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Date of Birth : Nov 6th 1946
Sally Field has twice won Best Actress Oscars: for Norma Rae (1979) and for Places In the Heart (1984, with John Malkovich). Despite these heavyweight credits, she has never quite shaken the spunky-but-naive persona she established in the 1960s TV series Gidget and The Flying Nun (in which she played a young novice whose outfit absurdly gave her the ability to fly). She expanded her range in the 1970s, appearing with Jeff Bridges in the drama Stay Hungry (1976, with Arnold Schwarzenegger) and getting raves for her performance as a young woman with multiple personality disorder in the TV movie Sybil (1976). Her success in the 1980s allowed her to produce movies, including Steel Magnolias (1989) and Dying Young (1991), both starring Julia Roberts. In the late '90s Field was still appearing in the movies and spending time behind the camera, directing two TV movies and the theatrical release of Beautiful (2000). She also found work in television, including a recurring role on E.R. and a short-lived series, The Court (2002). Fields joined the cast of the TV drama series Brothers & Sisters in 2006, (along with Calista Flockhart and Rob Lowe) and earned an Emmy for best actress in a dramatic series.


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What is infrared?
- Infrared is electromagnetic wave energy. Like light, infrared (radiant) energy travels at the speed of light in a straight line until it strikes an object.
How Does Infrared Heating Work?
- A gas-fired infrared tube heater or high-intensity heater (normally ceiling suspended) emulates the warmth of the sun by generating radiant energy that converts to useable heat when absorbed by objects in its path. In buildings, objects such as floors, tools, and machinery absorb the infrared radiant energy. This creates a "heat sink" where warmth is stored and re-radiated to warm the surrounding air.
Can infrared cut my fuel costs?
- Yes. It is not unusual to generate fuel savings of 32% or more compared to forced air heating methods such as unit heaters. In high bay structures, forced air heaters are impractical because warm convective air rises to the ceiling, leaving floors relatively cold. In fact, warm air must stratify from the ceiling downward to keep people warm at the floor level. Consequently, building owners find that their forced air heaters run almost continually, only to find an outrageous monthly fuel bill.
By contrast, infrared heaters emit quiet radiant energy to the floors, which absorb and re-radiate heat from the ground up. This translates to warm, comfortable conditions at the people zone and less wasted convective heat at the ceiling. In immense structures such as warehouses and aircraft hangars, infrared heat is the only practical choice for creating comfort and energy savings.
Are there any negative side effects from standing under an infrared heater?
- Infrared heaters do get hot, so proper mounting distances and clearance requirements must be met. However, there are no harmful effects from the radiant heat energy. Unlike the sun, infrared heaters do not produce ultra-violet rays, only comfortable radiant warmth, like standing by a fireplace or stove.
Do some infrared heaters perform better than others?
- Yes. Every infrared heater manufacturer will say different things about why they feel their product is the best. You may need to sift through the jargon to find out for yourself what makes one appliance brand better than another. Click Why Choose Superior Radiant and discover why our distributors prefer the "Superior Technology and Superior Performance" of SRP's heaters.
So what criteria should I use to select an infrared tube heater brand?
- So what criteria should I use to select an infrared tube heater brand? We suggest looking at the criteria specifiers use to determine performance and reliability. These criteria are:
- Control box design (controls should be isolated out of the air stream)
- Serviceability (easy control access and easy to diagnose problems)
- Burner design (affects heat uniformity)
- Emitter tubing (hot rolled? Aluminized? Heat-treated aluminized?)
- Couplings (connects the radiant tubes together - how good are they?)
Is maintenance required?
- Yes, for best performance, annual maintenance should be performed prior to the heating season. Recommendations for specific heater models can be found in the Installation/Operation Manual or click here for a pdf file. For general interest, Mechanical Business published a "Seasonal Start-up Guide" in October 2007 for infrared heaters.

subset: commoncrawl


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Monday, 8:00am
18 June 2012
A circle that moved the earth
Design history
Graphic design
Information design
Copernicus's diagram of the planets, 1543 – infodesign history in Eye 82
With the spread of print and Protestantism dethroning old sources of certainty, sixteenth-century Germany was ripe for revolution, writes Alexander Ecob in Eye 82.
Among the most radical challenges to dogma was Nicolas Copernicus's De revolutionibus orbium coelestium (1543) – his treatise on the movements of the heavens, setting forth his theory of the heliocentric universe. In one diagram, thousands of years of consensus were overturned as Copernicus moved the earth, saying 'In medio vero omnium residet Sol,' which translates as: 'In the midst of all, however, the Sun resides.'
The technical nature of the book, replete with numerical tables of observations and scientific terminology, made its main contents impenetrable to ordinary readers. The introduction was more accessible, but the plainest explanation of the paradigm-shifting theory came from an elegant half-page diagram.
Representing the six known planets enclosed within a sphere of fixed stars, the Sun sitting motionless at its centre, the diagram condensed pages of figures and tables into little more than a few circles of ink. Its austerity and precision echo the Euclidean geometric diagrams on which Copernicus's calculations were based, and emphasise the scientific foundation of the work: there is no decoration or glamour, as was common in celestial diagrams of the time, just a straightforward statement of facts, the definitive expression of the data.
The success of De revolutionibus itself may have been overstated – Copernicus posited problematic circular, rather than elliptical, orbits, and it was not until posthumous revisions of his theory were made (by Kepler, Galileo and Tycho) that heliocentrism became the consensus among scientists. But the image of the heliocentric universe has become an icon of scientific endeavour and rational thought; without it, and the scientific revolution it initiated, the world we live in today could have been a very different place.
First published in Eye no. 82 vol. 21, 2012
Eye is the world's most beautiful and collectable graphic design journal, published quarterly for professional designers, students and anyone interested in critical, informed writing about graphic design and visual culture. It's available from all good design bookshops and online at the Eye shop, where you can buy subscriptions and single issues. Eye 82 is out now, and you can browse a visual sampler at Eye before you buy on Issuu.


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Ratchet & Clank Video Feature
Ted Price gives us an insider at the success of the Ratchet and Clank series and what is ahead.
New Ratchet & Clank game coming exclusively to the PS3; upcoming game to return to series' action-adventure roots.
Ted Price gives us an insider at the success of the Ratchet and Clank series and what is ahead.
Ted Price, president of Insomniac Games, takes a look back at the developer's 10-year history.
Designer Cory Stockton takes you on a tour through the offices of Insomniac Games.
Jeff Gerstmann gives the final word on the sequel to GameSpot's PS2 Platformer of the year.
Ted Price of Insomniac Games talks about what it took to make the sequel to Ratchet & Clank a bigger and better game.
This exciting new trailer for Ratchet & Clank 2: Going Commando shows off a number of insane new environments as well as some of the flying you'll be doing in ...
Amazon France listing suggests high-definition combination pack of PlayStation 2 action titles due out May 16 on PlayStation 3.
Developer of Ratchet and Clank, Resistance signs on to create an original game for Xbox 360 and PS3 with Electronic Arts publishing through external developer program.
Valve cofounder to be honored for creating Steam at March developer conference, as Marble Madness creator is honored by Academy of Interactive Arts and Sciences.
SOCOM II, Jak II, Ratchet & Clank: Going Commando, Rise to Honor, and ATV Offroad Fury 2 will each only cost $19.99.
SCEA announces the North American release of Ratchet & Clank: Going Commando.
Sony and Insomniac's dynamic duo let it all hang out in their upcoming sequel.
We take the sequel to Sony and Insomniac's platformer for a spin.
We get our hands on an early version of Ratchet & Clank 2 at the PlayStation Experience 2003.
Insomniac Games is hard at work on the next Ratchet & Clank game.
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Used Cars for Sale in Clarksville, IN
Located in Clarksville, IN, Craig and Landreth Clarksville serves Southern Indiana and Louisville KY offering a wide variety of used cars, used trucks, and used SUVs. At Craig and Landreth Auto Group, you can shop for a pre-owned car, take a test drive, get a trade-in appraisal, and learn more about your financing options. Browse our online inventory of reliable and inspected used vehicles. Email us, message us, or call us at (812) 280-8018 today to speak with a sales professional.
Reliable Used Cars in Louisville and Indiana
Whether you're searching for an affordable used car or truck in Clarksville, Louisville, Lexington, Bowling Green, or Jeffersonville, purchasing a reliable used car should be a simple, enjoyable experience. You get a free CarFax vehicle history report and trade in appraisal with Craig and Landreth Auto Group.
From Elizabethtown KY to Jeffersonville IN, see used car photos, prices, and specs from the top manufacturers including Acura, Alfa Romeo, Audi, Bentley, BMW, Buick, Cadillac, Chevrolet, Chrysler, Dodge, FIAT, Ford, GMC, Honda, Hyundai, INFINITI, Jaguar, Jeep, Land Rover, Lexus, Lincoln, Maserati, Mazda, Mercedes-Benz, MINI, Mitsubishi, Nissan, Porsche, RAM, Subaru, Toyota, Volkswagen, and Volvo.
Craig and Landreth also offers used cars under $10,000. If you plan on financing a car, look no further. We match customers with the best interest rate possible through our long list of preferred lenders.
Used Car Dealership Clarksville and Louisville
Craig and Landreth Clarksville is a no games, no hassle car dealership nearby. Stop by any of our locations, choose the perfect car or truck to meet your automotive needs, take a test drive and we will tell you exactly what it takes to purchase the vehicle. You can also search our Clarksville, Indiana used car listing online to see our entire inventory. Browse and get quotes for quality pre owned cars, near Jeffersonville, New Albany, Scottsburg, Salem, Louisville, and Shepherdsville areas.


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Spain's north-eastern region of Catalonia finally cast their vote despite all of the resistance from the Spain's authorities. The non-binding vote went ahead after Spain's constitutional court ruled out a formal referendum. Almost 2 million people out of the population of 7.5 million could vote and the preliminary result is an overwhelming 80% in favor of vote of independence for Catalonia.
Catalan leader Artur Mas hailed the non-binding poll "a great success" that should pave the way for a formal referendum. Spanish Justice Minister Rafael Catala dismissed the poll as "fruitless and useless", however. "The government considers this to be a day of political propaganda organized by pro-independence forces and devoid of any kind of democratic validity," he said in a statement.
Judging from the recent events the region will not be allowed to gain independence in any democratic sort of way. Unfortunately, it is completely unclear whether Catalan are prepared to stand up and fight for their rights with weapon in hand. With the non-equivocal resistance from Spain that may eventually remain the only way though, just like the fight of the Eastern Ukraine for independence showed. It may be hard to imagine a bloody military battle in Spain but a year ago it was impossible to imagine a bloody battle in Ukraine either.
One thing that Spanish government made very clear is that they are not letting the region go. That stands to reason, no country is keen on breaking itself up, so why should they? If Catalonia wishes independence, they will have to fight for it. The economics of politics is such that it must become more expensive for Spain to keep them than to let them go. Is there a peaceful and non-destructive way to do that?


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PhD., University of Maryland
Published author
Jonathan is a published author and recently completed a book on physics and applied mathematics.
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PhD., University of Maryland
Published author
Jonathan is a published author and recently completed a book on physics and applied mathematics.
Planck's constant, abbreviated h, is the ratio of photon energy to the frequency. Planck's constant is used in the blackbody radiation spectrum, which indicates that energy is carried by light in discrete amounts. Planck's constant is also used when calculating the photoelectric effect.
So let's talk about Planck's constant. What is Planck's constant? Well, Planck's constant is a number that comes out of measurements of the blackbody radiation spectrum. So, the blackbody radiation spectrum indicates that if you've got light with a certain frequency, that, the energy that's carried by that light can only be carried in discreet multiples of h times f where this h is Planck's constant and again we measure that form experiment. Form the blackbody radiation spectrum, we fit the data to the experimental or to the theoretical curve that Planck gave us and then we get this number h. It's called Planck's constant and it's given by 6.66 times 10 to the -34 joules seconds. So that when I multiply by a frequency, which is one over seconds, then I'll get an energy, joules.
So, the way that we can understand Planck's constant is the ratio of photon energy that quantum that that discreet amount of energy that you can carry with a certain frequency f, to the frequency. So it's energy divided by frequency. And we got to get the same value for every single frequency. So this is the number that we get from blackbody radiation spectrum data. Alright. But that's not the only place that it shows up. It also shows up in the photoelectric effect. The photoelectric effect tells us that the maximum kinetic energy is given by some number times the frequency of light that you're shining on that metal surface minus a constant that depends only on the surface.
Now, according to Einstein, this hf is the photon energy. That's the way that it was explained to us and he won a Nobel Prize for that explanation. So h needs to have the same value when taken from photoelectric effect data and when taken from blackbody radiation spectrum data. And you know what, when we do the experiments, it works. It gives you exactly the same value. Alright. So let's go ahead and do some problems. These are fairly simple. We're just basically going to plug some numbers in a formula.
So how much energy is carried by a single photon with frequency 2 times 10 to the 12 hertz? Well, jeez. Energy equals hf 6.626 times 10 to the -34, 2 times 10 to the 12. Now as with everything when you got scientific notation what you want to do is the numbers first and then the tens. So, 2 times 6.626. Well, that's going to give us 13.2 what is it? 52 and then it will be times 10 to the what? Well, 12-34 is -22. What's the unit? Well, jeez. It's a energy. Everything was in SI units, so it's in SI units. So that's the answer, 13.252 times 10 to the -22 joules. Alright?
Let's do another one. How much energy is carried by a single photon and this time, I'm not giving you the frequency, giving you the wavelength. So we got to take the frequency in order to use e=hf. Well, e=hf but frequency and wavelength are related by frequency times wavelength, equals speed of light. So that means frequency is the speed of light divided by the wavelength and now it's just easy. So it's 6.626 10 to the -34 and then it's c is 3 times 10 to the 8 divided by, what was my wavelength? Well, it was 500 nanometers. But I'm supposed to work in SI units. So it's 500 nano is 10 to the -9. So we're going to say 5 times 10 to the -7. Alright. Numbers first. 6.626 times 3 over 5 and now e got the tens.


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Delphi + C# Developer (subcontract, USA)
Location: O'Fallon, MO
Type: Contracted
Min. Experience: Mid Level
Oasis Digital Solutions Inc. is looking for a handful of skilled, motivated subcontractors to join our projects. Our current needs are primarily in Delphi and C# / .NET, so we favor developers with knowledge of both. Qualifications:
- Substantial Delphi (GUI and non-GUI) development expertise and experience.
- Likewise for C#, ideally covering both web-tier and algorithmic development
- Good working knowledge of SQL in general; ideally specific expertise with MS SQL Server: Queries, Stored Procedures, etc.
- Good written and spoken communication skills; everyone says this, but we really mean it!
- BachelorÄôs degree in a technical discipline
- Eligible to work in the USA
This is subcontract work; you will supply your own hardware, workspace, and so on. For this position, you must live in in the USA, and be able to travel for collaborative work a few times per year. Other than that, the work can be done from anywhere.
The best fit for our needs is an intermediate-level person, but we are willing to consider a wide range of experience levels.
Our teams collaborate extensively; new members always join an existing project with other Oasis Digital developers. We are not a staffing firm.
Our hiring process is unusual: before hiring, we send a short problem description, and pay you for a dayÄôs work writing software. We judge you by what you produce, rather than by your credentials.
No phone calls please; please apply only via our web site. Email us if you have questions about the job.
No recruiters, no outsourcing shops; we are not able to offer H1B sponsorship.
More information visit: http://oasisdigital.com/careers.html


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Author Archives: M1SCRM
Welcome to World Auto Service!
My staff and I are working hard to be your number one choice in automotive repair and maintenance. Our team is dedicated to providing you and your vehicle with professional service and exceptional customer care.
We are located in the Parkville section of the west end of Hartford, just minutes from West Hartford downtown.
I've been providing automotive repair service for this community and surrounding communities from this location over 30 years, first as a tech and then as owner of World Auto Service LLC in 1998.
Please schedule an appointment with our friendly staff by clicking the Appointment tab, above or by calling (860) 232-0626.


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Conferences can be a prime space for bloggers to recruit new readers. Last week at SXSWi it was fascinating to watch hundreds of bloggers attempt to standout from the crowd, network and develop fruitful relationships with others there. In this video I point out 5 of the better tips and strategies that I saw:
- Unique Business Cards
- Elevator Pitches that Solve Problems
- Utilize Your Badge
- Interview People that You Meet
- Do something Out of the Box
Watch this video also on Youtube.


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Patients & Families
For Health Professionals
Does exercise really help your skin and acne?
– Margo*
Exercise has many benefits, like feeling good about yourself, being in top shape, looking good, and being mentally sharp.
It's not clear whether exercise helps improve acne, but it definitely doesn't hurt. The only exception may be the athlete who wears equipment such as protective pads and chin straps on helmets that rub against the skin and may make acne worse in those areas. But fear not, your run-of-the-mill favorite gym T-shirts won't cause any such problems.
Whether you have a lot of acne or just the occasional zit, exercise may actually help because it increases blood flow, unclogs pores through sweating, and reduces stress, a major acne trigger.
The bottom line is that the benefits of exercising, whether they include acne reduction or not, outweigh the benefits of sitting around on the couch. Who cares if you have great skin and a good complexion if you aren't taking care of the rest of your body?
*Names have been changed to protect user privacy.


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I wish them a lifetime
I mentioned last week that I had been away at a wedding, Luisa's wedding, and a number of you wrote that you were eager to see pictures. I felt a little unsure about posting them, to be honest, because it was her wedding day and hers to share, but she says that I can go for it. Here we are.
Luisa was one of the first friends I made through blogging. I guess it was about six years ago, give or take a bit. That was when Brandon was still living in New York, and I would go there to see him every couple of months. Luisa was still living in New York then, too. She and I had exchanged e-mails, and on one of my visits, we made plans to meet. I think I remember that it was raining hard that night, and I must have been late, because I ran down the sidewalk to get there. Or maybe she did? One of us was soaked, at least. Maybe she'll remember. But we met, and we kept in touch, and not long after, we happened to have dinner the night before Brandon proposed to me. She asked if I thought we would get married, and I said that I did, but that I had no idea when we would decide to get engaged. And then, the next afternoon, he asked me. I loved that she was a part of our story that way, and I feel lucky to have been there to watch her and Max go through the same transformation.
The wedding was almost three weeks ago, but I still find myself replaying scenes from it in my head. Maybe, as you scroll down, you'll understand what I mean. They gave us a beautiful night and a whopper of a party. I wish them a lifetime just like it.
I'll be back in a day or two, with a recipe.


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10% off by signing up to our newsletter + Free shipping on orders 150+
Cool Craft.
A marriage of traditional and Mod style, our Needlepoint Pillows are the perfect punctuation for your pillowscape. Each pillow is embroidered by hand and backed in luxe velvet. Forget the fusty needlepoint of yore and embrace our sharp and chic world.


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Google has disrupted what it believes to be a targeted phishing campaign aimed at stealing e-mail from government officials, contractors and military personnel.
The criminals behind the campaign have broken into hundreds of Gmail accounts belonging to "U.S. government officials, Chinese political activists, officials in several Asian countries (predominantly South Korea), military personnel and journalists," among others, Google said in a blog post published Wednesday.
The company believes that the accounts were compromised "likely through phishing" by a cyber campaign run out of Jinan, China. That's the city whose Lanxiang Vocational School was linked in a New York Times report last year to the December 2009 attacks on Google's back-end systems. The targets of the 2009 campaign were human rights activists, and activists were also hit by this recent phishing campaign, Google said.
The phishing campaign was first publicly disclosed by the blog Contagio Malware Dump, which reported in February that government personnel and contractors were being hit with what are known as spear-phishing attacks. These attacks use specially crafted e-mail messages, written to appear like they come from someone known to the victim.
Victims were sent spoofed e-mail messages that looked like they came from friends or partner agencies, including targets in the U.S. Department of State, the Office of the Secretary of Defense, and Defense Intelligence, Contagio Malware Dump reported. "The message is crafted to appear like it has an attachment with links like View Download and a name of the supposed attachment. The link leads to a fake Gmail login page for harvesting credentials," Contagio Malware Dump said.
Once they had access to the Gmail accounts, the hackers then forwarded e-mail to their own addresses and harvested the data they found in order to launch future attacks.
Although these spear-phishing attacks didn't affect a lot of users, attacks on Web-based e-mail accounts have become a common problem for companies such as Google, Microsoft and Yahoo. Just last month Microsoft patched a Web programming bug in its Hotmail service that allowed hackers to break into e-mail accounts. Security vendor Trend Micro said that that flaw was used to steal e-mail messages.
Webmail accounts are often hit with less sophisticated, widespread attacks, too. Scammers like hacked e-mail accounts because they can use them to circumvent spam filters. Even users who do not handle sensitive information routinely find their Webmail accounts broken into and used to promote things such as illegal pharmaceutical websites.
Google has notified the victims of the attack and secured their accounts. The company has also "notified relevant government authorities," it said in its blog post.
Robert McMillan covers computer security and general technology breaking news for The IDG News Service. Follow Robert on Twitter at @bobmcmillan. Robert's e-mail address is firstname.lastname@example.com


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SEOUL (REUTERS) - Samsung Electronics Co Ltd is bracing for its weakest smartphone profit growth this year since 2007 as arch rival Apple Inc challenges its domination in China's US$80 billion (S$101 billion) market.
Samsung's mobile devices business, which earns two thirds of the company's profit, will come under pressure when Apple makes its phones available from Jan 17 via China Mobile Ltd , through which Samsung has been selling smartphones for around seven years.
Apple is also widely expected to sell smartphones with larger screens come autumn when it traditionally announces products, neutralising a selling point that Samsung has enjoyed since introducing its Galaxy Note in late 2011.
"Profit decline in mobiles will be inevitable, as the majority of growth will come from cheaper, low-margin phones, while competition at the high end will get only tougher with Apple's iPhone deal in China," said Shinhan Investment analyst Kim Young Chan.
Operating profit at Samsung's mobile devices division is likely to grow by a low single digit or to shrink mildly in 2014, after increasing its size by eight times over the past five years, according to a Thomson Reuters' Starmine SmartEstimate of 23 analysts, which gives greater weighting to the more accurate analysts.
"Its business was already hit in the fourth quarter by Apple's strong iPhone sales, and the impact will continue at least until the end of the first quarter," said Mr Kim.
Samsung, the world's biggest smartphone maker with a third of the market, will release October-December earnings guidance on Tuesday which will likely show operating profit growth of 10 percent at 9.75 trillion won (S$11.7 billion), according to Starmine.
That would be 4 per cent less than the record 10.2 trillion won of July-September as Apple enjoyed buoyant sales in the United States and Japan during the year-end holiday season.
Fourth-quarter earnings were also likely pulled down by a special bonus related to the 20th anniversary of the "New Management" strategy of Chairman Lee Kun-hee, which analyst estimates put at 300 billion to 700 billion won.
Samsung is the biggest smartphone vendor in China with sales reaching around 70 million units last year, or 20 per cent of its total shipments, analysts estimate.
But Apple's China Mobile incursion and possible larger screen offerings could cut sales of Samsung's latest Galaxy S and Note series by 3 per cent this year, BNP Paribas estimates.
The iPhone is widely perceived in China as a gold standard for high-end products, analysts say.
"We think one of the key reasons Samsung has managed to take market share from Apple so far is its large-sized screen offerings," BNP analyst Peter Yu said in a note.
"However, this gap is likely to narrow if Apple launches large-screen phones in 2014. Unless Samsung further differentiates itself with flexible Oled (organic light-emitting diode) screens, it may lose some of these high-end customers."
Samsung shares have been pummelled in recent weeks by 22 analysts downgrading fourth-quarter earnings estimates over the past 30 days.
The shares, worth US$190 billion, fell 10 per cent over the past fortnight to a 4-month low last week, wiping off market value to the tune of US$19 billion - equal to the total value of shares of Sony Corp.
The won's rise to a five-year high against the US dollar has also been prompting investors to sell, as a strong won reduces the value of Samsung's repatriated earnings.
A strong won is particularly troublesome for Samsung's components business, which generates around 30 per cent of overall operating profit, because it primarily settles accounts in dollars, analysts said.
Samsung's brightest spot is its semiconductor unit, which brings in 20 per cent of operating profit, and which enjoys growth estimates of around 42 per cent this year.
Overall operating profit growth for 2014 is likely to be 6.2 per cent, the slowest pace in three years, according to Starmine.


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Lakewood Park Pest Control Service Area
Pest Control in Lakewood Park
Effective pest control and termite control for those who live and work in Lakewood Park starts by calling Hannan Environmental Services. Family-owned and operated; we have a direct connection to the city of Lakewood Park. Over the years, we have built up a strong reputation for providing pest control in Lakewood Park all for a low, affordable price.
Mosquito Control in Lakewood Park
Mosquito prevention can improve the Florida lifestyle. In addition to the annoying mosquito bites, they also carry diseases like Dengue, Chikungunya, Yellow Fever, and the Zika virus.
The key is to kill not just the adult, but the larvae as well. We place our traps in areas they breed and use green ingredients that target both the mosquito larvae and adults. By contaminating the female and using her to spread larvicide to multiple breeding sites around the traps. Doing so kills the larvae before they become biting adults.
We take pride in our mosquito prevention track record. Hannan has treated over 11,000 homes in South Florida in the past 18 years. We currently protect about $6 Billion dollars worth of real estate.
We specialize in mosquito prevention services and prevention as well. It's our goal to protect our customers' property. You should be able to use your outdoor spaces such as a pool, patio, or deck without feeling plagued by mosquitoes.
With over 3000 species of mosquitoes around the world, there are a number that regularly carries infectious diseases. Contacting our company regarding mosquito prevention can help to make sure that we can create a deterrent for mosquitoes across your property and provide effective relief so that you can enjoy outdoor areas again.
Many mosquito species have become completely immune to chemicals like DEET. As a result, we have created a wide range of solutions that can cover large areas and prevent mosquitoes from regularly invading your backyard.
Our mosquito prevention service initially begins with us inspecting your property to identify areas where mosquitoes will regularly hide or breed in great numbers. We can treat these areas to prevent mosquitoes from breeding there.
Through our professional tools, we can deliver immediate relief for your mosquito problem. By performing an on-site visit and customizing a plan that will work for your needs, we will take care of the problem head-on.
Termite Prevention in Lakewood Park
No Tent Termite TreatmentTent fumigation uses a deadly gas (sulfuryl fluoride) which is pumped into a structure with a nearly 100% success rate. The downfall there is zero residual to protect your home from wood-destroying insects to re-infest the home. Our process includes an extensive inspection procedure using our termite detection and trained termite specialists. A custom program is created to rid your home of wood-destroying insects and residual products are used to prevent re-infestation.
10 Year Termite GuaranteeState-of-the-art molecular technology dramatically improves the transport of the Termidor HE Copack active ingredient into the soil creating an Enhanced Protection Zone. Termidor HE Copack "locks" to the soil around your home where it stays put and stays effective. Termidor HE Copack reduces the need for much of the disruption, digging, and drilling typically required with a liquid termiticide application, resulting in:
77% smaller trenches around your home
One-third less drilling around your home
Lawn Care in Lakewood Park
Keeping your lawn and shrubs looking their best often means regularly treating them to prevent pest infestations and fungus growth. Not Only can our certified technicians work at eradicating a wide range of weeds. They can also control fungus and pests from across your lawn and shrubs. With this in mind, we follow a series of guidelines that are set forth by the department of agriculture and the FDEP. Finally, it's our goal to help your green spaces look their absolute best and to improve the curb appeal of your home. Try the Hannan lawn and shrub care service today!
Additionally, If you have noticed that your lawn is starting to accumulate brown patches, or your trees and shrubbery have been affected by mold, fungus, or other issues, contact us immediately and we can create a lawn and shrub care solution that will suit the needs of your property.
Furthermore, If you are interested in getting healthier shrubs or grass systems throughout your property, contact our staff today or head over to Facebook and message us. As you can see we have a series of solutions that can help your lawn and shrubs look at their absolute best. Not to mention we offer no-obligation irrigation inspections to our lawn and shrub care service. To summarize we can keep your lawn looking pristine with these services today.
Our Pest Control Services in Lakewood Park
Our wide range of services begins when you call our offices. A trained technician will explain our services, answer your questions, and set up an appointment for a free inspection of your property. Once the inspection is complete, we offer a free estimate of our services, so you know the price upfront. If you decide to accept, we start to work right away with the following services:
We rid your property of all types of pests which include roaches, spiders, ants, mosquitoes, and even bed bugs. Plus, we offer effective lawn and shrub care to rid your yard of weeds. Our years of serving the Lakewood Park community have resulted in developing new pest control services that meet your needs while fitting your budget.
Unwanted Pests in Lakewood Park
Here at Hannan Environmental Services, we understand that proper pest control begins by providing a complete line of services that provide our customers with fast, effective results. Hannan Environmental Services can eliminate the following pests to ensure your home remains a comfortable sanctuary for you and not pests.
Why Hannan Environmental Services?
Our services are founded on being family-owned and operated. This means we have a vested interest in those who live and work in Lakewood Park to provide the best in pest control and termite control services. But our reputation goes well beyond that.
Effective pest eradication does not mean using harsh or environmentally unsuitable chemicals or products. At Hannan Environmental Services, we emphasize safe products and methods that protect the environment which starts with your family, pets, and those who live or work inside.
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There are hundreds of combinations of Olympic sized barbells and at Muscles and Curves we carry them all! Not only that, but we have the best prices online and all barbells have free shipping included in the cost.
Choosing the correct Olympic bar for your needs can be a little bit of a challenge. You first need to know what you plan on using the bar for and how much weight you think the bar will ever need to hold. Then you need to start looking at all the specifications of each brand and model of bar you are interested in. For starters, straight Olympic bars come in 7 ft, 6 ft and 5 ft lengths. They can be made of many types of metal and have different types of coatings. The knurling, the raised metal hash marks on the bar, can be in different locations on the bar to accommodate different uses and grips.
Olympic Lifting
If you're looking at barbells for actual Olympic style lifting, clean & jerk, snatch, power cleans, etc., then you're going to have even more options to deal with. The sleeves at the end of all Olympic barbells rotate, but it is more critical that the rotation be smooth and fast when you are performing Olympic lifts. If the sleeve doesn't spin smoothly then it will affect the rotation of the weight which in turn hinders your ability to flip your wrists and get under the weight quickly. To achieve this type of spin, quality Olympic barbells will have bushing or bearings in the sleeve.
Another aspect of a quality Olympic barbell is the ability to withstand being dropped repeatedly through its lifespan without bending, warping or breaking. Since Olympic lifters usually drop the weight from anywhere as high as fully extended overhead, the bar absolutely must be able to bounce well with the load of bumper plates.
Power Lifting
Power lifting barbells have different requirements than the bars used by Olympic lifters. A quick spinning sleeve isn't necessary since the lifter will only be doing squat, deadlifts and bench press. However, the bar must be able to withstand the extreme amount of weight that a power lifter is capable of moving. The bar needs to bend slightly as the lifter moves the weight and then spring back into a perfectly straight line once the weight is unloaded. Also, powerlifters often like the knurling in different locations than other lifters based on where the place and hold the bar. For instance, some power lifting bars have a strip of knurling in the middle of the bar to grip the back during squats.
Basic Weight Training
For your basic weight lifting bar you don't need any of the fancy options supplied for other purposes. You'll just want to get a basic barbell that will hand the amount of weight you can lift AND allow some room for future strength increases. While competition bars can have a weight capacity as high as 1,500lbs, most entry level bars have around a 500lb capacity. Do keep in mind each manufacturer's warranty for bar bending and breaking.


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Journal EntriesThis recurring website feature highlights articles from The GASB Report, the GASB's monthly newsletter. The current article appeared in the September 2013 issue.
Leases Task Force FormedGASB Chairman David A. Vaudt recently announced the appointment of a task force to assist with the Board's Leases project. Members of the task force are:
- Peggy Arrivas, associate vice president and system-wide controller, University of California
- Ted Chapman, director, U.S. Public Finance Infrastructure, Standard & Poor's
- Lisa Collier, assistant state auditor, Texas State Auditor's Office
- Barbara Flickinger, managing director, Portfolio Surveillance Western Region, National Public Finance Guarantee
- Daniel McCarron, comptroller, Port Authority of New York and New Jersey
- Kathy Opp, deputy director, Lands and Waterways, Idaho Department of Lands
- David Phillips, partner, Greene, Finney and Horton LLP
- Sherry Phillips-Hymel, chief budget analyst, Fiscal Services, Louisiana State Senate
- William Quam, director of plant and financial accounting, Santee Cooper
- Melanie Seale, assistant finance director, City of San Antonio
- Joseph Stefko, president and chief executive officer, Center for Governmental Research
- Peter Stettler, director, Municipal Credit Analytics, BMO Capital Markets
- Todd Webster, managing director, Audit Services, KPMG.
What Do Task Forces Do?The GASB assembles task forces for most major current projects and certain research activities. Task forces serve as a sounding board, providing suggestions and feedback to the GASB as a project or research progresses. Task force members also review the papers the GASB staff prepares for Board meetings and monitor the Board's deliberations, commenting as appropriate.
How Are Participants Selected?Task forces are officially appointed by the GASB chairman after consultation with the other GASB members, the Governmental Accounting Standards Advisory Council (GASAC) chairman, and GASB staff.
Task force members typically have a particular expertise or experience with the issue being addressed in the project or research and also are capable of articulating the views of other, similar constituents. They can identify possible implementation difficulties, assess the potential cost of proposed standards, or opine on the usefulness of the information that will result from those standards.
Potential participants are primarily identified from the GASB's constituent database, from the GASAC, and from the lists of persons submitting comment letters in response to proposed standards. The GASB attempts to maintain an appropriate balance of financial statement preparers, auditors, and users on each task force. In addition to identifying persons that possess relevant knowledge and experience and that are representative of various types of constituents, the GASB tries to select persons it believes will actively participate by reviewing papers and proposed standards prepared for the Board and by providing regular feedback to the project staff.


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Director Richard Massingham
Duration 1min 25sec
Release Date 1945
Sponsor Ministry of Information for Ministry of Health
Synopsis Amusing health propaganda trailer on the dangers of sneezing
Text version of this film
The century between the first Public Health Act of 1848 and the start of the NHS in 1948 has been regarded as the golden age of public health. Coughs and Sneezes (1945), Modern Guide to Health (1947) and Jet Propelled Germs (1948) are three of the most amusing public health campaign films in the immediate post-war era.
Often a filmic extension of wartime posters featuring rhyming slogans, the publicity was designed to show how thoughtlessness helps to spread not only the common cold, but also many other diseases. Indeed, the whole 'coughs and sneezes' campaign, which extended beyond the war, was far more to with fighting absenteeism than concern about people catching a cold.
Copyright and access
A monthly round-up of news, blogs, offers and events.
KewRichmondTW9 4DU
All content is available under the Open Government Licence v3.0, except where otherwise stated


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After discussing contrast at a very top level view, I would like to introduce two twins, closely related to contrast – High Key and Low Key.
Both High Key images and Low Key images make an intensive use of contrast, but in a very different way. When approaching a shoot of a dramatic portrait, the decision of making it a High Key, Low Key or "just" a regular image has great impact about the mood that this picture will convey. While High Key images are considered happy and will show your subject as a tooth-paste poster; Low Key portraits are dramatic and convey a lot of atmosphere and tension. Let's explore those two dramatic lighting alternatives.
When looking at a High Key picture, you will probably notice two things right away. (Other than the happy-happy-joy-joy mood of the picture) The first thing is that the picture is bright. Yes – to create a high key image you need to set your exposure levels to high values. You will want to watch out, though not to over expose.
The other noticeable feature of High Key images is the lack of contrast. In addition for the tone being bright, you will notice that it is almost even across the scene. This is achieved by carefully setting the lighting of the picture. More about that later.
A third feature, that need closer attention to notice is the lack of shadows in the picture. The shadows cast by the model (or subject) are suppressed by lighting in the scene.
High Key image by moogs
Opposing High Key images are Low Key Images. In Low Key images the tone is darker, and the controlling color is usually black. There will be lots of dark areas in the picture. It is very common for Low Key images to give special attention to contour lines, emphasizing them with highlights.
Low Key images are also notable for a great deal of contrast that they display. Most notable is the rim light. A light surrounding the subject illuminating only the contour of the shape. So the contrast is between dark shape and bright contour.
Low Key image by ixelkhan
High Key, Low Key and mood – usually, High Key images are considered happy. They convey positive emotions, while Low Key images are darker and present drama or tension.
Happy High Key image by j_photo
Thoughtful Low Key image by .Bradi.
In the up coming articles I'll talk about the lighting setup needed for creating High Key and Low Key pictures. Want to make sure you catch them? Register to the RSS feed or the newsletter.
And here is your self assignment – for this week, your self assignment is does not involve taking any pictures. It involves careful examination of you surroundings. As I said before, Low Key and High Key are used to convey moods. Try to make some good use of your TV watching time; instead of couch potatoly looking at the ads, try and see which one are high key and which ones low key. try and analyze the adds in terms of darkness/brightness, shadows, background, and lighting. Keeping the images and results in mind will help you when we come to discuss of setups and results.


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A Chechen immigrant shot to death in Florida after an altercation with an FBI agent implicated himself in a triple slaying that officials believe may have been connected to Boston Marathon bombing suspect Tamerlan Tsarnaev, authorities said.
Ibragim Todashev's Chechen roots and mixed martial arts background mirror that of Tsarnaev, the 26-year-old Boston bombing suspect killed in a shootout with police days after the April 15 terrorist attack. The two also had lived in the Boston area.
Todashev, a 27-year-old mixed martial arts fighter, was fatally shot early Wednesday at his Orlando home during a meeting with the agent and two Massachusetts state troopers, authorities said. The agent was taken to a hospital with injuries that were not life-threatening.
Three law enforcement officials, speaking on condition of anonymity, said initially that Todashev had lunged at the FBI agent with a knife. However, two of those officials said later in the day it was no longer clear what had happened. The third official had not received any new information.
The FBI gave no details on why it was interested in Todashev except to say that he was being questioned as part of the Boston investigation. However, two officials briefed on the investigation said he had implicated himself as having been involved in the 2011 triple-slaying in a Boston suburb that authorities believe may have been connected to Tamerlan Tsarnaev. The officials spoke on condition of anonymity because they were not authorized to release details of the investigation.
Todashev resided in nearby Watertown, Mass., last year, public records show. His father, Abdul-Baki Todashev, said Todashev was in college when about five or six years ago when he got an opportunity to go to the United States to study English. He said he later agreed to his son's request to remain in the U.S. "because it seemed like the safest country."
Several of Todashev's former roommates who were questioned by the FBI said he knew Tamerlan Tsarnaev, an aspiring boxer, from mixed martial arts fighting in Boston and that the FBI was asking about him.
Muslin Chapkhanov, a former roommate, said Todashev "was living in Boston and I think he trained with" Tamerlan Tsarnaev.
Tsarnaev's younger brother, Dzhokhar, survived the shootout with police and is now charged with carrying out the attack that killed three people and wounded more than 260 in downtown Boston. He is also charged in the slaying of an MIT police officer days later.
Todashev's father said his son gave up martial arts because of an injury and later held a number of jobs, including as a driver at a retirement home, before moving to Florida within the past year. Todashev had lived on and off with other Chechens in the Orlando suburb of Kissimmee and had moved to Orlando more recently, friends said.
His father said his son had planned to come to Chechnya this week to visit his extended family, but was asked by the FBI to delay his trip.
Investigators have been trying to establish the scope of the plot. In addition, authorities in Massachusetts said they would investigate whether Tamerlan Tsarnaev had any connection to the unsolved 2011 deaths in the Boston suburb of Waltham, where three men were found in an apartment, their throats slit and marijuana sprinkled over their bodies. One of the victims was a boxer and a friend of Tsarnaev's.
While he was being interviewed, Todashev made statements implicating himself in the 2011 Waltham slayings, two officials briefed on the investigation said. Neither official knew whether Todashev had also implicated Tamerlan Tsarnaev in the killings. The two, a federal law enforcement official and a Massachusetts state official, spoke on condition of anonymity because they were not authorized to release details of the investigation.
Neither official was sure of the extent of Todashev's supposed involvement.
Former roommate Khusen Taramov said the FBI was asking questions about a conversation Todashev had with the older bombing suspect a month before the Boston Marathon attack.
The ex-roommate said Todashev shared the substance of his previous conversations with investigators with him and that he was completely forthcoming. That's why he was surprised that Wednesday's interview ended the way it did.
"He told them everything," Taramov said. "He told everything he knew. … I don't know why that (the shooting) happened. It's crazy."
But Taramov also said Todashev was afraid before Wednesday's interview.
"That's what he asked me before he pretty much died," Taramov said. "He asked me, 'If something happens can you go out and tell all the truth, what exactly happened.'"
Like Todashev, the Tsarnaev brothers have roots in the turbulent Russian regions of Dagestan and Chechnya, which have become recruiting grounds for Islamic extremists. Investigators have said the brothers carried out the Boston bombing in retaliation for the U.S. wars in Iraq and Afghanistan.
An FBI team was dispatched from Washington to review the shooting, standard procedure in such cases.
Police records suggest Todashev had a hot temper. He was arrested this month on a charge of aggravated battery after getting into a fight over a parking spot with a father and son at an Orlando shopping mall. The son was hospitalized with a split lip and several teeth knocked out, according to a sheriff's report. Todashev claimed self-defense.
"By his own admission Todashev was recently a former mixed martial arts fighter," the arresting deputy said in his report. "This skill puts his fighting ability way above that of a normal person."
Todashev was released on $3,500 bail after his May 4 arrest. His attorney, Alain Rivas, didn't respond to a call for comment Wednesday.
Todashev was also arrested by Boston police in 2010 after a road rage encounter. Witnesses told police that he argued with two other drivers and cut them off with his vehicle. According to a police report, he yelled, "You say something about my mother, I will kill you."
Todashev's said he was worried that with his son was dead, the FBI could now pin any crime on him.
"Out of fear of the lawlessness in Chechnya, I sent him to the U.S., because it seemed like the safest country at the time," he said. "Now I'm thinking about how to bring home his body. As it turns out, I sent him to his death."


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B.C. Premier's office defends $475K credit card bill
B.C. Premier Christy Clark's office is defending a credit card bill that is more than double the size of her predecessor Gordon Campbell's.
Records from the Office of the Comptroller General show the Clark's office charged $475,000 in expenses to credit cards during the 2011/12 fiscal year.
Charges under Clark's tenure include several tabs for thousands of dollars at various top restaurants, such as $3,267.66 at Ferris Oyster Bar in Victoria and $2,279 at Bishops in Vancouver.
The charges also include a large number of travel expenses with airlines, hotels, plus office supplies, and more than $100,000 from communications companies Rogers and Telus.
The year before under former premier Gordon Campbell, the office's expenses totalled $205,000 and $195,000 the year before that.
Extra duties raised expenses
However a spokesperson for the Premier's office says there are three key reasons by the office's expenses were more than twice as high as under Clark's predecessor.
First, the office grew substantially when it took over intergovernmental relations last year, raising the cost of regular expenses.
Second, B.C. hosted other premiers in both Victoria and Vancouver for the Council of Federation meetings, and Clark's office footed the bill.
And third, Clark embarked on one of B.C.'s most expensive trade missions to Asia earlier this year.
Still, Jordan Bateman, the B.C. director of the the Canadian Taxpayers Federation says the bill raises red flags and the office should be under more scrutiny. The Federation wants public access to all receipts related to government spending.
"Cell phone bills of $120,000, $140,000 in airfare — these are huge expenditures at a time when we are borrowing money to balance the books. That's not right. We need to make sure that we are restraining ourselves in every part of the public service, including the premiers office," said Bateman.
On Monday an all-party committee of B.C. MLAs that is responsible for overseeing spending at the legislature promised a major overhaul will put its financial books in order within the next six months.
The promise comes after B.C. Auditor General John Doyle delivered a scathing report last week that said the committee and its comptroller were not producing any useful financial statements or maintaining even the most basic accounting records.


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a hat from mafuyu, socks from the shop and a piece of an old embroidery, seen in het maagdenhuis here in antwerp. somehow thought these images fit together.
Oct 30, 2009
Oct 29, 2009
do animals cry
we saw a beautiful performance tonight,by meg stuart.
if it comes close to you, please go!
op 23:39 2 comments:
Oct 27, 2009
favorite library book
3 pics from a beautiful library book. guess it goes from here to renilde and back. the last one is a personal (unfinished-too unpatient!) try-out.
you can find more about the book here.
Labels: books
Oct 26, 2009
Labels: apartments, charlotte
Oct 25, 2009
it's a beautiful morning
Oct 24, 2009
remember this mouse? lisa brought him a turtle shell!
op 12:20 4 comments:
Oct 23, 2009
to the post office
Oct 22, 2009
socks and other things
op 22:14 3 comments:
Oct 20, 2009
yukari miyagi
want to have this book!
and another thing: thank you so much for all your orders and comments on our webshop! we are really really happy! we are busy making packages, but we'll ship them out very very soon!!!
and another thing: thank you so much for all your orders and comments on our webshop! we are really really happy! we are busy making packages, but we'll ship them out very very soon!!!
op 21:56 7 comments:
Labels: books
Oct 19, 2009
we're open!
our webshop is now open!! look here!!!
Oct 18, 2009
these are only a few things that will be for sale online from tomorrow on in our webshop!!! we're very happy to tell you this! there will be lots of stationary, some pillows from at swim-two-birds, a few vintage pins and a lot more!
thanks a million to danny who made the shop, and for being so patient with us. he's the best!
see you there tomorrow 19th at 6:00 PM (CEST)!!!!
Oct 17, 2009
2 pictures from veroniks place. a new painting and a writing on the window- her favorite things: painting and writing with a chalk-marker.
Oct 16, 2009
Oct 14, 2009
Oct 13, 2009
supplement to the italian dictionary
we have a new book by bruno munari! it's about expressing yourself without words. illustrated with many beautiful photographs! found the book through trui's blog.
Labels: books, mieke willems, shop
Oct 12, 2009
look at these beautiful bedsocks. handmade by a nice old lady. they are in the store right now, except for those in the middle ;)
Oct 11, 2009
things we both have (26)
a beautiful moomin (gift from the sweetest mia, for the both of us!)
op 18:20 9 comments:
Labels: things we both have
Oct 9, 2009
frank visser of ijm is probably the best stylist in the world! it was nice meeting him today in our store!
Labels: ijm
Oct 8, 2009
paul rand
Labels: books, mieke willems, shop
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How Are 20% of Human Genes Patented? [Factoid]
Source: http://gizmodo.com/5811899/how-are-20-of-human-genes-patented
John Sulston, along with Sarah Chan and John Harris, write that scientific process is being stymied due to excessive ownership of scientific intellectual property. One of the more troubling statistics? Private companies have patented nearly 20% of human genes.
For example, it is estimated that some 20% of individual human genes have been patented already or have been filed for patenting. As a result, research on certain genes is largely restricted to the companies that hold the patents, and tests involving them are marketed at prohibitive prices. We believe that this poses a very real danger to the development of science for the public good.
Essentially, if any group wants to conduct research on certain types of genes, they have to pay the patent holder to formally carry out the experiment. And then, of course, there are the pharmaceutical companies, who will buy up expiring patents to prevent potential competitors from infringing on the market territory of their status quo drug.
All of this, according to Sulston and co., means we're limiting the best possible scientific breakthroughs. Instead, we're stuck waiting for the ones which prove most profitable. That sucks. [Guardian via Open Science]
Image via Shutterstock


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Dog trainer helped TODAY's , and now she's offering advice for you and your canine companion.
Dogs can be sensitive to changes in their lives, just as humans can be. A family member going off to college, the arrival of a new baby, a change in the family's work or school schedule — all of these can upset a dog's routine and trigger troubling behavior changes. A dog who has been comfortable with human absence in the family's old schedule may start to whine or bark upon departure, be destructive when no one is around, even to the point of self-injury, or even break housetraining. In the most severe cases, this sensitivity to being alone can progress into full-blown separation anxiety. Though separation anxiety tends to be over-diagnosed, real separation anxiety, which can be likened to a human panic attack, is truly painful for all involved.
The most prudent — and least agonizing — approach is to prepare your canine family member for what lies ahead. Anticipate what the new family schedule will look like, including what stretches the dog will be alone, who will be leaving when and in what order, and who will be the dog's companion at different times during the day. Then, try to morph your current schedule into this new schedule gradually. The trick is to identify the changes the dog will experience, unbundle them, and then work on each of them separately.
So, for instance, the pooch may be most bonded to the mom who, on the old schedule, left the house first, and the dad would distract and redirect the dog by calling him and getting him started playing a favorite game. But, in the new schedule, the dad needs to leave first. Start by practicing when other family members are home but offering no distraction to the dog. The mom can take the trash out, a trip which will take just a few minutes, and then return, all without fanfare. Gradually randomize the departures, with different lengths of time and different family members present, and ultimately with no family members present.
Another disruption might be when the teenage son, who had been the dog's afternoon playmate, goes to college, leaving the dog without company until the first parent returns home from work. So, to begin working on this, the son should simply do other things around the house rather than playing with the dog. When the first parent returns home, the three can engage in a favorite game together and, over time, the son can become less involved as the parent takes over this activity.
Start preparing weeks, even months, in advance if possible, so that adjustment can be gradual. Particularly in the case of the arrival of a new baby, it can be harmful to the relationship if the dog attributes his new life-scape — getting less attention, not being allowed on the couch or into the second bedroom turned baby nursery — with the sudden arrival of the tiny tyke.
Here are some tips to help with the process:
- If the dog is losing his most bonded person, either due to increased or long-term absence, start strengthening the dog's relationships with other family members.
- Gradually prepare your dog if he will have more time alone at home. For more detail on preventing and treating separation distress, see my article "Home Alone".
- Exercise is a great way to diffuse the anxious energy that can accompany changes in routine. Dogs, like humans, are best equipped to relieve stress through physical outlets, so increasing exercise, even just in the early stages of the adjustment process, can help. (See my articles "Exercise Indoors" and "Exercise Outdoors" for creative ideas about games to play with your dog.)
- Dogs are genetically programmed to hunt for their food. One reason there is such a prevalence of behavior problems in pet dogs is that they have so little mental challenge; they need to have work to do! A healthy, balanced day should include mental stimulation as well as physical exercise. So, instead of giving your dog his food in a bowl, give him problems to solve, by way of stuffed puzzle toys, in order to obtain meals and snacks. (See my Kong handout for some stuffing recipes.)
- Have a dog walker lined up well in advance of the schedule change and make sure that your dog is acquainted and comfortable with them long beforehand. It would be a good idea to have them take trial walks with your dog.
Of course, all dogs are different and some dogs are more sensitive to change than others. The soft, bondy dog may be more affected by changes in playmates or time spent alone than the more independent dog. The playful, energetic dog may be more sensitive to changes in exercise routine than the couch potato dog. You know your dog best and so are best equipped to help him navigate the challenges. Just give him, and yourself, plenty of time, patience, and love to make peace with what lies ahead.
Owner of , Laura Garber, is a dog trainer and behavior specialist who regards training as an exercise in building relationship rather than obedience. She is Interim Head of Behavior at the Town of Hempstead Animal Shelter in Hempstead, Long Island.


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OVERVIEW: What every practitioner needs to know
Bronchiolitis is a common clinical syndrome of infants and young children involving infection of the lower respiratory tract, typically by seasonal viruses such as respiratory syncytial virus (RSV). Bronchiolitis affects up to one third of children in the first 2 years of life and is the leading cause of hospitalization among infants in the United States. Although hospitalization rates and medical expenditures due to bronchiolitis have increased over recent decades, mortality remains low.
Most children with bronchiolitis can be diagnosed based on clinical findings alone, and additional laboratory or radiology testing adds little to management and is not recommended for routine care. Atypical or severe presentations should prompt consideration of the differential diagnosis, since other conditions can present with respiratory distress during the winter viral season.
Recommended therapy for bronchiolitis has been controversial, and currently no treatment beyond routine supportive care has been shown to improve long-term outcomes. Bronchodilators may have a short-term benefit in selected children with bronchiolitis, although this must be weighed against their adverse effects and costs. Current guidelines recommend against regular use of these agents. Epinephrine may be more effective than albuterol but is generally limited to a role as a rescue agent in the hospital setting.
Continue Reading
For inpatients, nebulized hypertonic saline may shorten the length of hospitalization. Limited data suggest that patients with severe disease may benefit from treatment with high flow nasal cannula oxygen, helium-oxygen mixtures or nasal continuous positive airway pressure. Corticosteroids have not been found to be beneficial for routine treatment of infants with bronchiolitis. Further evidence is required to verify the potential benefit of combination therapies such as epinephrine and dexamethasone.
Are you sure your patient has bronchiolitis? What are the typical findings for this disease?
The definition of bronchiolitis varies in research studies and clinical practice guidelines. This may relate to the specificity required in distinguishing cases caused by primary viral infection (classically with RSV in a healthy infant) from viral-induced wheezing in a young child with chronic asthma (typically due to rhinovirus). The presentations of these different causes can overlap substantially and confound simplistic approaches to diagnosis and therapy. In addition, there is variability internationally in the definition of bronchiolitis, with more specific definitions proposed in the United Kingdom compared with the United States, where wheeze is generally considered the hallmark finding in association with a variety of other symptoms.
Combining these definitions, the most typical findings include:
a child less than 2 years old presenting with onset of wheezing and signs of a concomitant upper respiratory tract infection such as rhinorrhea and cough;
coarse rales on examination, typically heard bilaterally in the lung fields;
signs of respiratory distress, including intercostal and/or suprasternal retractions, nasal flaring, or breathing with abdominal muscles;
fever may be present or absent.
What other disease/condition shares some of these symptoms?
The differential diagnosis for bronchiolitis includes:
Nonviral lung infections
Bacterial pneumonia
Mycoplasma pneumonia
Chlamydia trachomatis
Mycobacterium tuberculosis
Gastroesophageal reflux
Anatomic abnormalities
Airway or esophageal foreign body
Laryngeal or tracheomalacia
Vascular ring or sling
Tracheoesophageal fistula
Bronchogenic cyst
Mediastinal mass
Congestive heart failure
Allergic reaction
Cystic fibrosis
What caused this disease to develop at this time?
Pathophysiologic characteristics: Bronchiolitis occurs when a respiratory virus descends from the upper airway to the bronchioles, causing airway inflammation and obstruction with mucus and fibrin. The role of bronchospasm is debated but does not appear to play an important part in young infants with classic presentation. Bronchiolitis can occur in healthy infants, but underlying conditions such as chronic lung disease, immunosuppression, or impaired airway clearance due to exposures (e.g., tobacco smoke) or underlying neuromuscular disease can worsen the process. Underlying cardiovascular disease may be worsened by hypoxemia due to ventilation-perfusion mismatch, increased pulmonary vascular pressures, or other effects of bronchiolitis. Genetic variation may play a role, but at this time polymorphisms have only been associated without clear causality.
Epidemiologic features: Bronchiolitis is estimated to occur in up to one third of children during the first 2 years of life, with about 3% of all infants in the United States requiring hospitalization. Rates of hospitalization doubled over the 1980s and 90s, although it is unclear whether this is due to a change in the severity of disease or the threshold for hospitalization caused by the advent of new technology such as pulse oximetry. Recent estimates show mild declines in hospitalizations. Mortality is estimated at about 2/100,000 live births.
What laboratory studies should you request to help confirm the diagnosis? How should you interpret the results?
Laboratory studies can be used to identify the viral infection causing bronchiolitis or to detect complications of bronchiolitis such as concomitant bacterial infections. In general, identification of the virus does not provide information that is useful in guiding the management of an individual patient and is not recommended for routine care of bronchiolitis. Viral testing can be useful for epidemiologic purposes to identify the onset of RSV season or as part of a program to prevent spread of nosocomial infection in a hospital setting. However, programs developing cohorts of patients using symptoms alone without viral testing have also been successful in reducing nosocomial spread.
Viral testing
Testing is performed on respiratory specimens, typically obtained by suction or swabbing of secretions from the upper respiratory tract:
Viral culture has been the traditional gold standard for virus identification, although it requires several days for results to obtained.
Molecular techniques such as polymerase chain reaction have high sensitivity and specificity and can be batched for turnaround within hours. The high sensitivity of these tests has been reported to exceed that of culture because of the low quantity of virus required to produce positive results. This can also cause potential confusion if a virus from a prior infection causes a positive result. Studies have found that up to 40% of asymptomatic infants may test positive by PCR for some respiratory virus, in particular rhinovirus.
Rapid viral antigen tests have varying sensitivity and specificity depending on the test used and the quality of respiratory specimen that is provided. Immunoassay tests generally have poorer test characteristics than direct fluorescence tests. Interpretation of any test with limited accuracy needs to be adjusted based on the expected prevalence of the disease. In periods of peak viral prevalence, the predictive value of a positive test result is generally good, but in times of low prevalence, false-positive results may be more common than true-positive results.
Concomitant bacterial infection
An important consideration for any viral test is the fact that respiratory viruses such as RSV can be shed for weeks after an acute infection. Therefore a viral test performed on a febrile child may represent an earlier infection rather than the cause of the acute fever. This has been a limitation of studies attempting to use testing for common respiratory viruses as a screen for bacterial infection in febrile infants. In general, studies using clinical criteria of bronchiolitis rather than viral testing alone have had low rates of concomitant bacterial infection.
For febrile infants with clinical symptoms of bronchiolitis during the first 2 months of life, rates of serious bacterial infection have been significantly lower than the rates reported for febrile infants in general, in particular for meningitis and bacteremia. Rates of occult urinary tract infection are also lower but remain common enough (5%-6%) to warrant routine investigation. Evaluation for bacterial infection in older infants should be based on specific signs or symptoms. Acute otitis media has been reported as a complication in as many as 60% of cases of bronchiolitis although the need for treatment with antibacterials is unclear.
Would imaging studies be helpful? If so, which ones?
Imaging modalities such as chest radiography can be used to rule out other potential causes of respiratory distress, evaluate the extent of pulmonary disease, or detect potential complications such as bacterial pneumonia. In general, for typical cases of bronchiolitis, routine chest radiography provides little information to guide management and is not recommended. In one study of 265 children younger than 2 years of age with a typical onset of bronchiolitis presenting as a first episode of viral-associated wheezing in an otherwise healthy child with a non-toxic appearance, none of the radiographs influenced acute management, and the rate of antibiotic use increased because of inappropriate interpretation of radiographs with a viral pattern.
Radiography is indicated in children with atypical presentations or severe symptoms. The degree of atelectasis and other typical findings of bronchiolitis on radiographs have been associated with the severity of the disease course, but it is unclear if this adds information to clinical examination findings.
If you are able to confirm that the patient has bronchiolitis, what treatment should be initiated?
Supportive care is the mainstay of treatment for bronchiolitis. Parents should be instructed in assessment and provision of basic supportive measures, as symptoms may progress over the course of the illness.
Assessment and clearance of the upper airway using suction can improve respiratory distress, particularly in young infants who are obligate nasal breathers.
Oxygenation should be assessed using pulse oximetry, and oxygen should be provided to keep saturation levels greater than 90%. Arbitrary higher thresholds for initiating oxygen may result in unnecessary hospitalization, as was documented in a recent randomized trial. Transient episodes of hypoxemia may resolve with positioning and suctioning. A recent study using home saturation monitoring identified that these events occur commonly in infants with bronchiolitis managed as outpatients and are not associated with progression of disease. Use of continuous pulse oximetry can detect self-limited hypoxemic episodes that may result in prolongation of hospital stay; continuous monitoring can be discontinued as an infant improves. Studies of home oxygen for stable infants with bronchiolitis have demonstrated safety in high-altitude locales.
Hydration status should be assessed and appropriate intervention provided. Most infants with bronchiolitis can continue to feed by mouth. For severely ill infants, fluid can be provided by the nasogastric or intravenous route. Intake and output should be assessed, as free water retention can be a complication of bronchiolitis and other pulmonary disorders.
Routine chest physiotherapy was not demonstrated to be beneficial in one small study.
Bronchodilators: Use of bronchodilators such as albuterol has not been found to improve outcomes in infants with a typical presentation of bronchiolitis. Most of these studies were limited to infants under a year of age with a first presentation of wheeze associated with a viral respiratory infection. In older children or those with recurrent episodes of wheezing a trial of albuterol may be considered using a nebulizer (usually at a dose of 2.5 mg in 3 mL saline) or metered dose inhaler (two puffs) with a spacer and face mask. Epinephrine may be more effective (see discussion in the section discussing evidence) but is generally limited to the hospital setting and given by nebulizer (3 mL of 1:1000 L-epinephrine solution or 0.5 mL of 2.25% racemic epinephrine diluted with 2.5 mL saline). Assessment of response to bronchodilators should be conducted in an objective fashion to determine if there has been a response, and treatment should be continued only in patients in whom a benefit has been observed.
Hypertonic saline: Limited evidence suggests that use of repeated doses of nebulized hypertonic saline (usually 3%) given to children hospitalized with bronchiolitis may reduce length of stay. Since bronchospasm is a potential complication of hypertonic saline, some studies have given it with a bronchodilator. Studies in the outpatient setting have found varying results and use is not recommended in recent treatment guidelines.
What are the adverse effects associated with each treatment option?
Bronchodilators can cause a variety of potential harms, including tachycardia, hypoxemia, hypertension, pallor, vomiting, and tremor. Systematic reviews of studies using bronchodilators have not found significant adverse effects in standard use for healthy infants. Hypertonic saline can cause bronchospasm although this does not appear to be a clinically important effect when given with a bronchodilator.
What are the possible outcomes of bronchiolitis?
Outcomes for infants with bronchiolitis are generally good, although the short-term burden on the child and family can be significant. About 1 in 10 infants with bronchiolitis are hospitalized for supportive care. Risk for severe disease, such as the need for mechanical ventilation, is increased among infants with underlying cardiopulmonary disease, immunodeficiency, prematurity, and young age (<2-3 months). Mortality from bronchiolitis has remained low over recent decades at about 2.2/100,000 live births.
Recovery from bronchiolitis can require weeks; the median duration of symptoms has been estimated at 12 days, but up to 20% of children continued to have intermittent cough at 3 weeks after onset of illness. A long-term association with increased risk for asthma in later childhood has been demonstrated for infants with severe bronchiolitis requiring hospitalization, although it is unclear if this is a complication of bronchiolitis or an underlying characteristic of the child.
Treatment options such as bronchodilators are generally safe but have limited short-term efficacy and should be continued only when they demonstrate benefit after a trial of therapy. Therapies such as leukotriene-receptor antagonists intended to speed recovery and reduce long-term effects of bronchiolitis have not been found to be effective.
What causes this disease and how frequent is it?
Epidemiologic features
Bronchiolitis is caused by a variety of infectious agents but most typically by respiratory viruses common during the winter season.
These viruses include the following:
RSV is a paramyxovirus that circulates in annual epidemics during the winter months and accounts for 50%-80% of bronchiolitis cases. RSV is a ubiquitous agent during this season, infecting 90% of children during the first 2 years of life, a third of whom experience lower respiratory tract infection. Reinfections with RSV occur throughout life but generally are limited to the upper airway in healthy individuals. RSV spreads by large droplet transmission directly from patient to patient or by contact with viral particles on surfaces, which remain infectious for several hours.
Human metapneumovirus (HMPV) is another paramyxovirus that has infectious characteristics similar to those of RSV in regard to seasonal characteristics and mode of infection. HMPV was relatively recently described, but studies of banked specimens show it consistently has accounted for 3%-19% of bronchiolitis cases. The clinical course of HMPV and RSV appear to be similar.
Rhinovirus has an emerging role as a cause of bronchiolitis and is more common in children older than 6 months of age. Rhinovirus is known as a common trigger of wheezing in older children with chronic lung disease and asthma. Rhinovirus is a common coinfecting agent with RSV or HMPV.
Parainfluenza (especially type 3)
Coinfection with multiple viral agents is seen in 10%-30% of children hospitalized with bronchiolitis. The impact of infection with multiple viruses on the risk for severe disease is unclear, with varying results across different cohorts.
The genetics of bronchiolitis is an evolving area of research. Various single-nucleotide polymorphisms have been associated with an increased risk for severe disease, but they are not clearly established.
How do these pathogens/genes/exposures cause the disease?
Infection with respiratory virus descends from the upper airway, typically over several days, causing inflammation of the epithelium of the bronchioles, accompanying edema, and peribronchial infiltration by mononuclear and other white blood cells. The airways can become plugged with mucus, necrotic epithelium, and fibrin, leading to atelectasis and air trapping distal to the obstruction. Ventilatory-perfusion mismatch can lead to hypoxemia. Airway inflammation can cause smooth muscle constriction, although bronchospasm appears to play little role in producing symptoms for typical cases of bronchiolitis in young infants. Exposures or underlying conditions, such as immunodeficiency or neuromuscular disease, that impair airway clearance can lead to more severe disease.
Other clinical manifestations that might help with diagnosis and management
In outpatient studies, hypoxemia in the mild range (<94%-95%) has been associated with an increased need for hospitalization and progression to severe disease. This concern may play a role in increased hospitalization rates for bronchiolitis over recent decades with the availability of pulse oximetry, since this level of hypoxemia is not detectable on physical examination alone. A recent trial suggests that mild hypoxemia may contribute to unnecessary hospitalization, as infants for whom the pulse oximetry reading was artificially raised were more frequently discharged without an increase in return visits (see discussion in the evidence section).
Studies assessing inpatients with bronchiolitis have demonstrated prolongation of hospital stay resulting from the use of continuous pulse oximetry and detection of transient hypoxemia.
In general, mild hypoxemia should be a consideration in decision making and level of monitoring of infants with bronchiolitis, but oxygen should be initiated only when clearly indicated (typically at a saturation <90%), and continuous monitoring should be discontinued as the infant improves.
What complications might you expect from the disease or treatment of the disease?
Acute complications from bronchiolitis include respiratory failure and apnea requiring mechanical ventilation. Risk for respiratory failure has been consistently associated with the presence of underlying chronic illness, including prematurity, congenital heart disease, chronic lung disease, and immunodeficiency, although it also occurs in healthy infants. Apnea occurs in fewer than 5% of infants hospitalized with bronchiolitis and has been associated with age less than 1 month or a postconceptual age of less than 48 weeks for premature infants.
How can bronchiolitis be prevented?
Prevention of bronchiolitis is not currently an option because vaccines to prevent infection with common causes such as RSV have not proved to be successful. Interventions to reduce morbidity of bronchiolitis have been focused on high-risk populations, such as premature infants or those with underlying cardiopulmonary disease or immunodeficiency.
Prophylactic therapy with RSV immunoglobulin (palivizumab) has been found to be safe and effective in reducing morbidity from RSV in high-risk infants. Guidelines published by the American Academy of Pediatrics in 2014 recommend therapy for infants with hemodynamically significant heart disease or chronic lung disease of prematurity born before 32 weeks' gestation and requiring supplemental oxygen for at least the first 28 days of life. Other populations, such as infants with severe immunodeficiency or neuromuscular disease, have not been well studied but may benefit from therapy.
Environmental exposures: Passive exposure to tobacco smoke is known to be a risk factor for many adverse health-related outcomes, although it has not been clearly linked to risk of outcomes in bronchiolitis such as hospitalization. Exposure to other young children in a home or child-care setting is a risk factor for high-risk infants.
Genetic factors: Studies have linked various single-nucleotide polymorphisms with risk for severe bronchiolitis, although these associations are preliminary and not appropriate for clinical use.
Nutritional factors: Breastfeeding has not been shown to reduce risk of hospitalization for bronchiolitis, although guidelines encourage breastfeeding in all infants. Other potential nutritional risk factors such as vitamin D status are under investigation but are not clearly linked to outcomes.
What is the evidence?
Treatment of bronchiolitis has been a topic of controversy and fairly extensive research in comparison with other topics in pediatrics. There are many challenges in assessing the efficacy of therapies for this condition. Infants with bronchiolitis manifest multiple physical findings, such as use of accessory muscles, increased respiratory rate, and other signs of increased work of breathing; findings on lung auscultation, such as rales and wheezes, and abnormalities on physiologic measures such as pulse oximetry. These findings change rapidly from minute to minute in bronchiolitis, in particular with clearance of mucus from the airways that can affect all of these findings. For these reasons it may be difficult to determine whether a change in status was attributable to a therapy.
For short-term improvement there are several bronchiolitis scores (such as the Respiratory Distress Assessment Instrument often used in research studies) that have some evidence for interobserver reliability and limited evidence of validity. A recent trial has called into question the role of mild hypoxemia in driving unnecessary hospitalizations. The investigators randomized otherwise healthy infants with mild to moderate bronchiolitis to receive an altered pulse oximeter that read three points above the true reading. Although infants in the altered oximeter group were less likely to be hospitalized (25% versus 41% for the control group), they were not more likely to return to the hospital for unscheduled care. Another study by this group documented that transient hypoxemia occurs commonly in infants with bronchiolitis managed at home, and these events were not associated with return visits to the hospital or other measures of progression of disease. Longer term outcomes may be assessed by duration of symptoms or requirement for care such as hospitalization, although these also are confounded by the variation in criteria used by different providers. These issues and current recommendations for therapy are summarized in a Clinical Practice Guideline published by the American Academy of Pediatrics and updated in 2014.
"American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Clinical Practice Guideline: Diagnosis and Management of Bronchiolitis". Pediatrics. vol. 134. 2014. pp. e1474-e1502.
Schuh, S, Freedman, S, Coates, A. "Effect of oximetry on hospitalization in bronchiolitis: A randomized clinical trial". JAMA. vol. 312. 2014 Aug 20. pp. 712-8.
Principi, T, Coates, AL, Parkin, PC, Stephens, D, DaSilva, Z, Schuh, s. "Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis". JAMA Pediatr.
Many randomized controlled trials have assessed the efficacy of bronchodilators such as inhaled albuterol and epinephrine for bronchiolitis. To assess this literature, it is best to reference a rigorous systematic review of trials as has been published by the international Cochrane Collaboration.
Gadomski, AM, Bhasale, AL. " Bronchodilators for bronchiolitis". Cochrane Database of Systematic Reviews. 2014. pp. 6(This review of 30 trials including a total of 1992 infants found no improvement in oxygen saturation, hospitalization rate or duration, or time to resolution of illness attributable to bronchodilators. In outpatient studies there was a statistically significant improvement in clinical scores that was of questionable clinical significance. Results varied across trials, and there was also improvement noted in control patients. The review concludes that given their adverse effects and no proven benefit on outcomes, bronchodilators are not effective in the routine management of bronchiolitis.)
Hartling, L, Bialy, LM, Vandermeer, B. "Epinephrine for bronchiolitis". Cochrane Database of Systematic Reviews. vol. 6. 2011. pp. CD003123
Hartling, L, Fernandes, RM, Bialy, L. "Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and met-analysis". BMJ. vol. 342. 2011. pp. d1714
The Cochrane Collaboration review assessed 14 trials comparing epinephrine with either other bronchodilators or placebo. Overall there was some evidence of benefit among children treated with epinephrine as outpatients on short-term measures such as clinical scores and oxygen saturation when compared with placebo. When compared with albuterol, small improvement in short-term measures was also observed. These studies did not demonstrate a reduction in long-term hospitalization rates, and evidence of benefit was limited to a few selected short-term outcomes when assessed for hospitalized children.
The lack of effect of epinephrine in reducing hospitalization rates was also reported in a large recent trial that also assessed corticosteroids (see below). The more recent meta-analysis by the same group included the recent trial and, when all data was pooled, found a reduction in hospitalization rate by 33% when epinephrine was given in the emergency department but no significant difference in hospitalization at 7 days.
Overall, the current evidence on the use of bronchodilators for bronchiolitis supports, at best, a short-term improvement in clinical measures with no demonstrated improvement in long-term outcomes. Epinephrine may be more effective than albuterol, but administration is generally limited to the hospital setting. The AAP guideline recommends against routine use of bronchodilators for all children with bronchiolitis, but epinephrine may be useful as a rescue agent in the hospital setting.
Corneli, HM, Zorc, JJ, Majahan, P. "A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis". N Engl J Med. vol. 357. 2007. pp. 331-9.
Plint, AC, Johnson, DW, Patel, H. vol. 360. 2009. pp. 2079-89. (These two large multicenter trials based in the emergency department assessed the role of corticosteroids for bronchiolitis. The first, from the Pediatric Emergency Care Applied Research Network (PECARN) network in the United States, found no benefit of a single dose of oral dexamethasone compared with placebo in reducing hospitalization or improving bronchiolitis symptoms.
The second, from the Pediatric Emergency Research Canada (PERC) network in Canada, found similar results using a longer course of dexamethasone, but also explored two other interventions in a factorial trial design. Epinephrine nebulization alone did not reduce hospitalization, but the combination of epinephrine with oral dexamethasone showed a potential benefit, equivalent to a relative reduction of 35% in hospitalization rate over the 7 days after the emergency department visit. Because this interaction effect was not hypothesized in advance, the results needed to be adjusted for multiple analyses and did not reach the level of statistical significance.
Synergy between corticosteroids and beta-agonists is well described in other pulmonary conditions such as asthma, but a definitive recommendation regarding use of these agents for bronchiolitis will await further evidence.
The AAP Bronchiolitis Practice Guideline recommends against routine use of corticosteroids for treatment of bronchiolitis.)
Several trials have assessed the role of nebulized hypertonic saline for treatment of bronchiolitis. This agent may have an effect on clearing mucus and other potential mechanisms and is used in the management of cystic fibrosis.
Zhang, L, Mendoza-Sassi, RA, Wainwright, C, Klasses, TP. "Cochrane Database of Systematic Reviews". vol. 74. 2013. pp. CD006458(This review of eleven trials found benefit among children hospitalized for bronchiolitis in improving clinical scores and reducing hospital length of stay compared with placebo. Studies in the emergency department have found varying results but no consistent benefit.)
Schuh, S, Lalani, A, Allen, U. "Evaluation of the utility of radiography in acute bronchiolitis". J Pediatr. vol. 150. 2007. pp. 429-33.
Ongoing controversies regarding etiology, diagnosis, treatment
The current body of evidence regarding treatment of bronchiolitis remains uncertain about the efficacy of combination therapy with corticosteroids and epinephrine (see discussion in the section on evidence above). In addition, evidence is limited regarding the efficacy of therapies for severe bronchiolitis including heliox (helium and oxygen), high flow nasal cannula oxygen, and continuous positive airway pressure, which have been studied in case series and small trials.
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- OVERVIEW: What every practitioner needs to know
- Are you sure your patient has bronchiolitis? What are the typical findings for this disease?
- What other disease/condition shares some of these symptoms?
- What caused this disease to develop at this time?
- What laboratory studies should you request to help confirm the diagnosis? How should you interpret the results?
- Would imaging studies be helpful? If so, which ones?
- If you are able to confirm that the patient has bronchiolitis, what treatment should be initiated?
- What are the adverse effects associated with each treatment option?
- What are the possible outcomes of bronchiolitis?
- What causes this disease and how frequent is it?
- How do these pathogens/genes/exposures cause the disease?
- Other clinical manifestations that might help with diagnosis and management
- What complications might you expect from the disease or treatment of the disease?
- How can bronchiolitis be prevented?
- What is the evidence?
- Ongoing controversies regarding etiology, diagnosis, treatment