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A systematic mapping review of Randomized Controlled Trials (RCTs) in care homes
A thorough understanding of the literature generated from research in care homes is required to support evidence-based commissioning and delivery of healthcare. So far this research has not been compiled or described. We set out to describe the extent of the evidence base derived from randomized controlled trials conducted in care homes.
A systematic mapping review was conducted of the randomized controlled trials (RCTs) conducted in care homes. Medline was searched for "Nursing Home", "Residential Facilities" and "Homes for the Aged"; CINAHL for "nursing homes", "residential facilities" and "skilled nursing facilities"; AMED for "Nursing homes", "Long term care", "Residential facilities" and "Randomized controlled trial"; and BNI for "Nursing Homes", "Residential Care" and "Long-term care". Articles were classified against a keywording strategy describing: year and country of publication; randomization, stratification and blinding methodology; target of intervention; intervention and control treatments; number of subjects and/or clusters; outcome measures; and results.
3226 abstracts were identified and 291 articles reviewed in full. Most were recent (median age 6 years) and from the United States. A wide range of targets and interventions were identified. Studies were mostly functional (44 behaviour, 20 prescribing and 20 malnutrition studies) rather than disease-based. Over a quarter focussed on mental health.
This study is the first to collate data from all RCTs conducted in care homes and represents an important resource for those providing and commissioning healthcare for this sector. The evidence-base is rapidly developing. Several areas - influenza, falls, mobility, fractures, osteoporosis – are appropriate for systematic review. For other topics, researchers need to focus on outcome measures that can be compared and collated.
Care homes provide accommodation, together with nursing or personal care, for persons who are or have been ill, who have or have had a mental disorder, who are disabled or infirm, or are or have been dependent on alcohol or drugs
In some countries, such as the Netherlands and USA, health care professionals are based within, or employed by, care homes
Quest for Quality, a document by the British Geriatrics Society
Medline (1950-Jun 2009) was searched for "Nursing Home", "Residential Facilities" and "Homes for the Aged", combined using the "OR" command. Results were limited for English language and RCTs. CINAHL with full text (1978-June 2009) was searched for "nursing homes", "residential facilities", "skilled nursing facilities", with results limited to RCTs. The Allied and Complementary Medicine Database (AMED) (1985-June 2009) was searched for "Nursing homes", "Long term care" and "Residential facilities" combined using the "OR" command and "Randomized controlled trial" using the "AND" command. The British Nursing Index and Archive (BNI) (1985-June 2009) was searched for "Nursing Homes", "Residential Care" and "Long-term care". Abstracts were reviewed by a single researcher and articles included if they described interventions evaluated by RCT in residential, nursing or care homes.
A keywording strategy
The abstracts of the 3226 unique citations identified from the search were examined, 331 of which described RCTs in care homes. Forty of these were excluded at full review leaving 291 articles in this review. A PRISMA flow diagram is shown in Figure
Figure 1
PRISMA flow diagram
PRISMA flow diagram.
The majority of studies (145) were conducted in the USA, followed by the UK (24) and the Netherlands (23): 163 articles came from the Americas, 87 articles from Europe, 23 from Asia and 16 from Australasia.
Figure 2
Number of articles published by year
Number of articles published by year.
Key methodological attributes of the studies are outlined in Table
36 primary targets for interventions were identified, as summarised in Table
For interventions targeting resident behaviour, most pharmacological studies evaluated risperidone
Seven studies targeting prescribing of medications looked at incorporating pharmacist review, with or without physician involvement, into clinical pathways on or after admission to care home
The majority of studies targeting nutrition evaluated nutritional supplementation using vitamin, mineral, and/or protein-energy supplementation
Studies targeting influenza in residents predominantly compared doses or types of vaccine
Studies targeting quality of life were heterogeneous. Under this heading, studies evaluating psychological or behavioural interventions evaluated group or individual therapies to build self-esteem
Studies targeting depression evaluated exercise therapy
Interventions targeting mobility were much more homogenous. Ten physical therapy studies all evaluated forms of exercise therapy
Oral health studies predominantly evaluated the role of mouthwashes, toothpastes and other oral preparations in dental hygiene
The majority of studies that evaluated falls prevention interventions focussed on multifaceted programmes
Studies targeting quality of care focussed predominantly on care home administration: four examined quality assurance programmes
Of the less frequently studied areas, large cohorts were seen in studies targeting fractures and osteoporosis. These areas were also notable for the similarity of the interventions studied and outcome measures recorded: all eight fracture studies evaluated hip protectors
Ten studies evaluated case management in the care home setting. The effect of psychiatric case management was evaluated in six studies, two on behavioural disturbance
These findings provide a unique resource for those providing health care to the care home sector, collating for the first time the range of interventions and outcomes that have been tested using RCTs specifically in care homes. There have been a considerable number of RCTs of interventions specifically in care homes (292 between 1974 and 2009). These studies are relatively recent, since half of them were published in the last 6 years. They evaluated a diverse range of interventions such as light therapy, staff training and oral hygiene and an equally diverse range of targets such as reducing falls, increasing weight or improving mood. The studies were mostly functional (44 behaviour studies, 20 prescribing studies, 20 malnutrition studies) rather than disease based (1 study each for UTI and COPD). Over a quarter of papers focussed on mental health or behaviour. Despite our use of systematic searching, we found no previously published studies that had collated this literature.
A limitation of this review is the geographical distribution of papers, with the majority of studies arising from the USA and relatively few from non-English speaking nations, thus reducing the generalisability of the findings worldwide. Our decision to select only RCTs means that we have not collated the entire evidence base for interventions in care homes and are likely to have missed several important studies as a consequence. Such studies would include those focussing on policy, facility organizational characteristics and the ways in which care homes interact with other care services, including the health service – these have been recognised to be important drivers of care quality but have been studied by means other than RCT
It is possible that staff trained in the care home setting – as some doctors are in the Netherlands or USA – are aware of many of these studies but it is less likely that those who provide health care to care homes as part of generic primary care will be familiar with them. The recent growth in the number of papers means that even health care professionals with an interest in the area will be out of date if they have not recently consulted the literature. The wide-ranging nature of the studies identified will have relevance to commissioners, and health care professions including general practitioners, geriatricians, psychiatrists, nurses, occupational, physio- and speech and language therapists, dieticians, dentists, pharmacists and social workers – as well as care home staff. From a research perspective, there were few targets where multiple studies evaluated similar interventions against a common outcome measure. The obvious exceptions were influenza, falls, mobility, fractures and osteoporosis and these areas are suitable for systematic reviewing. There was great diversity of interventions and targets, such that there were few papers using the same intervention and the same target. Thus, despite the large numbers of papers found, much work remains to be done to develop a robust evidence-base for each intervention and each target. Although a detailed methodological critique is beyond the scope of a systematic mapping review, the fact that the majority of studies were unblinded and did not employ cluster randomization means that many will have been methodologically flawed.
In summary, these findings represent an important resource for commissioners, clinicians and researchers involved with care homes. At the very least, the diversity of interventions and outcomes illustrated should challenge nihilism towards this health care sector and encourage further innovation.
Competing interests
The authors have no competing interests to declare.
Authors' contributions
ALG was lead researcher and also lead author. JRFG and PAL contributed to the development of the keywording strategy. All authors participated in the literature review and contributed to drafting the final manuscript. All authors read and approved the final manuscript.
This article presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0407-10147). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
The authors would also like to acknowledge the support of the British Geriatrics Society, who provided an SpR start-up grant in support of ALG at the outset of this project.
The Medical Crises in Older People study group also includes: Isabella Robbins, Jane Dyas, Justine Schneider, Sarah Goldberg, Rowan Harwood, Kathy Whittamore, Sarah Lewis, Simon Conroy, Anthony Avery, Fiona Jurgens, Judi Edmans, Lucy Bradshaw, Helen Boardman, Rachel Elliot, Matt Franklin and Davina Porock.
A national census of care home residents
The Importance of Physician Presence in Nursing Homes for Residents with Dementia and Pneumonia
Nursing Home Physician Specialists: A Response to the Workforce Crisis in Long-Term Care
Medical services for older people in nursing homes — Comparing services in England and The Netherlands
A typology of reviews: an analysis of 14 review types and associated methodologies
Grading quality of evidence and strength of recommendations
Effect of Acetaminophen on Behavior, Well-Being, and Psychotropic Medication Use in Nursing Home Residents with Moderate-to-Severe Dementia
Alprazolam as an Alternative to Low-Dose Haloperidol in Older, Cognitively Impaired Nursing Facility Patients
A Randomized, Double-Blind, Placebo-Controlled Study of Aripiprazole for the Treatment of Psychosis in Nursing Home Patients with Alzheimer Disease
Efficacy and Tolerability of Carbamazepine for Agitation and Aggression in Dementia
A Randomized, Double-Blind, Placebo-Controlled Study of the Efficacy and Safety of Donepezil in Patients with Alzheimer's Disease in the Nursing Home Setting
Divalproex Sodium in Nursing Home Residents With Possible or Probable Alzheimer Disease Complicated by Agitation: A Randomized, Controlled Trial
Pharmacologic treatment of noncognitive behavioral disturbances in elderly demented patients
Melatonin Fails to Improve Sleep or Agitation in Double-Blind Randomized Placebo-Controlled Trial of Institutionalized Patients With Alzheimer Disease
The effects of olanzapine in reducing the emergence of psychosis among nursing home patients with Alzheimer's disease
Olanzapine Treatment of Psychotic and Behavioral Symptoms in Patients With Alzheimer Disease in Nursing Care Facilities: A Double-blind, Randomized, Placebo-Controlled Trial
Propranolol for Disruptive Behaviors in Nursing Home Residents With Probable or Possible Alzheimer Disease: A Placebo-Controlled Study
Risperidone is effective for wandering and disturbed sleep/wake patterns in Alzheimer's disease
Risperidone for psychosis of Alzheimer's disease and mixed dementia: results of a double-blind, placebo-controlled trial
Comparative efficacy of risperidone versus haloperidol on behavioural and psychological symptoms of dementia
The Effect of Risperidone on Nursing Burden Associated with Caring for Patients with Dementia
A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia
Risperidone in the Treatment of Psychosis of Alzheimer Disease: Results From a Prospective Clinical Trial
Effect of Antipsychotic Withdrawal on Behavior and Sleep/Wake Activity in Nursing Home Residents with Dementia: A Randomized, Placebo-Controlled, Double-Blinded Study The Bergen District Nursing Home Study
Dag Aarsland: Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study–The Bergen District Nursing Home Study (BEDNURS)
A randomized trial of dementia care in nursing homes
Effects of behavioral interventions on disruptive behavior and affect in demented nursing home residents
Can we help persons with dementia find their way in a new environment?
Pet therapy and institutionalized elderly: A study on 144 cognitively unimpaired subjects
Keep music live: music and the alleviation of apathy in dementia subjects
Music therapy in moderate and severe dementia of Alzheimer's type: a case-control study
The effects of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan
Exercise program for nursing home residents with Alzheimer's disease: a 1-year randomized, controlled trial
Light Treatment for Neuropsychiatric Behaviors in Alzheimers Disease
A randomized, controlled trial of bright light therapy for agitated behaviors in dementia patients residing in long-term care
Effect of light on agitation in institutionalized patients with severe Alzheimer disease
Behavioural management in nursing and residential homes: a randomised controlled trial
An evaluation of a family visit education program
Impact of Training Dementia Caregivers in Sensitivity to Nonverbal Emotion Signals
Educating Nursing Assistants to Communicate More Effectively With Nursing Home Residents With Dementia
The effect of integrated emotion-oriented care versus usual care on elderly persons with dementia in the nursing home and on nursing assistants: a randomized clinical trial
The effects of a psychomotor activation programme for use in groups of cognitively impaired people in homes for the elderly
Reality orientation versus sheltered workshops as treatment for the institutionalized aging
STAR: A Dementia-Specific Training Program for Staff in Assisted Living Residences
Challenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions
Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention
A Stimulation-Retreat Special Care Unit for Elders With Dementing Illness
Randomized controlled trial of different models of care for nursing home residents with dementia complicated by depression or psychosis
Effect of Person-Centered Showering and the Towel Bath on Bathing-Associated Aggression, Agitation, and Discomfort in Nursing Home Residents with Dementia: A Randomized, Controlled Trial
Efficacy of aromatherapy (Lavandula angustifolia) as an intervention for agitated behaviours in Chinese older persons with dementia: a cross-over randomized trial
Gradual withdrawal from benzodiazepines in residents of homes for the elderly: experience and suggestions for future research
Effects of a pharmacist's medication review in nursing homes: Randomised controlled trial
Clinical medication review by a pharmacist of elderly people living in care homes–randomised controlled trial
Randomized controlled intervention in cardiovascular drug treatment in nursing homes
Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression
Withdrawal of neuroleptic medications from institutionalized dementia patients: results of a double-blind, baseline-treatment-controlled pilot study
Once-Daily Cefepime Versus Ceftriaxone for Nursing Home Acquired Pneumonia
Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes
An outreach intervention to implement evidence based practice in residential care: a randomized controlled trial [ISRCTN67855475]
Does the addition of a pharmacist transition coordinator improve evidence-based medication management and health outcomes in older adults moving from the hospital to a long-term care facility? Results of a randomized, controlled trial
Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial
The impact of regular multidisciplinary team interventions on psychotropic prescribing in Swedish nursing homes
Withdrawal of Haloperidol, Thioridazine, and Lorazepam in the Nursing Home: A Controlled, Double-blind Study
The Effects of Withdrawal of Dopaminergic Medication in Nursing Home Patients With Advanced Parkinsonism
Antibiotic Use, Hospital Admissions, and Mortality Before and After Implementing Guidelines for Nursing Home Acquired Pneumonia
A randomized trial of a program to reduce the use of psychoactive drugs in nursing homes
Predictors of antipsychotic withdrawal or dose reduction in a randomized controlled trial of provider education
Educational program for nursing home physicians and staff to reduce use of non-steroidal anti-inflammatory drugs among nursing home residents: a randomized controlled trial
Physician and staff assessments of drug interventions and outcomes in Swedish nursing homes
Effect of enhanced psychosocial care on antipsychotic use in nursing home residents with severe dementia: cluster randomised trial
Impact of a Buffet-style Dining Program on Weight and Biochemical Indicators of Nutritional Status in Nursing Home Residents: A pilot study
Effect of Family-Style Meals on Energy Intake and Risk of Malnutrition in Dutch Nursing Home Residents: A Randomized Controlled Trial
Prevention of Unintentional Weight Loss in Nursing Home Residents: A Controlled Trial of Feeding Assistance
No effect of 16 weeks flavor enhancement on dietary intake and nutritional status of nursing home elderly
Enhancement of Select Foods at Breakfast and Lunch Increases Energy Intakes of Nursing Home Residents with Low Meal Intakes
Effects of food fortification on nutritional and functional status in frail elderly nursing home residents at risk of malnutrition
Does low lactose milk powder improve the nutritional intake and nutritional status of frail older Chinese people living in nursing homes?
Medical nutrition therapy for the prevention and treatment of unintentional weight loss in residential healthcare facilities
Nutritional status of elderly female nursing home residents; the effect of supplementation with a physiological dose of water-soluble vitamins
Early nutritional supplementation immediately after diagnosis of infectious disease improves body weight in psychogeriatric nursing home residents
Study of the effect of a liquid nutrition supplement on the nutritional status of psycho-geriatric nursing home patients
The effect of oral nutritional supplements on habitual dietary quality and quantity in frail elders
Providing Nutrition Supplements to Institutionalized Seniors with Probable Alzheimer's Disease Is Least Beneficial to Those with Low Body Weight Status
Protein-energy oral supplementation in malnourished nursing-home residents
Multifaceted nutritional intervention among nursing-home residents has a positive influence on nutrition and function
Effects of oral functional training for nutritional improvement in Japanese older people requiring long-term care
Quality of life and stimulation of weight gain after treatment with megestrol acetate: correlation between cytokine levels and nutritional status, appetite in geriatric patients with wasting syndrome
Improvement in quality-of-life measures and stimulation of weight gain after treatment with megestrol acetate oral suspension in geriatric cachexia: results of a double-blind, placebo-controlled study
The Correlation of Cytokine Levels With Body Weight After Megestrol Acetate Treatment in Geriatric Patients
Effect of Multivitamin and Mineral Supplementation on Episodes of Infection in Nursing Home Residents: A Randomized, Placebo-Controlled Study
Improvement of the immunoglobulin subclass response to influenza vaccine in elderly nursing-home residents by the use of high-dose vaccines
Antibody response after influenza immunization with various vaccine doses: a double-blind, placebo-controlled, multi-centre, dose–response study in elderly nursing-home residents and young volunteers
Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak
Immunogenicity and efficacy of Russian live attenuated and US inactivated influenza vaccines used alone and in combination in nursing home residents
Flu: Effect of Vaccine in Elderly Care Home Residents: A Randomized Trial
Induction of mucosal antibodies by live attenuated and inactivated influenza virus vaccines in the chronically ill elderly
Protective efficacy of combined live intranasal and inactivated influenza A virus vaccines in the elderly
Co-administration of l-cystine and l-theanine enhances efficacy of influenza vaccination in elderly persons: Nutritional status-dependent immunogenicity
Immunogenicity and safety of a novel IL-2-supplemented liposomal influenza vaccine (INFLUSOME-VAC) in nursing-home residents
Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity, and health service use among residents: cluster randomised controlled trial
Comparison of three different influenza vaccines in institutionalised elderly
Immunogenicity and safety of three commercial influenza vaccines in institutionalized elderly
Immunogenicity of new virosome influenza vaccine in elderly people
Duration of Antiviral Prophylaxis During Nursing Home Outbreaks of Influenza A: A Comparison of 2 Protocols
Long-Term Use of Oseltamivir for the Prophylaxis of Influenza in a Vaccinated Frail Older Population
Safety and efficacy of long-term use of rimantadine for prophylaxis of type A influenza in nursing homes
Inhaled Zanamivir Versus Rimantadine for the Control of Influenza in a Highly Vaccinated Long-term Care Population
Inhaled Zanamivir Versus Placebo for the Prevention of Influenza Outbreaks in an Unvaccinated Long-term Care Population
Efficacy of zanamivir for chemoprophylaxis of nursing home influenza outbreaks
Enhancing the self-esteem of selected male nursing home residents
Evaluation of the effect of a life review group program on self-esteem and life satisfaction in the elderly
A randomized controlled trial of a specific reminiscence approach to promote the well-being of nursing home residents with dementia
A controlled evaluation of reminiscence and current topics discussion groups in a nursing home context
Effect of Refractive Error Correction on Health-Related Quality of Life and Depression in Older Nursing Home Residents
Impact of participating in volunteer activities for residents living in long-term-care facilities
Animal-Assisted Therapy and Loneliness in Nursing Homes: Use of Robotic versus Living Dogs
Effect of Tai Chi on state self-esteem and health-related quality of life in older Chinese residential care home residents
Physiological and psychological effects of back rubs
Does an Exercise and Incontinence Intervention Save Healthcare Costs in a Nursing Home Population?
Effect of nursing home staff training on quality of patient survival
Training in dementia care: a cluster-randomized controlled trial of a training program for nursing home staff in Germany
Partners in Caregiving in a Special Care Environment: Cooperative Communication Between Staff and Families on Dementia Units
Effects of control and predictability on the physical and psychological well-being of the institutionalized aged
Influence of a "friendly visitor" program on the cognitive functioning and morale of elderly persons
A randomized trial of early psychiatric intervention in residential care: impact on health outcomes
Effect of family style mealtimes on quality of life, physical performance, and body weight of nursing home residents: cluster randomised controlled trial
Outcomes of Comfort Touch in Institutionalized Elderly Female Residents
Bright Light Treatment Decreases Depression in Institutionalized Older Adults: A Placebo-Controlled Crossover Study
BE-ACTIV: a staff-assisted behavioral intervention for depression in nursing homes
Exercise training for depressed older adults with Alzheimer's disease
An exploratory cluster randomized controlled trial of group exercise on mobility and depression in care home residents
Effects of transcutaneous electrical nerve stimulation (TENS) on self-efficacy and mood in elderly with mild cognitive impairment
AD-venture program: Therapeutic biking for the treatment of depression in long-term care residents with dementia
Easy rider wheelchair biking. A nursing-recreation therapy clinical trial for the treatment of depression
Assessing depression following two ancient Indian interventions
Effect of Bright Light and Melatonin on Cognitive and Noncognitive Function in Elderly Residents of Group Care Facilities: A Randomized Controlled Trial
Drug treatment of depression in frail elderly nursing home residents
A randomized, placebo-controlled trial of paroxetine in nursing home residents with non-major depression
A controlled clinical trial of sertraline in the treatment of depression in nursing home patients with late-stage Alzheimer's disease
Probing the safety of medications in the frail elderly: evidence from a randomized clinical trial of sertraline and venlafaxine in depressed nursing home residents
Structured reminiscence: an intervention to decrease depression and increase self-transcendence in older women
Self-worth therapy for depressive symptoms in older nursing home residents
Depression among nursing home elders: Testing an intervention strategy
Control-relevant intervention in the treatment of minor and major depression in a long-term care facility
Effect of a combined walking and conversation intervention on functional mobility of nursing home residents with Alzheimer disease
Exercise classes in rest homes: effect on physical function
An exercise program to improve fall-related outcomes in elderly nursing home residents
A randomized outcome evaluation of group exercise programs in long-term care institutions
Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing Homes
Comparison of the effectiveness of two programmes on older adults at risk of falling: unsupervised home exercise and supervised group exercise
Exercise with physically restrained nursing home residents: maximizing benefits of restraint reduction
A Controlled Trial of Exercise by Residents of Old People's Homes
Effectiveness of a group exercise program in a long-term care facility: a randomized pilot trial
Controlled whole body vibration to decrease fall risk and improve health-related quality of life of nursing home residents
Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial
Effects of a fall prevention program including exercise on mobility and falls in frail older people living in residential care facilities
Changes in Postural Balance in Frail Elderly Women during a 4-Week Visual Feedback Training: A Randomized Controlled Trial
The effectiveness of three different strengths of chlorhexidine mouthrinse
Stannous fluoride in dentifrice: an effective anti-plaque agent in the elderly?
ART and Conventional Root Restorations in Elders after 12 Months
Plaque removal with an experimental chewable toothbrush and a control manual toothbrush in a care-dependent elderly population: a pilot study
The effect of chlorhexidine acetate/xylitol chewing gum on the plaque and gingival indices of elderly occupants in residential homes
The effects of the combination of chlorhexidine/thymol- and fluoride-containing varnishes on the severity of root caries lesions in frail institutionalised elderly people
Microwave disinfection of dentures for the treatment of oral candidiasis
Improving oral health in institutionalised elderly people by educating caregivers: a randomised controlled trial
Buffering effect of a prophylactic gel on dental plaque in institutionalised elderly
Improvement of taste sensitivity of the nursed elderly by oral care
Efficacy of a sonic toothbrush for plaque removal by caregivers in a special needs population
Oral health care education and its effect on caregivers' knowledge and attitudes: a randomised controlled trial
Adjunctive subantimicrobial dose doxycycline in the management of institutionalised geriatric patients with chronic periodontitis
Effectiveness of a multifaceted intervention on falls in nursing home residents
A Randomized Controlled Trial of Fall Prevention Strategies in Old Peoples' Homes
Falls prevention in residential care homes: a randomised controlled trial
A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT)
Fall Prevention in Residential Care: A Cluster, Randomized, Controlled Trial
A randomized trial of a consultation service to reduce falls in nursing homes
A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study
Should Older People in Residential Care Receive Vitamin D to Prevent Falls? Results of a Randomized Trial
A fall prevention program for elderly individuals. Exercise in long-term care settings
A randomized controlled trial of fall prevention by a high-intensity functional exercise program for older people living in residential care facilities
Impact of a falls menu-driven incident-reporting system on documentation and quality improvement in nursing homes
Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention
Systematic Implementation of an Advance Directive Program in Nursing Homes: A Randomized Controlled Trial
Improving the Use of Hospice Services in Nursing Homes: A Randomized Controlled Trial
Satisfaction with nursing home care of a relative: does inviting greater input make a difference?
Randomized Clinical Trial of a Quality Improvement Intervention in Nursing Homes
A randomized trial of quality assurance in nursing homes
A Quality Improvement Intervention to Increase Palliative Care in Nursing Homes
Using goal attainment scaling to improve the quality of long-term care: a group-randomized trial
Biobehavioral Correlates of Relocation in the Frail Elderly: Salivary Cortisol, Affect, and Cognitive Function
Assisting cognitively impaired nursing home residents with bathing: effects of two bathing interventions on caregiving
A Cooperative Communication Intervention for Nursing Home Staff and Family Members of Residents
Impact on nursing home staff of training about death and dying
A cluster randomised controlled trial to reduce the unmet needs of people with dementia living in residential care
Cost effectiveness of training incontinent elderly in nursing homes: a randomized clinical trial
Bladder Training and Kegel Exercises for Women with Urinary Complaints Living in a Rest Home
Urinary Incontinence in Disabled Elderly Women: A Randomized Clinical Trial on the Effect of Training Mobility and Toileting Skills to Achieve Independent Toileting
A phase II exploratory cluster randomized controlled trial of a group mobility training and staff education intervention to promote urinary continence in UK care homes
Introducing a New Incontinence Management System for Nursing Home Residents
The effects of patterned urge-response toileting (PURT) on urinary incontinence among nursing home residents
Randomized, Placebo-Controlled Trial of the Cognitive Effect, Safety, and Tolerability of Oral Extended-Release Oxybutynin in Cognitively Impaired Nursing Home Residents with Urge Urinary Incontinence
Does Eradicating Bacteriuria Affect the Severity of Chronic Urinary Incontinence in Nursing Home Residents?
Does oxybutynin add to the effectiveness of prompted voiding for urinary incontinence among nursing home residents? A placebo-controlled trial
Effects of Oral Estrogen and Progestin on the Lower Urinary Tract Among Female Nursing Home Residents
Translating Clinical Research into Practice: A Randomized Controlled Trial of Exercise and Incontinence Care with Nursing Home Residents
Clean intermittent catheterization: safe, cost-effective bladder management for male residents of VA nursing homes
A randomised controlled trial testing the impact of exercise on cognitive symptoms and disability of residents with dementia
Acute exercise facilitates semantically cued memory in nursing home residents
The effect of planned walking on communication in Alzheimer's disease
Donepezil in patients with severe Alzheimer's disease: double-blind, parallel-group, placebo-controlled study
Ginkgo for elderly people with dementia and age-associated memory impairment: a randomized clinical trial
Training of conversational skills with institutionalized elderly: a preliminary study
Comprehensive approach of donepezil and psychosocial interventions on cognitive function and quality of life for Alzheimer's disease: the Osaki-Tajiri Project
Randomized, controlled trial of a nonpharmacological intervention to improve abnormal sleep/wake patterns in nursing home residents
Does physical activity improve sleep in impaired nursing home residents?
A randomized trial of a combined physical activity and environmental intervention in nursing home residents: do sleep and agitation improve?
Effect of Light Treatment on Sleep and Circadian Rhythms in Demented Nursing Home Patients
Effect of morning bright light treatment for rest and activity disruption in institutionalized patients with severe Alzheimer's disease
Melatonin and Bright-Light Treatment for Rest & Activity Disruption in Institutionalized Patients with Alzheimer's Disease
A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns
Evaluation of temazepam and diphenhydramine as hypnotics in a nursing-home population
A cluster randomised controlled trial to evaluate a policy of making hip protectors available to residents of nursing homes
The effect of type of hip protector and resident characteristics on adherence to use of hip protectors in nursing and residential homes–an exploratory study
Efficacy of a hip protector to prevent hip fracture in nursing home residents: the HIP PRO randomized controlled trial
Hip protectors in aged-care facilities: a randomized trial of use by individual higher-risk residents
Prevention of hip fractures by external hip protectors: a randomized controlled trial
Uptake and adherence with soft- and hard-shelled hip protectors in Norwegian nursing homes: a cluster randomised trial
Effect on hip fractures of increased use of hip protectors in nursing homes: cluster randomised controlled trial
Increased Use of Hip Protectors in Nursing Homes: Economic Analysis of a Cluster Randomized, Controlled Trial
Arginine Supplementation Is Well Tolerated but Does Not Enhance Mitogen-Induced Lymphocyte Proliferation in Elderly Nursing Home Residents with Pressure Ulcers
Arginine Supplementation Does Not Enhance Serum Nitric Oxide Levels in Elderly Nursing Home Residents With Pressure Ulcers
Impact of Vitamin A Supplementation on the Incidence of Infection in Elderly Nursing-home Residents: A Randomized Controlled Trial
Effect of 6 month supplementation with different combinations of an association of antioxidant nutrients on biochemical parameters and markers of the antioxidant defence system in the elderly. The Geriatrie/Min.Vit.Aox Network
Effects of trace element and/or vitamin supplementation on vitamin and mineral status, free radical metabolism and immunological markers in elderly long term-hospitalized subjects. Geriatric Network MIN. VIT. AOX
Effects of an Exercise Intervention on Immunologic Parameters in Frail Elderly Nursing Home Residents
Nutritional Formula Improved Immune Profiles of Seniors Living in Nursing Homes
A randomized trial of low-air-loss beds for treatment of pressure ulcers
A randomized control trial to evaluate pressure-reducing seat cushions for elderly wheelchair users
Pressure Ulcer Healing with a Concentrated, Fortified, Collagen Protein Hydrolysate Supplement: A Randomized Controlled Trial
Oxyquinoline-containing ointment vs. standard therapy for stage I and stage II skin lesions
The effectiveness of massage with and without dimethyl sulfoxide in preventing pressure ulcers: A randomized, double-blind cross-over trial in patients prone to pressure ulcers
Randomised clinical trial of ultrasound treatment for pressure ulcers
Effectiveness of turning with unequal time intervals on the incidence of pressure ulcer lesions
Alendronate Improves Bone Mineral Density in Elderly Women with Osteoporosis Residing in Long-Term Care Facilities: A Randomized, Double-Blind, Placebo-Controlled Trial
Efficacy of different doses and time intervals of oral vitamin D supplementation with or without calcium in elderly nursing home residents
Between-Meal Risedronate Does Not Alter Bone Turnover in Nursing Home Residents
Vitamin D supplementation and the prevention of fractures and falls: results of a randomised trial in elderly people in residential accommodation
Preventing fractures among older people living in institutional care: a pragmatic randomised double blind placebo controlled trial of vitamin D supplementation
Educating nursing home staff on fracture prevention: a cluster randomised trial
Randomized Trial to Improve Fracture Prevention in Nursing Home Residents
Effects of the Serial Trial Intervention on Discomfort and Behavior of Nursing Home Residents With Dementia
Effectiveness of advanced illness care teams for nursing home residents with dementia
Effects of a controlled exercise trial on pain in nursing home residents
The clinical efficacy of reflexology in nursing home residents with dementia
Cognitive-behavioral pain management for elderly nursing home residents
A Clinical Trial of the Effectiveness of Regularly Scheduled Versus As-Needed Administration of Acetaminophen in the Management of Discomfort in Older Adults with Dementia
A Comparison of Two Short Education Programs for Improving Low Back Pain-Related Disability in the Elderly: A Cluster Randomized Controlled Trial
Induced disability in nursing home patients: a controlled trial
Outcomes of enhanced physical and occupational therapy service in a nursing home setting
The effect of skill training on functional abilities of nursing home residents with dementia
Cluster randomized pilot controlled trial of an occupational therapy intervention for residents with stroke in UK care homes
Care intervention for older adults with Alzheimer's disease and related dementias: effect of family involvement on cognitive and functional outcomes in nursing homes
A randomized trial of physical rehabilitation for very frail nursing home residents
Chronic Constipation Management for Institutionalized Older Adults
Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial
Intervention with Dietary Fiber to Treat Constipation and Reduce Laxative Use in Residents of Nursing Homes
Efficacy of an Herbal Dietary Supplement (Smooth Move) in the Management of Constipation in Nursing Home Residents: A Randomized, Double-Blind, Placebo-Controlled Study
Effects of resistance and functional-skills training on habitual activity and constipation among older adults living in long-term care facilities: a randomized controlled trial
The use of intramuscular cefoperazone versus intramuscular ceftriaxone in patients with nursing home-acquired pneumonia
Oral immunization with bacterial extracts for protection against acute bronchitis in elderly institutionalized patients with chronic bronchitis
Immunogenicity of a 23-valent pneumococcal polysaccharide vaccine in elderly residents of a long-term care facility
Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trial
Effect of a Clinical Pathway to Reduce Hospitalizations in Nursing Home Residents With Pneumonia: A Randomized Controlled Trial
The effect of staff training on the use of restraint in dementia: a single-blind randomised controlled trial
Short-term effects of an educational intervention on physical restraint use: a cluster randomized trial
A clinical trial to reduce restraints in nursing homes
An evaluation of two bathing products in a chronic care setting
Effect of specialized bathing systems on resident cleanliness and water quality in nursing homes: a randomized controlled trial
The effects of an exercise and incontinence intervention on skin health outcomes in nursing home residents
Vitamin D supplementation in elderly nursing home residents increases 25(OH)D but not 1,25(OH)2D
The effect of vitamin D supplementation on vitamin D status and parathyroid function in elderly subjects
Ultraviolet Irradiation Corrects Vitamin D Deficiency and Suppresses Secondary Hyperparathyroidism in the Elderly
Measurement of Outcomes within a Multicentred Randomized Controlled Trial in the Evaluation of the Experimental NHS Nursing Homes
Geriatric assessment teams in nursing homes: do they work?
Omega-3 Fatty Acid Prevents Heart Rate Variability Reductions Associated with Particulate Matter
Theophylline-Improved Swallowing Reflex in Elderly Nursing Home Patients
Dysphagia in Elderly Nursing Home Residents with Severe Cognitive Impairment can be Attenuated by Cervical Spine Mobilization
Added-purpose versus rote exercise in female nursing home residents
Effects of a Care Protocol on Care Outcomes in Older Nursing Home Patients with Chronic Obstructive Pulmonary Disease
Daily oral care and cough reflex sensitivity in elderly nursing home patients
An Intervention to Increase Fluid Intake in Nursing Home Residents: Prompting and Preference Compliance
Care staff training in detection of depression in residential homes for the elderly: Randomised trial
Does treatment of constipation improve faecal incontinence in institutionalized elderly patients?
The Effect of Music on Hypertensive Patients
Interpersonal skill training with institutionalized elderly patients
Comparison of Routine Glove Use and Contact-Isolation Precautions to Prevent Transmission of Multidrug-Resistant Bacteria in a Long-Term Care Facility
Prospective randomized comparison of therapy and no therapy for asymptomatic bacteriuria in institutionalized elderly women
Pre-publication history
The pre-publication history for this paper can be accessed here:


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O2 in 1985 became one of the original two mobile phone networks, along with Vodafone, and today is the commercial brand of Telefonica UK. O2 offers monthly mobile phone and SIM only contracts and has a customer base of 23 million customers.
According to Ofcom, O2 has the highest customer satisfaction for any mobile provider, an achievement it has attained for seven years in a row. After sales customer service is available during daylight hours, seven days a week.
O2 provides 2G, 3G and 4G internet access, with the latter requiring a 4G smartphone, 4G SIM card and 4G tariff. To help customers manage their internet/data usage, the My O2 app can be download for free.
The Priority app gives all O2 customers access to perks such as £1 Lunch on Monday, your favourite Channel 4 shows available 48 hours before they air on TV and the option to get tickets to music, comedy and sports events 48 hours before they go on general release.
O2 Wifi, with 10,000 UK hotspots, means that O2 customers don't need to use up their data allowance and O2 Wifi is up to 10 times faster than a normal mobile connection. O2 customers can also access London Underground Wi-Fi, which is available in over 250 London underground stations in the ticket halls, escalators and platforms.

subset: commoncrawl


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Mother's Diamond Accent Circle Pendant in Sterling Silver (4 Names)
Item# 20007262
A mother's love is endless � honor her family with this personalized pendant. Crafted in sleek sterling silver, this slender open circle-shaped design can be personalized with up to four names, each up to eight characters in length, engraved in a stylish script font. Shimmering diamond accents provide sparkle and shine. A look Mom will treasure, this pendant is buffed to a brilliant luster and suspends along an 18 inch curb chain that secures with a spring-ring clasp. View product details
Diamond carat weights (CT.) represent the approximate total weight (T.W.) of all diamonds in each setting and may vary no more than .07 below the stated weight. Typographic errors are subject to correction. Merchandise enlarged to show detail and may not always be exactly as pictured. Promotions, prices, styles and availability may vary by store and online.


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You've already got 5 items in your shopping cart, so there's no room to reserve another one. If you'd like, you can take something out of your cart to make room for this one.
Play Trailer
Footloose (2011)
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1:53 min|
Redbox Play Pass eligible
Plot Summary
Plot: Ren McCormack is transplanted from Boston to the small southern town of Bomont where he experiences a heavy dose of culture shock. A few years prior, the community was rocked by a tragic accident that killed five teenagers after a night out and Bomont's local councilmen and the beloved Reverend Shaw Moore responded by implementing ordinances that prohibit loud music and dancing. Not one to bow to the status quo, Ren challenges the ban, revitalizing the town and falling in love with the minister's troubled daughter Ariel in the process.
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how consumer-product relationships influence consumers decis
Describe your experiences or observations with product positioning within marketing strategy through analyzing how consumer-product relationships influence consumer decision making, application of strategies toward product positioning, and integration of promotional strategies within a marketing plan. In what ways does your company operate with these factors, and how effective has it been? If your company involved with these factors or you were not involved with them, indicate how you think they would help your company and in what way?
product: PROACTIV
Solution Preview
My product observation will be PROACTIV
If you are in the USA, when you google acne medicine, Proactiv will be the first on your list. The marketing people in this organization are truly experts, many buyers of Proactiv are not at all pleased with how the product works, but clearly, given its successful sales rate and consumer base, millions are convinced they need and want an ongoing system of fighting acne. Isn't it something that all businesses want? Let's take a look at the advertisement on TV first, Jessica Simpson, Avril Lavigne, Justin Bieber, Katy Perry, and Vanessa Williams who thank the product for their currently flawless ...


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More than 200 Knox Community Elementary School students' original poems could be published this fall in the 2011 Young American Poetry Digest, a program of the National Schools project.
Charles Ratliff, writing teacher at the school, says nearly 800 poems were submitted to be considered for the anthology, which is a collection of writing in book form. He says the work of 50 fifth graders, 79 fourth graders,
and 70 third graders were accepted.
Ratliff says however, just because a students received an acceptance letter does not mean his or her poem is automatically published in the anthology. He says he found that when students write for a specific purpose, such as writing for contests, their writing becomes so much better.
Photo provided by Charles Ratliff.


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Contraption Ogling: Google Embraces a Hardware Future
In our trove of information this time around are Google's cell phones, virtual reality headset, keen speaker and upgraded Chromecast.
As usual, these are not audits. The appraisals, in the mean time, reflect exactly the amount I'd jump at the chance to experiment with every thing, regardless of the possibility that they do generally little to propel the lazy cell phone showcase.
Pixel Almost-Perfect
The primary cell phones Google has made without anyone else, Pixel and Pixel XL, are the first to hold up under Android 7.1 and the first to have the noteworthy Google Assistant inherent.
The Pixel has a 5-creep HD screen, while the Pixel XL offers a 5.5-crawl QHD show. The telephones have a quad-center processor and 4 GB of RAM.
I like that the unique mark sensor is on the back - that would invalidate the cumbersome wriggling I manage each time my iPhone neglects to perceive my thumbprint - and the consideration of a simple earphone jack is to a great degree welcome in the wake of the kerfuffle over Apple's choice to dump it.
The iPhone 7 has one sound preferred standpoint, with stereo speakers to Pixel's single speaker.
I value Google's capacity to house the 12.3-megapixel camera altogether inside the telephone's body, keeping away from a focal point projecting from the back. Shockingly better is the boundless, full-determination photograph and video stockpiling Google is putting forth Pixel proprietors.
There's a ton to respect about these telephones, yet I can't summon up any genuine energy for them. They appear to be consummately adequate first class cell phones with welcome elements - yet little appears to be genuinely creative or noteworthy.
Pixel and Pixel XL are great initial steps for Google's in-house cell phone division. I can dare to dream the following stage is even more a goliath jump.
Rating: 4 out of 5 Millions of Photos
Milder VR
Google additionally has its own particular virtual-reality headset, Daydream VR. It works much like the Samsung Gear VR, or even Google's own Cardboard, in that you slide a perfect cell phone, (for example, Pixel) into the front of the visor and strap the thing to your head. The headset consequently combines with the telephone utilizing the handset's NFC chip.
Where Daydream VR has a major preferred standpoint, at any rate from my viewpoint, is in the delicate material form that suits eyeglass wearers. I discover Oculus Rift exceedingly uncomfortable while wearing my scenes, so much obliged for that, Google.
Alongside physical catches, the controller has movement location, which I'm certain will prove to be handy for gaming. With respect to substance, you'll have the capacity to venture into true areas utilizing Google Street View and check out YouTube's 360-degree recordings. Netflix, Hulu and HBO applications will work with the stage as well.
Similarly as with Gear VR, this is a minimal effort path for individuals to begin trying different things with virtual reality. I like the outline of this framework, yet the stage's future will rely on substance and how fruitful Google is in enrolling designers and accomplices to exploit Daydream VR.
Rating: 4 out of 5 Whole New Worlds
No Voice Like Home
Google's keen speaker, Google Home, is not too unique at first glance from Amazon Echo, put something aside to be US$50 less expensive and being more profound imbued into Google's administrations rather than Amazon's.
I like that it works with Chromecast, so I could request that Home play something on my TV immediately (YouTube now for video, yet more administrations are clearly in transit). On the music side, you can play from Spotify, Pandora, and others.
In the event that you become weary of utilizing your voice, you can tap the top to respite or play music or roll your finger over it to change the volume. The plan is straightforward and tasteful, and I like that there are swappable choices for the base.
Shrewd speakers are inalienably fascinating, and I surely utilize Google benefits more than Amazon. I'm simply not certain how helpful Home really would be for me, or how it would fit into my life. Still, on the off chance that I can simply bark at a crate to begin playing the following scene of Luke Cage, I won't whine.
Rating: 4 out of 5 Simple Orders
Chromecast Powers Up
Chromecast Ultra streams video in 4K determination, for some odd reason. For those of us without a 4K-prepared TV, it's clearly quicker than past models, on account of more grounded WiFi availability, and there's an appreciated Ethernet port to boot.
It's an iterative change, instead of a progressive one, which bodes well. There appears to be little explanation behind Google to rehash the wheel when Chromecast is such a runaway achievement.
Roku just overhauled its line of players, and the passage level cost of those gadgets is far lower than Chromecast Ultra's $69 retail cost. Be that as it may, such is the convenience of Chromecast that I question Google will surrender a lot of its business to Roku. This most recent rendition will undoubtedly be pretty much as strong as past incarnations.
Contraption Ogling: Google Embraces a Hardware Future
lanka hotnews


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Morning sunshine gave way to increased afternoon clouds and another round of storms across the area. This is all courtesy of a cold front moving through. The cold front won't have a lot of interest in moving far though, so we may see stormy skies return to parts of the area for a third day in a row on Thursday.
Through Tonight: Storms that peppered the area have pushed east, with some lingering rain still falling in spots. The front is still to the northwest, so another pop up shower or storm is possible for a bit. That said, with earlier storms using up the fuel and the sun setting, anything else should be rather isolated if it happens at all. Lows range from the mid-60s to near 70, as light winds swing around toward the north and northwest overnight.
Tomorrow (Thursday): Cold fronts love to stall out and die around here in summer, so it shouldn't be too surprising this one doesn't get too far tomorrow. While storm odds are down compared to yesterday and today, it's hard to rule them out completely, especially I-95 and east during the afternoon into evening. With skies at least partially shrouded by clouds, and slightly cooler air trying to filter in, highs are mainly in the 83-87 range.
See Dan Stillman's forecast through the weekend. And if you haven't already, join us on Facebook and follow us on Twitter . For related traffic news, check out Dr. Gridlock.
Storm pictures from today: Storms that sent their worst mainly to the south and east of the city created some wild skies on their way through. A sampling is below.
At least I have my foul weather gear today. Here's the Potomac right now, @capitalweather : pic.twitter.com/8BTPYYqfI6— Wilson Freeman (@driftingfocus) July 9, 2014
Fredericksburg Thunderstorm as seen from NE Spotsylvania County @chrisvawx @Toppersweather @capitalweather #nofilter pic.twitter.com/834AGUZZOt— Ryan Fulks (@Field_Strong) July 9, 2014
@capitalweather Just off Bell Haven Marina: pic.twitter.com/WHqQb2OSGe— Wilson Freeman (@driftingfocus) July 9, 2014


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St. Hazards - Last Minute Deals!
All rates for everything from camping to waterfront condos on Middle Bass Island are 50% off until June 10, 2012 with a minimum two night rental. Friday and Saturday must be included for a weekend rental. Call 800-837-5211 for your discount.
So if it is a weekend get-a-way, a week long relaxing honeymoon, or your next bachelor party the full service facilities and a warm... friendly staff all make for a vacation that you will remember forever.
Come feel the cool breezes on Middle Bass Island.
Visit St. Hazards Waterfront Resort and make some memories!


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Trend Watch: Turquoise Blue Backgrounds in Food Photos
OK, we'll admit this trend is somewhat confined to Gourmet magazine (and one particular photographer), but we're seeing food against this peacock, turquoise blue so much it's starting to get weird. Don't get us wrong, we love the color...
We're just so used to seeing food against a clean, white backdrop. And yet, against this turquoise shade, brown duck looks toasty and crisp, not neutral, and green herbs stand out not because of a stark contrast but because they work so well with the color palette.
The photographer in all of these photos is Romulo Yanes. We appreciate that his pictures don't look like typical, white dish/linen napkin/soft light food shots. And we do really love the color. We just can't decide if it looks more like a wall color and less like dinner.
Huh. What do you think? Does this color make you hungry? Make you pay attention?
See the recipes along with the photos:
Related: Look! Peacock Blue Kitchen Cabinets
(All images: Romulo Yanes for Gourmet)


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Quality Policy
Source Photonics is committed to providing our customers with products and support of the highest quality. We strive to consistently meet and exceed the expectations of our customers, and to continuously improve the quality of our products and services through focused improvement programs and by fostering a company culture centered on quality. We work closely with our suppliers to ensure compliance to all quality standards of our raw materials. Source Photonics conforms with and is certified to the requirements of ISO9001:2008 and TL9000.
Our quality policy is to put the customer first and commit to continuous improvement in our quality system.


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This hotel comprises a total of 120 rooms and offers guests convenient facilities.
This hotel is located within the city of Genoa.
All guest rooms are equipped with a minibar, a hairdryer, a safe and air conditioning.
The hotel features a gym, where sports enthusiasts can enjoy a workout.
There is city tax payable by guest directly to hotel.
Room Facilities:
Central airconditioned


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Tiger Mistress
May 3, 2010 by Post Team
Tiger Mistress:According to ATM – Joslyn James – the mistress of Tiger Woods that he wants to apologize – now also wants an apology from the elegant Ritz Carlton, claiming she is the victim of discrimination stripper
Tiger Mistress — Victim of Stripper Prejudice?
TMZ has obtained a letter from the attorney Gloria Allred always fighting, saying James had booked a room at the Ritz in Charlotte, North Carolina for a stay of three days that ended Friday – which would have been a place of James could have hung his hat and showered after performing at a strip club.
Imagine the dismay of James, Allred says, when he landed in Charlotte "after a long and tiring journey from Los Angeles, only to learn the Ritz had canceled his reservation, the hotel says, because she was a guest of a high standard and would attract the media too.
But Allred argues the real reason for the cancellation may be due to Tiger could have been accommodated in the same hotel. And Gloria complains if Tiger was staying there, "… we are appalled to think she could have chosen to accommodate a golfer's rich, famous, who has admitted lying to his wife … more than a woman whose heart is broken … "
Allred wants the hotel to conduct a full investigation.
Please feel free to send if you have any questions regarding this post , you can contact on
Disclaimer: The views expressed on this site are that of the authors and not necessarily that of U.S.S.POST.


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Louis Brandt
BiographyNew York, USA
Louis Brandt was born on November 1, 1913 in New York, USA. He was an assistant director and director, known for God's Little Acre (1958), Murder by Contract (1958) and City of Fear (1959). He died on October 1, 1971 in Los Angeles, California, USA. Read more... <


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September 1, 2011 BY Brendan Dunne
We just showed you the Disney x adidas Originals Superstar II 'Mickey X' and it looks like these two collaborators have another one up their sleeve: the adi-RISE 'Mickey X'. It seems like the designers over at adidas were doing their best to avoid having this one go down as a typical cartoon collabo, with Mickey mean mugging on the tongue and the crossbones like logo hits on the heel and the stripes. The color choice speaks to something more serious as well, with a solid black patent leather mixed in with a bit of red here and there. Follow us after the jump for more pictures of the latest from the Disney x adidas Originals collection and cop the adi-RISE 'Mickey X' from retailers like Mr. R Sports.
Filed under: Adidas Collaboration Just Released
Tags: adidas adiRise Mid


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Representative Sandy Adams (FL-24) released the following statement about the highway/flood/student loan/rural schools conference report which passed the House today.
"It is time for Congress to stop following the same flawed playbook of the past. Why should hard-working families in Florida pay their gasoline taxes in Orlando to have them sent to Washington, D.C.? This defective transportation bill divvies up these taxes and uses them to cover bureaucratic costs and pet projects across the country. It then returns them at the current rate of 91 cents on the dollar back to Florida. Additionally, this legislation allows for new toll lanes on I-4, continues Florida's role as a donor state from the Highway Trust Fund, does nothing to expedite the approval of the Keystone pipeline, and it robs $18.8 billion from the general revenue fund.
"The bill before us today also packages together several unrelated pieces of legislation, rather than debating each bill on its merits. While reauthorizing flood insurance is important for Florida and my district, it should not be airdropped into a conference report in the dark of night to pass in a last minute vote before a holiday weekend. The House passed stand-alone flood insurance reauthorization, and the Senate should have dealt with it under regular order, not as an attachment to a totally unrelated bill. Like flood insurance, adding student loans and rural school provisions to this conference report is yet another example of an inability by those who are in positions of leadership to change the direction of Washington and get our federal government under control."
Source: http://adams.house.gov/News/DocumentSingle.aspx?DocumentID=301743


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Full biographyJon Iwata leads IBM's marketing, communications and citizenship organization. His global team is responsible for the marketing of IBM's product and services portfolio in more than 170 countries, market intelligence, communications, and stewardship of the IBM brand, recognized as one of the most valuable in the world.
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Jon reports to IBM Chairman, President and Chief Executive Officer Ginni Rometty. He is chairman of the IBM Values and Policy Advisory Board and vice chairman of the IBM International Foundation.
Jon joined IBM in 1984 at the company's Almaden Research Center in Silicon Valley. He was appointed vice president, corporate communications, in 1995 and senior vice president, communications, in 2002. He assumed his current role in 2008.
Jon is a trustee of Cooper Hewitt, Smithsonian Design Museum. He is a director of the Japan Society, a director of the Association of National Advertisers and an advisory board member for the Yale Center for Customer Insights.
Jon is recognized as a leader in both the marketing and corporate communications professions. He is an inductee of the Marketing Hall of Fame, the CMO Club Hall of Fame and the Page Society Hall of Fame, which honors lifetime achievement in business communications. He is a recipient of the Distinguished Service Award from The Seminar, an organization of Chief Communications Officers. He holds a B.A. from the School of Journalism and Mass Communications at San Jose State University.
Jon is co-inventor of a U.S. patent for advanced semiconductor lithography technology.


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- Enjoy these Cocker Spaniel photos collected by a bunch of us Cocker Spaniel lovers on our I Love Cocker Spaniels Facebook Page! We have a LOT more pictures on the Facebook page, but we're hoping to get more and more people to participate here and post their own photos on our discussion forum here.
- Thirsty!
Don't miss out on all the photos on Cocker Spaniel Photos Page One and Cocker Spaniel Photos Page Three!


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Horse Adoption
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Build Guide by Antonetti5
Not Updated For Current Season
This guide has not yet been updated for the current season. Please keep this in mind while reading. You can see the most recently updated guides on the browse guides page.
Anivia Build
Ability Sequence
Not Updated For Current Season
The masteries shown here are not yet updated for the current season, the guide author needs to set up the new masteries. As such, they will be different than the masteries you see in-game.
This is a build I have used in my past and it has worked very well for me. This build is for previous Anivia players that have experience with her. If you are just looking for a very kick *** build than you got it right here. Please comment and if you have any suggestions for my build I will be more than happy to accept advice.


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Philippines Typhoon Haiyan: 'Storm surge crushed all of these buildings'
Officials are struggling to bring aid to areas of the Philippines worst affected by Typhoon Haiyan, with up to 10,000 people feared dead in Tacloban.
There is no clean water, no electricity and very little food in the city.
Rupert Wingfield-Hayes from Tacloban, where an estimated 80% of the buildings have been destroyed.
10 Nov 2013
- From the section Asia


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by Staff Writers
Washington (AFP) Nov 28, 2011
The United States remains "concerned" about the European Union's plans to charge all airlines for carbon emissions when flying in and out of Europe, a US official said Monday.
Europe is facing a growing chorus of opposition, with the International Civil Aviation Organization joining US and Asian airlines in urging the EU to exclude foreign carriers from rules coming into force on January 1.
During a US-EU summit in Washington on Monday, President Barack Obama "made clear... that we're quite concerned about this regulatory regime," US Ambassador to the European Union William Kennard told reporters.
Obama met with European Council President Herman Van Rompuy, European Commission President Jose Manuel Barroso and EU foreign policy chief Catherine Ashton.
Kennard said the United States would have preferred a "multilateral" approach, earning immediate rebuke from his EU counterpart in Washington, Joao Vale de Almeida.
"We are not opposed to a multilateral solution," said Almeida. "But we have been waiting for too long for that, we have been waiting for 15 years for the International Civil Aviation Organization to come to any sort of deal on that."
The EU is already fighting in Europe's top court to defend its decision to include airlines in its Emissions Trading System (ETS), which furious US carriers say violates international climate change and aviation pacts.
The carbon trading scheme is used to charge industries such as oil refineries, power stations and steel works for CO2 emissions as part of Europe's efforts against climate change.
In 2012, airlines will have to pay for 15 percent of the polluting rights accorded to them, the figure rising to 18 percent in the period 2013-2020.
The US House of Representatives weighed in last month, passing a bill directing the US government to forbid US carriers to take part "in any emissions trading scheme unilaterally established by the European Union."
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hi all , just doing my full licence at the mo and be looking at first big bike , ive spent the last year or so riding around on my rs 100 , so not looking to jump straight on a 600 or 1000 , but ive been looking at the honda rvf 400 nc35 or vfr 400 nc30 as i really love these bikes but was wondering what there like as a first bike , are they usable , reliable , thanks sam
First proper bike
Posts 9 | Views 475
go for a 600
I was gonna go with a 400 when i first passed my test in 2006.. I ended up getting a CBR600 and was glad I went with the 600... Its a little overwhelming to think of a big bike, but trust me... a 600 is a better way to go than a 400.. You will be bored in a week. I'm now riding a 900 zx9r and loving it even more. Try a few test rides before you decide.
Just check
the insurance on any bike you're interested in - the 400 may well be far easier in this regard.
i agree with littlerick.. get a 600 a 400 will get boring quite quickly.
lets be serious
600's while you can still loose your licence on them get boring compared to a 1000 but they are easier to use in traffic by a long way luckily im in australia and me have nice big roads with out many cars on them
Insurance, Comfort...
Insurance is a huge unknown. Many 400s are quite high insurance and some 600s are relatively low so you will definitely need to check. When checking insurance for 400s be particularly wise about modifications and if its an import or not (Many 400s are imports from Japan) - That can make a HUGE difference. From my brief explorations there was little difference between insuring a ZXR400 and a CBR600RR. Slightly milder bikes like the GSX600F & CBR600F were about 2/3 the cost of the out and out sports whilst bikes like the Fazer FZ6, ER6F, SV650 etc were 1/3 the cost of a an out and out sports 600. Solid but good bikes like the CB500 & ER5 are cheaper still to insure and run...Even a Hornet is likely to be significantly cheaper to insure than an out and out sports...
Also consider what riding you are likely to do. The out and out sports bikes are beautiful bikes but very uncomfortable for commuting (all that weight on the wrists and shoulders is not nice whilst travelling slowly) whilst the NC30/NC35 are of an age where they will need work to keep them on the road every year (e.g. brake cables replaced, fuel tanks might leak, suspension refreshed...).
zxr 400
Had a green/white/blue zxr400 for a year or so when i was 18 - absolutely loved it but i was too lanky to fit on it. Was incredibly uncomfortable on the knees as they hit the fairing if not tensed up.
Any of the old 600's will probably be your best bet as they will be physically larger. A GSXR (srad) or ZX6r can be cheap but reliable if you search for a good 'un.
first proper bike
hey sam gsx600f i did my direct access april last year like you thought about 400s but went with gsx600f for 2 reasons 1 insurance is just under £200 fully comp checked 4 or 5 different bikes through mcn compare the f was £150 cheaper than the r second is not as desirable so cost alot less mine 2004 with 2000 miles full dealer service one owner from brindley honda wolverhampton and 12 months warranty cost £2100 i use it all year round for 16 mile commute and bike meets and it will keep pace with most other bikes upto about a ton thats about it before it goes flat my bike now done 27000 miles and no problems apart from when i left parking lights over weekend and drained battery mine does about 150 to reserve and then costs about 13 to15 quid to fill hope this helps
**vfrs and rvfs **
are fantastic bikes and most people are forgetting here that a well ridden 400 in the twisties will run rings round an old six undred. but if you are over six foot they feel uncomfortable .........but i would reccomend a good vfr or rvf with good grippy tyres they are such a hoot, zxrs are revvy and don't like being restricted cbrs are rare
hang on what about an rs 250 they are also fantastic but can be a little pricey to maintain....hope this helps o.t.g.


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