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Heart failure (HF) is a clinical syndrome that usually develops after sufficient myocardial cell damage has occurred to impair ventricular contractility or relaxation. To maintain tissue and organ viability, the neurohumoral axis is activated. Neurohumoral activation is adaptive initially; however, with time, sustained neurohumoral activation produces symptomatic and progressive HF. There is no cure for HF, although with recent advances in treatment, prognosis can be improved, hospitalizations prevented, and quality of life enhanced. These improvements, however, are modest in most patients (Cleland et al., 2006; Koelling, Chen, Lubwama, L'Italien, & Eagle, 2004; Shahar & Lee, 2000).
Urinary Incontinence in Critically Ill Older Adults
Over 317,000 older adults fracture their hips annually ("HCUP facts and figures," 2005) and are hospitalized for medical management and surgical repair. Older adults represent 38% of discharged patients from nonfederal hospitals and have greater risks from hospitalization than younger patients (R. M. Palmer, 2006).
Pressure Ulcer Prevention and Management
The cost of pressure ulcers is high, both in terms of suffering caused to the patient and the financial burden on society and the patient (Bennett, Dealey, & Posnett, 2004; Edwards, 1994; Hopkins, Dealey, Bale, Defloor, & Worboys, 2006; Langemo, Melland, Hanson, Olson, & Hunter, 2000; Nixon et al., 2006; Thomson & Brooks, 1999). Pressure ulcer prevalence ranges from 2.3 to 28% in long-term-care facilities (Coleman, Martau, Lin, &Kramer, 2002; Lahmann, Halfens, &Dassen, 2005). Incidence figures on intensive care wards vary between 8 and 40% (National Pressure Ulcer Advisory Panel, 2001). Prevention of pressure ulcers is important from the viewpoint of the patient, care provider, and society.
Wound Healing in the Elderly
Healing wounds is a complicated process and an understanding of the normal function of the skin layers and wound-healing cascade is vital to good outcomes. As people age, changes occur to the skin layers as well as to wound-healing phases that delay or impede the healing process. Complicating the wound-healing process is the fact that a large number of hospitalized elderly will be diagnosed with one or more medical conditions that will also affect wound healing. The combination of these skin layer and wound-healing phase changes in the elderly coupled with medical conditions, including cardiac and respiratory illnesses and diabetes makes it very difficult or impossible to heal chronic wounds such as pressure, arterial, venous, and diabetic ulcers.
This chapter lists the demography of the elderly and the background and significance of wounds. A description of normal skin layers and functions along with the changes that occur as people age follows. The normal wound-healing cascade and changes that occur with the elderly population are then presented. Finally, the influences of poor tissue perfusion, malnutrition, and infection on wound healing are described.
Background and Significance
The treatment of chronic wounds costs Americans billions of dollars annually and a 10% increase in cost for the treatment of chronic wounds is projected per year (Administration on Aging, 2003). Millions of people are affected by one or more chronic wounds each year (Mustoe, O'Shaughnessy, & Kloesters, 2006; Pittmam, 2007). Pressure ulcers, venous stasis ulcers, and diabetic ulcers comprise most of the chronic wounds (Mustoe et al., 2006). The prevalence of chronic wounds is a concern. One hundred and twenty of 100,000 persons between the ages of 45 and 64, 150 of 100,00 persons between the ages of 65 and 74, and 800 of 100,000 persons over the age of 75 have a chronic wound (Pittman, 2007). Three and a half percent of the population 65 years and older have a venous stasis ulcer. The reoccurrence rate of venous stasis ulcers is approximately 70% (Hess & Kirsner, 2003). Seventeen million people have been diagnosed with diabetes. Approximately 15% of those diagnosed with diabetes will develop a diabetic ulcer (Hanft, Temar, & Williams, 2002; Hess & Kirsner). A lower extremity amputation will be necessary in 15 to 20% of those who have a diabetic ulcer and these numbers are predicted to increase as more people are diagnosed with diabetes (Hanft et al.; Hess & Kirsner).
The most common ulcer to occur in the critical care elder is pressure ulcers. The National Pressure Ulcer Advisory Panel (NPUAP) suggests incidence rates of hospitalacquired pressure ulcers range within 0.4 to 38% (NPUAP, 2001). However, the higher incidence rates of 20 to 38% are found in the critical care areas of the hospital. These elders are most vulnerable because of their comorbid conditions. Moreover, there is ample evidence to suggest these ulcers occur very early (within 72 hours) during the critical care stay. The NPUAP suggests that mortality rates are as high as 60% for elders with pressure ulcers within 1 year of hospital discharge. It should be noted that the ulcer may not cause the demise of the elder, but rather is an indicator of the decline in health status posthospitalization.
The prevalence of facility-acquired pressure ulcers reported by the NPUAP in acute-care facilities ranges from 10 to 18%. Patients over the age of 70 account for 70% of hospital-acquired pressure ulcers (Thomas, 2001). Estimated costs of treating patients with pressure ulcers in 2004 dollars are $9.1 to $11.6 billon annually (Zulkowski, Langemo, Posthauer, & NPUAP, 2005. Treatment cost per pressure ulcer was $20,900 to $151,700 dollars (Zulkowski et al.). As of October 1, 2008, the Centers for Medicare and Medicaid Services will no longer pay for any hospital-acquired stage III or stage IV pressure ulcer. Thus, it will be imperative for hospitals to identify and heal these ulcers early in their development.
Skin Layers and Function
The skin is the body's largest organ; it forms a protective barrier from the external environment and at the same time maintains internal homeostasis (Wysocki, 2007). The thickness of skin varies from 0.5 mm to 6 mm (Wysocki). Skin weighs approximately 6 pounds or is equal to 15% of the entire body mass for an adult (Wysocki). The skin has several functions, including: (a) protection against pathogens, (b) protection against trauma, (c) protection against ultraviolet radiation, (d) thermoregulation, (e) skin immune system, (f) sensation, (g) metabolism of vitamin D, (h) communication, (i) regeneration of new skin cells, (j) elimination of waste products, and (k) expression
of emotions (Allwood & Curry, 2000; Doughty & Sparks-DeFriese, 2007; Langemo & Brown, 2006). The skin is divided into three main layers known as the epidermis, dermis, and subcutaneous. The epidermis and dermis layers are separated by the basement membrane.
The epidermis is avascular and receives oxygen and nourishment by diffusion. Langerhans cells are found in the epidermis and are responsible for identification, uptake, development, arrangement of soluble antigens, and sensitization of T lymphocytes (Wysocki, 2007). The epidermis contains glucose, carbohydrates, and enzymes for energy (Allwood & Curry, 2000). The body's ability to access this energy is crucial to wound healing. The epidermis contains five layers, including: (a) stratum corneum, (b) stratum lucidum, (c) stratum granulosum, (d) stratum spinosum, and (e) stratum germinativum (Allwood & Curry; Wysocki). The description and function of the epidermis layers are listed in Table.1 (Allwood & Curry; Wysocki).
Table·1 Functions of the Epidermis Layers
Epidermis Layers
Description and Function
Stratum corneum
Top layer (.02 mm to .5 mm) Composed of dead keratinocytes Flat cells without nuclei Cells shed continually Cells consist of keratin (a tough, fibrous, insoluable protein) Protects from external stimulus entering the body Averts water loss
Stratum lucidum
Established in thick epidermis of the palms of the hands and soles of the feet One to five cells deep Transparent layer Cells are nonviable Consists of prekeratin filament and protein Protects from friction by the toughness of the layer
Stratum granulosum
Granular layer One to five cells deep Diamond shaped not flattened Contains proteins to help organize the keratin filament
Stratum spinosum
Spinous layer Contains the desmosome, which is a cell–cell junction Polyhedral Produces involucrin (precursor to cornified envelopes) Contains new keratin filaments
Stratum germinativum
Basal layer
Single layer of basal keratinocytes Respond to extracellular matrix, growth factors, hormones, and vitamins As cells leave the basal layer differentiation begins Consists of Rete ridges that assist in the adherence of the epidermis to the dermis Melanocytes for skin pigmentation
The dermis layer is the thickest part of the skin ranging from 2 mm to 4 mm deep (Wysocki, 2007). The dermis contains cells, nerves, skin appendages, and blood vessels. The dermis layer is divided into two layers known as the papillary dermis and reticular layer. The papillary dermis is responsible for the nourishment and oxygenation of the viable cells of the epidermis (Allwood & Curry, 2000; Wysocki). The reticular layer contains hair follicles, nerve sensory endings, sweat glands, and sebaceous glands. The reticular layer of the dermis is accountable for the skin's sturdiness and strength (Allwood & Curry).
Two primary proteins found in the dermis are collagen and elastin. Collagen is a structural protein that is matured by secreted tropocollagen from dermal fibroblasts and an extracellular course (Allwood & Curry, 2000; Wysocki, 2007). The dermis consists of type I fiber-forming collagen, which provides the skin's tensile strength (Wysocki). Elastin is a protein that is fiber forming, which provides elastic recoil to the skin (Allwood & Curry; Wysocki). Elastin forms structures similar to a coil or spring that can be stretched and returned to its original shape (Wysocki).
Three main cell types found in the dermis are fibroblasts, macrophages, and mast cells. Their functions are listed in Table.2 (Allwood & Curry; Wysocki).
The subcutaneous layer contains loose connective tissue. This layer connects the dermis to the muscle (Allwood & Curry, 2000). This layer provides vascularization, insulation, energy stores, mobility of the skin, and cushioning for underlying structures (Wysocki, 2007).
Table·2 Cell Type and Function
Cell Type
· Most abundant cell
· Forms connective tissue
· Secretes growth factors
· Derived from tissue monocytes from bone marrow precursor cells
· Most important cell due to their adaptability
· Secrete growth factors, cytokines, and immune molecules
· Antibacterial effects
· Coagulation
· Angiogenesis
· Tissue remodeling
· Phagocytosis of debris and foreign bodies
· Vital in reabsorption and recycling of tissue and their components
· Participate in immune response
· Critical in wound healing
Mast cell
· Found surrounding vascular connective tissue
· Mainly in the papillary layer and subcutaneous tissue
· Secrete proteins
· Responsible for the release of histamines with injury, infection, and exposure to allergens
· Numerous in subacute and chronic inflammatory diseases
· Phagocytosis
Skin Layer Function Changes in the Elderly
All three of the skin layers are present as people age but changes occur within these layers that affect wound healing. The changes to the epidermis, dermis, and subcutaneous layer begin in the third decade of life and these changes continue over many years (Allwood & Curry, 2000; Doughty & Sparks-DeFriese, 2007). Some of these changes are visible in the second decade of life as a result of excessive exposure to sunlight (Montagna & Carlisle, 1979). Major changes are evident at approximately 70 years old (Doughty &Sparks-DeFriese). The epidermal and dermal junction flattens, which increases shear-injury risk (Pittman, 2007). Changes that occur within the three skin layers are described in Table.3 (Allwood & Curry; Baranoski, 2001; Gosain & DiPietro, 2004; Doughty & Sparks-DeFriese; Johnson, 1996; Montagna & Carlisle; Pittman; Roberts, 2007; Vohra & McCollum, 1994; Witkowski & Parish, 2000).
Repair Mechanisms
Repair occurs by two different mechanisms. The first mechanism is regeneration, which is tissue repair. The second mechanism is scar tissue formation or connective tissue repair. The mechanism for repair depends on the depth of the tissue damage. Partial thickness, which involves the epidermis and dermis layers, heals by regeneration. Full thickness, which extends past the dermis layer, heals by connective tissue repair.
Table·3 Skin Changes in the Elderly
Layer Changes
Epidermal layer
· Epidermal turnover time increases, which delays wound healing time
· The barrier protection function is deceased, which increases the risk for irritation and breakdown of the skin
· A decrease in the amount of Langerhans cell production increases the risk of cancer and infection
· A decrease in Langerhans cell production decreases immunity properties of the skin
· Melanocytes are decreased as well as an abnormal production of melanocytes, which decrease protection against ultraviolet radiation Reduction in sensation, which increases the risk for trauma and injury
Dermal layer
· Dermis decreases in thickness and appears flatter and thinner
· Decrease in the number of sweat glands: hypothermia and heat stoke are more likely
· Decreased vascular components, approximately 35% of vertical capillary loops
· Blood vessels are more pronounced
· Skin elasticity decreases, which is related to age and sun damage
· Collagen appears to be unwinding and elastin appears to be lysing
· Wrinkling and sagging occur
· Decreased skin turgor is apparent
· Structure is irregularly shaped
· Dehydration of skin
· Decreased macrophage production
· Decreased inflammatory response
· Decrease in mast cells and melanocytes, which affects allergic reactions
· Healing time is delayed
· Bruising and purpura are evident
· Decreased amount of subcutaneous fat layer
· Decrease in thermoregulation
· Decreased insulation to extremities
· Decreased skin fold breadth
Normal Wound-Healing Cascade
The normal wound-healing cascade is a complex process that is activated the instant damage occurs to the skin. Knowledge of normal wound-healing phases is essential for the clinician in order to understand the changes that occur as people age. The normal wound-healing cascade and the cell functions will be described in the following sections.
Some literature combines the vascular response and inflammatory phase because homeostasis occurs simultaneously with the inflammatory phase (Ayello et al., 2004). Homeostasis is achieved when vasoconstriction of the blood vessels occurs and platelets arrive at the wound. A blood clot is formed by the platelets to hinder blood loss Hess & Kirsner, 2003). Blood clotting is started by commencement of a proteolytic cascade that produces thrombin and fibrin (Knighton, Fiegel, Doucette, Fylling, & Cerra, 1989; Shultz & Mast, 1998). Thrombin works together with platelets to create alpha granule release of platelet growth factors (Knighton et al.). Fibrin creates the blood clot, which consists of fibrin, red blood cells, and platelets (Knighton et al., Shultz & Mast). The blood clot is a new matrix that seals the wound and protects it from bacterial invasion and water loss (Mast & Schultz, 1996). Following this initial response, vasodilatation and increased capillary permeability occur, which causes leakage of plasma (Ayello et al., Schultz et al., 2003).
Platelet degranulation provides the first signals to begin the wound-healing cascade. Alpha granule of the platelets contain growth factors, which are: (a) platelet derived growth factors (PDGF), (b) insulin-like growth factor-1 (IGF-1), (c) epidermal growth factors (EGF), (d) fibroblast growth factor (FGF), and (e) transforming growth factor-Β (TGF-Β) (Schultz et al., 2003). These growth factors are released from platelets and leave the wound, migrating into the surrounding tissue and blood vessels (Mast & Schultz, 1996). Growth factors release signals to inflammatory cells as a response to injured cells (Hess & Kirsner, 2003). Growth factors stimulate production, movement, and delineation of wound cells that include epithelial cells, fibroblasts, and endothelial cells (Ayello et al., 2004). This begins the inflammatory phase of wound healing, which is catabolic. Growth factors and functions are described in Table.4 (Morykwas & Argenta, 1997; Okan, Woo, Ayello, & Sibbald, 2007; Woo, Ayello, & Sibbald, 2007).
Growth Factors and Functions
Growth Factors
Platelet derived growth factors (PDGF)
Derived from platelets, fibroblasts, keratinocytes, and macrophages
· Deposition of extracellular matrix
· Angiogenesis
· Fibroblast and immune cell initiation
· Increases collagen synthesis
· Increases TIMP synthesis
· Decreases MMP synthesis
Insulin-like growthfactor-1 (IGF-1)
Derived from fibroblasts, neutrophils and macrophages
· Stimulation of keratinocytes and fibroblasts
· Initiation of endothelial cell
· Angiogenesis
· Collagen synthesis
· Deposition of extracellular matrix
· Metabolism of cells
Epidermal growth factors (EGF)
Derived from fibroblasts, keratinocytes and macrophages
· Stimulation and movement of keratinocytes
· Deposition of extracellular matrix
Fibroblast growth factor (FGF)
Derived from fibroblasts, endothelial cells, and macrophages
· Deposition of extracellular matrix
· Angiogenesis
· Initiation of endothelial cell
· Stimulation and movement of keratinocytes
Transforming growth factor-B (TGF-Β)
Derived from platelets, fibroblasts, and macrophages
· Chemoattractant to fibroblasts
· Deposition of extracellular matrix
· Increases collagen synthesis
· Increases TIMP synthesis
· Decreases MMP synthesis
Inflammatory Phase
The first cells to arrive to the wound and initiate phagocytosis are polymorphonuclear neutrophils (PMN) (Hess & Kirsner, 2003). These are blood-borne cells that protect the host from bacteria and infection. Neutrophils release tumor necrosis factor-a (TNFa) and interleukins IL-2 and Il-4, which are proinflammatory cytokines that work at the site of injury (Mast & Schultz, 1996). Neutrophils also release matrix metalloproteinase eight (MMP-8), which consists of neutrophil elastase and neutrophil collagenase (Schultz & Mast, 1998). The purpose of MMP-8 is to remove the damaged extracellular matrix, which is replaced with new extracellular matrix (Schultz & Mast). This action allows for the wound-healing cascade to continue in a proper sequence. The number of neutrophils present decreases dramatically within 72 hours after the initial injury has occurred.
Monocytes are crucial in the inflammatory phase. Monocytes are blood-borne cells that are attracted to the wound by complement-derived peptides (C5a), degradation products from fibronectin, and TGF-Β (Knighton et al., 1989). Monocytes mature into macrophages within 24 to 48 hours after the injury has occurred (Hess & Kirsner, 2003; Knighton et al.).
Macrophages are considered the most important of the wound cells because they are involved in all phases of wound healing (Frenkel et al., 2002). Macrophages replace neutrophils in the wound and are responsible for several actions during the inflammatory phase. They initiate phagocytosis, which breaks down dead cells and the damaged matrix (Hess & Kirsner, 2003). Macrophages are bactericidal and promote angiogenesis (Ayello et al., 2004).
Macrophages secrete more growth factors and signal for additional macrophages and monocytes to respond to the wound as a result of their chemoattractant properties (Schultz et al., 2003). Macrophages secrete proinflammatory cytokines that attract inflammatory cells into the wound from the surrounding blood vessels (Frenkel et al., 2002). The proinflammatory cytokines are TNF-a ´ and interleukins IL-1, IL-6, and IL-8. IL-1 and TNF-a ´ rouse vascular endothelial cells to express cell bonding (Schultz & Mast, 1998). The IL-1 and TNF-a ´ are mitogenic with fibroblasts, MMP expression is up regulated, and tissue inhibitors of metalloproteinases (TIMPs) are down regulated (Schultz & Mast). The vascular cells construct IL-8 as a response to IL-1 and TNF-a ´ to express cell bonding on the inflammatory cells (Schultz & Mast). IL-6 is responsible for fibroblast production and protein synthesis (Schultz et al., 2003). Amino acids and sugars are converted from macromolecules by macrophages for wound healing (Hess & Kirsner, 2003).
Mast cells are derived from the dermis. One function of these cells is local inflammation, which increases the sensation of pain. Another function of the mast cell is to increase vascular permeability. Histamines, prostaglandins, leukotrienes, and enzymes are released by mast cells.
Proliferative Phase
The next phase of wound healing is the proliferative phase or the connective tissue phase, which is anabolic. This phase can last for several weeks (Hess & Kirsner, 2003). During the proliferative phase, the number of inflammatory cells decreases and is replaced by fibroblasts, endothelial cells, and keratinocytes (Ayello et al., 2004). Macrophages are mediators for the initiation of the proliferative phase (Frenkel et al., 2001). The proliferative phase is initiated by the stimulation of the movement of fibroblasts, epithelial cells, and vascular endothelial cells to begin the healing of the wound by the formation of granulation tissue (Schultz et al., 2003). Cell movement and production persist as a temporary matrix is created, which contains fibrin and fibronectin (Ayello et al.; Schultz et al.). Granulation tissue replaces the temporary matrix as it fills the wound cavity. Granulation tissue provides a moist surface for cell migration. A decrease in wound dimension occurs as the wound edges contract together, lessening the wound-surface dimension as the wound fills with granulation tissue. Granulation tissue is vastly vascular and damage to this tissue occurs easily. Granulation tissue contains fibroblasts, keratinocytes, macrophages, immature collagen, endothelial cells, and new blood vessels (Hess & Kirsner, 2003).
Approximately 5 days after injury fibroblasts arrive to the wound. Fibroblasts secrete PDGF, IGF-1, bFGF, TGF-a , and keratinocyte growth factor (KGF). Fibroblasts stimulate production of cells, creation of extracellular proteins, and formation of new blood vessels (Ayello et al., 2004; Schultz & Mast, 1998). Fibroblasts produce and release collagen, a major connective tissue protein, as well as elastin and proteoglycans molecules (Ayello et al.). Fibroblasts initiate the production of collagen, which gives the tissue strength and composition (Hess & Kirsner, 2003). Fibroblasts do not perform phagocytosis so dead cells and a damaged matrix impede the migration of these cells.
Keratinocytes are the main cells of the epidermal layer and travel from the wound edges for epithelialization (Hess & Kirsner, 2003; Woo et al., 2007). Epithelialization is the last step in the proliferative phase. Keratinocytes form scar tissue as they travel and reproduce across the wound bed only with the existence of healthy granulation tissue (Hess & Kirsner). Growth factors and cytokines synthesized by keratinocytes are TGF-a ˆ , TNF-a ´ , and Il-1/A, which stimulate cell production, extracellular protein formation, and angiogenesis (Mast & Schultz, 1996). Keratinocyte's five main functions are to (a) assist with proliferation of cells, (b) attract other cells to the wound, (c) provide antibacterial properties, (d) initiate epithelialization, and (e) signal transduction activity (Woo et al., 2007).
Endothelial cells promote development of new blood vessels quickly, which are necessary for nutrition for the new tissue. These cells stimulate fibrinolysis, breaking down the temporary matrix so fibroblast movement and collagen synthesis can occur. The growth factors synthesized by endothelial cells are vascular endothelial growth factors (VEGF), bFGF and PDGF (Mast & Schultz, 1996).
Maturation Phase
The final phase is the maturation phase or the remodeling phase. This phase can take months to years and is catabolic. Collagen fibers are the main substance in the wound and fiber collection increases creating a thick collagenous arrangement. Fibroblasts, MMPs, TIMPs, and TGF are vital to organizing, remodeling, and maturing the collagen fibers (Hess & Kirsner, 2003). Fibroblasts stimulate production of collagen, elastin, proteoglycans, MMPs, and TIMPs (Mast & Schultz, 1996). This action persists until the tensile strength of scar tissue is approximately 80% of normal tissue (Hess & Kirsner). Apoptosis or programmed cell death decreases fibroblast and capillary density (Ayello et al., 2004). Scar tissue decreases and the appearance of the scar tissue becomes less red and flat over time (Ayello et al.). This is known as the remodeling of the scar.
Wound Healing Alterations in Animal Models
Ashcroft, Horan, andFerguson (1997)
Rate of healing is dependent on the cause, depth, and site of injury
Absence or presence of comorbidities affects wound healing Age-related changes were noted in the rate and quality of wound healing
A delay in inflammatory response was noted due to monocytes/macrophage and B-lymphocyte migration
Decrease in the number of cytokines released or a damaged migration response
Decreased action of macrophages Decrease in plasma fibronectin, which could affect attachment and migration of cells A delay of epithelialization was observed
Quirinia and Viidik (1991)
Ischemia affects wound healing more significantly in older rats then younger rats
Repair of vascular components should be a priority intervention Ischemia is more harmful during the beginning stages of wound healing Ischemic wounds are more susceptible to infections that impair the inflammatory phase
Swift, Burns, Gray, andDiPietro (2001)
Neutrophil migration was unchanged in excisional wounds but macrophagemigration was significant
Increase in the number of macrophages but the action of the macrophages was decreased
A reduction in phagocytosis as well as the amount of damaged matrix that was affected
Reduction of signaling from cell surface Macrophage secretion of VEGF for angiogenesis was reduced T-cell migration is delayed as well as altered actions of the cells Inflammatory and proliferative responses are significantly reduced with chemokine-production alterations
Wound-Healing Cascade Changes in the Older Adult
Changes in the rate of healing time have been reported in the literature among the fetus, children, adults, and the elderly (Stotts & Wipke-Tevis, 2001). The woundhealing process is greatly affected when elders have one or more medical conditions.
As a person ages, wounds heal slower as well as become chronic because of a delayed inflammatory phase when one or more chronic diseases are present (Stotts & WipkeTevis). This can be attributed to changes within the wound-healing cascade as well as the influence of chronic disease and medications that affect tissue perfusion (Gusenoff, Redett, &Nahabedian, 2002; Langemo &Brown, 2006; Stotts &Wipke-Tevis). Malnutrition and infection contribute to impeded wound healing in the elderly (Gusenoff et al.; Stotts & Wipke-Tevis).
Wound-healing studies are limited with human subjects for ethical reasons. Researchers have established that changes occur during the wound-healing cascade, which include (a) an increase of adherence of the platelets to the endothelium; (b) increase of the release of alpha-granules by platelets; (c) a decreased amount of nitric acid by endothelial cells; (d) a decrease of neutrophils; (e) decrease in the response from keratinocytes, fibroblasts, and endothelial cells; and (f) a decrease in collagen (Allwood & Curry, 2000; Doughty & Sparks-DeFriese, 2007). The existence of a direct correlation between animal models and human models is unknown (Swift, Burns, Gray, & DiPietro, 2001). However, three studies using animal models describe changes that occur within the wound-healing cascade, these are described in Table.5 (Ashcroft, Horan, & Ferguson, 1997; Quirinia & Viidik, 1991; Swift et al.). Other researchers have observed that injecting activated monocytes/macrophages into wounds increases the healing rate of pressure ulcers in the elderly and spinal cord injured (Frenkel et al., 2001, 2002).
The most important factor in aiding the wound-healing process in elders in critical care is increasing tissue perfusion. This can be incredibly challenging for critically ill elders who have hemodynamic challenges. The wound cannot heal without sufficient blood supply. Intrinsic factors such as anemia, diabetes, cardiovascular disease, hypotension, chronic obstructive pulmonary disease, low blood protein levels, high temperature, and smoking can increase demand for oxygen and the metabolic rate (Doughty & Sparks-DeFriese, 2007; Grey, Harding & Enoch, 2006; Stotts & Wipke-Tevis, 2001). Severe anemia affects tissue perfusion, which decreases the oxygen transportation capability of the blood (Langemo & Brown, 2006; Phillips, 1999; Stotts & Wipke-Tevis). Macrovascular and microvascular changes in the circulatory system in diabetic patients reduce tissue perfusion (Baranoski, 2006; Phillips, 1999). Patients with cardiovascular disease who have low ejection fractions have a reduction in tissue perfusion and low capillary closing (Calianno, 2000). An elevation of 1 degree in body temperature increases oxygen demand and metabolic rate by 10% (Andrychuk, 1998).
Oxygen requirements vary depending on the wound-healing phase. The inflammatory phase has the highest requirement (Doughty & Sparks-DeFriese, 2007). Bactericidal activity is more effective with higher oxygen levels (Doughty & Sparks-DeFriese). Improved collagen synthesis and tensile strength are reported with higher levels of oxygen (Doughty & Sparks-DeFriese). The proliferative phase requires lower oxygen levels (Doughty & Sparks-DeFriese). A degree of hypoxia in the wound can enhance angiogenesis (Doughty & Sparks-DeFriese).
Certain medications that are prescribed to treat chronic diseases can affect the skin layers and wound-healing cascade (Doughty &Sparks-DeFriese, 2005). Corticosteroids impede regeneration of the epidermis and collagen synthesis (Allwood & Curry, 2000; Baranoski, 2006; Tashkin, Murray, Skeans, & Murray, 2004; Torres & Stadelmann, 2006). Antibiotics, corticosteroids, and hormones can change the skin's protective barrier function. The inflammatory response is affected by other medications such as analgesics, antihistamines, and nonsteroidal antiinflammatory agents (Doughty & Sparks-DeFriese). Antihypertension, vasoactive medications and diuretics may cause hypotension and dehydration of the skin (Andrychuk, 1998). Chemotherapy medications may interrupt the cell cycle and production of cells (Andrychuk).
Malnutrition and a lack of hydration impede wound healing (Cutting & Cardiff, 1994; Ratliff & Bryant, 2004; Stotts & Wipke-Tevis, 2001). Low protein serum levels are linked with delayed wound healing (Calianno, 2000; Grey et al., 2006). Collagen synthesis is reduced with low blood protein levels so tissue is thinner, which impedes wound healing (Phillips, 1999; Torres & Stadelmann, 2006). Functions of protein include reproduction of cells, construction of antibodies, alteration of the wound, creation of blood vessels, and promotion of collagen synthesis (Andrychuk, 1998). Adequate intake of protein, calories, fat, vitamins, and minerals are vital for suitable nutrition for wound healing (Stechmiller, 2003; Stotts & Wipke-Tevis, 2001). Dehydration is also correlated with wound healing because of drying of the skin (Posthauer, 2006).
Bacteria from surrounding skin contaminate the wound within 24 hours (Mustoe et al., 2006). High levels of bacteria in wounds can delay or impede wound healing (Cutting & Cardiff, 1994; Ovington, 2001). Chronic wounds are contaminated with bacteria (McGuckin, Goldman, Bolton, & Salcido, 2003; Ovington, 2002). Patients can present with fevers; tachycardia, hypotension, delirium, leukocytosis, or high glucose levels, which affect tissue perfusion and oxygen demands (McGuckin et al.). High quantities of bacteria are found in chronic wounds, which result in a prolonged inflammatory phases (Dow, Browne, & Sibbald, 1999). Inflammatory cells are constantly released, neutrophils continue to migrate to the wound, and thrombosis and vasoconstriction persist (Dow et al.; Falanga, 2002). A reduction in oxygen in a wound results in production of bacteria, damage of tissue, and reduction of platelets (Dow et al). Infected wounds have increased drainage, which alters the production and function of wound cells (Falanga). Extracellular matrix proteins are damaged by proteases that are found in the exudate (Falanga). Copious amounts of drainage can affect growth factors as well as fibroblasts and keratinocytes, which are necessary for wound healing (Falanga).
The management principles to consider in healing wounds in critical care are multifactorial. Thus, you have to understand the unique needs of the critically ill older adult. Assessing the patient as a whole and not simply the whole in the patient is critical. However, several management principles should be considered in wound healing in older adults (Brem & Lyder, 2004). The use of support surfaces to offload pressure (alternating air mattresses, low-air-loss mattresses or air-fluidized mattresses) is critical. Further, the use of frequent turning (every 1 to 2 hours) is beneficial. The removal of debris and/or necrotic tissue in the wound bed, as this may lead to wound infection is necessary. If infection is noted, it is imperative to use silver dressings or to implement IV antibiotics. The use of cleansing solutions or debridement may be very helpful in removing wound debris and/or necrotic tissue. Meeting the nutritional requirements for the critically ill older adults is important as wounds heal with a positive nitrogen balance. If too much protein is lost healing will be delayed as low protein stores lead to negative nitrogen balance, which will further delay healing. Finally, the principle of moist wound healing should be employed. Wounds heal faster when they are moist. Too much exudate may macerate surrounding tissue and if the wound is too dry, granulation tissue will not proliferate.
Figure. 1
Deep tissue injury pressure ulcer.
Assessment of the pressure ulcer in the intensive care unit revealed a 5 cm x 5 cm x 0 cm ulcer with a thick yellow brown necrotic area. There was no odor or drainage. The edges were not demarcated. The periulcer tissue was indurated with erythema
Initial treatment included chemical and sharp debridement of thick yellow brown tissue. Bone was revealed in the base of the wound and osteomyelitis was diagnosed. The tissue in the base of the wound was pale pink with edema. Negative pressure wound therapy was started with silver foam dressing once the necrotic tissue was removed and antibiotic therapy was initiated. Patient had a myocutaneous flap placed 2 weeks later.
The patient was unable to receive his heart transplant until the sacral pressure ulcer healed. He eventually received the heart transplant and was discharged home.
Figure·2 Stage IV pressure ulcer.
Wound healing is a complex process that is affected as people age. Researchers have shown that changes occur within the skin layers and wound-healing cascade that can slow the healing process. These changes can be complicated by chronic disease, medications, nutrition, and infection, which makes it very difficult or impossible to heal chronic wounds such as pressure, arterial, venous, and diabetic ulcers. It is critical for clinicians caring for critically ill older adults to understand the wound-healing processes to optimize treatment.
Administration on Aging. (2003). U.S. Department of Health and Human Services. A profile of older Americans: 2003. Retrieved May, 10, 2008, from http://www.infectioncontroltoday.com
Andrychuk, M. (1998). Pressure ulcers: Causes, risk factors, assessment, and intervention. Orthopaedic Nursing, 4, 65–81.
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Ashcroft, G., Horan, M., & Ferguson, M. (1997). Aging is associated with reduced deposition of specific extracellular matrix components, an upregulation of angiogenesis, and an altered inflammatory response in a murine incisional wound healing model. Journal of Investigative Dermatology, 108(4), 430–437.
Ayello, E., Dowsett, C., Schultz, G., Sibbald, R., Falanga, V., Harding, K., et al. (2004). Time heals all wounds. Nursing 2004, 34(4), 36–42.
Baranoski, S. (2001). Skin tears: Guard against this enemy of frail skin. Nursing Management, 32(8), 25–32.
Baranoski, S. (2006). Raising awareness of pressure ulcer prevention and treatment. Advances in Skin and Wound Care, 19, 398–407.
Brem, H., & Lyder, C. (2004). Protocol for successful treatment of pressure ulcers. American Journal of Surgery, 188, 9–17.
Calianno, C. (2000). Assessing and preventing pressure ulcers. Advances in Skin & Wound Care, 13(5), 244–246. Cutting, K., & Cardiff, K. (1994). Criteria for identifying wound infection. Journal of Wound Care, 3(4), 198–201.
Doughty, D., & Sparks-DeFriese B. (2007). Wound-healing physiology. In R, Bryant & D. Nix (Eds.), Acute and chronic wounds: Current management concepts (3rd ed., 56–81). St. Louis: Mosby.
Dow, G., Browne, A., & Sibbald, R. (1999). Infection in chronic wounds: Controversies in diagnosis and treatment. Ostomy Wound Management, 45(8), 23–40.
Falanga, V. (2002). Wound bed preparation and the role of enzymes: A case for multiple actions of therapeutic agents. Wounds: A Compendium of Clinical Research and Practice, 14(2), 47–57.
Frenkel, O., Shani, E., Ben-Bassat, I., Brok-Simoni, F., Rozenfeld-Granot, G., Kajakaro, G., et al. (2002) Activated macrophages for treating skin ulceration: Gene expression in human monocytes after hypo-osmotic shock. Clinical and Experimental Immunology, 128, 59–66.
Frenkel, O., Shani, E., Ben-Bassat, I., Brok-Simoni, F., Shinar, E., & Danon, D. (2001). Activation of human monocytes/macrophages by hypo-osmotic shock. Clinical and Experimental Immunology, 124, 103–119.
Gosain, A., & DiPietro, L. (2004, Feb.). Aging and wound healing. World Journal of Surgery (online journal).
Grey, J., Harding, K., & Enoch, S. (2006). ABC of wound healing: Pressure ulcers. British Medical Journal, 332(4), 472–475.
Gusenoff, J., Redett, R., & Nahabedian, M. (2002). Outcomes for surgical coverage of pressure sores in nonambulatory, nonparaplegic, elderly patients. Annals of Plastic Surgery, 48(6), 633–640.
Hanft, J., Temar, K., & Williams, A. (2002). Indirect benefits of tissue replacements justify costs. Bio Mechanics, IX (12).
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Langemo, D., & Brown, G. (2006). Skin fails too: Acute, chronic, and end-stage skin failure. Advances in Skin & Wound Care, 19(4), 206–212.
Mast, B., & Schultz, G. (1996). Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Repair and Regeneration, 4, 411–420.
McGuckin, M., Goldman, R., Bolton, L., & Salcido, R. (2003). The clinical relevance of microbiology in acute and chronic wounds. Advances In Skin & Wound Care, 16, 12–25
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Morykwas, M., & Argenta, L. (1997). Nonsurgical modalities to enhance healing and care of soft tissue wounds. Journal of the Southern Orthopaedic Association, 6(4), 279–288.
Mustoe, T., O'Shaughnessy, K., & Kloeters, O. (2006). Chronic wound pathogenesis and current treatment strategies: A unifying hypothesis. Plastic and Reconstructive Surgery, 117 (7S), 35S–41S.
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Okan, D., Woo, K., Ayello, E., & Sibbald, R. (2007). The role of moisture balance in wound healing. Advances In Skin & Wound Care, 20, 39–53.
Ovington, L. (2001) Battling bacteria in wound care. Home Heath Care Nurse, 19(10), 622–630.
Ovington, L. (2002) Dealing with drainage: The what, why, and how of wound exudate. Home Heath Care Nurse, 20(6), 368–374.
Phillips, L. (1999). Pressure ulcers—Prevention and treatment guidelines. Nursing Standard, 14(12), 56–62.
Pittman, J. (2007). Effect of aging on wound healing: Current concepts. Journal of Wound, Ostomy, Continence Nursing, 34(4), 412–417.
Posthauer, M. (2006). Hydration: Does it play a role in wound healing? Advances in Skin & Wound Care, 19(2), 97–102.
Quirinia, A., & Viidik, A. (1991). The influence of age on the healing of normal and ischemic incisional skin wounds. Mechanisms of Aging and Development, 58, 221–232.
Ratliff, C., & Bryant, D. (2004). Preemptive strike: Use new WOCN guideline to prevent wounds. SUCCESS in Home Care, 3, 20–24.
Roberts, M. (2007). Preventing and managing skin tears: A review. Journal of Wound, Ostomy and Continence Nursing, 34(3), 256–259.
Shultz, G., & Mast, B. (1998). Molecular analysis of the environment of healing and chronic wounds: Cytokines, proteases, and growth factors. Wounds: A Compendium of Clinical Research and Practice, 10(Suppl. F), 1F–9F.
Schultz, G., Sibbald, R., Falanga, V., Ayello, E., Dowsett, C., Harding, K., et al. (2003). Wound bed preparation: Asystemic approach to wound management. Wound Repair and Regeneration, 11, 1–28.
Stechmiller, J. (2003). Early nutritional screening of older adults: Review of nutritional support. Journal of Infusion Medicine, 26(3), 170–177.
Stotts, N., & Wipke-Tevis, D. (2001). Co-factors in impaired wound healing. In D. Krasner, G, Rodeheaver, & G. Sibbald (Eds.), Chronic wound care: A clinical source book for healthcare professionals (3rd ed., pp. 265–272). Malvern, PA: HMP Communications.
Swift, M., Burns, A., Gray, K., & DiPietro, L. (2001). Age-related alterations in the inflammatory response to dermal injury. Journal of Investigative Dermatology, 117(5), 1027–1035.
Tashkin, D., Murray, E., Skeans, M., & Murray, R. (2004). Skin manifestation of inhaled corticosteroids in COPD patients: Results from Lung Health Study II. Chest 2004, 126(4), 1123–1133.
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Diamond Bar Wedding | Jessie + Danielle
Congratulations to Jessie and Danielle, who started the new year off with a kiss and I do. Danielle, who traveled from her hometown of Idaho, looked amazing for her beautiful So Cal wedding.
Jessie met Danielle while he was training for baseball on a semi pro team and soon fell in love. They were happy to celebrate their wedding day surrounded by Jessie's family who are local here in the Inland Empire. Let me just say, that this couple knows how to celebrate!
Click here for Slideshow
Vows were exchanged in the lovely Calvary Chapel Golden Springs.
The Limo shot.
My favorite shot of the day.
Laughter, I love it!
We had a nice walk around the local vintage district.
Danielle, you are gorgeous!
The handsome Jessie, looking so dapper.
Guests toasted to the happy couple at the Coco Palm and danced the night away.
Danielle and Jessie,
Have a blessed and wonderful new life together. Thank you for including me in your special day!

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Accommodation in Anglet - 5 matches
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Anglet urban center
68 avenue d'Espagne, 64600 ANGLET Map
Hotels | Located at the heart of beautiful lush-green grounds with its own heated swimming pool, tennis court and children's play areas, the Novotel Resort & Spa Biarritz-Anglet, refurbished in 2016, can offer you a raft of top-quality facilities: Read more
Anglet beaches
Hotels | This hotel boasts 48 rooms decorated in colour schemes that pack plenty of punch! This top-quality hotel offers direct access to the beach. Read more
Anglet urban center
28 avenue de Maignon, 64600 ANGLET Map
Hotels | Sited in a lovely lush setting, 4 km from the beaches of Anglet and Biarritz and 2 km from the golf course. Read more
Anglet beaches
Hotels | The hotel's 99 air-conditioned bedrooms are built around a sunny, extremely spacious outdoor patio in warm colours, and something of a sylvan atmosphere. Direct access to the beach and a patio overlooking a heated saltwater pool (May to October). Read more
Anglet beaches
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Hotels | On one of the most beautiful sites along the Basque Coast, Hôtel de Chiberta, at the heart of the golf course and 300 meters from the beach, nurtures a delightfully harmonious lifestyle. Read more
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Triveni Mitra Mandal is a non-profit organization representing the Maharashtrian community, in the Cincinnati, Northern Kentucky and Dayton area.
Our mission is to organize Indian cultural events to make new friends, preserve "Marathi" culture, give back to the community here and teach our traditions to the younger generation. Triveni Mitra Mandal encourages your participation to make its mission possible!
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Windsurfevolution goes to the mountains...
As well as offering windsurf coaching and instructor training, Jim Collis and Windsurfevolution are proud to announce an extension to the tuition side of things.
Jim, qualified under the British Association of Snowsport Instructors (BASI), is now offering ski tuition for groups and individuals in Europe between the months of December and March.
Jim's Skiing Background
Having qualified as a BASI alpine ski instructor in 1999, Jim has worked as a ski teacher in a variety of locations, including the Trois Vallees in France (Courchevel, Meribel and Meribel-Mottaret), Aviemore in Scotland, and most recently the Aosta Valley in Italy (Pila, Courmayeur and La Thuile)
Ski Coaching TripsJim is available for ski tuition, courses and trips for groups and individuals from December through to March in the UK and Europe. For further information, course costs and booking, please contact Jim


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DJ GarGar's unconventional San Diego band samples
The Beautiful State draws from No Knife, Buck-O-Nine and others
Jay Allen Sanford 2 p.m., Dec. 5
Josh Vasquez: Guitar (acoustic), Guitar (electric) | Marc Encabo: Bass guitar | Tyler Kreutel: Drums | Chaz Cabrera: Saxophone
Genre: Blues & Soul, Funk, Jazz, Latin | Tejano, Rock
Sound description: Drawing from the roots and nuances of jazz music and infusing a diverse set of sounds from funk, rock, soul, and Latin music, the band has together developed a seasoned sound with infectious grooves and catchy melodies.
No shows scheduled | Post a show | View show history
Inception: San Diego, 2009
Ex-Band Members: John Avery, Saxophone Hiram Garza, Keyboards, Piano
Formerly known as Jazz Avenue, the Reo Collective was founded by teen musicians from the School of Creative and Performing Arts (SDSCPA) in San Diego, where they began their studies in music and stumbled upon the school's award-winning jazz program, under the direction and mentoring of Tamara Paige, head of the Music Department.
They have performed at the House of Blues San Diego and Dizzy's, as well as with the San Diego Repertory Theatre and CYC Theatre and at events like the annual Ocean Beach Music and Arts Festival. Sax player Chaz Cabrera graduated in 2011 but remains with the band.
In early 2012, they won Best Teen Band in the USA in the third annual SchoolJam USA Competition, earning $5000 for their school music education program, and $1000 toward the purchase of new equipment, and a professional music video recording session on the John Lennon Educational Tour Bus.
Following their win, the band traveled to Frankfurt, Germany to headline the Original SchoolJam Competition and perform at at MusikMesse 2012. Describing how the band felt about sweeping the competition, saxophonist John Avery responded, "It's beastly. All the bands were so good. It's just ridiculously amazing that we won."
The band's music teacher Tamara Paige was on hand to share in their win, commenting that the $5,000 prize will go a long way in the strengthening their music education program. Later in 2012, the band released their full-length Bridging the Gap.
In 2015, the group was involved in the production of a documentary known as Bass Clef Bliss. The group's personnel shifted after a recording session, and four of the remaining members - Marc Encabo, Josh Vasquez, Tyler Kreutel, and Chaz Cabrera - decided to change the band name from Jazz Avenue to the Reo Collective.


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Dieruf Hardware & Rental Center has the rental equipment in Jeffersontown, Kentucky you need. We offer everything from heavy equipment like Bobcat and Toro to sanders, grinders, tillers, and wallpaper steamers. Dieruf Hardware has tool rental for Jeffersontown, Kentucky as well!
If you need to clean a drain, dig a ditch, pressure wash the house, or grind that big stump in your yard, we have the rental equipment you need. At Dieruf's Rental Center you can rent top-of-the-line brands like Bobcat, MiTM, Stihl, and Husquvarna. Equipment rental is easy at Dieruf Hardware! We have a wide variety of rental tools that you can rent for any home improvement projects you may have. Check out some of the rental equipment we have available for you at Dieruf Hardware & Rental Center.
Located at 9608 Taylorsville Road in Jeffersontown, KY, we serve the communities throughout Jefferson County including the nearby areas of Fern Creek, Newburg, St. Regis Park, Douglas Hills, Middletown, Hurstbourne, and Fisherville.
-Complete system for small drain cleaning- 3" diameter
-Comes with a variety of cables, cutters, and accessories to unclog any drain
-Automatic adjustment allowing you to get your cable into the line faster, full out faster.
-Walk-behind trencher, 20.8-hp
-Increased stability on rough and uneven terrain with solid-rubber trail wheel, reduces break over when loading and unloading and improves leverage when trenching
-Easy hand controls grouped at operator's station
-Built for performance in tight areas-perfect to travel between fence gates or between homes
-Dig Depth: 8ft 6in, Ground Level reach 14ft, Dump Height: 8ft 8in
-Two travel speeds
-Comfortable seat with retractable seat belt, arm rest, and cup holder (enclosed cab)
-Lightweight and easy-to-use
-40lb seed mixer capacity regulates even seed delivery
-Solid 11-guage steel for maximum durability
-No chip or bend blades made of high-carbon, heat treated spring steel
-Removes Thatch, bare spots, soil compaction from turf in 20" passes
-Heavy duty wheels with steel rims and roller bearings to absorb vibration for operating comfort
-Self-Propelled with free swinging, heat treated, tempered flail blade reel
-Fixed pressure with thermal relief valve pump protection
-Quick release gun/wand holder and hose wrap
-Professional-grade insulated trigger gun with safety lock-off
-2000 Watts, 120V
-Less than 46lbs
-Super quiet
-Stable power for computers and more
-Cutting system with unique tooth design for efficient and precise cutting
-Teeth are available for 3 various soil levels and are easily rotated
-Powerful enough to grind stumps 12" below the ground
Your Store


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For many people, the only thing holding Android back as a gaming platform is its lack of physical buttons. There's a limited range of inputs possible with a touch screen, and even then accuracy tends to lag way behind a controller or a keyboard and mouse. That's why MOGA exists. It's a line of game controllers by PowerA specifically designed for Android.
As a companion piece to my review of the MOGA Pocket, I interviewed MOGA Game Content Test Lead Mike Sindona over email about the benefits of MOGA's controllers for developers and gamers, the differences between products in the line (there are currently two models, with two more on the way), mobile gaming, and more.
What drove you to create the MOGA controllers? How do you think they improve the Android gaming experience?
As our company is filled with some old-school, die-hard gamers, we experienced some frustration towards playing advanced mobile games that had "virtual controls" on screen. We felt that they'd be better played with a real, physical controller over touch-screen controls. If you play the games listed in our Pivot app with a MOGA and without, I'm sure you'll agree with us.
For many games currently available, and new games we're testing that are not yet released, using a top-quality physical controller like the MOGA Pro or Pocket instead of the frustrating touch-screen controls is literally a game-changer. You get tactile feedback with a controller in your hands, using the analog sticks, face buttons, and triggers. Your thumbs are moved off of the screen so you're able to see more of the game while you play on the go. While at home, if your device supports it, you can connect it to your TV via HDMI and game with a true-console experience while you sit back on your couch with a MOGA in your hands.
Do you think gaming on an Android phone or tablet has the potential to be as good as it is on dedicated gaming devices? How do you see Android+MOGA as different to, say, a PlayStation Vita?
Not just "as good as" but much better. A dedicated gaming device is pretty much just that: Another digital device only for gaming. But thanks to the MOGA, your "gaming device" is not just for gaming; it's your mobile device used for phone calls, internet, GPS/maps, email, etc etc. It's only a gaming device when you need it to be. Plus, the average mobile game is around $1-$2 (if not "free to play"), while most "portable gaming system" titles are usually $20+ per game: that's around 10 MOGA Enhanced games for the price of only one Nintendo DS or PS Vita game. The value is definitely there too when you consider that the MOGA controllers are less than 1/4th the price of the typical portable gaming system.
What kinds of issues did you run into during the engineering and design phases? Does Android have any problems handling Bluetooth controllers, and are there any compatibility issues across devices that you had to worry about?
As Android is kind of an "open market" with tons of different devices, we strive for compatibility with all devices running Android 2.3 and higher. We are not aware of any compatibility issues with Bluetooth. Overall, we have hundreds of different mobile device models here at MOGA HQ and our controllers work with all of them.
How is Mode A better than Mode B on the MOGA Pro controller? Were there any problems getting the MOGA controllers working with existing apps?
Mode A is our "SPP Bluetooth" mode for the MOGA Pro (and also the only mode for the MOGA Pocket). We initially offered the Mode A to allow all older phones still running Android 2.3 to 4.0 the ability to enjoy gaming with a controller. At the time, only devices 4.0 and higher could use the HID controller mode in any game. Now that newer phones are released out of the gate with Android 4.0 and higher, and the population of non-4.0+ phones is dwindling, there are other benefits to using the MOGA SDK (Mode A – SPP).
Our population of MOGA owners is currently around 60-70% MOGA Pocket. If, as a developer, you do not add Mode A support (via our simple-to-implement SDK), you're effectively preventing 70% of our population from enjoying (and paying you money) for your game. Most of the hard work when adding controllers to your mobile game is in the production and design steps (wrapping your head around HOW a controller should work with your game). The actual coding part is easy. Once you do it using our SDK (for Mode A), later adding HID support would take maybe a few hours max.
We offer our developer partners other benefits if they decide to implement our SDK, like free tech and testing support, and potential co-marketing efforts like getting their app listed in our Pivot app, social media blasts, MOGA website space, demos at gaming events, & etc.
The only challenges we faced in the beginning was to convince "mobile-only" developers that their games would actually be "enhanced" when played with a MOGA. Some "got it" right away, while others needed a bit more encouragement. We've met with many developers in person (at events like GDC, PAX and E3) to show them the benefits of MOGA gaming first hand. A majority of the time, once they got their hands on a MOGA and wrapped their heads around it, then they'd join us. The other bit of positive feedback is that most developers state that implementing our SDK is a piece of cake. Anywhere from just 2 hours to a few days max of coding. That's a minuscule investment of resources when you consider you're opening up your game to our dedicated population of hard-core MOGA gamers who are always excited for that next, new MOGA title.
All the Android game developers I spoke to at the PAX Australia games convention in July seemed really happy with the MOGA controllers. What's the feedback been like from devs and from gamers?
Devs and gamers alike, once they get their hands on a MOGA, love it. We are working with hundreds of developers currently and have MANY games coming out in the next 6 -12 months that are going to be MOGA enhanced. We get constant emails from our MOGA owners asking "When is X game coming to MOGA?!? It NEEDS to be on MOGA now!!" We usually agree with these fans and politely ask them to propose that question to their favourite game's developers as well 😉
The buttons on the MOGA Pocket feel very flat and click-y compared to the MOGA Pro, which is more in line with the softer convex style of console controllers. Was this to keep the profile down? How do you think the controllers compare with each other in terms of the gaming experience?
We designed the Pocket with mobility in mind, hence; the smaller size, the thinner profile, and the flatter analog "sticks" and buttons. We designed the Pro based on consumer and developer feedback, who demanded a console-quality and styled controller even if it meant losing a bit of that portability (of sticking a controller in your back pocket). Currently, most of the games listed in Pivot are both Pro and Pocket compatible. Some older games aren't perfect experiences with the newer Pro (due to some developers not wanting to spend any more resources on an older game to update it for the Pro) while a very few of the newest games' devs focused on the Pro only and aren't perfect experiences on the Pocket. When anomalies are identified, we here at MOGA work hard to convince those games developers to resolve these issues, but ultimately it's their game and they choose to update it or not.
What are your favorite Android games? Anything from the console or PC gaming world you're hoping to see on Android soon?
I'm personally a Shooter fan, but I'm nostalgic for the classics. I love the old-school Sonic games as well as Another World (called "Out of This World" in the USA). We have a large team here and I'm sure everyone has their own favourite genre and game title. I'd love to convince EA to re-release the old Sega EA NHL games onto the mobile platform and then let us play with a MOGA. That'd be a dream come true.
To wrap things up, could you tell us a few things about your future plans? What's next for the MOGA team?
We're always working on new great things, so keep checking back with us!
Thanks, Mike
I'd like to say a big thanks to Mike for taking the time to answer our questions, and to wish him and the team good luck for their future endeavours.
You can order the MOGA Pro or MOGA Pocket direct from the MOGA website, or from a variety of retailers, with the Power Series additions (which charge your phone while you play) set for a fall release in the States. But before you make your decision, be sure to check out our review of the Pocket.


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Floyd Mayweather Jr. has made some questionable decisions since he's retired from the sport of boxing. He's been in and out of the media lately trending on topics that tarnishes his image as a role model to his fans/followers. Despite gaining 9 figure paydays, Mayweather is always in pursuit of more lucrative paydays and expanding his brand to a bigger audience.
The decision to train Soulja Boy shows that Floyd Mayweather is willing to work with anyone as long as it benefits him financially. Soulja has been trending for the past few weeks but for all the wrong reasons. However, Floyd Mayweather is a business man. He understands that it's important for him to always be in the lime light even if it requires him to be ridiculed and judged for his decisions.
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(CNN) -- Police in Ohio say a father cut his family off from the outside world, sexually abused at least one of his daughters and locked one child in a closet-sized room for a year.
A grand jury has indicted Jeffrey York, 47, on charges that include rape and child endangerment, CNN affiliate WJW reported. Police in Madison Township, Ohio, revealed new details about the investigation to reporters Saturday.
Authorities began investigating in December, when York's wife called 911 to report a sexual offense, Detective Dan Boerner said. When detectives arrived, she told them she and her seven children wanted to leave the home.
Family members accused York of abusing them mentally and physically for more than a decade, Boerner said.
"The children who were of age for education were home-schooled for the most part, had no friends to speak of and no real outlets or resources to go to," he said.
York locked one child in a tiny room for a year, Boerner said, letting the child out periodically to go to the restroom.
"In general, meals were brought to this child. Access to clothing, the restroom and everything was restricted by Mr. York," Boerner said.
A grand jury has indicted York on charges that include two counts of rape involving a female under the age of 13, five instances of gross sexual imposition and six counts of child endangering, WJW reported. York has pleaded not guilty to the charges.
The public defender representing York declined to comment when reached by CNN affiliate WEWS.
Detectives who have worked on the case for months said the investigation is difficult to handle.
"There are just so many directions to go," Boerner said. "It's not just one allegation involving one victim. It's multiple allegations involving multiple victims, so it makes it a little more difficult."


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A super fertile mother has a 700,000 to one family after giving birth to two sets of twins - one identical, one fraternal - with no 'filler baby' in between at incredible odds.
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The Centre for Family Research is seeking participants for a ground-breaking study of trans and/or non-binary parent families. The study focusses on families with (at least) one trans and or/non-binary parent (who has identified as such since before their child was born), with a child aged 0-10 years.


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and energy saving ideas.
By John Helm
These days all the talk is about saving energy and there are a lot of new as well as old systems to take advantage of the sun for heating and even cooling. Since my years in university I have been aware and have studied the various ways to take advantage of this free source of energy. The problem is that while the suns energy is there to be taken and used for free, the actual ways that we collect it and turn it into a form which is useable are generally not free and sometimes very expensive.
Over the years I have made many proposals to my architectural clients to implement various ideas into their projects. For the most part when the costs came in they resorted to the time tested and much less expensive standard forms of heating and cooling. The initial cost of the equipment can take many years to pay for itself and in the US at least where people tend to move often they don't consider it a wise investment.
Therefore, in this short article I will restrict my comments to the things that we can do in our existing homes that require little or no costs and then I will discuss a few things we can do in our new homes to maximize the collection of the sun's energy for heating and turn that around for cooling.
Existing Homes
We will start this little journey at the front door. Do you know that just putting a good door mat outside and a rug inside the exterior doors can save energy? Yes it can. Approximately 80% of the dirt we bring into our homes comes from our shoes. So just cleaning them before entering saves the extra time we would have to use the vacuum cleaner. Taking off the shoes and putting on house shoes or slippers will save even more.
Now I'm going to tell you some things you probably already know but I bet you don't do them. Since I said no extra expense, I will stick to the things we can do just to maximize heating or cooling and minimize heat gain or loss without spending any money. The windows are generally the major tool here. They represent a hole in our walls when it comes to energy gain and loss. So they need to be managed. Assume you have curtains and better yet shutters that open and close. In the morning when the sun is out in the winter, open the south facing curtains or shutters while keeping the windows closed to let in the solar energy and open the doors of those rooms to the rest of the house. Keep the others closed until the outside air temperature warms up or you just can't stand having them closed. As the sun passes reverse the process. At night shutter everything up.
If you have a fireplace, close the flue when you are not using it. Heat rises the open flue sucks the heat right out. On the subject of heat rising remember that it will rise to the upper floors on a two story house. If those floors contain the bedrooms, close the door leading to the stairs if you have them during the day or if no stair doors close the bedroom doors. There is no need to heat rooms not in use.
In the summer we reverse the above. Keep the south facing windows shuttered. Open the flue and open second floor windows that don't face south.
Also keep in mind that hard surfaces such as tile and concrete absorb heat. This function can be used in winter and summer. If you have a tile floor for example expose it to the sun in the winter it will heat up a radiate the heat back out in the evening. In the summer protect it from the sun; you might even cover it with a rug but only in the summer. In the summer we can open all the windows in the night to cool the house and then promptly close them in the morning.
New Homes and Remodels
The most cost affective way to minimize energy use in new homes, when we remodel or make additions is to use the things we would build anyway in a way that is energy use conscious and does not add any or little to the cost. As before we start with windows for natural light north facing windows are great but that's the worst location for heat loss or gain. They don't see the sun. So it's best to minimize them unless we are building an artists studio or they face a beautiful view. South facing windows are the one's we want with hard surface floors facing them and concrete walls inside the house to absorb the heat to be radiated out in the evening. Skylights that can be opened bring in natural light and when opened in the summer allow the heat to rise out of the house.
Those big south facing windows are great in the winter as long as the sun is out; they are not so great when it's not. So we should make some provision to cover them and of course they should be double glazed as should all the windows, even triple glazed in harsh climates. And what do you do about them in the summer? In the summer they must be shaded. This can be done several ways. We can shutter them, put up louvers or roll up awnings. Permanently shading them will eliminate their use for heating in the winter so don't do that. One way we all know is to plant deciduous trees near them. Those trees will shade them in the summer and allow the sun to shine in during the winter as well as provide a nice appearance in the view and the yard.
Fireplaces can be a good source of heat if properly designed using outside air for combustion and some form of providing circulation of the heat generated. Glass doors allow radiant heat to pass while minimize the amount of heated inside air that rises up the flue. In the summer open the glass doors and the flue to allow the heat to flow out. Fans can be placed in the attic at little expense to draw out additional heat.
Let's also not forget insulation, perhaps the very most important addition. Blanket insulation made of fiberglass is the least costly and in fact adds little to the overall cost. If one objects to the glass fiber there are also natural products made of wood and recycled cotton. Increasing the thickness of walls in wood frame construction allows increased insulation but at added cost though not that much in the overall picture. Another item to consider is using one of the modern house wrap products instead of the conventional tar paper. They seal the walls, but allow moisture to pass from the inside to the outside.
Finally let's not forget the lighting. Windows, skylights and solar tubes can minimize the amount of lighting we need to turn on during the day. Proper placing of lighting for general purpose lighting as well as task lighting is important to minimize electrical usage. The use of fluorescent light wherever possible can reduce energy use by 2/3rds and as they become less expensive LED lights will bring consumption down even more.
So I have just touched a bit on the overall subject perhaps you, your architect and your contractor will be encouraged to use these ideas and think of more on your own.
Copyright 2009 by John Helm may not be reproduced in any form without the permission of the author.
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Friday, October 23, 2009
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Just like the grow with me shirt, the gown has sleeves that are long and can be folded back to fit for a long time. The loose cut allows for a super comfy fit. The hem has an elastic to allow for an easy diaper change! The gown can even be worn as a long top or dress when baby is growing up.
The hat and mittens are the perfect accompaniment with the gown to take your baby home to their new surroundings! The mittens will protect newborns from their nails and the beanie to keep their heads nice and warm. Made out of bamboo, this set is ultra soft and breathable for any season.
66% bamboo rayon, 28% cotton, 6% spandex.Machine wash cold, hang to dry.Made in Montreal
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Blueberry Bread Pudding with Lemon Glaze
Looking for a delicious Summer bread pudding that will put your taste ~ buds into total bliss . . . look no further this Blueberry Bread Pudding with Lemon Glaze is sure to take your ta...
Blueberry Bread Pudding with Lemon GlazeServings: 12 | Skills: Beginning | Prep Time: 30 min (not including thaw time) | Bake Time: 45 min
Blueberry Bread Pudding with Lemon Glaze
12 Rhodes dinner rolls baked according to the package
1 cup heavy cream
1 cup whole milk
1/2 cup sugar
1 teaspoon vanilla
3 large eggs
a dash of salt
10-oz bag of frozen blueberries
1/4 cup sugar
3 Tablespoons cornstarch
Glaze: 1 1/2 cups powdered sugar
zest & juice from 1 large lemon
12 Rhodes dinner rolls baked according to the package directions.
Cut into approximately 1" cubes. (You can cover the cubes & allow them to stale a bit overnight if you like.)
In a large bowl, whisk 1 cup heavy cream, 1 cup whole milk, 1/2 cup sugar, 1 teaspoon vanilla, 3 large eggs, & a dash of salt. Add the bread cubes to the bowl & allow them to soak & absorb that liquid for 10-15 minutes.
While your bread is soaking, put a 10-oz bag of frozen blueberries, 1/4 cup sugar, & 3 Tablespoons cornstarch in a bowl. Zap it in the microwave for 1 minute to slightly thaw the blueberries. Stir/fold the berries gently.
In a greased 13x9" pan, layer half of the soaked bread cubes, then top that with all of the blueberries, & lastly, dollop the remaining half of the soaked bread crumbs.
Bake at 350 for 45-50 minutes until browned on top & the custard is set.
Meanwhile, put 1 1/2 cups powdered sugar in a bowl, zest & juice 1 large lemon & add it to the bowl. Whisk until smooth.
Pour glaze over the slightly cooled bread pudding.
Serve warm!
30 Comments
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Cal South PRO+ ODP Day Camp Discounts
|Registering at once
|Discount Code
|Family Discount
|3 or more players
|Save $10 per player
|Group Discount
|5 or more players
|Save $20 per player
|Team Discount
|7 or more players
|Save $30 per player
*Discounts are ONLY applicable to online registrations that are paid in full at point of registration; the required number of registrations must be in one order for the discount codes to activate.
Cal South PRO+ ODP Day Camps
The Cal South PRO+ ODP Soccer Camps program enters its 17th year of operation designed for all boys and girls ages 8 years old to 14 years old, and we are committed to reaching the highest level open to them in the sport. They are "developmental" in that our experienced camp staff, already used to dealing with and developing talent at the state, regional and national levels, will build on and improve the technical and tactical skills that players have acquired during the soccer year. Through our program, we will create a challenging environment where each player will learn about themselves - their strengths and weaknesses. Players will be encouraged to compete in and outside of their comfort zones, will be given the knowledge and tools to improve.
We have scheduled six different day camps in strategic locations throughout Southern California this summer to provide every player between the ages of 7 and 14 the opportunity of attending our camps. Each camp lasts three hours, with the emphasis placed on quality, not quantity. Each group will have a low coach-to-player ratio, so as to optimize the individual development of each player. For goalkeepers at each camp, we provide one GK-specific session conducted by one of our goalkeeping staff coaches.
Monday through Friday, the coaches will emphasize tactics, speed of play, speed of thought, movement with and without the ball, and technical speed. Making good decisions under pressure will be the theme of the week, with the opportunity to apply what has been taught each day under match conditions.
At the end of the week, each player will feel challenged, will have been evaluated personally by their coach, and will be eager to take their game to the next level. This represents exceptional value.
PRO+ ODP Morning Camp Daily Schedule:
|Warm Up & Ball Mastery
|Technical & Tactical Exercises
|Break: Discussion on PRO+ ODP, Nutrition, Fitness, Tactics
|4v4 Street Soccer
|7v7 / 11v11
|Cool Down
|Camp Ends
Camp Highlights:
• USSF 'A' & 'B' licensed professional coaching staff
• English Premier League coaches
• UEFA licensed coaches
• Cal South PRO+ ODP staff coaches
• Excellent coach-to-player ratio
• Camp curriculum modeled after U.S. Youth National Team programs
• Quality fields and facilities
• Personalized camp evaluation
• ODP player identification opportunities
• Nike Soccer Camp t-shirt
• Specialized goalkeeper training
Campers must come prepared with:
• A soccer ball
• Proper soccer clothing
• Water
• Pencil/pen and paper to take notes
• Sun block
• Shin guards


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Rather than just being a direct competitor to Google, Microsoft's Bing search engine is morphing into a much more interesting animal.
The company announced Bing for Developers at its Build conference in San Francisco today, which opens up Bing's data as a set of APIs for developers to implement in their Windows apps.
"I learned a lesson in the '90s when I was a developer on Windows OS," said Microsoft VP Gurdeep Singh Pall on stage at the conference. "That is, if we can do something with an API that is good, third parties can do something that is dynamite."
As the slide above shows, Bing for Developers will include the engine's web index and knowledge graph, but it will also focus on the Natural User Interface, or NUI.
To show off what's possible with the new integration, Pall demoed a companion travel app, which sported voice controls, a voice guide, Expedia integration, and Bing images integration. The app looked slick, but it was clearly produced for this particular demo.
Pall also revealed that the Bing Maps application in Windows 8.1 will (finally) include support for 3D imagery. That's something Google has had for years, and Apple featured prominently in its troubled map app.
Bing for Developers is yet another way Microsoft is trying to tempt devs away from other platforms, but it remains to be seen if anyone will actually find these features interesting. The Bing brand has been something of a joke in the search world, so it's not exactly the sort of thing that will excite developers.


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How to Paint a Floor
Turn a worn-out wood floor into a warm cottage classic with a simple checkerboard pattern
The burgundy red floor in the master bedroom of Sara and Andrew's Massachusetts farmhouse didn't fit the fresh and energetic personality of the newlyweds. But refinishing wasn't an option on a limited budget. So to update the space, they painted the floor in a light checked pattern, using beige and white to warm up their cool blue walls. Recently, This Old House senior technical editor Mark Powers used their techniques to create a similar floor in his own house. Here he shows how a little measuring and a couple of coats of durable floor paint can add a little personality to a room for a small price.
Floor paint: Bay Harbor Beige and Patio White by Benjamin Moore
about $39 per gallon
Overview for Painting a Floor
Day-to-day timeline
Friday: Sand and clean the floor; paint the base color.
Saturday: Lay out, tape, and paint the pattern.
Sunday: Apply a second coat or polyurethane as needed.


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Assumption of the Blessed Virgin Mary - Calgary, Alberta
Pastor: Rev. Roman Planchak
Website: www.abvmcalgary.com
9:00 a.m. (Ukrainian)
11:00 a.m (English)
Great Vespers and Confession:
7:00 p.m.
Holy Days: 10 a.m. (Ukr. / Eng.)
Week Days: 9:00 a.m. or as announced in the Bulletin
History of the Parish
CALGARY – ASSUMPTION of the Blessed Virgin Mary Parish – Парафія Успіння Матері Божої
The first Ukrainian church community in the southern part of the Province of Alberta was founded in Calgary. The first Ukrainian settlers coming from Western Ukraine, started to arrive at the end of the 19 th century. In 1905 there were approx. 30-40 families, and their financial situation was very desperate. The first priest to visit the people was Fr. John Zaklynsky in 1901. From 1903 the Basilian Fathers were visiting the faithful on a regular basis. The Liturgies were held in the Roman Catholic Parish of St. Mary and later in St. Anne Roman Catholic Church in the eastern part of town. Some Roman Catholic clergy that were mostly French and 2 of them Polish, provided spiritual help to our people.
In 1910 the Primate of Ukraine, Servant of God the Metropolitan of Lviv, His Grace Andrey Sheptytsky, escorted by Fr. Matthew Hura, OSBM, visited Calgary. He encouraged the faithful to look for their own church building. The church of St. Stephen was built in 1912 in the district of Taxido Park. The first Bishop for the Ukrainian Catholics in Canada, Most Reverend Nykyta Budka donated $1,000.00 towards the building fund. Until 1915 the Roman Catholics were also using our church.
The first permanent priest assigned to Calgary was Fr. Ivan Dumych (1913-1914) and in his time Bishop Nykyta Budka paid his first visit to the parish. During World War I, 1914-1918, Fr. Mykola Shumsky looked after the parish. Fr. Shumsky and some other parishioners were arrested during the war, being citizens of the Austro-Hungarian Monarchy. Ukrainians arriving from Western Ukraine (Halychyna and Bukowyna) were all citizens of the Austro-Hungarian Monarchy who was at war with the British Empire. Canadian police closed the church for two full years. Between the two world wars of the 20 th century, when no priests were available, the Basilian Fathers were visiting the parish community. The Roman Catholic Bishop John J. Kidd was very supportive and provided accommodation for the Basilian Fathers. He even suggested, in consultation with Bishop Nykyta Budka, to move the Parish to Riverside, where most of the parishioners were living. The move became a reality for the first Ukrainian Parish of St. Stephen in 1926. In addition the clergy also provided services in Forest Lawn starting in 1926 and continuing for many years.
From the 1930s' to the 1950s', Mr. Michael Waretsky took care of the church choir. In 1939 Fr. Jaroslaw Chyz was assigned to Calgary and in a very short time established the Ukrainian Catholic Brotherhood of Canada (BUCC), Ladies League (Mariys'ka druzhyna) and the youth organization U.C.Y. (Ukrainian Catholic Youth). At the same time a Ukrainian language program was developed at the parish. A great percentage of the parishioners voted to follow the Gregorian calendar in 1940. In 1944-1945 a church residence was built, however a fire destroyed the inside of the church and most of the church vestments, etc. were lost. It happened when Fr. Michael Syrnyk was the parish pastor.
Church life began to be more visible when a Bishop was assigned for Western Canada and an Exarchate was established, that later on became the Ukrainian Catholic Eparchy of Edmonton.
Sisters Servants of Mary Immaculate were invited to join the Parish community in 1953 by Fr. Yuri Kowalsky. A new wave of immigrants arrived from Western Europe and joined the parish. St. Stephen was already too small to accommodate all the faithful. Seven blocks north of the church a nice peace of land was purchased for a future church. The construction began in the Marian year 1954, and from 1955 the church basement was used for the services. St. Stephen was sold in 1967 and in the same year the new church building changed the name from St. Stephen to Assumption of the Blessed Virgin Mary. Fr. Yuri Kowalsky, a survivor of the German Concentration Camps in Auschwitz and Dachau, and a very devoted priest to the Virgin Mary, proposed that the parishioners change the Patronage of the church to the Feast of the Dormition of the Theotokos. In 1959 Fr. Yuri was moved to St. Josaphat Cathedral in Edmonton and Fr. Basil Martynyk continued the final stages of the church construction and later of the church residence.
From 1960 an assistant priest was serving the community. On Sundays three Divine Liturgies were held to better serve the faithful. In 1962 the parish celebrated their Golden jubilee. Ukrainian language instead of the Old Slavonic was introduced in the services in 1966. In time Ukrainian artist Ivan Denysenko designed an iconostasis and painted the inside front part.
In 1967 a new church community was established in south-western Calgary in honor of St. Stephen. Many young families left the parish and joined the new community.
Thanks to priests like Fr. Yuri Kowalsky, Fr. Basil Martynyk, Fr. Basil Woloshyn and Fr. Bill Hupalo, the Parish was always supporting many of the Ukrainian church projects within and outside of Canada.
Basilian Fathers who served the parish between the years 1903-1937: Fr. Mark Dyrda, Fr. Platonid Filas, Fr. Anthony Strotsky, Fr. John Chrysostom Tymochko, Fr. Matthew Hura, Fr. Basil Ladyka, Fr. Damascene Popovych, Fr. Mark Romanowych, Fr. George Zydan, Fr. Basil Kamenetsky, Fr. Josaphat Tymochko, Fr. Sophron Diakowich, Fr. Paul Olinsky, Fr. Theodozy Dobko, Fr. Peter Hewko, Fr. Matthew Sianchuk and Fr. Methodius Hannas
Eparchial clergy that served the community: Fr. John Zaklynsky (1901), Fr. Mykola Shumsky (1915-1916), Fr. A. Czerepaniak (1918-1919), Fr. Hryhorij Vaselewych (1921-1922), Fr. Michael Kuzmak (1923), Fr. Ivan Kolcun (1926), Fr. Ambrose Redkevych (1926-1927), Fr. Anthony Luhovy (1927-1929), Fr. Paul Reshetylo (1937-1938), Fr. Jaroslaw Chyz (1939-1942), Fr. Michael Syrnyk (1942-1944), Fr. Andrew Choronzy (1944-1945), Fr. Nestor Drohomereckyj (1945-1951), Fr. Yuri Kowalsky (1951-1959), Fr. Basil Martynyk (1959-1986), Fr. Paul Lysak (1986-1993), Fr. Basil Woloshyn (1993-1995), Fr. Anton Tarasenko (1995-2000), Fr. William Hupalo (2000-2003), Fr. Serhiy Harahuc (2003-2013), Fr. Michael Bohun (2013-2018), Fr. Roman Planchak (2018-).
Assumption Parish Posts
Video: Nativity 2018 – Assumption Ukrainian Catholic Church Calgary – Parish Choir 'Surma'
Різдво 2018 Парафіяльний Хор 'Сурма' При Церкві Успення Пресвятої Богородиці Українська греко-католицька церква Калґарі, Альберта, Канада Диригент пані Ірина Калинович Парох всечесний о. Роман Планчак Christmas 2018 Parish...


text: Citi Bike users pedal through the streets of Manhattan. Some members of Generation Z, the younger generation following the millennials, are less inclined to own cars and lean more toward bike-sharing and ride-sharing services. John Moore/Getty Images hide caption toggle caption John Moore/Getty Images YR Media Generation Z May Not Want To Own Cars. Can Automakers Woo Them In Other Ways? YR Media December 8, 2017 Selling cars to the group that follows the millennials won't be easy. Instead of just making cars, automakers are trying to make a move, whether it's car-sharing, ride-hailing or self-driving. Generation Z May Not Want To Own Cars. Can Automakers Woo Them In Other Ways? Listen · 3:24 3:24 Toggle more options Download Embed Embed <iframe src="https://www.npr.org/player/embed/568362029/569345958" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player"> Transcript


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Pre-Hurricane Sunday Cooking; Butternut Squash Soup
(a little lazy, I used canned butternut squash).
1 15oz can butternut squash
1 medium onion
2 carrots
1-2 cloves garlic
1-2 tsp chili flakes
1 tsp cinnamon
1tsp baking soda
2 cups vegetable broth
1 1/2 cups half & half
Sauté diced carrots and onion, add mined garlic, chili flakes, cinnamon.
Add veggie broth & simmer for 15 minutes. You can puree the broth & veggies at this point or leave it chunky ( that's what I do).
Add the can of butternut and half and half. Whisk together and adjust seasoning with salt and pepper.
I let it simmer for an additional 10 minutes.
Serve hot and enjoy.


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Maker of Donut County is shocked when a free knock-off beats his game to the market
Indie developer says his game has been copied by a company that's backed by cash from Goldman Sachs
Ben Esposito has been working on his much-anticipated video game Donut County for the last five years.
He plans to release the game, in which you play as a hole in the ground, by the end of 2018.
Imagine his surprise, then, when he discovered that a game that looked remarkably similar to it was already available on Apple's App Store.
"I got an email from a friend with a screenshot of an Instagram ad. And in the ad was this other game where there's a hole in the ground," Esposito told Day 6.
"The text of the email said, 'They stole your game!' So I looked up this game on the App Store and sure enough, it's number one in the free apps. And that's when I started freaking out."
(gif source: PlayStation/YouTube)
In Donut County, players move a hole in the ground around the screen, swallowing up anything it touches. The more the hole "eats," the bigger it gets.
It's got a charming, papercraft-like art style featuring characters like a duck riding a scooter and a chatty family of raccoons.
Hole.io, published by the Paris-based mobile studio Voodoo, also features a hole in the ground that gets bigger as it swallows more objects. Gone are the raccoon family and storyline, replaced by a more generic cityscape setting.
(gif source: MasterOv/YouTube)
In a tweet, Esposito described Hole.io as a "cheap clone," its core gameplay mechanic seemingly lifted from trailers for Donut County.
"I was really concerned, because my game is the exact same concept. It's a hole in the ground, you move it around, stuff falls in and it gets bigger — which I thought was such a wacky idea that no-one else would use it," he said.
In a statement, a representative for Voodoo told Day 6 that "our developers, whether internal or external … freely interpret existing gameplays as it is the custom throughout the profession where all developers feed off each other's creations.
"For instance, Donut County and Hole.io are two games with similar gameplay but with different interpretations that each bring a unique game experience," the statement said.
Cecilia D'Anastasio, a reporter for the games site Kotaku, characterised the statement as "dripping with slime."
D'Anastasio said Voodoo has "put out a number of games that resemble, in pretty significant ways, other indie developers' games as well."
She explained that game designers and studios have historically used pre-existing ideas or concepts to make new ones all the time. Nintendo owns the likeness of Mario, for example, but not the idea of running and jumping on a two-dimensional plane.
That practice often leads to entire new genres of games growing out of a single game's new idea.
Who owns the 'idea' behind a game?
The fine line lies in the distinction between a game that's merely "inspired by" a previous game, and a game that's an outright copy.
"It's easy enough to spot literal copying – the copy or elements of the copy are exactly the same as the original," Mark Edwards, an Ontario-based lawyer with expertise in digital and traditional entertainment industries, told Day 6.
"But what if the game is not literally a copy, but simply uses a feature or combination of features of the original game?"
He cited a 2013 decision involving a television cartoon, where the Supreme Court of Canada took a "holistic" approach that considered "the cumulative effect of the features copied from the work" in the case.
"In the case of Donut County and Hole.io, it is possible that the growing hole feature of Donut County is itself so distinctive and original that this feature alone constitutes a substantial part of the original game," he said.
Clone wars
D'Anastasio pointed to Infinite Golf, which resembles Vancouver-based Pirate Games' 2014 hit Desert Golfing, as well as The Fish Master, which plays similarly to Ridiculous Fishing by Vlambeer.
Like Donut County, a clone of Ridiculous Fishing called Ninja Fishing appeared in app stores before Ridiculous Fishing itself was finished.
"It almost killed the company right there and then," Vlambeer's Rami Ismail told Kotaku.
"Independent creators come from a place of passion," he said, "and nothing will destroy that passion like feeling like you've been taken advantage of — and nothing will kill the drive to be creative faster than seeing someone else treat it as a cynical cash-grab."
According to Variety, Voodoo "doesn't hide that it games Apple and Google's ranking systems" — meaning that many people may find games like Hole.io, but not the games that they allegedly copied in the first place.
The story pointed to Voodoo's own website, which proclaims: "We are experts at buying cheap installs in big numbers, thanks to our mobile growth team."
Goldman Sachs invest in Hole.io makers
In both Canada and the United States, taking a clone to court is often too costly for small businesses like indie game makers.
"It takes a lot of energy, takes a lot of time and it takes a lot of money. And when you're putting in 40, 50, 60, 70 hours a week trying to not just put out a video game, but generate hype for an upcoming video game, I can't imagine anything less appealing than pursuing a lawsuit," said D'Anastasio.
The prospect of facing off against a company like Voodoo in court could be especially daunting. It recently received a $200 million US investment from Goldman Sachs' private equity fund, aiming to double its staff to 150 this year.
As for Donut County, Esposito expressed a degree of resignation at the Hole.io situation while remaining hopeful for his own game's fortunes.
"I feel like I'm kind of I have to come to terms with it and I have to just relax and say, 'Look, this is just a hazard of making something new," he said.
"It's a hazard of being small and needing exposure to get people to buy your art."
Written by Jonathan Ore. This segment was produced by Annie Bender.