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This story of "the worst day this country ever had" — a roughly 12-hour period when an armed paramilitary group blows up the Capitol and takes over the
In fact, if the amount of disbelief that needs to be suspended to enjoy this movie could be turned into dollars, it would pay off the national debt with some money left over to buy star
Emmerich, as the $3 billion worldwide gross accumulated from films such as "Independence Day" and "The Day After Tomorrow" indicates, is a director with an instinct for the obvious, a past master at making overblown versions of old-fashioned Saturday matinee-type stories.
But though the director knows how to keep action moving, he's done himself no favors in the past as a screenwriter. Here, however, he has the benefit of a script by James Vanderbilt ("Zodiac,"
Emmerich also has the great benefit of Tatum, an actor who is ideally cast as the kind of regular guy you might not look at twice. Someone, however, who just happens to possess the kind of extraordinary skill set that comes in handy when the fate of this nation, not to mention the entire free world, is on the line. That kind of regular guy.
Tatum plays John Cale, a man with a dream. Yes, Cale's had a rough past, including two combat tours overseas and an insubordinate personality that's made holding a job difficult, but his aspirations extend all the way to 1600 Pennsylvania Ave.
Currently an employee of the U.S. Capitol Police, assigned to guarding Speaker of the House Eli Raphelson (the veteran Richard Jenkins), Cale burns to be a
Cale didn't even vote for Sawyer, but he's a divorced dad in the doghouse with his sullen 11-year-old daughter Emily (
So when Dad wangles a job interview with the Secret Service inside the building (realistically duplicated by production designer Kirk M. Petruccelli in a series of Montreal sets), he brings Emily along.
Unfortunately for Cale, the person he has to go through to make the career change is Special Agent Carol Finnerty (a buttoned-down
For while Cale has been fruitlessly pleading his case, a gang of nefarious intruders so suspicious looking they practically have "terrorist" tattooed on their foreheads, have infiltrated the White House and, under the leadership of Emil Stenz ("
Martin Walker (a strong James Woods), the outgoing head of the Secret Service and a man with problems of his own, knows just the protocol to follow when things like this happen, but it's to no avail. Bullets are fired, men are killed (though almost no blood is visible in this
It takes awhile for the aims of these terrorists to be revealed (and, frankly, they are never as clear as they might be) but it matters not. For John Cale and his daughter are among the folks being held hostage, and that is no small thing.
Special Agent Finnerty may have sniffed at Cale's abilities (O ye of little faith) but they turn out to be formidable. Possibly the most resourceful man on the planet, Cale is soon demonstrating every gift necessary to take on these heavily armed evildoers and keep the president safe. Lots of bullets head in his direction, but the one with his name on it has yet to be made.
Of course all of this is wildly implausible and completely silly if you stop to think about it. But the action in "White House Down" is so continuous and so convincingly photographed by cinematographer Anna Foerster — even when it involves flaming helicopters and armed limo chases around the White House lawn — that it rarely leaves you the leisure for mature reflection.
Helping add verisimilitude are the actors, especially Tatum and Foxx. They end up as a very unlikely buddy team able to share laughs — as well as armaments.
At 2 hours and 17 minutes, "White House Down" goes on for too long, and even by its own admittedly loose standards it has an ending that defies belief. But if this film had a sensible bone in its body, it wouldn't be the kind of fun it turns out to be.
'White House Down'
MPAA rating: PG-13 for prolonged sequences of action and violence including intense gunfire and explosions, some language and a brief sexual image
Running time: 2 hours, 17 minutes
Playing: In general release


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Aegean archaeology has had a prominent role at Sheffield for almost thirty years. This concentration led to the establishment in 1995 of the Sheffield Centre for Aegean Archaeology with the support of the University. Since then, the Centre has gone from strength to strength, and its identity was enhanced by the establishment of a Chair in Aegean Archaeology in January 2004. Never before has there been such a concentration of both staff and postgraduate researchers as there is today, and never before have we been able to offer staff, students and academic visitors alike such excellent and wide-ranging facilities for research. The Centre remains dedicated to providing an inter-disciplinary environment for research in to all aspects of the archaeology of the Aegean.
Site Preservation

subset: commoncrawl


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Activity Pals
For single seniors. Get together with others to attend events, shop, go sightseeing, dine out and more. 301-596-6385.
The Bain Center
5470 Ruth Keeton Way, Columbia. 410-313-7213.
•Acting Up! Tuesdays, 10:30 a.m. A theater club. Call center to confirm attendance. Free.
•Another Way to See It Laughter Club. Mondays, 9 a.m. $2 instructor fee at class each week.
•Bunco! Aug. 31, 10:30 a.m. Free.
•Canasta. Mondays, 1 p.m.
•Chess. Wednesdays, 1 p.m.
•Computer Seniors of America. Day classes available for basic, advanced and specialized courses.
•Duplicate Bridge. Tuesdays, noon. Free.
•End of Summer Block Party. Tue., Aug. 28, 11 a.m. Entertainment by Golden Gals and Guys, and the Theatre Club. Donations accepted, reservations required.
•E.S.L. Wednesdays, 10 a.m. Help improve your conversational English. Participate in small groups with tutors. 410-313-7213. Free.
•Friday Documentaries. Aug. 31, "A Man named Pearl."
•Gathering of the Arts. Mondays, 1 p.m.; and Thursdays, 9 a.m. Drop-in class, bring your own supplies.
•Gospel Choir Summer Concert. Fri., Aug. 24, 11 a.m. Free.
•Health Insurance Assistance. Weekdays, 9 a.m.-5 p.m. Information and counseling services. Medicare beneficiaries, people age 60 and older, and those with disabilities age 55 and older. 410-313-7391.
•Let's Walk and Move. Tuesdays, 1 p.m.
•Mah Jongg. Wednesdays, 1 p.m.
•Music Appreciation. First and third Fridays, 10 a.m. The 30 Greatest Orchestral Works. Free. Call center to reserve a seat.
•Parkinson's Support Group. First Saturdays, 10:30 a.m. For individuals with a diagnosis of early onset Parkinson's disease. Malcolm Wolf, 301-490-7288 or email@example.com.
•Ping pong. Call center for availability.
•Scrabble. Tuesdays, 1 p.m.
•Sixty-Plus Wills/Legal Screening. Third Wednesdays, 1 p.m. Services include simple wills, powers of attorney, living wills, small estates and deed changes. 410-313-1400 to schedule an appointment.
•Thursday Afternoon Movies. Thu., Aug. 23,"Moneyball."
•Toss Across. Aug. 24, 10:30 a.m. A combination of bean bag toss and horseshoes. Free.
•Wii Club. Tuesdays, 10 a.m. Improve hand-eye coordination and get exercise while competing against peers. Free.
•Work up the Beat. Thursdays, 1:30 p.m. Freestyle dancing, no instructor. Free.
East Columbia50+ Center
6600 Cradlerock Way, Columbia. 410-313-7680.
•AARP Driver Safety Course. Aug. 31, 10 a.m. For ages 50 and older. Call center to register.
•Basket Weaving. Sept. 5, 10:30 a.m. Create a harvest basket. $38.
•Belly Dance. Tuesdays, 1 p.m.
•Chess Club. Thursdays, 1 p.m.
•Harmonize Exercise. Mondays and Wednesdays, 9 a.m.
•Latin Jam Dance Movement. Thursdays, 1 p.m.
•Mah Jongg. Mondays, noon; Wednesdays, 10 a.m.
•Reflexology. Fridays, 9 a.m. $53 an hour.
Elkridge Senior Center
6540 Washington Blvd., Elkridge. 410-313-5192.
•Age Well Exercise. Tuesdays and Thursdays, 9 a.m. Low-impact exercise for any fitness level.
•Book Club. Second Tuesdays, 12:30-1:30 p.m.
•Cards and games. Tuesdays and Thursdays, 9 a.m.-4 p.m.
•Chair Yoga. Tuesdays and Fridays, 10:30 a.m.
•Computer Seniors of America. Day classes available for basic, advanced and specialized courses. Stop in or call for description and offerings.
•Golden Corral Bingo Breakfast. Second Fridays, 8:30 a.m. Breakfast for $7.95; free bingo.
•Free Bread Day. Wednesdays, all day.
•Just Bead It. Second Wednesdays, 10:30 a.m. Make a craft with beads. $6 per craft.
•Legal Aid Help and Assistance. Second and fourth Fridays, 10 a.m. Free.
•Line Dance. Wednesdays, 2-3 p.m.
•Rummikub. Second Tuesdays, 1:30 p.m.
•St. Augustine Bingo Lunch. Third Tuesdays, 11:30 a.m.-2 p.m. Free homemade lunch and cash bingo.
•Walking Club. 8 a.m. for the summer; 9 a.m. starting in October.
Ellicott CitySenior Center
9401 Frederick Road, Ellicott City. 410-313-1400.
•Ask the Pharmacist. Mon., Aug. 27, 11 a.m.
•Bingo. Tue., Aug. 28, 1 p.m. $3.
•Blood Pressure Screening. Tuesdays, 9 a.m.-noon.
•Famous Duels. Aug. 30, 12:30 p.m.
•Friday Flicks/Documentaries. Fridays, 1 p.m.
•Insighters Group. Tuesdays, 12:30 p.m.
•Needlework Club. Mondays and Fridays, 10 a.m.
•Pinochle. Mondays and Fridays, 10 a.m.
•Sixty-Plus Wills/Legal Screening. Fourth Wednesdays, 1 p.m. Services include simple wills, powers of attorney, living wills, small estates and deed changes. 410-313-1400 to schedule an appointment.
•SPRING Insighters Group. Tuesdays, 12:30 p.m.
Gary J. ArthurCommunity Centerat Glenwood
2400 Route 97, Cooksville. 410-313-5440.
•Animal Olympics. Fri., Aug. 24, 11 a.m.
•At Your Service, Mr. President. Sept. 7, 11 a.m.
•Billiards. Weekdays, 9 a.m.-2 p.m.
•Culture, Conversation and Cuisine – Italy. Fri., Aug. 24, noon. $6.
•Drop-in Basketball. Mondays, Wednesdays and Fridays, 9 a.m.
•Drop-in Painting. Wednesdays, 9 a.m.-noon. Free.
•Duplicate Bridge. Mondays and Wednesdays, 1 p.m. $1.
•Pinochle. Mondays and Fridays, 10 a.m.-5 p.m.
•Silver Sneakers Walking Club. Weekdays, 8 a.m.
•Waffle Bar. Sept. 5, 9 a.m.
Recreation Center
3300 Norbert's Way, Ellicott City. 410-313-7311.
•Bingo. First Fridays, 1 p.m. Ages 55 and older.
•Bridge. Wednesdays, 9:30 a.m. Ages 55 and older.
•Community Knitting and Crocheting Group. Second and fourth Wednesdays, 1-3 p.m. Knit and crochet afghans, blankets, baby wear and more for local charities, hospitals and senior centers.
•Duplicate Bridge. Wednesdays, noon-3:30 p.m.; and Fridays, 9:15 a.m.-12:30 p.m. Drop in for a few hours of duplicate bridge. Bring a bag lunch; coffee, tea and treats will be available.
•Mah Jongg. Wednesdays, 1 p.m. Ages 55 and older. Free.
•Pinochle. Wednesdays and Fridays, 9:30 a.m. Ages 55 and older.
•What to be Alert to After Signing up for Medicare. Learn how to get the most out of coverage and reduce problems or confusion. To register, 410-313-7391.
Longwood Senior Center
6150 Foreland Garth, Columbia. 410-313-7217.
•Art Therapy. Second and fourth Friday, 11 a.m.-noon.
•Coffee and Game Social. Tuesdays and Thursdays, 10 a.m.-2 p.m.
•Computer Classes. Monthly, 11 a.m.-2 p.m. Free. Call center for dates and description.
•Group Exercise. Wednesdays and Fridays, 9-10 a.m. Free.
•Line Dance. Mondays, 1-2 p.m.
•Yoga. Most Wednesdays, 10-11 a.m. Call center to confirm dates. Donation.
North Laurel50+ Center
9411 Whiskey Bottom Road, Laurel. 410-313-0380.
•Agewell Exercise Class. Tuesdays and Thursdays, 10 a.m. Sixteen classes for $35.
•Billiards. Weekdays, 9 a.m.
•Blood Pressure Screening. Tuesdays, 10:30 a.m.
•Computer Classes. Call for descriptions of offerings.
•Enhance Fitness. Mondays, Wednesdays and Fridays, 11:15 a.m. Sixteen classes for $51.
•Exercise Counseling. Second Thursday, 10 a.m. Call for an appointment.
•Handbuilding with Clay. Mondays, 1 p.m. Four classes for $42.
•Line Dance Drop-In. Tuesday, 11 a.m. $1.
•Mah Jongg. Fridays, 12:30 p.m.
•Open Art Studio. Mondays and Wednesdays, noon.
•Sit, Stitch and Give. Fridays, 11 a.m.
•Sittercize. Mondays, Wednesdays and Fridays, 12:30 p.m. Sixteen classes for $36.
•Spring Bereavement Group. Thursdays, 10:30 a.m. Find comfort in this short-term group for anyone mourning the loss of a loved one. Nominal fee. Karen Hull, 410-313-7466.
•Tap Aerobics. Wednesdays, 9:30 a.m. Six classes for $33.
•Walking Club. Weekdays, 8 a.m.
•Zumba Gold. Mondays, 10 a.m. Eight classes for $43.
Office on Aging
6751 Columbia Gateway Drive, Columbia. 410-313-5980.
•Maryland Access Point (MAP) — Part of the Howard County Office on Aging, is an information and assistance gateway for older adults, people with disabilities, family members, caregivers and professionals. Information on respite and home care, long-term care, in-home evaluation, aging in place/home modifications, retirement/planning for the future, Medicare and health insurance, chronic disease management, housing, transportation, income management and legal services. Appointments are conducted at the Columbia office, at senior centers or in your home, weekdays, 8 a.m.-5 p.m. Contact MAP at the number above, firstname.lastname@example.com or http://www.howardcountyaging.org.
Social GroupFor Singles 50+
Sundays, 11:45 a.m.-1:15 p.m. Complimentary coffee and snack. Oakland Mills Interfaith Center, 5885 Robert Oliver Place, Columbia. 410-997-0739.
Second and fourth Saturdays, 2:15-3:15 p.m. Volunteers needed to sing or play an instrument to perform for the elderly at the Lorien Health Center. All ages welcome. Tim Belton, 410-730-6006, 410-908-7805 or firstname.lastname@example.com.


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Yeah, you can totally sing along if you like.
This yarn was just what I needed: it's soft, lovely, muted and so, so pretty. I bought it years ago (when I was in Germany, in fact) but never found the right project for it. Until now. Funny how sometimes things just fall in place.
Malabrigo lace-weight in Mariposa + Whisper cardigan = summery Nashville cardi.


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Jim Drake's Entertainment blog
Please don't send me flowers, And I won't sing you love songs
Does the above headline sound somewhat familiar? It's a lyric from the new song "Something Bad" by Portland band The Druthers.
Funny enough, the vocals in their new song are done with a man and a woman duet too. To me, this lyric of the song, (which only lasts for something like half a verse) reminded me of the 1978 duet "You Don't Bring Me Flowers" from Neil Diamond and Barbra Striesand.
I should know, right? I mean, we had that 8-track hanging around.
So, you know me by now but I just had to ask. Was the writer of "Something Bad" just twisting these song lyrics around?
From lead singers Kirk Duncan and Erin Adkisson's answer I'd have to say in this case, I don't think so.
But it amazes me that it can take 33 years to unknowingly create a random song that sounds like it was influenced by another random song.
The Druthers, with their "heart-sweeping folk/pop with his and hers vocals" will be playing at Hood River's CEBU Lounge on Friday, Nov. 4.
1. The first thing I noticed on your CD packaging was the words "recorded in the finest living rooms." That is so true for most of today's bands. How long has your band been around, and how much time did you spend on your new CD "Everyday Ghost?"
The Druthers have existed for about two years now. Although, many of us have known each other and played music together for longer than that. We spent about nine months from start to finish on "Everyday Ghost." A few songs were recorded live and all at once initially...but all but two ("High Chatter" and "I Shouldn't Say What I'm Saying") have various over-dubs. Living room studios included: a beach house in Lincoln City, lead vocalist Erin Adkisson's living room and keyboard/trumpet player Jeff Simpson's bedroom.
2. Now, my next question is one that the younger generation may or may not understand, and it may shed light on what generations you guys are from (and perhaps me, too). In listening to the song "Something Bad," did I detect sort of a "Neil and Barbara" moment?
Yeah, you are on the right track ... but to be honest, I had to look up what you meant by a Neil and Barbara moment. "Something Bad" may be about a much more contentious relationship though. One person knows they're an idiot and the other is just trying to find the strength to say "no more."
3. A couple of your songs have lyrics that seem to hone in on some of the basics, —counting, vowels, kids songs — is this intentional throughout? Besides relationships where does the songwriter get his ideas?
I pull ideas from my life. I believe that the basics can be just as powerful as specific details. I'm a music lover ... all kinds ... I try to create songs with strong melodies and an honest message.
4. Besides your new CD, what else do you guys play? Are your shows more upbeat or more sit down and listen? (CEBU can get kinda noisy . . . )
We don't do many covers, but we do a song by Seven Mary Three, "Mercedes Benz" from Janis Joplin, "Tell Me Something Good" by Chaka Khan, and maybe a few others here and there. Our shows are much more upbeat than anything else, which is a little funny, because we actually have more "sad bastard" songs by far. But, we realize most people don't want to be bummed out on a Friday night. When we play a sit down show, we play our best music. But I promise we will keep it lively at the Cebu Lounge.
5. How did your band name "The Druthers" come into being? What exactly is a druther?
Our name comes from an early American phrase "I'd rather," which over time became "I'd ruther," or "if I had my druthers." If we had our druthers we would be making and performing music for a living ... maybe someday.
6. I thought my eyes were decieving me, but it could have been the bifocals, too. I counted 9 tracks on the cover but the CD player said 10. Is there a secret message hidden in that extra track somewhere?
No, no secret message. A version of the last song, "I Shouldn't Say What I'm Saying," was originally on Kirk Duncan's first CD. We recorded the "Everyday Ghost" version in one take and really wanted to add it to the collection, but didn't want to list it in hopes that it stood out as something completely different than the rest of the tracks. It's just an added bonus.
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Showerproof Cotton Reconstructed Trench Coat
€390.00 €390.00
All orders will be fulfilled by Burberry Limited and shipped from the UK. When you place your order, you accept Burberry's Terms and Conditions and confirm that you have read our Privacy Policy.
Size Guide
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- A reimagined trench coat cut to a relaxed, raglan-sleeved silhouette in showerproof cotton twill. Vintage check lines the design.
- Outer: 100% cotton
- Lining: 100% cotton
- Sleeve lining: 100% polyester
- Single-breasted button closure
- Button-through welt pockets
- Signature details: epaulettes, gun flap, button-tab cuffs, storm shield
- Dry clean
- Imported
Item 80010931
Wear this with


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Emma has been locked in her room her whole life from...
- by Bluevaines
- Rating:
- Published: 17 Jan 2014
- Updated: 9 Jul 2014
- Status: In Progress
Gwen moves to New York and seems to be liking it. Her world turns upside down when she meets Peter Parker and tries to find the secrets he's been hiding from her and the world. She not only gets saved, but meets a masked vigilantly that goes by the name of 'Spider-Man'. Deep inside, she knows she has feelings for him, but won't admit it. Spider-Man has feeling for her as well, but how can he be with her without putting her life in danger?
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M&D Builders & Bathrooms Specialists43 Feedback reviews, 98% positive
General building and property maintenance services in Norwich. If you need building services in the East Anglia region then look no further then M&D Builders for your building and maintenance needs.
Latest Bathroom Fitting feedback review:
By amie29959 on 2nd Nov, 2018
B & L Developments32 Feedback reviews, 97% positive
I moved back to the UK a few years ago after being in Germany .I was an experienced bathroom installer working along side my uncle's business and would like to continue this. I carry out complete bathrooms which involves minor building works, all tiling and plumbing work...
Latest Bathroom Fitting feedback review:
By dmpearson on 6th Oct, 2018
m.a.woodcock property services58 Feedback reviews, 91% positive
M.A Woodcock Property Services was established in August 2005, Working in and around Norfolk,carrying out all general maintenance and home refurbishments, Both domestic and commercial and also working with 2 city center letting agencies. Fully insured. Free quotations...
Latest Bathroom Fitting feedback review:
By s_reilly on 5th Nov, 2016
Aylsham On Tap42 Feedback reviews, 100% positive
Aylsham On Tap are a close family run business and as such we place a high value on customer service. Services we can offer •Kitchen Design & Installation •Floor & Wall Tiling •Bathroom Design & Installation •General Plumbing Work / Repairs •All types of work...
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By ikenrick on 15th Jun, 2018
Shane Betts kitchens and Bathrooms102 Feedback reviews, 100% positive
Hello, my name is Shane Betts and I have been trading now for over 20 years, I am highly experienced in all aspects of property refurbishments including Bathrooms, Kitchens, Tiling, Plumbing, Carpentry and much more. I always pride myself in achieving perfection for all my...
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By ancientaunt on 18th Sep, 2018
George Giles Home Improvements73 Feedback reviews, 97% positive
We are a small reliable building firm ,we offer building services ,electrical and plumbing and heating services ,we can offer upvc windows and doors with a 1 week turnaround ,from a house to an extention porch or garage ,we offer a 24 hour call out service 7 days a week no...
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By jamesm_61 on 21st Jun, 2018
LW Installations12 Feedback reviews, 100% positive
I have been fitting and designing kitchens and bathrooms since 1985 aged 18, I have excellent customer feed back and most of my work comes from recommendation, I have worked as a fitter for B&Q, John Lewis, Magnet & fitted Ikea, Homebase, Wickes & Wren kitchens, I also...
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By sam_567 on 3rd Oct, 2014
Glenn mason tiling7 Feedback reviews, 100% positive
My Name is Glenn Mason I am 48 years old I have worked in the trade for over 20 years,being employed with various companies.I have been involved primarily with installing bathrooms for the elderly + disabled.I have been self employed for just over 2 years installing complete...
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By kevin84610 on 25th Nov, 2018
SR Kay Homefitters19 Feedback reviews, 100% positive
Hello and a warm welcome from SR Kay Homefitters. My name is Sean Kay, a home refurbishment specialist. I have built my reputation on reliability, a very high standard of workmanship and competitive pricing. Please feel free to contact me anytime for a free, no...
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By andyc2018 on 18th Nov, 2018
DW Cook Electrical Services22 Feedback reviews, 100% positive
I'm a qualified electrician & plumber whose been in business in Norfolk for 25 years.Work includes changing a plug to full rewires,fixing leaky taps to fitting a complete bathroom suite.I pride myself in giving a friendly,reliable,& professional service that fulfils my...
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By hilaryloddon on 17th Dec, 2017
Nestor Plumbing And Heating26 Feedback reviews, 100% positive
Cover all areas of plumbing and heating, boiler installs, Bathroom install, Kitchen design supply and install, maintenance and renovation, hot water cylinders, Unvented, heating components, the lot. Been trading since 2011. Covering noth domestic and commercial including...
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By michala38185 on 9th Nov, 2018
Andy Daniels carpentry and building services4 Feedback reviews, 100% positive
Kitchens & bathrooms can be the most expensive rooms to renovate in your home. If you are looking for a new kitchen or simply new worktops, doors, or tiles I can offer great workmanship at competitive prices and I am passionate about attention to detail. I offer a supply and...
Latest Bathroom Fitting client reference:
Reference taken by MyBuilder on 28th Oct, 2014
Toms Plumbing & Heating25 Feedback reviews, 92% positive
My name is Tom Williamson, I am a fully qualified plumbing and heating engineer. I take on basic jobs with a quick responsive and friendly service for a fair price.
Latest Bathroom Fitting feedback review:
By mrs_jackie_king on 6th Nov, 2018
R&B Home Improvements Ltd4 Feedback reviews, 100% positive
We undertake all aspects of domestic work. From clearances, Decorating to complete home renovations & extentions to a very high standard. We have experienced tradesmen to carry out all aspects of building works. We offer a 24 hour call out service for electrical...
Latest Bathroom Fitting feedback review:
By howard_395 on 4th Dec, 2017
Steve Jackman5 Feedback reviews, 100% positive
I have been working on my second career in home repairs, maintenance and improvements since 2015. I work for letting agents on behalf of landlords, and also directly for landlords and homeowners. I undertake a variety of small repairs and redecoration work, up to and...
Latest Bathroom Fitting feedback review:
By theresa_899 on 4th Oct, 2018
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Style # 225026
AVAILABILITY: Unavailable for immediate shipment.
Peplum 3/4 Sleeve Top is rated out of 5 by 9.
Rated 4 out of 5 by BebeCPAgirl from Good buy Fits great on the curves. Not my favourite though. Could love to see more colors, like navy blue, even pastel colors. Just good
Date published: 2016-04-22
Rated 3 out of 5 by Isamar from Good style but too tight I like it but it's too tight. Please buy a bigger size. I bought an xx small I am 63 and 108 pounds and it's super tight. The material is good.
Date published: 2016-04-03
Rated 5 out of 5 by Gisell from Great Fit I love this top...It fits great on the curves. Great Stretch I brought a large should have probably went with a medium
Date published: 2016-03-23
Rated 5 out of 5 by Malu from Love it! I am in love with this black top, my waist looks smaller and accentuate my curves. Sexy yet not too overwhelming <3
Date published: 2015-11-18
Rated 3 out of 5 by TRINI16 from BRIGHT COLORS NEEDED Beautiful top and great fit! We need more colors bright colors, lime green, orange, red, tangerine...etc....
Date published: 2014-10-26
Rated 2 out of 5 by Pim21 from Style I really like Rumba Red color in the clothing, but the style of the shirt need to change> I don't think Peplum looks flattering, instead it makes the girls' look pregnant. Please make this color in straight style shirt, not Peplum.
Date published: 2014-10-16
Rated 4 out of 5 by anancoco from lovely item very flattering top. the material is stretchy and VERY soft! i bought this in a xs and its pretty tight on me. i should have bought this in a size small. im a 34 b and have a small frame. but i can still wear this since the peplum part of the top helps hide the bit of bulge i have in my tummy area. the top is pretty low but shows off your girls. makes me look like i have boobs.
Date published: 2014-10-12
Rated 5 out of 5 by Peetree29 from Beautiful shirt Fits xs for me, I'm usually a size small. All the colors of this shirt are really pretty! This is by far, my favorite shirt from bebe. Good quality & worth every dollar. Great shirt to wear either during the day or for going out at night :-).
Date published: 2014-01-25


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Kaposis sarcoma is a cancerous
Causes, incidence, and risk factors
Before the AIDS epidemic, Kaposis sarcoma was seen mainly in elderly Italian and Jewish men, and rarely, in elderly women. Among this group, the tumors developed slowly. In AIDS patients, the cancer can develop quickly. The cancer may also involve the skin, lungs, gastrointestinal tract, and other organs.
In people with AIDS, Kaposis sarcoma is caused by an interaction between
People who have kidney or other organ transplants are also at risk for Kaposis sarcoma.
African Kaposis sarcoma is fairly common in young adult males living near the equator. One form is also common in young African children.
The tumors most often appear as bluish-red or purple bumps on the skin. They are reddish-purple because they are rich in blood vessels.
The lesions may first appear on the feet or ankles, thighs, arms, hands, face, or any other part of the body. They also can appear on sites inside the body.
Other symptoms may include:
Bloody sputum Shortness of breath
Signs and tests
The following tests may be performed to diagnose Kaposis sarcoma:
Bronchoscopy CT scan Endoscopy Skin biopsy
How this condition is treated depends on:
- How much the immune system is suppressed (
- Number and location of the tumors
- Symptoms
Treatments include:
- Antiviral therapy againstHIV
- Combination
- Freezing (cryotherapy)
Radiation therapy
Lesions may return after treatment.
Expectations (prognosis)
Treating Kaposis sarcoma does not improve the chances of survival from AIDS itself. The outlook depends on the persons immune status and how much of the HIV virus is in the patients blood (viral load).
Complications can include:
- Cough (possibly bloody) and shortness of breath if the disease is in the lungs
- Leg swelling that may be painful or cause infections if the disease is in the lymph nodes of the legs
The tumors can return even after treatment. Kaposis sarcoma can be deadly for a person with AIDS.
An aggressive form of African Kaposis sarcoma can spread quickly to the bones. Another form found in African children does not affect the skin. Instead, it spreads through the lymph nodes and vital organs, and can quickly become deadly.
Safe sexual practices can prevent HIV infection. This prevents AIDS and its complications, including Kaposis sarcoma.
Kaye KM. Kaposi's sarcoma-associated herpesvirus (human herpesvirus type 8). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 141.
Volberding PA. Hematology and oncology in patients with human immunodeficiency virus infection. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 400.
Review Date:
Reviewed By:
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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12 Just as a body is one whole made up of many different parts, and all the different parts comprise the one body, so it is with the Anointed One. 13 We were all ceremonially washed through baptism[a] together into one body by one Spirit. No matter our heritage—Jew or Greek, insider or outsider—no matter our status—oppressed or free—we were all given the one Spirit to drink. 14 Here's what I mean: the body is not made of one large part but of many different parts. 15 Would it seem right for the foot to cry, "I am not a hand, so I couldn't be part of this body"? Even if it did, it wouldn't be any less joined to the body. 16 And what about an ear? If an ear started to whine, "I am not an eye; I shouldn't be attached to this body," in all its pouting, it is still part of the body. 17 Imagine the entire body as an eye. How would a giant eye be able to hear? And if the entire body were an ear, how would an ear be able to smell? 18 This is where God comes in. God has meticulously put this body together; He placed each part in the exact place to perform the exact function He wanted. 19 If all members were a single part, where would the body be? 20 So now, many members function within the one body. 21 The eye cannot wail at the hand, "I have no need for you," nor could the head bellow at the feet, "I won't go one more step with you." 22 It's actually the opposite. The members who seem to have the weaker functions are necessary to keep the body moving; 23 the body parts that seem less important we treat as some of the most valuable; and those unfit, untamed, unpresentable members we treat with an even greater modesty. 24 That's something the more presentable members don't need. But God designed the body in such a way that greater significance is given to the seemingly insignificant part. 25 That way there should be no division in the body; instead, all the parts mutually depend on and care for one another. 26 If one part is suffering, then all the members suffer alongside it. If one member is honored, then all the members celebrate alongside it. 27 You are the body of the Anointed, the Liberating King; each and every one of you is a vital member.
The Voice Bible Copyright © 2012 Thomas Nelson, Inc. The Voice™ translation © 2012 Ecclesia Bible Society All rights reserved.


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JSU Library | Digital CollectionsJDigital Collections
Shown here are eight football players posing on the football field. All are unidentified. (circa 1960); Anyone who has additional descriptive information for this image is urged to contact the Houston Cole Library Technical Services Dept. at firstname.lastname@example.com or 256.782.5761.
Click tabs to swap between content that is broken into logical sections.


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Potential Genetic Link between Epilepsy, Neurodegenerative Disorders
TEHRAN (Tasnim) – A recent scientific discovery showed that mutations in prickle genes cause epilepsy, which in humans is a brain disorder characterized by repeated seizures over time.
However, the mechanism responsible for generating prickle-associated seizures was unknown. A new University of Iowa study reveals a novel pathway in the pathophysiology of epilepsy.
UI researchers have identified the basic cellular mechanism that goes awry in prickle mutant flies, leading to the epilepsy-like seizures.
"This is to our knowledge the first direct genetic evidence demonstrating that mutations in the fly version of a known human epilepsy gene produce seizures through altered vesicle transport," says John Manak, senior author and associate professor of biology in the College of Liberal Arts and Sciences and pediatrics in the Carver College of Medicine.
A neuron has an axon (nerve fiber) that projects from the cell body to different neurons, muscles, and glands. Information is transmitted along the axon to help a neuron function properly.
Manak and his fellow researchers show that seizure-prone prickle mutant flies have behavioral defects (such as uncoordinated gait) and electrophysiological defects (problems in the electrical properties of biological cells) similar to other fly mutants used to study seizures. The researchers also show that altering the balance of two forms of the prickle gene disrupts neural information flow and causes epilepsy.
Further, they demonstrate that reducing either of two motor proteins responsible for directional movement of vesicles (small organelles within a cell that contain biologically important molecules) along tracks of structural proteins in axons can suppress the seizures.
"The reduction of either of two motor proteins, called Kinesins, fully suppressed the seizures in the prickle mutant flies," says Manak, faculty member in the Interdisciplinary Graduate Programs in Genetics, Molecular and Cellular Biology, and Health Informatics. "We were able to use two independent assays to show that we could suppress the seizures, effectively 'curing' the flies of their epileptic behaviors."
This new epilepsy pathway was previously shown to be involved in neurodegenerative diseases, including Alzheimer's and Parkinson's.
Manak and his colleagues note that two Alzheimer's-associated proteins, amyloid precursor protein and presenilin, are components of the same vesicle, and mutations in the genes encoding these proteins in flies affect vesicle transport in ways that are strikingly similar to how transport is impacted in prickle mutants.
"We are particularly excited because we may have stumbled upon one of the key genetic links between epilepsy and Alzheimer's, since both disorders are converging on the same pathway," Manak says. "This is not such a crazy idea. In fact, Dr. Jeff Noebels, a leading epilepsy researcher, has presented compelling evidence suggesting a link between these disorders. Indeed, patients with inherited forms of Alzheimer's disease also present with epilepsy, and this has been documented in a number of published studies."
Manak adds, "If this connection is real, then drugs that have been developed to treat neurodegenerative disorders could potentially be screened for anti-seizure properties, and vice versa."
Manak's future research will involve treating seizure-prone flies with such drugs to see if he can suppress their seizures.


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ALZip 8.51
With more support for more archive formats than any major archive utility and child's-play ease-of-use, ALZip is ideal for computer savvy users and first-time users alike.
Open 36 ZIP, archive and compression file formats (ALZ, ALX, 7z, ACE, ARC, ARJ, B64, BH (1), BH (2), BHX, BIN, BIN (CD), BZ2, CAB, EAR, ENC, GZ, HA, HQX, ICE, ISO (CD), JAR, LCD (CD), LHA, LZH, LZ7, MIM, PAK, RAR, TAR, TGZ, UUE, WAR, XXE, Z, ZIP, ZOO and 001).
Create 8 ZIP, archive and compression file formats (ALZ, ZIP, LZH, CAB, JAR, TAR, TGZ, and BH).
Open CD image files (ISO, BIN). Open virtual CD files (LCD).
Create SFX (exe) files for free.
Split files for easy transfers.
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Control CPU usage with background/forground compression/extraction.
Extract large ZIP64 files.
The intuitive and user-friendly interface turns beginners into archiving experts in minutes. If you can click, drag and drop, you already know most everything you need.
Download ALZip to see how it can brighten your digital life.


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Ted Nugent Deemed Detroit's Greatest Guitar Player of All Time
Michigan's MLive! took a special poll to determine the greatest guitar player in the Detroit area, and when they were finished, all signs pointed at Mr. 'Stranglehold' himself – Ted Nugent. 'Uncle Ted' beat out Jack White, Marshall Crenshaw, and Wayne Kramer of MC5, among others.
Known as "Motor City Madman," the musical icon of rock 'n' roll won the title by a landslide, with a total of 428 votes. The numbers tallied showed over 51 percent of those voicing their opinion voted Nugent, proving that his hometown followers are proud of his five decades of multi-platinum and sold-out worldwide tours.
Throughout this year, Nugent can be seen on the road with other legendary rock bands, REO Speedwagon and Styx, on the Midwest Rock 'n' Roll Express Tour. The multi-city trek has been dubbed as one of the hottest summer package tours of the year by Rolling Stone magazine. Check out a list of the forthcoming tour dates for Nugent below.
Ted's landmark 1977 album 'Cat Scratch Fever' recently celebrated its 35th anniversary and 'Stranglehold,' from his self-titled debut solo album, recently earned a spot on our Top 100 Classic Rock Songs countdown
Ted Nugent 2012 Tour Dates:
5/15 – Springfield, Mo. | O'Reilly Events Center (STYX & REO Speedwagon)
5/17 – Charlotte, N.C. | Verizon Wireless Amphitheatre (STYX & REO Speedwagon)
5/18 – Washington, D.C. | Jiffy Lube Live (STYX & REO Speedwagon)
5/19 – Virginia Beach, Va. | Farm Bureau Live Amphitheatre (STYX & REO Speedwagon)
5/20 – Alpharetta, Ga. | Verizon Wireless Amphitheatre (STYX & REO Speedwagon)
6/9 – Austin, Texas | ROT Biker Rally 2012
6/10 – Fayetteville, Ark. | Arkansas Music Pavilion
6/12 – Peoria, Ill. | Peoria Civic Center
6/14 – Mankato, Minn. | Vetter Stone Amphitheatre
6/15 – Medina, Minn. | Medina Entertainment Center
6/16 – Tama, Iowa | Meskwaki Bingo Casino Hotel
6/19 – Wichita, Kan. | Hartman Arena (STYX & REO Speedwagon)
6/21 – Kansas City, Mo. | Starlight Theatre (STYX & REO Speedwagon)
6/22 – St. Louis, Mo. | Verizon Wireless Amphitheatre (STYX & REO Speedwagon)
6/24 – Chicago, Ill.| Charter One Pavilion (STYX & REO Speedwagon)
6/26 – Cincinnati, Ohio |Riverbend Music Center (STYX & REO Speedwagon)
6/28 – Detroit, Mich. | DTE Energy Music Theatre (STYX & REO Speedwagon)
6/29 – Bethlehem, Pa. | Cuyahoga Falls, OH (STYX & REO Speedwagon)
6/30 – Cuyahoga Falls, Ohio | Blossom Music Center (STYX & REO Speedwagon)
7/1 – Atlantic City, N.J. | Borgata Hotel Casino & Spa Event Center (STYX & REO Speedwagon)


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As we entered 2010, we discussed how change is accelerating. Yes, every week, if not every day, this is a new industry. But we anticipate several changes that look to be great predictions for 2011. Yet again, it is time to dust off the crystal ball and expound on the next year.
2010 was a year of implementation in the areas of intent and behavior-based search results. We also saw the widespread implementation -- and rapid change at that -- of the local results influencing the search results page. Anticipating the direction that many of these changes would take, we performed a great many research projects and developed products focused on this area. Not at all surprisingly, these areas greatly broadened the focus of the company.
International search. It's an expansive issue that some people may not fully understand. However, it's important to grasp the topic on a basic level because the Internet is transforming the way the world does business.
From the United States to China, hundreds of countries not only participate in the Internet, but are also beginning to harness the power of online marketing. This presents more opportunities to market products and services worldwide.
In this Part 1 Back to Basics on international search, global trends will help clarify Internet usage and online marketing, and Bruce Clay Australia gives insight into search marketing from their perspective.
Head of Google Web Spam, Matt Cutts, took time away from Ozzie and Emmy (The Matt Cutts "Catts") at the end of 2010 to post a little titbit for Webmasters and SEOs via Twitter, which I'm sure added to the hangovers for a few Black Hats over the holiday season.
Google will [look] more at cloaking in Q1 2011. Not just, page content matters; avoid different headers/redirects to Googlebot instead of users.
Cloaking is the technique used to present different content, layout, functionality or headers (a completely different page or partial components of the page, known as Mosaic cloaking) to a search engine spider than to a user's Web browser.
Unfortunately, some webmasters may not understand the repercussions, and inadvertently cloak content, links or entire websites without even realising. This article outlines some of the common on-site functionality that may be (mis)interpreted as cloaking-spam.
Jump-Start Your Internet Marketing in 2011
Developments in search and Internet usage worldwide continue to remind us that we simply cannot ignore online marketing as part of the business plan.
Bruce Clay's feature article in this month's edition of the SEO Newsletter gives us some insight into areas of online marketing that are gaining speed and what to look out for in 2011.
This includes the emergence of Internet marketing optimization as a whole, with a focus on not just one facet of online marketing, but a holistic approach.
From search engine marketing and conversion rate optimization to social media optimization, local search and analytics, a healthy online marketing plan consists of many parts.
Before professionals can begin to wrap their heads around this massive undertaking, they must first commit to making it a goal.
Internet Marketing Optimization: Where to Begin?
It may or may not come as a surprise that small businesses and large corporations alike are still grappling with a healthy mix of more traditional marketing efforts and online marketing.
But, with the recession in recent years, many businesses are finding investing in online efforts makes more dollars and sense.
In some cases, it's the only way some businesses have been able to survive hard financial times.
Monies leftover in 2010 budgets and spend planned for 2011 should absolutely factor Internet marketing in as an area of focus.
Those that are new to online marketing should realize that one of the first steps is training.
Training is available from many sources, from professional online courses and in-person SEO training to industry conferences and various resources online.
Choosing the right training depends on level of commitment, time availability, budget and access.
Professional online training courses can be a great way for people to learn at their own speed, especially if they are in a remote area and cannot attend in-person training.
In-person SEO training gives a more hands-on personal approach to learning Internet marketing.
This approach can be a great investment for people who want one-on-one time with experts to ask questions relative to their own scenarios.
In the search industry, annual conferences can be a great way for people to learn the basics, brush up on their skills and network with leaders in their fields.
Online resources are great for staying up on changes in between attending training courses and conferences. These include industry blogs, news sites, how-to videos, webinars and more.
In a recent post on the Bruce Clay, Inc. blog, 3 Ways to Boost Your In-House Internet Marketing in 2011: Part 1 it discusses several options for Internet marketing training both online and in-person.
David Zinman, Yahoo's VP and GM for display advertising, departed the company this month. The company says the move is unrelated to the reorganization last month.
Shortly after Verizon announced they would be carrying the iPhone, Apple CEO Steve Jobs announced he would be taking a medical leave of absence to focus on his health.
Goldman Sachs (GS) invested $500 million in Facebook, feeding speculation that 2012 might lead to an IPO for the social network.
MySpace laid off 47% of its workforce, yet insists that its outlook is quite rosy. MySpace's CEO called it a "significant organizational restructuring that will ... impact about 500 employees."
Google hired two former SEOs Pierre Far and Gary Illyes, both well-known in the marketing community.
Usability queen Kim Krause Berg joined LiBeck Integrated Marketing.
Aussie Googlers Kate Vale (Google's first Australian employee) and Lars Rasmussen (Maps/Wave) left the company in late 2010. Rasmussen, after Google's decision to can Wave, left to join Facebook after a personal pitch from Mark Zuckerberg. Vale still to announce where she'll end up, although hinted she'd be interested in working at Facebook too.
SMX West in March is still accepting speaking pitches, closing on January 20. This is your final warning.
Now is also the time to plan your speaker pitches for SES New York (first round ends January 21). Early bird registration for SES New York ends Friday, January 21 as well. Use code: 20BRU for 20 percent off your ticket price.
Search geeks who want to attend SMX West should enter the Biggest Search Geek Contest sponsored by Marin Software. The contest is open to U.S. and U.K. residents. You have until February 18 to test your geek skills. If you're not throwing your hat in the ring, you can always register to attend using our 10 percent discount code: smx10bruceclay.
DOMAINfest in Santa Monica, Calif., is right around the corner, from February 1 to February 3. The conference is an Internet marketing event directed at domainers (those who buy and sell domains).
Southern California is also host to SES San Diego from February 22 to February 25, with the main event occurring on the 25th.
Those looking for in-house or in-person training for Internet marketing have several options this year. Aside from the nine search marketing-focused conferences hosted across the United States, Bruce Clay, Inc. holds SEO training worldwide.
One-day SEO training is available at conferences for 2011 as follows:
Bruce Clay, Inc.'s classroom-based SEO training for 2011 continues with a busy year. The company's Student Loyalty Program is extended through the first quarter of 2011 for American students.
In the U.S., the newly updated SEOToolSet® standard and advanced training and certification dates for 2011 have been announced. The first West Coast course begins January 17, with several others thoughout the year. Take your pick of 8 courses across the United States:
California Training 2011
The dates for NY Training 2011 will be announced later this year. East Coast students will be able to chose from two sessions during the year.
Bruce Clay Australia will be holding the next 3 Day SEO Training in Sydney:
One Day Training dates for 2011 have also been announced:
Ad:tech Sydney will run on March 9 and 10 for the benefit of marketing and advertising executives.
SMX Sydney will be held on April 14 and 15 for anyone in the online or search marketing field.
SEO training goes to Europe in the first-ever Bruce Clay, Inc. corso SEO on March 1 and March 2 in Milan, Italy. The course, taught in English by Bruce Clay and co-hosted by Bruce Clay Italia, is open to all international students. For more information in English, French, Italian, Russian or Spanish, contact the Bruce Clay Italia offices at +39 02 3809 3525 from 9 a.m. to 5 p.m. GMT +1 Berlin time.
Google revealed the proceeds of its Chrome for a Cause program that was launched for a short time in December with donations upwards of $1 million for five charities.
American Microsoft employees gave $96 million to charity in 2010, making it the largest collective contribution ever for the U.S.-based staff.
It's man versus computer in the upcoming high-tech Jeopardy! charity match. Two all-star contestants go up against IBM computer, Watson, airing February 14 to February 16.
Apple officers donated $3 million to charity at the end of last year, giving nearly 10,000 shares collectively.
Auto-generated content is very firmly against the AdSense TOS. Google laid down the law in a Fact vs. Fiction post on their AdSense blog.
Consumer Affairs published a report on what Facebook might not want you to know as it gets ready to go public.
Google and Bing grew in search share in December. Yahoo suffered in comparison.
The new social question site Quora drew attention at the beginning of the year. Search Engine Land asked why that was, in an attempt to discover the appeal of the service.
Digital Marketing lab has created a list of the Top Australian Facebook Pages and why they are successful.
If you have any questions or comments on any of the above Internet marketing news items or if you would like to suggest topics for future search engine optimization articles, please contact us at Bruce Clay, Inc.
Print the full SEO Newsletter


text: White (adj): The reflection of all visible light rays and the opposite of black. BlackBerrys are commonly sold primarily in black and personally, this just isn't cutting it. I thought black was a symbol of the bad guys? RIM definitely needs to go read some fairy tales. I want Prince Charming on his white steed, not Darth Vader breathing heavily. Lucky for all the chic-white-phone-lovers like me, a leaked picture of the BlackBerry Bold 9790 in black and Bold 9900 in white has been found! So far this has only been discovered for Rogers (Canada) users, but I'm hoping the trend will spread down to the Lone Star State, AT&T especially. While there's a picture giving my heart hope, pricing and release dates are still to be determined. Crossing my fingers that on my birthday, which is shortly after the upcoming holidays, my parents will have that sexy, white BlackBerry Bold 9900 all wrapped up and waiting for me.


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Mon 7.30pm - Romford Football
When and Where
Monday, November 27, 2017Repeats Weekly on Mondays
ONLINE £6.00 /per person
- We play at Pitch 10
- Meet 10 minutes before kick-off, at the reception
- Check in at the reception to avoid being marked as No show
- 3G artificial grass surface
- You can wear boots, No metal studs
- Changing rooms & Showers available
- Free car park available on site
- Closest train station Romford (10 mins bus ride from there)
Game Play Rules
- Goalkeepers: everybody is playing goalie. We rotate on goal every 6-7 minutes
- 1 hour booking
- You cannot score in the area
- Any kind of aggressive behaviour will NOT be tolerated
- Make sure you are in a mood to have fun & on time
Everyone must play fair, respect their team-mates and opponents. We play as gentleman
Pay via Credit/Debit card or PayPal account in order to secure your spot in the game.
If for any reason you cannot make it to the game you need to modify your RSVP as soon as possible, in order to free your spot. In case you are in the attendance list and you do no turn up for the game, you will be marked as a No-Show.
Please bring both a light and dark top with you to help splitting the teams at the pitch.


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$24.75 $27.50
Is the Pug as a Star on a classic Hollywood Movie poster? Yes it is, why not. Pug Dog Art Print Inspired by – Butch Cassidy and the Sundance Kid Vintage Movie Poster. Your dog as an actor or actress? Done! The custom dog portrait is welcome: http://etsy.me/2mU5G3s
Visit my shop here (over 300 dog breeds): NobilityDogs.etsy.com
Art available in a gallery wrapped canvas ready to hang on the wall, without framing. All Artworks are my own art. Please make your size and media selection before purchasing. The frame is not included.
🎦 📽 This Artwork is available in various formats and media.
💙 FINE ART PRINTS - print only. We use acid-free paper with vivid colors and stunning details.100% archival inks are used and with 12 color process for perfect colors. All prints include a 1" white border. Giclee prints are beautiful quality and if looked after will last a lifetime.
💙 CANVAS PRINTS - Canvas print includes a 1" white border to allow for future stretching or matting. Gallery Wrap Canvas stretched on thick wooden stretcher bars, side surfaces: mirrored image looks beautiful as a stand-alone piece. Giclee canvas is extremely high-quality digital art prints produced with archival quality inks and artist's canvas. A Giclee print on canvas is the perfect option for clients who want to have the look of the original oil in their wall.
🎁🎁 IMPORTANT NOTICE: GALLERY WRAP AND MUSEUM WRAP CANVASES 16x12" and 12x9" have a signature on the back and go directly from my production - Europe. PREMIUM CANVAS PRINT 16×12 inch has a signature on the back and goes directly from my production - Europe, too. Other CANVASES sizes will be shipped within 1 - 2 business days.
No receipt is ever included with shipments so you can send to your gift recipients with ease of mind!
1-3 business days
I'll do my best to meet these shipping estimates, but can't guarantee them. Actual delivery time will depend on the shipping method you choose.
Buyers are responsible for any customs and import taxes that may apply. I'm not responsible for delays due to customs.
Just contact me within: 14 days of delivery
Ship items back to me within: 60 days of delivery
Request a cancellation within: 2 hours of purchase
But please contact me if you have any problems with your order.
Because of the nature of these items, unless they arrive damaged or defective, I can't accept returns for:
Buyers are responsible for return shipping costs. If the item is not returned in its original condition, the buyer is responsible for any loss in value.
Please contact me if you have any problems with your order.
I'm happy to work custom and personalized


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Available in a wide variety of designs and configurations, such as side-by-side and French door, GE refrigerators are a stylish addition to any kitchen. GE matches its attention to aesthetics with a reputation for delivering quality and reliable food preservation performance with every refrigerator.
GE refrigerators help you keep your food and drinks organized with adjustable shelves and drop-down trays. Generously provisioned, temperature-controlled food drawers expand your storage options and help to keep your food fresher for longer while using less energy. Smart features such as FrostGuard monitor also enhance energy efficiency while protecting frozen items from freezer burn.
GE manufactures refrigerators with durability in mind so you can enjoy years of excellent operation from your appliance. However, when issues with your refrigerator arise, a great selection of quality refrigerator parts is available through Sears PartsDirect to simplify repairs so you can continue to benefit from the convenience and performance you've come to expect from your appliance for many more years to come.
Many models in GE's selection of refrigerators come with a built-in water dispenser capable of delivering either hot or cold water at the touch of a button. Combining ease of use with hassle-free maintenance, GE refrigerators make keeping the water supplied by the dispenser consistently clean as simple as regularly changing out a water filter. Sears PartsDirect's refrigerator water filter finder can help you quickly and easily obtain the right filter for your particular model.
With regular maintenance and timely repairs, your GE refrigerator can provide you with years of reliable operation. Find quality parts at Sears PartsDirect to keep your refrigerator operating at optimal levels. Discover tips and tricks and find the appropriate parts for your appliance by choosing the type of category from the list above, clicking the chat button, or calling 1-800-252-1698.


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I have about 10 and a half months until I turn 30... I've made some progress on the list, so I wanted to do a little recap post. I still have a lot to do... but I have some time.
I decided to repost the whole list this time along with some updates.
- Graduate from College - All set to graduate in December.
- Get a Teaching job
- Lose (at least) 50 pounds
- Quit Smoking
- Complete a 5K
Go a whole month without eating any fast food- DONE!
- Try 10 foods that I've never tried before 3 of 10
- Make at least 5 Quilts (including one for Parker and Maggie) 2 of 5
- Take the Wilton Cake Decorating Class
- Make or do at least 20 things that I've pinned on Pinterest I've done a lot of these, I just need to sit down and figure out how many of them I've done. I may already have 20, but I'm just not sure yet. I may do a post soon with Pinterest inspired projects I've done.
Watch at least 10 movies, made in the 1980s, that I haven't seen before- DONE!
- Watch the entire Sex and the City series in order (including both movies)
- Read 50 books (including 5 classics and 10 nonfiction) 6 of 50
Go to a Concert- DONE! Visit a museum- DONE! We took Parker & Maggie to Marbles Kids Museum in Raleigh, NC for one afternoon. They had a great time. I still want to go to some other museums, but for now, this one counts.
- See 3 Plays 1 of 3
- Blog every day for a whole month (including weekends)
- Write an Alphabibliography
- Organize my office
- Organize my closet
- Organize my pantry with Tupperware Modular Mates
Direct the Christmas Play at Church- DONE!
- Mail out Christmas Cards by December 1
- 10 Random Acts of Kindness
- Mail 20 cards (not including Christmas cards) 2 of 20
Upload a video of me singing in church to YouTube- DONE! I actually posted 2... Here's one of them: Have a Girl's Night with my Sister- DONE!
- Try 20 New Recipes 2 of 20
- Go on a picnic
- Take a day trip, alone, to the beach
Crystal's bookshelf: 50-books-for-thirty-before-30
So, that means I have 7 things on the list completely done... 9 in progress and a lot more to actually get done... I'm gonna be cutting it close, but I still feel like I can do all of these things before I turn the big 3-0!


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Prospective, Nonrandomized Controlled Trials to Compare the Effect of a Silk-Like Fabric to Standard Hospital Linens on the Rate of Hospital-acquired Pressure Ulcers
Hospital bedding and gowns influence skin moisture, temperature, friction, and shear, which in turn may affect the development of pressure ulcers. To evaluate the effect of a new silk-like synthetic fabric on the incidence of pressure ulcers in an acute care setting, two consecutive 6-month clinical trials were conducted among 307 consecutively admitted patients in a Medical Renal Unit (August 2008 and March 2010) and in 275 patients admitted to a Surgical Intensive Care Unit (ICU) (September 2009 to March 2010).
During the first 8 weeks, all patients used standard hospital bed linens, reusable underpads, and gowns. During the second 8 weeks, all admitted patients used the intervention linens (a silk-like fabric) followed by another 8 weeks of control (standard linen) use. Demographic variables and the prevalence of pressure ulcers on admission were statistically similar for control and intervention groups in both study populations with the exception of gender in the Renal Unit study (13% higher proportion of men in intervention group).
Average Braden Scores were also similar and low (<18) in all study patients. Upon admission to the Medical Renal Unit, 21 of 154 patients (13.6%) in the control and 26 of 153 patients (17.0%) in the intervention group had a pressure ulcer. The incidence of new ulcers was 12.3% in the control and 4.6% in the intervention group (P = 0.01); average length of stay was 5.97 days (s = 4.0) for control and 5.31 days (s = 3.8) for intervention patients (P = 0.07). In the Surgical ICU group, 18 of 199 patients in the control (9.1%) and four of 76 patients in the intervention group (5.3%) were admitted with a pressure ulcer; the incidence of new pressure ulcers was 7.5 % in the control and 0% in the intervention group (P = 0.01). Average length of stay was 4.5 days and 4.33 days in the control and intervention groups, respectively (P = 0.33). The significant differences between the control and intervention group in the rate of pressure ulcer development suggests that the type of linens used affect pressure ulcer risk and that this silk-like synthetic fabric technology may help reduce the incidence of pressure ulcers in high-risk patients. Controlled clinical studies in other patient populations are warranted.
Potential Conflicts of Interest: Ms. McPhail and Dr. Montgomery disclose they are employees of Precision Fabrics Group, Inc, Greensboro, NC, the manufacturer of the study fabric.
Whether patients are cared for at home, in hospitals, or in nursing homes, their support surfaces are typically covered by bed linens manufactured of fabrics comprised of either polyester/cotton or 100% cotton fibers.1 Patient gowns are made of similar fabrics. These cotton-blend fabrics have no special properties or performance attributes, such as moisture management or antimicrobial properties, despite the special needs of healthcare environments.2 In most healthcare facilities, bed linens and patient gowns are managed as housekeeping items.3 Although a patient's skin remains in constant contact with bedding and gown fabrics during the hospital stay, these cotton linens and gowns are not intended to be part of the therapeutic process.
The ability of a product to wick away moisture rapidly, transport moisture vapor, and dry quickly are important factors in helping fragile skin stay dry and minimize maceration.4-6 Reviews of the literature7-10 have determined that exposure of tissue to moisture from perspiration, incontinence, or wound exudate immediately increases these friction and shear forces; prolonged exposure to moisture also increases the adverse effects of friction and shear forces on tissue by further weakening the intercellular bonds in the epidermal layers, causing maceration and epidermal ulceration.
Textiles and pressure ulcer formation. A limited number of studies have specifically addressed both the effect of textile materials on skin moisture, temperature, friction, and shear for patients in healthcare settings and the possibility that textile materials could play a role in formation and prevention of pressure ulcers. Biesecker et al4 evaluated commercially available healthcare bed linens and reusable underpads to determine which biomechanical properties reduce the development of pressure ulcers. Specifically, two types of bedding (100% cotton and 50% cotton/50% polyester) and eight underpads of differing constructions were mechanically tested using an inclined plane and compared to assess their coefficient of friction (COF) when wet and dry. The COFs of wet cotton bedding and wet polyester/cotton bedding were found to be almost two times greater than dry bedding.
Another biomechanical study by Pryczynska et al5 evaluated the effects of different bed linen fabric weave patterns on frictional and moisture-management properties and how they could affect the moisture, friction, and shear forces surrounding bedbound patients. The shortcomings of traditional bedding with regard to the prevention of skin damage, such as abrasions and chafes and pressure ulcers, were discussed. Three cotton-fiber blend levels were evaluated in four weave patterns. The study verified the value of synthetic fibers, blended with cotton, in providing a smooth linen surface, as well as an embossed fabric construction to facilitate moisture drainage.
In a survey of the literature, Zhong et al6 reviewed biomechanical research related to the interactions between textile materials and human skin; specifically, the skin responses to moisture, heat transfer, and friction were discussed. The authors' findings highlighted the difficulty in relying on in vitro experiments to realistically represent the skin/fabric biomechanical system; the authors concluded the role textiles play in the formation and prevention of pressure ulcers is generally understudied, despite its potential influence on factors that contribute to skin ulceration, specifically pressure, shear/friction, and skin hydration.
Friction and fabrics. Friction is the adherent force that resists shearing of the skin, which may result in epidermal or dermal abrasion as the patient moves or is repositioned in bed. Friction and shear can occur when a patient moves or is moved across the coarse surface of a cotton bed sheet.4,11 Gerhardt11 conducted in vivo measurements to demonstrate how epidermal hydration affects friction between the skin and textile fabrics: 22 Caucasian participants (average age 31.7 years, average body mass index [BMI] 23.3) rubbed their inner forearm against a hospital fabric and a plate measuring force. Highly linear relationships between skin moisture and skin-fabric friction were found for each participant. Gerhardt also found that COFs of skin against wet cotton-polyester fabric exceeded those of skin against dry cotton-polyester fabric by a factor of more than two. In a retrospective, correlation study12,13 of 347 patients (average age 69 years, 73.5% Caucasian, 13.8% Black/African American, admitted to a medical-surgical ICU), data were collected on 65 pressure-related wounds, 20 Stage I, and 45 Stage II, Stage III, and Stage IV ulcers. Development of Stage II, Stage III, and Stage IV pressure ulcers was found to be almost six times more likely for patients with high exposure to friction and shear than in patients with low exposure.
New fabric technology. Recognizing deficiencies in the ability of cotton-blend healthcare fabrics to keep patients' skin dry and to minimize friction and shear,14 a new silk-like fabric technology manufactured by Precision Fabrics Group, Inc (Greensboro, NC) was developed for use as bed linen or bed sheets to provide a generally cleaner, drier, smoother surface than that exhibited by cotton-blend fabrics, thus minimizing friction between the skin and fabric. As seen in Figure 1, continuous-filament yarns woven into the silk-like synthetic fabric provide a smooth support surface, free of broken or discontinuous fibers. This enhanced smoothness helps minimize the potential for irritation and abrasion of sensitive skin. The silk-like fabric is a plain-weave construction of 100% continuous-filament yarns, where 100% nylon yarns are woven in one direction of the fabric, and >99% polyester yarns in the other (perpendicular) direction. The polyester yarns have a nonround fiber cross-section to create microchannels to facilitate moisture wicking and rapid drying more quickly than is possible with cotton (see Figures 2 and 3).15 This new fabric technology also incorporates a durable antimicrobial treatment to overcome cotton's inherent tendency to facilitate the growth of bacteria.16 To control growth of odor- and stain-producing bacteria and fungi, a commercially available antimicrobial agent — a quaternary ammonium compound (3-Trimethoxy silyl propyl dimethyl octadecyl ammonium chloride) — is applied to the fabric.17
The purpose of this study was to evaluate the effect of bed linens, underpads, and patient gowns made with the silk-like fabrics (hereafter referred to as the "Intervention") in reducing the development of pressure-induced wounds.
Methods and Procedures
Two prospective, nonrandomized controlled trials were conducted in succession at Moses H. Cone Memorial Hospital, Greensboro, NC from August 2008 to March 2010. The initial trial was conducted in the Medical Renal Unit from August 2008 to January 2009. Once the Medical Renal Unit trial was completed and the results were analyzed and reviewed, a decision was made to repeat the trial in a separate unit within the hospital with a different patient population similarly at risk for pressure ulcers. The second trial took place in the Surgical Intensive Care Unit (ICU) from September 2009 to March 2010. The fabric evaluated in the studies (DermaTherapy®) was developed and manufactured by Precision Fabrics Group, Inc, Greensboro, NC.
To derive an appropriate sample size for the two studies, available research involving the prevention of pressure ulcers was reviewed.18 In almost all cases, the number of participants was <100. A sample size of two times the highest sample size of the published studies — ie, approximately 200 subjects — was deemed appropriate.
Investigational Review Board (IRB) approvals for the studies were obtained from the 17-member Moses Cone Health System IRB.
Methodology. The study protocols for both trials involved three sequential sessions. During the first 8 weeks of each trial, all patients admitted to the study units who met the inclusion criteria used the control items. During the second 8-week period, all patients admitted to the study units who met the inclusion criteria used the intervention items. During the third 8-week period, all patients admitted to the study units who met the inclusion criteria used the control items. Patients whose stay in the units overlapped the control and intervention sessions were excluded from the study data — ie, patients included in the study data were either on the control or intervention items for their entire stay in the units.
Products. Control items included a conventional, usual-care hospital flat top sheet, fitted bottom sheet, pillowcase, underpad, and patient gown, all made with cotton-blend fabrics. Intervention items included a flat top sheet, fitted bottom sheet, pillowcase, underpad, and patient gown, all made with the silk-like fabric. The intervention underpad was identical to the control underpad with the exception of the top surface fabric; the layer closest to the patient's skin was comprised of the silk-like fabric. The inner "soaker" layer and moisture barrier used in the intervention underpad were the same as used in the control underpad.
Populations. The patient populations in the Medical Renal Unit and the Surgical ICU were chosen because patients had multiple comorbidities and had been identified as being at high-risk for pressure ulcer development.
Inclusion/exclusion criteria. The inclusion criteria for both trials included male or female patients of any race, admitted to the Units for a minimum of two consecutive days (48 hours). Patients who were placed on specialty beds (eg, pressure-reduction beds, bariatric beds) upon admission or during their hospital stay were excluded.
Study protocol. A convenience sampling method was used and all patients admitted or transferred to the Renal Unit who met the inclusion criteria were asked to consent to be part of the trial. As a result of the experiences and results from the Renal Unit study, no informed consent was obtained from patients in the subsequent Surgical ICU study. This deviation from the study protocol was a proved by the IRB.
Care protocol. All enrolled patients received treatment normally provided for their medical needs for the duration of the study. Standard care treatment included the appropriate use of pressure-reduction positioning, ongoing management for nutritional stability, moist wound dressings for participants admitted with a pressure ulcer, and appropriate incontinence management for all study patients.
One deviation from standard care protocols occurred in the Surgical ICU study. During the control study period, standard ICU departmental patient-care protocols were used; patients with early signs of a pressure ulcer were placed directly on mattress overlays, without the use of fitted sheets. Patients who did not exhibit early signs of a pressure ulcer remained on standard-care cotton fitted sheets. During the intervention session, the intervention fitted sheets were placed over the mattress overlays when overlays were used. No other modifications were made in the ICU standard-care protocols. This deviation in the ICU study protocol also was approved by the Investigational Review Board.
Data collection. The following variables were collected at admission and extracted from the records of all patients who participated in the two studies:
• Patient demographic data — weight, gender, age, and the medical diagnosis of each patient;
• Patient history and comorbidities, including but not limited to hypertension, anemia, diabetes, and kidney disease;
• Albumin level, a basic screening tool for monitoring protein levels and used as a part of the standard care protocol at Cone Health System. Albumin levels are an indicator of nutritional status and fluid balance. Albumin measurements below normal levels of 3.6 g/dL have been found to indicate a potential risk for pressure ulcer formation19,20;
• Braden scores, a widely used and validated assessment tool available to assess patients' risk of developing pressure wounds.21 In addition to admission assessment, the Braden Scale score was obtained on a daily basis, consistent with hospital protocol. For the purpose of this study, only admission Braden Scale scores were used. Each patient's primary nurse recorded daily skin assessments per hospital protocols.
In both studies, the primary endpoint was the development of new pressure ulcers. For patients with a pressure ulcer, computerized case report forms were used to record and monitor wound information including wound location, stage, size, wound bed color, drainage, and condition of surrounding skin. All pressure ulcers were documented and staged per National Pressure Ulcer Advisory Panel (NPUAP) guidelines by staff nurses who are educated annually on assessment and staging of pressure ulcers and use of the Braden Scale.21 Patients were otherwise provided the usual standard of care. Only data from wounds identified as Stage I through Stage IV pressure ulcers, unstageable ulcers, and deep tissue injury (DTI) wounds were collected. Other wounds, such as postoperative surgical site infections or soft-tissue infections, were not included.
Data storage. Two files were used to de-identify patient criteria and protect patient confidentiality: one included the patients' medical record numbers and was linked to the subjects' study ID numbers. This file, linking patients' medical record numbers and their study ID numbers, was maintained in a secure location within the Cone Health System, accessible only to those individuals who were authorized to view it. A second separate file, which included the data collection tool, was only linked to the subjects' study ID numbers.
Data analysis. Descriptive statistics were used to summarize all demographic, comorbidity, and outcome variables. Intervention and control group averages were compared using the t-test, assuming equal variance; for comparisons, P <0.05 was considered statistically significant.
Statistical calculations were performed using StatPlus® Professional software (v2009), AnalystSoft, Inc, Alexandria, VA.
Medical Renal Unit study. A total of 307 patients were enrolled in the study on the Medical Renal Unit. Of those, 154 were in the control and 153 in the intervention group; in the control group 59 were men and 95 were women, compared to 78 men and 75 women in the intervention group (P = 0.02). On admission, with the exception of gender, no significant differences in demographic variables (weight, age, and albumin level) were observed. The average weight of the control and the intervention patients was 80.0 Kg (s = 25.0) and 78.9 Kg (s = 20.2), respectively (P = 0.32). Average ages of the control and the intervention patients were 63.2 years (s = 14.0) and 62.5 years (s = 16.5), respectively (P = 0.23). The proportion of men in the intervention session was 13% higher than in the control group (P = 0.02), and albumin levels for control and intervention patients averaged 2.84 g/dL (s = 0.6) and 2.80 g/dL (s = 0.8), respectively (P = 0.32) (see Table 1).
The vast majority of patients had several comorbidities, including hypertension (225, 73.5%), anemia (179, 58.5%), diabetes mellitus (157, 51.3%) and renal failure (148, 48.4%), but few significant differences between patients in the control and intervention groups were observed (see Table 2). Anemia was more common in the control group, whereas drugs/alcohol and dementia were more common in the intervention group. The average total Braden score for all patients on admission was 17.1, but differences in Braden subscale and total score between control and intervention patients were small (see Table 3). Patients with Braden scores of 15 to 18 are considered at risk for developing pressure ulcers.21 Braden scores for patients in the renal study averaged 17.1 in both the control (s = 2.7) and intervention groups (s = 3.1) (P = 0.49) (see Table 3). The collective data analysis of patients at admittance indicates a good homogeneous mix in the Renal Unit Study.
On admission, the percentages of patients with pressure ulcers in the control and intervention groups were 13.6% (s = 0.3) and 17.7% (s = 0.4), respectively (P = 0.21) (see Tables 4 and 5). During the study, 19 of 154 patients (12.3%, s = 0.3) in the control and seven out of 153 patients in the intervention group (4.6%, s = 0.2) developed a pressure ulcer (P = 0.01) during an average length of stay of 5.97 days (s = 4.0) for control and 5.31 days (s = 3.8) for intervention patients (P = 0.07). At discharge from the Renal Unit, 20.1% (s = 0.4) of control patients still had a pressure ulcer, compared to 13.7% (s = 0.3) of intervention patients (P = 0.07). The average number of days between admission and pressure ulcer development was 6.8 (n = 21 wounds; s = 3.7) for control versus 7.8 (n = 8 wounds; s = 6.7) for intervention patients. The average number of pressure ulcers per patient in the control group increased from 0.188 to 0.279 (48%) between admission (s = 0.5) and discharge (s = 0.6) (P = 0.08), while the average number of pressure ulcers per patient in the intervention group decreased from 0.229 to 0.177 (23%) between admission (s = 0.6) and discharge (s = 0.5) (P = 0.19) (see Table 4).
The average number of new pressure ulcers per patient was 0.136 (s = 0.4) in the control and 0.052 (s = 0.3) in the intervention group (P = 0.01). Of those, 0.11 new Stage I pressure ulcers per patient developed in the control group (s = 0.4) for a total of 17 pressure ulcers, while 0.04 new Stage I pressure ulcers per patient for a total of six pressure ulcers developed in the intervention group (s = 0.2) (P = 0.02). Further, 10 pressure ulcers or 0.07 new Stage II and higher pressure ulcers per patient developed in the control group (s = 0.3), and three pressure ulcers or 0.02 new Stage II and higher pressure ulcers per patient developed in the intervention group (s = 0.1) (P = 0.02). Patients using the intervention linens had 36.8% fewer pressure ulcers at discharge from the Renal Unit than patients in the control group (P = 0.05), or 0.117 versus 0.279 wounds per patient, respectively. In the control group, 31 patients were discharged with 43 pressure ulcers (61.4 %) compared to 21 patients in the intervention group, who were discharged with 27 pressure ulcers (38.6 %). During the first 8-week control period, the average number of pressure ulcers per patient was 0.12 (s = 0.4). During the 8-week intervention period, the number of pressure ulcers per patient averaged 0.05 (s = 0.2). During the second 8-week control period, the number of pressure ulcers per patient averaged 0.16 (s = 0.4).
Surgical ICU study. A total of 275 patients were enrolled in the Surgical ICU study. Of those, 117 were men and 82 were women in the control group and 44 were men and 32 were women in the intervention group (P = 0.47). Average patient weight was 89.6 Kg (s = 25.6) in the control group and 88.7 Kg (s = 22.1) in the intervention group (P = 0.40). Average patient age in the control and intervention groups was 64.4 years (s = 14.9) and 65.6 years (s = 12.6), respectively (P = 0.28). Albumin levels were low but not significantly different between patient groups (average 2.63 g/dL (s = 0.7) and 2.67 g/dL (s = 0.9) (P = 0.38) (see Table 6).
The most common comorbidities were hypertension (150, 54.5%), atherosclerosis (111, 40.4%), diabetes (92, 33.5%), and pulmonary problems (88, 32.0%). Only the proportion of patients with pulmonary problems and anemia were significantly higher in the control than in the intervention group (see Table 7). The average total Braden scores were 16.2 (s = 2.8) in the control and 16.5 (s = 2.8) in the intervention group (P = 0.08) (see Table 8). The average number of pressure ulcers per patient on admission was 0.131 (s = 0.5) in the control and 0.132 (s = 0.6) in the intervention group (P = 0.50) (see Table 9).
By the end of the 24-week trial period, a total of 15 patients had developed a pressure ulcer: 7.5% of patients in the control groups developed nine Stage I and 12 Stage II or greater ulcers and 0% of patients in the intervention group developed pressure ulcers during an average length of stay of 4.58 days (s = 4.0) for control and 4.33 days (s = 4.9) for intervention patients (P = 0.33). The average number of days between admission and pressure ulcer development was 3.4 days (range = 5 days; n = 21 wounds; s = 1.6) for control versus 0 days (range = 0 days; n = 0 wounds; s = 0) for intervention patients.
The average number of new pressure ulcers per patient was 0.106 (s = 0.4) in the control and 0.0 (s = 0) in the intervention group (P = 0.02). Of those, 0.05 new Stage I pressure ulcers per patient developed in the control, while 0.0 new Stage I pressure ulcers developed in the intervention group. (P = 0.09). Further, 0.06 new Stage II and higher pressure ulcers per patient developed in the control group and 0.0 new Stage II and higher pressure ulcers developed in the intervention group. (P = 0.02). Patients using intervention had 43.4% fewer pressure ulcers at discharge from the Surgical ICU than patients in the control group (P = 0.16), or 0.186 versus 0.105 wounds per patient, respectively. In the control group, 23 patients were discharged with 37 pressure ulcers (82%) compared to four patients in the intervention group who were discharged with eight pressure ulcers (18%). During the first 8-week control period, the average number of pressure ulcers per patient was 0.13 (s = 0.4). During the 8-week intervention period, the number of pressure ulcers per patient averaged 0.0 (s = 0). During the second 8-week control period, pressure ulcers per patient averaged 0.08 (s = 0.4).
The average number of pressure ulcers per patient in the control group increased from 0.131 to 0.186 (42%) between admission (s = 0.5) and discharge (s = 0.6) (P = 0.16), while the average number of pressure ulcers per patient in the intervention group decreased from 0.132 to 0.105 (20%) between admission (s = 0.6) and discharge (s = 0.3) (P = 0.39) (see Table 9).
On admission, the percentages of patients with pressure ulcers in the control and intervention groups were 9.1% (s = 0.3) and 5.3% (s = 0.2), respectively (P = 0.15) (see Table 10). During the study, 15 of 199 patients (7.5%, s = 0.3) in the control and 0 of 76 patients in the intervention group (0%, s = 0) developed a pressure ulcer (P = 0.01). At discharge from the Surgical ICU, 11.6% (s = 0.3) of control patients still had a pressure ulcer compared to 5.3% (s = 0.2) of intervention patients (P = 0.06).
In acute care hospitals, the incidence of pressure ulcers ranges from 3% to 29.5%, with the higher rates found in critical care areas of the hospital.21 In a national prevalence/incidence study23,24 of data obtained between 1999 and 2004 in the United States, the overall number of patients who developed pressure ulcers after admission in acute care settings remained steady at 7.6%. In the current study, with the exception of 0% incidence for the intervention group in the Surgical ICU study, the overall incidence of patients with pressure ulcers ranged from 4.6% to 20.1% — within the ranges found in the literature. Further, the facility-acquired incidence for control patients in the current study in the Renal and Surgical Intensive Care Units was 12.3% and 7.5%, respectively. Although the incidence of 12.3% found in the Renal Unit study is higher than predicted for a general acute care population, it is important to note the Renal and Surgical ICUs selected for the current studies were more likely to reflect higher-than-normal incidence rates, but the direct relationship between patients with renal failure as a comorbidity and the incidence of pressure ulcers has not been well investigated. Relevant data can be found in a 2003 survey25 by the Victorian Quality Council (VQC) of 48 health services in metropolitan, rural, and regional areas, representing slightly more than 7,000 beds, conducted to better understand the incidence of pressure ulcers for a range of cohorts. In the VQC survey, patients with pressure ulcers with renal failure as a comorbidity were found to have an incidence rate of 42%. Similarly, patients in ICUs are typically bedbound, unconscious, with respiratory failure, or immobilized for substantial time periods while undergoing life support measures, which increases the risk of pressure ulcers.25 A nested case-controlled study by Baumgarten et al26 that evaluated extrinsic risk factors such as admission to an ICU determined the odds of having pressure ulcers were twice as high for persons with an ICU stay as for those without an ICU stay. Thus, the incidence rates for pressure ulcer development for control patients in the current study fall within the range associated with patients in Renal Units and ICUs as reported in the literature. However, it should be noted that the 4.6% and 0% incidence rates in the Renal Unit and Surgical ICU associated with pressure ulcer development for the intervention groups in the current study were generally below the levels reported elsewhere.
Patients were not told into which groups they had been placed, but due to the differences in product texture, the intervention items were easily distinguished from the control. Members of the nursing staff also were able to identify the intervention products, although their standards of care remained consistent throughout the study.
Due to the need to maintain segregation of control and intervention items and the logistical requirements associated with laundering, both trials were carried out in three sequential stages: 8 weeks on control items, followed by 8 weeks on intervention items, and then 8 weeks on control items. As previously stated, patients involved in the transitions from control to intervention products and intervention to control products were excluded from the analyzed data. Only patients using either the control or intervention items for their entire stay in the study units were included in the study data. This arrangement did not allow for simultaneous randomization of patients on the control and intervention products.
The effect of existing pressure ulcers as a risk factor for developing additional pressure ulcers was not examined, but baseline prevalence did not differ between the two groups.
The studies were conducted in only two hospital units. Therefore, the results were limited to two patient populations: renal and surgical ICU patients.
Multiple steps were taken in this sequential study design to minimize bias: 1) baseline risks of pressure ulcers for patients in the Intervention and Control groups were measured on a daily basis throughout both studies to ensure consistency; 2) demographic data, including weight, age, albumin levels, comorbidities, gender, and Braden scores at admittance for the before and after control and intervention groups showed no clinically significant differences affecting bias; 3) before and after control groups were included to reduce bias; 4) all groups were studied for 8 weeks with no overlap between control and intervention group subjects with regard to product use; 5) study nurses were blinded with respect to study data and trends in wound care; 6) mattresses were identical for all patients; 6) studies were sufficiently sized to detect clinically important differences in endpoints; 7) all wound stages, including Stage I wounds, were included in the study sample and the analysis; study data were analyzed with and without Stage I pressure ulcers to assess the degree of consistency in observations; and 8) patient participants were examined daily by the nursing staff to determine the presence and stage of wounds. The nursing staff used NPUAP guidelines for staging wounds, but because multiple nurses were involved in making wound assessments, bias could have occurred in interpretations of guidelines and the potential transient nature of Stage I pressure ulcers must be taken into consideration. However, any wounds in question during the study were adjudicated by an independent nursing observer.
In two separate studies involving a total of 582 patients, the therapeutic performance of silk-like synthetic bedding and patient gown products was compared with conventional cotton-blend products currently used in hospitals and healthcare facilities. In both patient care settings, the incidence of pressure ulcers was lower in patients using the intervention than those using standard hospital linens. In the Medical Renal unit, the incidence of facility-acquired pressure ulcers was 12.3% in the standard compared to 4.6% in the intervention linen group. Similarly, in the Surgical ICU, the incidence of pressure ulcers was lower in the intervention (0 %) than in the control group (7.5%). These findings indicate that state-of-the-art synthetic textile materials have the potential to reduce the development of pressure ulcers and, thereby, contribute to better healthcare outcomes for patients at risk for or who have pressure ulcers. Additional studies in other populations such as long-term care are warranted.
Dr. Coladonato is Medical Director, Medical Renal Unit, Moses H. Cone Memorial Hospital, Greensboro, NC. Ms. Smith is Vice President of Nursing, Wesley Long Community Hospital, Greensboro, NC. Ms. Watson is Assistant Director of Nursing Renal/Medical-Surgical; and Ms. Brown is Department Director-Surgical ICU-2300, Moses H. Cone Memorial Hospital. Ms. McNichol is a Clinical Nurse Specialist/WOC Nurse, Wesley Long Community Hospital. Ms. Clegg is a Nurse Practitioner, Moses H. Cone Memorial Hospital. Ms. Griffin is Director of Supply Chain Operations, Cone Health System. Ms. McPhail is a Nurse Consultant and Dr. Montgomery is a Vice President, Precision Fabrics Group, Inc, Greensboro, NC. Please address correspondence to: Terry G. Montgomery, PhD, Precision Fabrics Group, Inc, 301 North Elm Street, Suite 600, Greensboro, NC 27401; email: firstname.lastname@example.com.
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