Wiley, Aquion's vice president of business development. "Everything we're made out of is cheap and staying cheap." Aquion is building shipping-container-size storage cells for solar, wind and other renewable energy producers who need to store the electricity they make before selling it to the grid. It's a hybrid battery using the food preservative, sodium sulfate, and is based on research coming out of Carnegie Mellon University's school of engineering. This simple and inexpensive concept should also work to augment diesel generators in remote areas, Wiley said, or back up the power supply of homes and businesses.
Solid State Lithium Ion For electric vehicles, weight, range and safety are the big concerns. One idea is using solid state technology that doesn't have a liquid electrolyte solution for a lithium-ion fuel cell. "That gives our cells greater energy density and also potentially reduces system complexity dramatically," said Ann Marie Sastry, CEO of Ann Arbor-based Sakti3. The firm's batteries pack more power into less space, said Sastry, a University of Michigan professor of materials science and engineering. There's no flammable material either, something that's recently plagued the Chevy Volt's battery. GM and Khosla Ventures are backing Sakti3's research and development efforts. Meanwhile in Japan, Toyota announced recently that its own solid state battery with a 600-mile range will be ready for roll-out sometime around 2015.
Lithium Air One materials scientist told me that lithium air is the "grand slam home run" of energy density. Lithium-air batteries differ from lithium-ion batteries in that they use carbon for their positive electrode instead of metal oxides. Carbon is lighter and reacts with oxygen in the surrounding air to produce electrical current. Although it promises a 1,000-mile range instead of just 125 miles for electric vehicles, lithium air batteries have also proven to be unstable. The big problem is that lithium ignites when it contacts moist air. But IBM researchers in California and Switzerland reported this month that they have solved a key problem in the battery's electrochemistry by finding a different kind of electrolyte solution. IBM hopes to have a prototype lithium-air battery by 2013. Startups like Berkeley-based PolyPlus are also hunting for this "holy grail" of battery tech. Critics say that lithium-air research has been underway for two decades without complete success.
Wikimedia Commons
Magnesium Ion Some researchers are looking beyond lithium. The Department of Energy's Advanced Research Projects Agency for Energy (ARPA-E) is funding high-risk, high-reward technology, such as the magnesium ion battery being developed at Pellion Technologies, an MIT spin-off. Pellion says its batteries will have twice the energy density as existing lithium-ion batteries for both consumer products and electric vehicles. At the same time, Toyota researchers in Michigan say they are developing their own magnesium battery for an EV that can run twice the distance as current batteries on a single charge, but don't expect it until 2020. The race is on.
A woman's home is her castle. But that castle can get pretty expensive to power, if the batteries that energize all of the electronic gadgets in the house and in the driveway are made from lithium-ion. Not only are they costly, but they don't last forever and needs to be replaced.
But researchers found if instead of using the conventional graphite typically used in lithium-ion batteries, they used silicon dioxide, or quartz — a primary component in sand — the performance improved threefold.
Supercharged! Battery Power For The Future
"This is the holy grail — a low cost, non-toxic, environmentally friendly way to produce high performance lithium ion battery anodes," graduate student Zachary Favors of University of California, Riverside, said in a press release. Favors developed the new batteries along with engineering professors Cengiz Ozkan and Mihri Ozkan.
Favors found that sand from the Cedar Creek Reservoir, east of Dallas has a high percentage of quartz. He processed it to make pure silicon, which has a porous, sponge-like consistency. That porosity increases the energy density and is key to the improved performance.
Something Wrong? Zap It With Lasers: Photos
That could lead to smartphone and electric car batteries that last three times longer than conventional ones.
At the moment, the research team is perfecting their technique and working to produce larger quantities of the pure silicon.
The findings were published July 8 in the journal Nature Scientific Reports.
Credit: Mark M. Lawrence/CORBIS


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- February 19th - There were other stars, too though. The cats are... February 21, 2017
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Tag Archives: Bleak House
Driven like the snow
Today, we finally had some real winter weather. After the unseasonal warmth of Christmas, these last few cold, frosty, clear days have been a breath of fresh air for me. Yesterday, I watched the weather forecast hoping for snow. As … Continue reading
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In late February 2014, House Ways and Means Committee Chairman Dave Camp (R-MI) released a nearly 1,000 page discussion draft addressing tax reform. Chairman Camp's proposal includes changes to numerous sections of the Internal Revenue Code, including changes with respect to the taxation of individuals, capital gains and businesses. The discussion draft also includes changes relating to charitable giving and tax-exempt organizations.
The current sense of most political prognosticators is the Camp proposal has little chance of being enacted into law in the near term. Notwithstanding that the proposal is likely a "dead letter" in its current form, it is significant because it may well provide a framework for future tax legislation, including provisions impacting charitable contributions and tax-exempt organizations.
Charitable Giving. Chairman Camp's proposal includes several potential changes to the rules applicable to charitable giving, including:
Tax-exempt Organizations. Chairman Camp's proposal also includes changes impacting tax-exempt organizations, including:
Considerations. As noted above, Chairman Camp's discussion draft could be the starting point for tax reform, including any major change with respect to charitable giving and tax-exempt organizations. Whether there will be bipartisan cooperation or cooperation between the House and Senate with respect to tax reform anytime soon remains to be seen, but those interested in charitable giving and tax-exempt organizations would be well served to understand these proposals and the background and motivations that led to their consideration.
For further information click the following link for the draft legislation. Further resources include, a detailed section-by-section analysis of the legislation by the staff of the Joint Committee on Taxation.
See more »
DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.
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Bee a Reader in 2017
Jackets Love to Read!
*Please take care of all library book fines and lost book payments ASAP. Thank you!
Please do your part to help us with Book Care in the WISD Media Center.
1) Always keep books dry and clean. 2) Return the books when they are due.3) Use a bookmark to help keep pages looking neat.4) Shelve AR books in the correct spot with the spine out.5) Notify Mrs. Lowrie or Mrs. Connie if your book is in need of repair.
Box Tops for Education Update
We are off to a great start in our Box Tops Contestfor Preschool - 5th grades.
Congratulations to our 1st Grade, 2nd Grade, 3rd Grade, 4th Grade and 5th Grade students for earning anIce Cream treat after our 2nd collection.
1,000 Box Tops = Ice Cream! 2,000 Box Tops = Ice Cream! 3,000 Box Tops = Ice Cream!4,000 Box Tops = Pizza Party!
Check out our awesome totals! Way to go Jackets!
2nd Grade - 2,2491st Grade - 1,4683rd Grade - 1,3025th Grade - 1,1444th Grade - 1,000Kindergarten - 867Preschool - 704
*Please continue to bring in those Box Tops to your homeroom teachers. Our next collection is scheduled for: Tuesday, February 28th.
Available Resources - Our school has a subscription to the TumbleBookLibrary. TumbleBookLibrary is an online collection of TumbleBooks – animated, talking picture books which teach kids the joy of reading in a format they'll love. TumbleBooks are created by adding animation, sound, music and narration to existing picture books in order to produce an electronic picture book which you can read, or have read to you. Stop by the WISD Media Center for login information.
Check it out! www.tumblebooklibrary.com
The WISD Media Center also has an online subscription to the Kentucky Virtual Library. This database has access to numerous online resources. Stop by the WISD Media Center for a KYVL Quick Reference Guide which contains username and password information.
Dedicated to helping students become Lifelong Readers and Computer Literate.
Public Notice Williamsburg Independent School District Notice of Non-Discrimination Students, their families, employees and potential employees of the Williamsburg Independent School District are hereby notified that the Williamsburg Independent School District System does not discriminate on the basis of race, color, national origin, age, religion, marital status, sex or disability in employment, vocational programs, or activities as set forth in compliance with federal and state statutes and regulations. Any persons having inquiries concerning Williamsburg Independent School District compliance with Title II, Title VI, Title IX and/or Section 504 may contact: Amon Couch Williamsburg Independent School District 1000 Main Street Williamsburg KY 40769 606-549-6044 email@example.com
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Trav's Tree Services
When it comes to Tree Services in Melbourne, you need the expert and someone you can trust. That is where Trav's Tree services comes in. With years of experience, highly trained staff and qualified arborists that will provide you service, you are ensured to get the services your tree requires. With over years experience rescuing and removing trees the team have you covered with ...
16 Cotham Rd, Kew
Melbourne, VIC. C.P.: 3101
Stumps And Trees
Welcome to Stumps and Trees – A tree removal experts in Melbourne! We are committed to offering you with expert tree removal Melbourne as well as a full range of tree and stump removal services throughout Melbourne. Our highly skilled Stumps and Trees team will take care of all your tree lopping, pruning, chipping, trimming or maintenance needs with professionalism. ...
Wheelers Hill, VIC. C.P.: 3150
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A passenger aircraft carrying 175 people has been forced to make an emergency landing at Belfast International Airport.
Emergency crews were standing by close to the runway as the Thomas Cook Airbus A320 heading to Tenerife circled above ahead of the landing, authorities said.
The captain reported landing gear problems shortly after take off.
An airport spokeswoman said the airport was put on "full emergency standby".
However the plane landed safely at Belfast around 11.25 am on Tuesday.
Air traffic control company Nats said the plane touched down without incident.
The plane spent more than an hour in the air so as to lose fuel before the emergency landing.
Above: the Thomas Cook plane circles above Belfast as it prepares to make its emergency landing, as shown on a tracking website.


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NopComerce 3.0 - XML Sitemap Plugin
This project received 15 bids from talented freelancers with an average bid price of $671 USD.Get free quotes for a project like this
Project Budget$250 - $750 USD
Total Bids15
Project Description
We require a sitemap plugin for Nop Commerce that includes multiple features over-and-above what is currently offered by the platform.
The sitemap is to be split across multiple files:
o A master index file that just contains links to all of the below...
o A topic page sitemap.
o A sitemap for each of the product categories and subcategories (just the categories, themselves not the products).
o A sitemap for products.
o A sitemap for the blog section.
o A sitemap for the news section.
• It must be possible to assign priorities to the links in the sitemap.
• It must be possible to assign frequencies to the links in the sitemap.
• It must be possible to opt out pages and sections from the sitemap.
• It must be possible to include HREF lang to the sitemap for sites operating in multiple countries or across multiple languages.
• It must be possible to manually/programmatically add records to any of the above sitemaps and assign them all of the above attributes (priority, frequency, etc.)
We require this work to be built as a plugin so that we are able to use it across multiple projects easily and so that we can upgrade Nop and the plugin independently.
Skills Required
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text: The Nabe here was so delicious, it made the cabbage taste so good. I like that they will bring more pork, vegetables and even more broth for your pot. The sake was delicious and we ordered a bunch of sides including the chicken wings, fried oysters, salad. This was an outstanding meal. We also ordered this bread dessert as pictured...I... More


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Message boards :
Number crunching :
Tips for installing Windows 7 (to allow MS software updates)
(Message 46413)
Posted 20 days ago by MarkJ
I had 4 machines refusing to get updates. After I downloaded the msu files (stand alone installer) for each of the 3 kb's it got them all going again. 3 were W7 Pro and the 4th was a W7 Home Premium. The Microsoft fixit of course didn't fix anything.
Thanks for the details.
Message boards :
A Sad Goodbye
(Message 43958)
Posted 221 days ago by MarkJ
Tomba, you could have a rig running part time, say overnight if your electricity company has an off-peak rate. Sure its not as productive but you're still contributing what you can and your electric bill isn't as bad as before. Even if they don't have an off-peak rate you could run them part-time to minimise the cost.
As for lack of work units. I've been away from GPUgrid for most of our summer and autumn due to the heat. Its winter down here now (Sydney Australia) and finally cooled down so I have fired up my two GPUgrid machines with a GTX970 in each. Getting work units doesn't seem to be a problem. I am running a minimal cache on them (0.05 min and additional of 0.15 days). They download another work unit when they get to about 90% done.
I'll be dropping off again next week as I replace the two GPUgrid cruncher (but not the GTX970's).
Message boards :
Number crunching :
Boinc ver. 7.4.36
(Message 39729)
Posted 755 days ago by MarkJ
Thomas, what language is your system using?
There was a bug around using character sets like cryllic, but not sure if its still open or not.
Message boards :
Graphics cards (GPUs) :
ELSA Single-Slot GTX 750Ti
(Message 38418)
Posted 862 days ago by MarkJ
I bought a bunch of GTS460 cards from ELSA when I was in Tokyo a couple of years ago. They tend to have a rather weak fan and can't keep themselves cool enough. The 750ti should be better as it doesn't produce as much heat but just something to watch for.
Message boards :
Server and website :
(Message 38315)
Posted 868 days ago by MarkJ
Virus scanners usually do false-positives (that is they report it as a virus even though it isn't). The usual solution is to exclude the BOINC data directory from your virus scanner.
If you think it may really be one (not likely because you are the only reporting it) submit it to VirusTotal and they will run it through a number of different scanners.
Message boards :
Server and website :
Not getting short WUs
(Message 37266)
Posted 952 days ago by MarkJ
You're missing the closing tag for <options> and you need an opening and closing tag for cc_config. If you want to debug the scheduler stuff set the sched_op_debug tags with a value of 1 so you can see what it's requesting and getting back. They go within the log_flags tags.
You will probably also need to restart the client as some flags can only be set when it first starts. The BOINC event log should show what flags are set at start up and any exclusions.
Message boards :
Number crunching :
BOINC v7.2.28 has been released!
(Message 34007)
Posted 1184 days ago by MarkJ
BOINC 7.2.31 is now the recommended version. The only change since .28 was to suppress image display as part of notices. This was to correct an issue with one particular project where the images cause the manager to crash.
Message boards :
Graphics cards (GPUs) :
New GeForce BETA v331.40 drivers available
(Message 33329)
Posted 1237 days ago by MarkJ
I've heard unconfirmed reports it fixes the 36 hour TDR issue.
Message boards :
Number crunching :
Why am I getting TOO MANY WU's?
(Message 32881)
Posted 1258 days ago by MarkJ
I believe you need a load on the intel VGA (or DVI) port. One way is to plug a monitor in. Another way would be to use a dummy vga plug. The way most bios's are set up is if they don't detect a device on the iGPU and you have another graphics card they simply disable the iGPU
Also if you get the intel GPU driver through windows update its not usable for crunching. You need to get the 'full' package from the intel download centre.
Probably a bit late but maybe it will help someone else.
Message boards :
Graphics cards (GPUs) :
All WUs on GTX660 failing
(Message 31429)
Posted 1319 days ago by MarkJ
Have just built a new system with a GTX660 with the intention of running GPUGRID (encouraged by another system with a GTX660 that is working well). So far all 4 WUs that I have got start processing but fail after between 2 and 10 minutes. I think they have all had the "Driver has recovered after stopped working" message in Windows which I guess is an indication that the GPU hardware has failed. Both the old and new cards are factory overclocked (old one 1006 (1072 boost), new one 1033 (1098 boost). Memory on both is 1502.3 (which I think is not overclocked). GPU Core clocks reported by GPU-Z when running are 1162.7 (new) and 1123.5 (old) respectively. The new 660 is fine running PrimeGrid (two concurrent - pegged at 99% busy according to GPU-Z). Environmentals on both systems seem fine (temp about 60 degrees).
I'd suggest drivers. I notice the failing system has an ATI as well as Nvidia card. From memory you had to install ATI driver first followed by Nvidia. Also get drivers from Nvidia.com or GeForce.com and do clean install, don't rely on windows to install drivers.
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Family camp for New York City families
Sending the kids to summer camp doesn't always mean you'll be without them—try these cool family camp ideas!
RECOMMENDED: Full guide to summer camps in NYC
Family camp is a beautiful thing! It's a great way to give your kids a taste of camp life, plus you get to join in on the fun. You'll be swimming, rock climbing, hiking and roasting marshmallows together in nature—and what's better than that?
For more exciting things to do with kids, check out our lists of free things to do with kids and 101 things to do with kids in New York City.
Family camp near New York
Farm & Wilderness Family Camp
Leave the iPads at home and hightail it to this family-friendly escape in Vermont for a dose of simple living. Campers learn about sustainable farm life by helping with barn chores—your brood will adore visiting with the resident cows, pigs, sheep, goats, chickens and ducks. Plus, letting the kids pull their own vegetables for dinner from the organic garden, or baking pies using apples from the orchard, really drives home the idea of farm-to-table eating. Woodward Reservoir is a prime spot for swimming and canoeing, and the surrounding woods are flush with trails for hiking. Embrace the camping lifestyle by sleeping in open cabins with no electricity or hot water. Nighttime entertainment is of the unplugged variety (crafts, music and storytelling), but you might be surprised how much the kids come to enjoy it. All ages.
Tyler Place
No need to labor over the details of your family's summer vacation when you book a stay at this all-inclusive spot. Tyler Place is a welcoming resort that provides endless recreation for the entire crew, plus it removes the task of organizing meals and lodging from your plate. Cottages and suites nestled on 165 acres of woodlands and meadows serve as the safe and comfortable base from which kids can come and go as they please—everyone gets their own personal bike for speedy transportation around the property. Hit the indoor and outdoor pools to cool off, and take older kids to the Lake Champlain waterfront to go banana boating or tubing. Parents can indulge in wine-tasting tours, Pilates and candlelit dinners, while the tots can enjoy nature walks, scavenger hunts and more. All ages.
Camp Kaleidoscope
While youngsters on the autism spectrum might be overwhelmed by the controlled chaos of a typical summer camp, this program creates a safe haven just for them. Parents and kids can bunk up in a cabin, tent or Eco-Lodge at Common Ground Center, a 700-acre former farm in northern Vermont, where the staff of speech-language pathologists and occupational therapists makes it possible for special needs kids to experience all the joys of the outdoors. Tots head to Kidville each morning for fun activities, while the adults bask in art and nature as well as autism education. While away the rest of the day with calming nature walks, music workshops, watercolor painting and swimming. Kids ages 3–11 on the autism spectrum and their families.
Club Getaway Family Camp
Skip the agony of pitching a tent and bunk up in a country cabin at Club Getaway with your whole clan this summer. Loads of outdoor adventures await at this rustic lakeside resort in Connecticut, and though you won't exactly be roughing it, you'll be happy you're sleeping in an air-conditioned abode when a 90°F day rolls around. Get in some serious bonding time with the kids by taking on archery, arts and crafts, or even the flying trapeze as a group, then let the littles play under staff supervision at Kids Camp while you steal away for an adults-only excursion. How's rock climbing sound for date night? Evening entertainment for the whole family ranges from outdoor movies and campfires to game shows to Olympic challenges. Ages 4 and up.
Frost Valley YMCA Family Camp
This Catskills camp has the feel of a dude ranch in an East Coast setting. The rollicking rodeo put on by the equestrian staff every year will have everyone whooping and hollering, but the Western-style adventure doesn't stop there. Little cowboys and cowgirls can saddle up for riding lessons and trail rides or pull on some waders for a fly-fishing adventure. Yurts and platform tents provide no-frills lodging options that are easy on the wallet and a fun experience for the kiddos. Take your pick of programming like swimming, archery and theater games, or settle down for arty endeavors like origami or candle- and jewelry-making. All ages.
Medomak Family Camp
This stunning New England respite is just the place to put your first truly stress-free family vacation in the books. Lodging, recreation and equipment are all included, which means you and the tots can set your sights on the gorgeous, tree-lined lake. Canoeing, sculling, sailing and kayaking are waterfront favorites, but dry land ain't so shabby either, with berry picking, ultimate frisbee and kickball to choose from. Mom and Dad will totally want in on local beer and cheese tastings, massages and group yoga, but make sure to plan around the weekly lobster dinner served in the farmhouse dining room—even the tots will want in on the quintessential Maine feast. All ages.
Appalachian Mountain Club Family Adventure Camps
City families who fancy hiking and learning outdoor skills will dig this camp in New Hampshire's White Mountains. These alfresco adventures range from the "Wee Wanderers" level, for families with two- to five-year-olds, to above–tree line, hut-to-hut hikes for families with kids nine and up. Activities include hiking and paddle excursions, map and compass skills, and rescue dog demos. Families stay in AMC's lodges (private room, private bath) or high mountain huts (bunks). Meals typically consist of a breakfast buffet, a trail lunch and a sit-down family-style dinner with at least one kid-friendly option. All ages.
Family Nature Camp, College of the Atlantic
At this oceanfront camp in Bar Harbor, Maine, your family can go on tide-pool walks, naturalist-guided ecology hikes in nearby Acadia National Park and nature cruises along the coast. Add nature arts and crafts and a presentation from the "Bug Man," and you won't hear, "I'm bored" for six whole days. Families stay in suites in the college's residence halls. In the dining hall, you'll eat meals made from mainly local, organic ingredients, humanely raised meat and freshly caught Maine seafood. All ages.
Family Week at Omega
Two hours' travel by car or train, will take you to this serene Hudson Valley retreat center. At the Omega Institute in Rhinebeck, your kids can join in age-based activities ranging from "Little Forest People," where little ones commune with gnomes and faeries, and Rock Music Camp and Super Soccer Stars for the 8-to-13 crowd, to live-action role-playing for teens. What to do while they're having all this fun? You can energize your chakras with Afro-Flow Yoga, which combines meditative yoga with dance movements from West Africa and the Caribbean. Or head to the Wellness Center for a facial, massage or reiki session. Lodging options include tents, dorms and private family rooms. The normally vegetarian menu incorporates meat and fish, and special kids' options, for family week. All ages.
Windsor Mountain Family Camp
The hills are alive with the sound of Latin dancing, a cappella singing, stained-glass making and junkyard bands at the Windsor Mountain Family Camp. And all the usual camp activities are thriving, too, if some of your nearest and dearest want to do a spot of kayaking or tree-fort building, or perhaps some archery or zip-lining. You'll sleep in dorms, bungalows and cabins. Meals are made up of homemade fare that includes fruits and veggies from the camp garden, vegetarian options and plentiful snacks. All ages.


text:
Pendleton Marine engineers improve security in Sangin, Afghanistan
FORWARD OPERATING BASE ROBINSON, Afghanistan – Marines From Charlie Company, Combat Logistics Battalion 2, 1st Marine Logistics Group (Forward), enhanced security for coalition forces here in Helmand province, Nov. 25.
Located in the Sangin District where Marines from 3rd Battalion, 5th Marine Regiment are currently going toe-to toe with the enemy, the FOB was in need of additional protection, and the CLB-2 engineers were up for the task.
"We are perfecting the FOB because they have weak spots in their defense, so we are giving them a safer place to sleep," said Lance Cpl. Eric Martinez, a bulk fuel specialist with Charlie Co., CLB-2,1st MLG (FWD).
The engineers worked both day and night so they could bring the security of additional Hesco barriers and concertina wire to the inhabitants of the FOB.
The dangers of Sangin were clear to the engineers the entire time they were constructing the defenses. They had first-hand experience with the Taliban the day they arrived.
"I was checking on a helicopter's [estimated time of arrival] with two other Marines when we heard gunshots" said Lance Cpl. John A. Ferrara, an engineer with 1st Platoon, Charlie Co., CLB-2, 1st MLG (FWD). "I ran for cover, and after I jumped in a piece of micro-terrain I looked back and saw Lance Cpl. [Jacob] Crane, and he shouted 'I can't feel my arm.'"
Crane had been shot in the neck by an enemy sniper.
"I saw blood on his shirt, so I ran back to grab Crane to get him to cover," said Ferrara, 22, from Tallahassee, Fla. "We immediately got him to the trucks where doc took care of him. The sniper missed all his vital organs, and he is lucky to be fine now."
The Charlie Company Marines immediately put up Hesco barriers near the area where one of their own was wounded in the effort to prevent surprise enemy engagement in the future.
The Marines who live and work on FOB Robinson are grateful the engineer platoon is there to help make their lives safer.
"The guys on the FOB are happy to have us here," said Sgt. Eloy C. Soto, an engineer with 1st Platoon, Charlie Co., CLB-2, 1st MLG (FWD). "They said we were doing good work."
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Presentation: Presence and Personality
Presented by: Sheerah Singer, Director of Marketing & Communications, Empire Wealth Strategies
Just to be online isn't enough anymore. The whole purpose of social media is to have a more immediate interaction between people, to build those lasting relationships. If you are going to be online you want to make sure that your profile is robust and your prepared to be responsive to your audience. Another major element of being online is personality. You are competing with hundreds if not thousands of other professionals using social media platforms as yellow pages and you need to stand out. Adding personal elements goes a long way to bridging the gap of online interactions for creating personal relationships. Presentation will include real life personal and business success stories illustrating these points.


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We are Outstanding In The Field: Setting tables at the source of ingredients, serving from farm to table across the country.
Our mission is to re-connect diners to the land and the origins of their food, and to honor the local farmers and food artisans who cultivate it.
Outstanding in the Field is a roving culinary adventure – literally a restaurant without walls.
Since 1999 we have set the long table at rural farms and urban gardens, on mountain tops and in sea caves, on islands and ranches. Occasionally the table is set indoors: a beautiful refurbished barn, a cool greenhouse or a stately museum. Wherever the location, the consistent theme of each dinner is to honor the people whose good work brings nourishment to the table.
See you at the table!
We are busy planning our summer tour schedule. We will have more than 80 new events released at the beginning of March. Stay tuned for more details!


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Notice: This is an old thread. The last post was 3028 days ago. If your post is not directly related to this discussion please consider making a new thread.
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need sangamo motor for Seth Thomas
To All:
Where can I buy a sangamo clock motor for a Seth Thomas circa 1935-1940? The motor has few identifying numbers. There is a ""452" ink stamped on the backing plate (there are 3 screws that hold the plate to the movement) Merritts and Tmesavers either don't have the motor or I have failed to navigate their poorly setup websites correctly. Thanks to all who can help. Sincerely, John #0159010
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Choose your preferred language. We speak English (US) and 42 other languages.
Most often used by people in the United States
All languages
Review score
3,451 reviews
This Orlando motel is 1.2 miles from the Orange County Convention Center across from the I-Drive 360 plaza, which includes the Orlando Eye Ferris wheel.
"The bed was soft and comfortable"
Review score
210 reviews
Featuring free WiFi, Travelodge Orlando Near Florida Mall is located in Orlando, Florida. The Florida Mall is 6 minutes' drive away, and Universal Orlando Resort is 10 minutes' drive from the...
"People at the front desk very friendly and willing to help"
Review score
89 reviews
This eco-friendly Orlando hotel is only 1 mile from the Florida Mall and less than a 10-minute drive from the Universal Studios.
"The room is very clean and nice. Staff is very helpful,patient,and nice."
592 reviews
Just 3.2 km from Orlando International Airport and other area attractions, this hotel boasts a hot breakfast, on-site restaurant, and outdoor pool.
"Quiet location.clean & comfortable close to airport."
Review score
2,153 reviews
Located on International Drive, this hotel is less than 3.1 km from Universal Orlando Resort.
"I loved that there was go kart racing right across"
Review score
1,640 reviews
The M Hotel I-Drive Near Universal Orlando is a family-friendly boutique hotel that offers a free continental breakfast with toast, butter, jam, cereal, milk, coffee, tea and water.
"Location, staff, surrounding abd of course rates sre excellent"
282 reviews
Located opposite The Florida Mall, this Red Roof Inn is 20 minutes' drive from The Walt Disney World Resort. Features include an outdoor pool and free WiFi.
2,728 reviews
This Orlando Econo Lodge is on International Drive 2.4 km from Universal Studios Orlando. Features include a free daily continental breakfast, free WiFi, and an on-site outdoor pool.
"The place was really clean And a good place to go …t to spend much because it is really a good hotel"
1,639 reviews
Located off International Drive and Highway 528, Red Roof Inn International Drive/Convention Center features an outdoor pool. The Orange County Convention Center is 7 minutes' walk away.
"All the facilities, the location and the attention."
Review score
139 reviews
Located off Highway 50, this Orlando Motel features an outdoor pool and free WiFi in every room. The Central Florida Fairgrounds and Barnett Park are 4 minutes' drive away.
"awesome people at the front desk , very gorgeous architecture , pool and spa - exelent"
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We're sorry, this listing is off the market. Try these listings instead:
Learning Center #454658 posted Sep 26, 2016
- Houston, Texas, United States
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Highly Profitable licensed business located in a fast moving and growing area in Fort Bend County with over 4800 sq. ft. State licensed has all state permits, located in the area of over 20 subdivisions neighborhoods, been in business over 30 years, hold over 248 kids. Located in Richmond Texas. Sellers...
Daycare Ctr NW Houston Near Subdivisions/Schools #462800 posted Feb 13, 2017
- Houston, Texas, United States
- $120,000
Wonderful daycare center in a great location in Northwest Houston. Near intersection of major thoroughfares. Easily accessible from Hiway and Beltway. Next to McDonalds and popular local restaurant. Surrounded by subdivisions and elementary schools. Within last 2 years, owner has refurbished the playground,...
Licensed Child Care Center for Sale in Houston #461853 posted Jan 28, 2017
- Houston, Texas, United States
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Licensed child care center is for sale in Northwest Houston. Day care offered to infants through elementary aged children. Before and after school programs engage children in a variety of lessons and preparation for Kindergarten. Residential surroundings encourage expansion. Teachers provide a nurturing...
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Top Definition
To redefine a word to make it related to the Nintendo Wii. Usually associated with a wiispelling.
Hah! You're so rubish at using a Wii that I'm going to wiidefine the word retard and call you a wii-tard.
by robcraine December 14, 2006
The Urban Dictionary Mug
One side has the word, one side has the definition. Microwave and dishwasher safe. Lotsa space for your liquids.Buy the mug
The Urban Dictionary T-Shirt
Smooth, soft, slim fit American Apparel shirt. Custom printed. 100% fine jersey cotton, except for heather grey (90% cotton).Buy the t-shirt


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my bond
Muni Week in Review: November 30, 2012
November 30, 2012
The bond market rally rolls on as demand remains strong.
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Catheter-related bloodstream infection (CRBSI) results in significant attributable morbidity and mortality. In this randomized, double-blind, placebo-controlled trial, we studied the efficacy and safety of a daily ethanol lock for the prevention of CRBSI in patients with a tunnelled central venous catheter (CVC).
From 2005 through 2008, each lumen of the CVC of adult hematology patients was locked for 15 minutes per day with either 70%-ethanol or placebo, where after the lock solution was flushed through. As a primary endpoint, the incidence rates of endoluminal CRBSI were compared.
Principal Findings
The intent-to-treat analysis was based on 376 patients, accounting for 448 CVCs and 27,745 catheter days. For ethanol locks, the incidence of endoluminal CRBSI per 1000 CVC-days was 0.70 (95%-CI, 0.4–1.3), compared to 1.19 (95% confidence interval, 0.7–1.9) for placebo (incidence rate-ratio, 0.59; 95% confidence interval, 0.27–1.30; P = .19). For endoluminal CRBSI according to the strictest definition (positive hub culture and identical bacterial strain in blood), a 3.6-fold, non-significant, reduction was observed for patients receiving ethanol (2 of 226 versus 7 of 222; P = .103). No life-threatening adverse events were observed. More patients receiving ethanol discontinued lock-therapy (11 of 226 versus 1 of 222; P = .006) or continued with decreased lock-frequency (10 of 226 versus 0 of 222; P = .002), due to non-severe adverse events.
In this study, the reduction in the incidence of endoluminal CRBSI using preventive ethanol locks was non-significant, although the low incidence of endoluminal CRBSI precludes definite conclusions. Therefore, the lack of statistical significance may partially reflect a lack of power. Significantly more patients treated with ethanol locks discontinued their prophylactic treatment due to adverse effects, which were non-severe but reasonably ethanol related. Additional studies should be performed in populations with higher incidence of (endoluminal) CRBSI. Alternative sources of bacteremia, like exoluminal CRBSI or microbial translocation during chemotherapy-induced mucositis may have been more important in our patients.
Trial Registration
ClinicalTrials.gov NCT00122642
Citation: Slobbe L, Doorduijn JK, Lugtenburg PJ, el Barzouhi A, Boersma E, van Leeuwen WB, et al. (2010) Prevention of Catheter-Related Bacteremia with a Daily Ethanol Lock in Patients with Tunnelled Catheters: A Randomized, Placebo-Controlled Trial. PLoS ONE 5(5): e10840. doi:10.1371/journal.pone.0010840
Editor: Jeffrey A. Gold, Oregon Health and Science University, United States of America
Received: January 19, 2010; Accepted: April 29, 2010; Published: May 26, 2010
Copyright: © 2010 Slobbe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was supported by Fonds NutsOhra, The Netherlands. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
The indwelling central venous catheter (CVC) has become an essential feature of modern patient management. However, its use puts patients at risk for various complications, especially catheter-related bloodstream infection (CRBSI). CRBSI accounts for a major cause of healthcare-related bacteremia and leads to prolonged hospital stay and significant attributable costs.[1]–[4] Reported attributable mortality varies from 2% up to 25% in critically ill patients.[2], [5] In a meta-analysis, the odds-ratio for mortality in patients with CRBSI was 1.65 compared to control patients who were matched for severity of illness.[5]
In contrast to short-term CVCs, CRBSI in patients with tunnelled or implanted devices is thought to be mainly caused by endoluminal colonization due to contamination of the catheter hub.[6], [7] Evidence-based recommendations on CRBSI prevention have been published.[8], [9] To some extent, endoluminal CRBSI can be prevented if an antibiotic solution is instilled in the catheter.[10]–[12] However, the preventive use of antibiotics should be avoided if alternative options exist.[13], [14] Although there is evidence to support the concept, methodologically appropriate clinical studies on the use of preventive antiseptic solutions are scarce. For this purpose, ethanol is increasingly considered as a promising candidate. For CRBSI-treatment, an ethanol-lock has been demonstrated to be efficacious in several observational studies.[15]–[17] More recently, an ethanol-lock has also been studied for CRBSI-prevention.[18]–[21] A major advantage of ethanol would be the broad antimicrobial spectrum without compromising future antibiotic treatment. Furthermore, it is cheap and universally available.
In the current randomized, clinical trial, we study the efficacy and safety of a daily 70%-ethanol lock on the prevention of endoluminal CRBSI in hematology patients with long-term tunnelled catheters.
Materials and Methods
The protocol for this trial and supporting CONSORT checklist are available as supporting information; see Protocol S1 and Checklist S1.
Ethics statement
The institutional review board approved the protocol; written informed consent was obtained from all patients.
Study design and ethanol lock procedure
The study was performed at the Erasmus Medical Center, a tertiary referral hospital with 2 locations in Rotterdam, The Netherlands. Eligible study-participants were all consecutive adult (age, >17 years) hematology patients with a tunnelled silicone CVC, inserted in the preceding 72 hours before study-entry. All catheters used in this study, were silicone devices (Hickman®), that were placed at the radiology ward after carefully scrubbing the insertion site with chorhexidine-containing antiseptics, applying maximum sterile barrier precautions, including the use of a long-sleeved sterile gown, cap, mask and gloves, together with the use of sterile sheet drapes.
Excluded were patients with an alcohol-intolerance or concomitant treatment with metronidazole. Patients were enrolled from July 2005 through August 2008. The study was a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov Identifier: NCT00122642). Randomization was performed using a computer-generated list of randomly assigned permuted blocks. Randomization was catheter-based, which implies that patients could be randomized more than once if insertion of a new CVC was needed. Concealment of allocation and provision of blinding was guaranteed by uninvolved employees of the Department of Pharmacy, who delivered patient-labelled ampoules containing either 70%-ethanol or placebo (0.9% NaCl).
During hospitalization, every lumen of the CVC (3 ml) was locked for 15 minutes per day, following which the solution was flushed through with 10 ml 0.9% NaCl. During outpatient settings, the lock was instilled by the nursing staff once weekly before renewal of the regular heparin solution.
An investigator-blinded safety analysis was performed after inclusion of 80 patients, as some patients experienced adverse effects immediately after flushing the lock solution through. This provisional analysis led to an amendment that allowed these patients to continue with a modified lock regimen, in which only 1 lumen was locked per day.
Data collection and definitions
Baseline characteristics included age, sex, presence of neutropenia (neutrophil count, <500 cells/µl) at study-entry, underlying malignancy, site of catheter insertion, and number of catheter lumens. During follow-up, we recorded catheter dwell time, stay at the intensive care unit, treatment with total parenteral nutrition (TPN), and use of glycopeptides, which is the treatment for presumed/proven beta-lactamase resistant gram-positive microorganisms in our hospital. Safety data were registered for all patients, including all-cause mortality during the study episode until 30 days after catheter removal, and the discontinuation of study medication. Subjective parameters were recorded for a random sample of 25% of patients by means of a questionnaire.
In case of suspected CRBSI, definitions from current guidelines were followed.[8] In case of documented bacteremia or when a glycopeptide was started empirically, a culture of the inside of all catheter hubs was performed. The catheter insertion site was cultured in case of local inflammation or unexplained bacteremia. As our intervention would reasonably prevent only endoluminal CRBSI, effort was made to distinguish this modality. Strictly endoluminal CRBSI was defined as a positive central or peripheral blood culture with the same genotypic (for coagulase-negative staphylococci (CNS)) or phenotypic (for other microorganisms) strain cultured from the hub, for which directed antimicrobial therapy was started. For CNS or other skin-colonizers, ≥2 blood cultures had to be positive when no peripheral cultures were available.
In case of bacteremia, we calculated the differential time-to-positivity (DTTP), which denotes the difference in time-to-positivity of a peripheral blood culture minus the time-to-positivity of a central blood culture. DTTP of ≥2 hours accurately predicts the catheter to be the source of the episode of bacteremia, which applies especially to patients with long-term catheters.[22], [23] Therefore, CRBSI with DTTP of ≥2 hours in the absence of insertion site or tunnel infection was considered as a separate entity. When DTTP was not available, CRBSI was diagnosed in case of a positive peripheral or central blood culture with an identical microorganism detected on the catheter tip in the absence of any other infectious source. The latter two entities were defined as presumed endoluminal CRBSI, because strictly, these episodes cannot be diagnosed as endoluminal CRBSI with absolute certainty, although an endoluminal origin is more likely in the absence of signs of exoluminal infection. Exoluminal CRBSI was defined as bacteremia with negative hub cultures, but with the same strain cultured from blood and a clinically infected insertion site, combined with either DTTP of ≥2 hours or an identical microorganism detected on the tip.
Microbiological procedures
Regardless of suspicion of infection, catheter tips were processed by the semi-quantitative roll plate method.[24] After incubation for 72 hours, microorganisms were identified and quantified by standard microbiological methods. Catheter tip colonization was defined as a positive semi-quantitative tip culture of ≥15 colony forming units (cfu)/ml. Blood cultures were processed according to routine procedures, using the Bactec system (BD; USA).
For genetic typing of isolated CNS strains, we used arbitrarily-primed PCR, as described in detail elsewhere.[25], [26] Strains were considered identical if all 3 primers showed corresponding DNA-fingerprints. When the strain was not available for genotyping, strains were considered phenotypically identical if antibiotic susceptibility patterns showed at maximum one disconcordant result.
End points were reviewed by 2 blinded investigators (L.S. and B.J.R.). Patients with strictly endoluminal CRBSI and patients with presumed endoluminal CRBSI were considered as the primary outcome measure. The predefined secondary goals were to compare overall CRBSI (including exoluminal infection), overall bacteremia, incidence of positive hub and catheter tip cultures, all-cause mortality, and treatment with systemic antibiotics (glycopeptides versus other compounds) for both groups. Safety data were also assessed as a secondary outcome.
Statistical analyses were performed using SPSS, version 15.0 (Chicago; USA). Tests were two-sided and a P value <.05 was considered statistically significant. Analyses were based on catheter episodes and performed on a modified intent-to-treat (ITT) population, consisting of all enrolled patients who received at least 1 dose of study-solution. Follow-up was censored at the moment a primary endpoint was diagnosed, at catheter removal, or at death of patients.
Based on a comparable population, CRBSI was assumed to occur in ≥20%.[27] We assumed that the majority of CRBSI would be endoluminal CRBSI. Therefore, a sample size of 219 catheter episodes per group was calculated to detect a hypothesized 50%-reduction of endoluminal CRBSI with 80% power (α = .05). According to recommendations of the Centers for Disease Control and Prevention, we also determined CRBSI rates per 1000 CVC-days.[28] Kaplan-Meyer curves, to describe the rate of CRBSI for both groups as a function of time, were constructed and compared with log-rank tests.
The separate contribution of TPN, stay at the intensive care unit, underlying disease, neutropenia at time of catheter insertion, catheter insertion site, and number of catheter lumens were assessed in a Cox regression model. For secondary endpoints, differences between groups were analyzed with chi-square tests or Fisher's exact tests in case of dichotomous variables; differences in means were compared with student's t-tests, as appropriate.
A total of 379 patients were enrolled, accounting for 453 catheter episodes. No study solution was administered in 5 catheter episodes, so the modified ITT-analysis was based on data obtained from 448 episodes (376 patients). Ethanol locks were administered in 226 catheter episodes. Characteristics of the 2 groups are summarized in Table 1; a flow-diagram of the study protocol is provided in Figure 1.
Prophylactic effect of 70%-ethanol lock on CRBSI
The differences between the rates of endoluminal CRBSI in both groups were not statistically significant (Table 2). For ethanol locks, a total of 14,262 catheter days and 10 episodes of endoluminal CRBSI were recorded, accounting for a rate of 0.70 CRBSIs per 1000 CVC-days (95% confidence interval, 0.4–1.3). For placebo, 16 endoluminal CRBSIs during 13,483 catheter days were observed, with a rate of 1.19 CRBSIs per 1000 CVC-days (95% confidence interval, 0.7–1.9). The calculated incidence rate ratio was 0.59 (95% confidence interval, 0.27–1.30), which implies a non-significant reduction of 41% for patients treated with ethanol locks (P = .19). In Figure 2, Kaplan-Meyer curves are presented to describe the rates of CRBSI as a function of catheter dwell time. No significant difference was observed when these curves were compared with log-rank tests (P = .22). In patients who classified for endoluminal CRBSI according to the strictest definition (positive hub culture with identical bacterial strain in blood), a 3.6-fold reduction was observed for patients allocated to ethanol locks (2 of 226 versus 7 of 222; P = .103).
Data are presented as a function of catheter dwell time for patients treated with an ethanol lock (n = 226) or placebo.
Neither treatment with TPN nor stay at the intensive care unit, underlying disease, neutropenia at time of catheter placement, catheter insertion site, or number of catheter lumens contributed individually to the development of CRBSI (data not shown).
Secondary goals
Results are presented in Table 1 and 2. The mean catheter dwell time was 63.1 days (range, 2–486 days) for ethanol locks versus 60.7 days (range, 4–308 days) for placebo (P = .71). The mean duration of the use of a glycopeptides (6.0 versus 5.0 days) did not differ between patients randomized to ethanol locks or placebo (P = .62). Also, the duration of treatment with other classes of systemic antibiotics did not differ between ethanol locks (mean duration, 17.4 days), or placebo (mean duration, 16.7 days). Overall CRBSI was recorded in 21 of 226 patients allocated to ethanol locks versus 24 of 222 patients treated with placebo (P = .71). For overall bacteremia, these results were 91 of 226 versus 91 of 222 patients, respectively (P = .95).
Tip cultures were performed on 347 catheters. Rates of detection of microbial growth were 49 of 171 in patients treated with ethanol locks and 57 of 176 in patients allocated to placebo (P = .52). Of all catheter episodes in which bacteremia was documented (n = 182), CNS was detected as the causative pathogen in 106 episodes (58%), which was equally distributed between both groups, as were other causing microbes (Table 3). Hub cultures were performed in 147 patients, and were positive in 8 patients in the ethanol arm versus 11 patients in the placebo arm (P = .67). However, different strains were obtained from hubs as compared with blood cultures in 4 patients, (n = 2 for ethanol and placebo). Therefore, not all patients with positive hub cultures qualified for endoluminal CRBSI.
Safety and tolerability aspects
Data are presented in Table 4. All-cause mortality in patients allocated to ethanol locks was 7 of 226, compared with 5 of 222 patients randomized to placebo (P = .77). None of the involved deaths were diagnosed with CRBSI during the catheter episode.
No differences were observed in the incidence of thrombosis. In patients allocated to ethanol locks, 1 device had to be removed because of a rupture of 1 of the 3 catheter lumens, which occurred while the patient was asleep. No life-threatening adverse events were observed. One ethanol treated patient had syncope shortly after flushing through the first lock solution. During subsequent ethanol lock procedures, no further adverse effects occurred in this particular patient. Significantly more patients receiving ethanol locks discontinued lock therapy (P = .006) or continued with a frequency-adjusted regimen (P = .002), as compared to placebo. This was due to subjective feelings of discomfort, including facial redness or flushing, feelings of drowsiness or an alcohol taste after flushing the lock solution through. No differences in levels of hepatic enzymes (aspartate-aminotransferase, g-glutamyl transpeptidase) and mean corpuscular volume of red blood cells were observed after 2 weeks of lock therapy when compared to baseline values (P>.5 for all parameters; data not shown).
The present randomized clinical trial on the use of a preventive ethanol lock showed a non-significant 41%-reduction of endoluminal CRBSI in patients allocated to ethanol locks for occurrence of CRBSI as expressed per 1000 CVC-days. Also, the 3.6-fold reduction as observed in ethanol lock patients who classified for endoluminal CRBSI according to the strictest definition was not significant. No differences were observed for catheter dwell time, use of glycopeptides and other systemic antibiotics, and rates of overall CRBSI or bacteremia between groups.
In patients treated with ethanol locks, 1 device had to be removed due to loss of integrity of the CVC; another person experienced an episode of syncope after the first lock procedure but not after subsequent procedures. No other serious adverse events were observed, which is in agreement with other reported data.[20] Significantly more patients treated with ethanol locks discontinued their prophylactic treatment. All reported adverse effects were non-severe but reasonably ethanol related. In future studies, this may partially be circumvented by removing the lock solution instead of flushing it through, as has safely been done in other recent studies.[21], [29]
We took efforts to perform a double-blind, randomized trial. However, due to the specific ethanol odour that could be sensed after opening the ampoules by the nursing team, blinding was not 100% in daily practice. Nevertheless, the principal investigators were not directly involved in patient management and were therefore completely blinded at all time. Furthermore, the primary endpoint has no subjective element in its definition, which may reasonably minimize potential bias.
Currently, several promising observational in vivo data on the treatment of CRBSI with ethanol locks have been reported.[15]–[17] Overall tolerance of ethanol was good in these studies and no significant adverse effects were observed. Furthermore, several case-series on the use of preventive ethanol locks have been published. In a recent case-series, Mouw and colleagues described 10 TPN-dependent paediatric patients with tunnelled catheters, who were treated with a 70%-ethanol lock solution between TPN infusions.[19] Infection rates in 5 children of whom data were available from the period before initiation of lock therapy declined from 11.2 to 2.1 CRBSIs per 1000 CVC-days. In a recent small randomized trial, Sanders and colleagues observed a reduced incidence of CRBSI with a 70%-ethanol lock in hematology patients with tunnelled CVCs.[21] CRBSI occurred in 3 versus 11 patients in the ethanol and control groups, respectively (odds-ratio, 0.18; 95% confidence interval, 0.05–0.65). Catheter survival was longer in the ethanol group (P = .003). Several differences with our study should be taken into account. First, Sanders et al. used less stringent CRBSI definitions. With this respect, it is surprising that the large majority of CRBSIs was caused by gram-negative microorganisms instead of staphylococci. One wonders whether these episodes of bacteremia were the consequence of translocation from the gut rather than CRBSI. The lack of stringent definitions may also partly explain the high incidence of CRBSI (31 per 1000 CVC-days) in the control group, which is around 16 times lower in our present study (1.19 per 1000 CVC-days) and another landmark study.[28] Interestingly, the preliminary data of a randomized trial performed by Crnich and colleagues, including 359 long-term tunnelled or implanted CVCs, showed no benefit of the use of a 50%-ethanol lock for CRBSI-prevention in hospitalized patients.[29]
Ethanol acts bactericidal and fungicidal against a broad range of bacteria and even yeasts without concerns of resistance development.[18] In vitro, it has been demonstrated that a 15%-ethanol concentration was able to kill most planktonic microorganisms.[30] For microorganisms in established biofilms, which is the case in CVCs, concentrations of 40% to 70% were required to achieve a bactericidal effect because penetration into a biofilm is harder to establish.[31] As a concern, it has been reported that a 100%-ethanol lock solution was associated with catheter occlusion.[32] Another report showed that infusion of polyurethane catheters with 70%-ethanol resulted in qualitative softening of the catheters.[33] More recently, however, no changes were observed on the biomechanical properties of polyurethane catheters, which were submerged in an ethanol solution for 9 weeks.[34] An overview of all recent studies, discussing the most relevant aspects of the ethanol lock technique was published recently.[35]
Several factors may explain the lack of efficacy as observed in our study. First, for practical reasons we used a lock time of 15 minutes daily per catheter lumen. This was decided because a longer dwell time would have interfered too much with patient care. A recent in vitro study showed that a significant 3-log reduction in the number of biofilm-associated gram-positive cocci occurred already after 20 minutes exposure to a 60%-ethanol lock solution. A dwell time of 30 minutes was required for complete eradication.[36] However, another in vitro study showed recently that an exposure time of 1 minute to a 70%-ethanol solution was sufficient for the sterilization of a bacterial biofilm.[37]
Second, a lock-based intervention will reasonably prevent only endoluminal CRBSI. By employing strict definitions we tried to differentiate endoluminal CRBSI from other entities. However, the true sensitivity of hub cultures to detect endoluminal infection is unknown. Furthermore, the incidence of strictly endoluminal CRBSI in the placebo arm was as low as 0.032% (7 of 222 patients). Therefore, the study was underpowered in retrospect. Taking this incidence rate into account, it can be calculated that future studies in comparable patient populations should include 848 patients to demonstrate a 75% reduction with 80% power, which is even augmented to 2282 patients to be able to show a 50% reduction of strictly endoluminal CRBSI.
Finally, bacteremia with CNS is not always CVC-related, but may result from translocation from the bowel in patients with severe mucositis.[38], [39] This could explain why despite the high overall incidence of CNS bacteremia, which occurred in 106 of all 182 episodes of bacteremia, no reduction of CNS bacteremia was seen due to the use of ethanol locks. The use of antimicrobial prophylaxis resulting in selective eradication of intestinal gram-negative but not gram-positive microorganisms may be the underlying cause. To test this hypothesis, we did genotypic identification of CNS in a random sample of 15 patients with documented bacteremia who were found to have concomitant CNS in rectal and/or vaginal mucosa or mouth swabs. Identical CNS strains in blood and mucosa were identified in 6 of 15 patients (40%).
Although the relevance of mucositis-associated bacteremia is not fully elucidated yet, it may be hypothesized that an intervention with an endoluminal CVC lock will not result in a reduction of overall bacteremia in patients who are treated with high-dose chemotherapy, and nearly inevitably suffer from severe mucositis. Also, the observed rate of exoluminal compared to endoluminal CRBSI in our study was higher than expected. Both these aspects may explain why our initial hypothesis that the rate of CNS bacteremia as observed in other studies reflects mainly endoluminal CRBSI may have been inaccurate in retrospect. In this view, the observed 3.6-fold reduction of strictly endoluminal CRBSI in patients allocated to ethanol locks is reassuring, as is the 41%-reduction of endoluminal CRBSI as expressed per 1000 CVC-days, because the lack of statistical significance may reflect a lack of power more than a lack of effectiveness.
However, the overall incidence of endoluminal CRBSI in our patients was low. One wonders whether the clinical benefits of this intervention, even in case of a significant reduction of endoluminal CRBSI, in this specific patient population would outweigh the extra amount of effort, costs and patient discomfort. Additional studies should therefore be performed in populations with higher incidence of (endoluminal) CRBSI, e.g., patients receiving long-term treatment with TPN.
Supporting Information
Checklist S1.
CONSORT checklist
Protocol S1.
Trial Protocol
We would like to thank Claudia Orelio, University of Applied Science Leiden; The Netherlands, for genotyping of CNS-strains.
Author Contributions
Conceived and designed the experiments: BJAR. Performed the experiments: LS BJAR. Analyzed the data: LS JKD PJL AeB EB WBvL BJAR. Contributed reagents/materials/analysis tools: LS EB WBvL. Wrote the paper: LS JKD PJL AeB EB WBvL BJAR.
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