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"Expedited Removal" and Deportation Under U.S. Immigration Law
Expedited removal is a form of "summary" deportation. It allows the Department of Homeland Security ("DHS") to deport non-U.S. citizens immediately and without a formal hearing.
Under U.S. immigration law, people who can be deported by expedited removal are those who:
Entered the U.S. without valid documents (such as a passport and/or visa);1 or
Obtained entry by actual or attempted fraud or misrepresentation.2
The majority of people deported by expedited removal are those caught entering the U.S. unlawfully.
But as the result of a recent White House Executive Order expanding expedited removal, U.S. Customs and Border Protection (CBP) can summarily deport anyone who:
Is suspected of being in the U.S. unlawfully, and
Cannot prove that he or she has been in the U.S. continuously for at least two years.3
People in expedited removal proceedings do not have the right to a hearing in front of an immigration judge. But they are still allowed to stay in the U.S. if:
They are a U.S. citizen, a lawful permanent resident ("green card" holder), or a lawfully admitted refugee or asylee, or
They have a credible fear of persecution or torture if returned to their home country.
To help you better understand expedited removal, our California immigration lawyers discuss, below:
1. When can the U.S. deport someone?
2. Who is subject to expedited removal?
3. Aren't non-citizens protected by the U.S. Constitution?
4. How does "expedited removal" work?
5. What are the consequences of deportation by expedited removal?
6. Can I appeal an order of expedited removal?
7. What if I am in the U.S. lawfully?
8. What if I have been in the U.S. unlawfully for more than two years?
9. How can I prove residency in the U.S.?
10. How can I avoid expedited removal?
11. What are my rights and obligations if I am stopped by the police?
12. What can I do if ICE shows up at my home?
13. What if I want asylum or am afraid to go back to my country?
14. What if I am sick or pregnant when I am detained?
15. Can children be deported through expedited removal?
16. Can I leave the U.S. voluntarily if I am put in expedited removal proceedings?
The U.S. has the right to remove (deport) non-U.S. citizens under certain circumstances. The most common are when a non-citizen has:
Entered the U.S. without inspection or permission (unlawful entry);
Obtained a green card or visa by fraud or misrepresentation,
Been convicted of a deportable crime or an "inadmissible" crime; or
Overstayed a valid U.S. visa (such as an F1 academic student visa).4
Anyone who enters or attempts to enter the U.S. unlawfully may be subject to expedited removal if they have not been in the U.S. continuously for at least two years. Fur purposes of avoiding expedited removal, "continuously" means two years straight with no absence whatsoever.5
In the past, people were subject to expedited removal only if they were apprehended:
Within 100 miles of a point of entry to the U.S. (such as the border), and
Within 2 weeks of entering the U.S.
But the recent White House Executive Order referred has expanded expedited removal to cover aliens found anywhere in the U.S. if they cannot prove 2 years of continuous residence.
In all other cases, a non-citizen is entitled to a formal deportation hearing before being removed from the U.S.
U.S. citizens and people who entered the U.S. lawfully are entitled to the benefits of the U.S. justice system before they can be deported. They obtain this right from the Due Process Clauses of the 5th and 14th Amendments to the United States Constitution.
Thus an immigrant who is lawfully present has the following rights:
A hearing before an immigration judge,
Representation by a lawyer (at the immigrant's expense),
To testify and call witnesses, and
To appeal an adverse decision to the Board of Immigration Appeals ("BIA").
But people subject to expedited removal do not have these rights.6 They are not even entitled to be represented by a lawyer.7.
Most people subject to expedited removal are apprehended by a Department of Homeland Security (DHS) officer at a U.S. entry checkpoint.
Others are apprehended by a U.S. Immigration and Custom Enforcement (ICE) officer when they are in the U.S.
The burden is on an immigrant to prove to a customs officer that he or she is lawfully present.
Anyone who can't produce the necessary documentation is subject to mandatory detention (lock-up). The U.S. can then commence deportation proceedings in as little as 24 hours -- even if that person is, in fact, here lawfully.
Someone who has been deported by expedited removal is barred from returning to the U.S. for at least 5 years (or longer, depending on the person's immigration and criminal history).8
However, if the reason for the expedited removal was fraudulent entry documents or claiming falsely to be a U.S. citizen, the person is barred from the U.S. for life.9
For this reason, lying about one's immigration status can have serious negative consequences.
People who are barred from the U.S. for any length of time can apply for a permission to have the time period in which they are inadmissible waived. But the U.S. is not obligated to grant a waiver.
For more information, please see our article on I-212 waivers.
Expedited removal orders can not generally be appealed.
In cases of extreme unfairness -- and if the alien is still in the country -- the alien may be able to file a petition for habeas corpus review. If the court agrees to hear the habeas petition, it will usually grant a temporary restraining order (TRO) to keep the alien from being deported before the habeas petition has been heard.
If an alien has already been wrongfully deported, their lawyer can submit a request to the CBP for review.10 If it is subsequently determined that the person should not have been deported, the order of expedited removal will be vacated.
The following people may not be deported by expedited removal:
U.S. citizens (who are not deportable at all),
Lawful permanent residents ("green card" holders), and
Lawfully admitted refugees or asylees.
If you are put into expedited removal and you fall into one of these categories, be sure to notify the immigration officer. He or she will then try to verify your claim using your fingerprints and government databases.
You may also be allowed to request documents from third parties (such as your family or lawyer).
An immigration officer who cannot verify your claim can refer your case to an immigration judge – though this is at the officer's discretion.11
If you are referred to an immigration judge, the judge will review the officer's determination. The judge's decision cannot be appealed.
Be aware, however, that if you are not a U.S. citizen, the government can still initiate formal removal proceedings against you if the department believes there are other grounds for deporting you.
Expedited removal is not supposed to apply to undocumented immigrants who have been in the U.S. continuously for more than two years. Instead, if the government wishes to deport them, they should be served with a Notice to Appear in a regular removal proceeding.
However, since expanded expedited removal is new, the policy has not yet been tested.
The new law may also, at some point, be challenged in court. It may turn out to be unconstitutional or unconstitutional as enforced.
Undocumented aliens who have been present in the U.S. for more than two years may want to speak to a lawyer to create a personalized plan for avoiding deportation.
An alien who is placed into expedited removal proceedings is supposed to be given a reasonable opportunity to establish that he or she was lawfully admitted to the U.S.
The immigration officer can consider government-issued identification along with documents such as receipts, phone records, and utility bills.
These documents may be in the possession of the alien. If an alien chooses not to carry such documentation on his or her person, such documents should be kept somewhere they are easily accessible by a family member, friend or lawyer.
The examining immigration officer should consider all such evidence and make further inquiry, if necessary.
But ultimately, the burden is on the alien to satisfy the examining officer that the alien is here lawfully. And even if lawful admission is established, the officer may examine the case to determine if the alien is deportable or inadmissible on some other basis.
People who are in the U.S. lawfully should carry identity documents (or a copy of such documents).
Those who are here unlawfully may want to discuss their situation with an experienced immigration lawyer.
Note that in Los Angeles, California the Los Angeles Police Department (LAPD) does not ask immigration status when interacting with people in the community. Law enforcement agencies in other so-called "sanctuary cities" usually have similar polices.
All undocumented immigrants should, however, have an emergency plan in case they are placed into removal proceedings. It should include how children and pets should be cared for and who family members or friends should notify
Immigrants have the right to remain silent just like U.S. citizens. Depending on where you live and the situation, however, you may be required to identify yourself to a law enforcement officer.
In California, you are not obligated to show a police officer identification unless:
You were driving and got pulled over, or
You were placed under arrest.
Otherwise, if an officer arrests you for refusing to show ID, it is a wrongful arrest and can be challenged.
But even a wrongful arrest can lead to negative immigration consequences. Thus we recommended that if you are arrested you exercise your right to remain silent and contact a lawyer immediately.
People do not need to let an ICE agent into their home unless the agent has a valid warrant signed by a federal judge. It is perfectly acceptable to ask the ICE officer(s) to slip the warrant under the door so you can review it.
If the warrant appears valid, you must cooperate as set forth in the warrant. If you have a valid U.S. passport, green card or visa, you can show it to the officer. Otherwise you should exercise your right to remain silent and say you want to speak to your lawyer.
An alien who is afraid to go home can ask for asylum in the U.S. or a "credible fear" review.
The immigration officer will usually then refer the matter to an asylum officer. The asylum officer will conduct an interview with the alien to see if the alien qualifies for relief under:
U.S. asylum law,
The U.N. Convention Against Torture (CAT protection),
The Violence Against Women Act (VAWA), or
Another program.12
The standard for the asylum officer's review is as follows:
If the alien has no prior history of removal from the U.S.: The alien must establish a "credible fear" of torture or persecution – that is, that it is more likely than not that he or she would face one of these if returned home.
If the alien has previously been under an order of removal from the U.S.: The alien must establish a "reasonable fear" of persecution or torture. This is a higher standard than "credible fear."
If the asylum officer finds that an alien has a credible or reasonable fear of persecution or torture, the alien will receive an asylum hearing before an immigration judge. The hearing will usually take place within 10 days. In the meantime, the alien will be kept in detention.
If the asylum officer decides that an alien has does not have a credible or reasonable fear of returning home, the alien can be deported. This decision is reviewable by an immigration judge.
Immigration officers have the right to place aliens in expedited removal proceedings on "parole" on a case-by-case basis. Parole is will usually granted if:
The alien does not represent a security risk,
The alien is unlikely to abscond (make off), and
There are "urgent humanitarian reasons" (such as pregnancy or a serious medical condition), or
There would be a "significant public benefit" – for instance, the alien's testimony is needed in court.13
As a condition of parole, the alien may be required to give reasonable assurances that he or she will appear at all hearings and/or depart the United States when required to do so.
Children can be placed into expedited removal proceedings (normally with a parent or other relative). However, they can usually be released:
To a close relative (brother, sister, aunt, uncle, or grandparent) who is not in detention and is willing to sponsor the minor, or
With an accompanying relative who is in detention.
If the minor has no suitable relatives but was accompanied by another adult, the release is determined on a case-by-case basis.
Unaccompanied minors will usually be referred to the Office of Refugee Resettlement ("ORR").
The ORR will try to find a relative to release the minor to, either in the U.S. or the minor's home country. Failing that, the minor will be placed in a foster home.
Immigration officers have the discretion to let immigrants return home by voluntary departure rather than having an order of removal on their record.
There will still be a record of the encounter, which could impact future applications for admission to the U.S. admission.14
But voluntary departure does not carry the same consequences of a removal order. Most importantly, it does not carry a mandatory period of at least 5 years before returning.
Concerned about expedited removal in Los Angeles? Call us for help…
Call us at (855) LAW-FIRM for help
If you or someone you know needs an experienced criminal or immigration lawyer in Los Angeles or another California community, we invite you to contact us for a free consultation.
Our California "crimmigration" lawyers can help defend you in criminal or immigration cases or help you apply for permission to enter or remain in the U.S. lawfully.
To schedule your free consultation call (855) LAWFIRM or complete the form on this page and a caring California immigration attorney will call you at a convenient time.
We also have experienced Nevada immigration lawyers to serve for your needs in Las Vegas, Reno and other Nevada communities.
Legal references:
Section 212 (a)(6)(C) of the Immigration and Nationality Act ("INA"). The INA is codified in 8 U.S. Code Chapter 12. In this article, references to the "INA" and "8 USC" are used interchangeably.
8 USC § 1182(a)(7).
8 USC § 1182(a)(6)(C).
See 8 U.S. Code § 1227 - Deportable aliens and 8 U.S. Code § 1182 - Inadmissible aliens.
8 U.S.C. § 1225(b)(1); 8 CFR (b)(1)(ii).
See 8 U.S.C. §§ 1252(a)(2)(A).
United States v. Peralta Sanchez, Nos. 14-50393, 14-50394, _ F.3d_(9th Cir. 2017).
The applicable time periods are: 5 years for anyone deported after regular or expedited removal proceedings initiated upon the person's arrival in the U.S.; 10 years for those who were otherwise ordered removed after a deportation hearing or who departed the United States while an order of removal was outstanding; 20 years for anyone deported a second or subsequent time; or Forever for anyone who was convicted of a crime that counts as an "aggravated felony," or who has been unlawfully present in the U.S. for more than one year. See INA § 212(a)(6)(C).
8 CFR § 103.5.
See the Executive Order referred to in the introduction of this article.
See 8 USC § 1225(b)(1)(A)(ii), (B); 8 CFR § 235.3(b)(4).
8 CFR § 235 (b)(1)(ii).
See 8 CFR § 235.3(b)(2)(i).


The U.S. relationship with China will only continue to grow in the coming decades, writes Gary Locke, the U.S. ambassador to China. He urges students to study abroad, especially in China, and private investors to support them to help ensure U.S. global competitiveness.
WE need more Americans studying abroad — particularly in China — and soon.
The U.S. Department of State and the International Institute of Education recently released new numbers on global study abroad in the annual Open Doors Report. Once again, China tops the list of countries sending students to study in the U.S. In the last academic year, the number of Chinese students studying in the U.S. grew by 23 percent to a population of nearly 158,000 students. American enrollments in China grew as well, but far more modestly at just under 2 percent — keeping China the fifth-most-popular destination for Americans studying abroad and taking the total population of Americans studying in China to just under 14,000.
We welcome more Chinese students, alongside those from other countries, coming to the U.S. for our world-class education system. These students internationalize our campuses and contribute to the U.S. economy: In 2010, international students spent nearly $22 billion on tuition, housing and other expenses. But with just over 1 percent of U.S. college students pursuing study abroad, we face real challenges to growing a generation of global citizens. But we can and must do better.
Secretary of State Hillary Rodham Clinton has called China, "One of our most challenging and consequential bilateral relationships." We welcome a strong, prosperous and successful China that plays a greater role in world affairs. It's good for the global economy and it's good for creating jobs back home in America. But in order for the U.S. to remain competitive in the global economy, we must ensure that our young people have the understanding and skills to engage with China during its impressive economic growth. Two years ago, President Obama announced an initiative designed to do exactly that.
The 100,000 Strong Initiative will increase the number and diversify the composition of Americans studying in China. Although it aims to increase to 100,000 the number of Americans studying in China over a four-year period, it is really the beginning of a long-term effort to encourage Americans to engage China constructively so that we can achieve our goal of global peace and prosperity. The initiative also enjoys personal support and engagement from Chinese President Hu Jintao.
Building on successful U.S. government-funded educational exchange programs, 100,000 Strong is a partnership with the private sector. As such, the Initiative represents the best of America — government, private sector, nonprofit and academic groups — coming together to invest in both our young people's future and the long-term stability of the U.S.-China relationship.
Private companies, foundations and individuals to date have pledged just more than $11 million to allow American students and educators from high schools, community colleges and four-year universities to study in China. Mega-artists like will.i.am, apl.de.ap and John Legend have signed on to do a December concert in Beijing that will open doors for underserved high-school students from five U.S. cities to study in China. Seattle joins leaders from Chicago, Los Angeles and Washington, D.C., as partners with the Department of State to make this Initiative a reality for high-school students across the United States.
Recognized as a national leader in providing Chinese-language training for public-school students, Seattle should be quite proud of its role in this initiative. Funds raised from the private sector for Seattle through the 100,000 Strong Initiative will support national study-abroad program Americans Promoting Study Abroad and Seattle-based nonprofit OneWorld Now!, which give hundreds of underserved public-high-school students the chance to learn Mandarin and send them on life-changing summer programs to China.
But we need more help. We estimate that at least $68 million in private funds will be required to achieve the president's goal of seeing 100,000 Americans study in China by 2014. The initiative needs the support of more American companies whose businesses are affected by the state of U.S.-China relations, and who need a strong, China-savvy pool of potential employees from which to recruit their future workforce.
The initiative needs corporations, foundations and philanthropists to create opportunities for underrepresented students across the United States to ensure that they have the same opportunities as other young Americans whose parents can afford to send them abroad. The initiative needs schools and study-abroad programs to leverage this presidential initiative to expand their study-abroad programs.
Americans have a huge role in determining whether China ultimately presents a threat or an opportunity for us. What will make the difference is how well the next generation is prepared to engage China. Armed with language skills and experience interacting with Chinese peers, the next generation will be able to manage the U.S.-China relationship in a way that will allow both countries to thrive. Seattle is poised to lead the way.
Gary Locke is U.S. ambassador to the People's Republic of China. He was governor of Washington from 1997 to 2005.


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Anti-Federalist Papers
Constitutional history
Election stories
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Remember the Ladies
Signers of Declaration
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Texas History
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This Day in History: Texans win their independence at San Jacinto
On this day in 1836, Texans win the Battle of San Jacinto. The battle was won in only 18 minutes! The decisive victory would ultimately ensure independence for the Republic of Texas.
It also avenged the blood that had been shed at the Alamo and at Goliad.
Santa Anna surrenders to a wounded Sam Houston.
The Texans (then "Texians") had accomplished their goal with a swiftness that would surely make George Washington's Continental Army a bit jealous. Texas declared its independence from Mexico on March 2, 1836. Within a matter of days, Sam Houston had been appointed "Commander in Chief of all the land forces of the Texian Army, both regulars, volunteers and militia," and he joined the Texian forces then gathered near Gonzales.
It wasn't long before he received word that the Alamo had fallen. Mexican forces were headed his way. Houston knew that the Texians weren't ready for a clash with a large Mexican force—at least not yet. An immediate retreat was imperative if the cause for independence was to survive.
Some Texian families had already been fleeing from the Mexican Army. Now the Texian forces fled, too.
Perhaps retreat doesn't come naturally to Texans!? Volunteers began flocking to join Houston. They'd heard about the Alamo, and they were ready to fight! By March 19, the size of the army had roughly tripled, and the army was starting to get antsy. Why were they retreating so far? When would they turn and fight?
Some Texians got so disgusted with the inaction that they left, but Houston was determined to pick his spot.
In the meantime, Mexican General Antonio López de Santa Anna had decided to personally join the pursuit of Houston. There was no way he was going to let some other Mexican general take credit for ending the Texian uprising!
Perhaps Santa Anna should have stayed behind. When the two sides finally met near San Jacinto in mid-April, Santa Anna made a few rookie mistakes. Houston chose to camp in a wooded area that hid his army's full strength of about 900 men. By contrast, Santa Anna's larger army made camp in a more vulnerable position. The choice was criticized by Colonel Pedro Delgado who noted that the spot chosen "was in all respects, against military rules. Any youngster would have done better."
On the night of April 20, the Mexican Army built breastworks and fortified its position. In the meantime, Houston had already issued an appeal for a final round of volunteers. "We view ourselves on the eve of battle," he'd written. "We are nerved for the contest, and must conquer or perish. . . . Be men, be freemen, that your children may bless their fathers' names."
How strange it must have been when the next morning dawned—and nothing happened! The Mexican Army received reinforcements, but still didn't attack. The Texians destroyed a bridge to prevent more Mexican reinforcements from arriving, but Houston didn't order an attack, either.
Santa Anna's soldiers relaxed their vigilance, just for a bit. They even took a siesta!
At 3:30 p.m., the Texians made their move. Shielded by high grasses and a rise in the land, they covertly approached the Mexican position. When they were about 200 yards away, they fired the first cannon. Texians were soon swarming over the Mexican breastworks. Within about 18 minutes, Houston later reported, "we were in possession of the enemy's encampment." The battle was over, but Texians continued to pursue the fleeing Mexicans for hours afterwards.
Chants of "Remember the Alamo! Remember Goliad!" echoed among the victorious Texians. It was basically a slaughter. Hundreds of Mexicans were cut down.
Santa Anna would be captured the next day. A little over three weeks later, a treaty was signed, requiring all Mexican forces to leave the Republic of Texas.
Edwin P. Hoyt, The Alamo: An Illustrated History (1999)
John Hoyt Williams, Sam Houston: Life and Times of Liberator of Texas an Authentic American Hero (1994)
Randy Roberts & James S. Olson, A Line in the Sand: The Alamo in Blood and Memory (2002)
Stephen L. Hardin, Texian Iliad: A Military History of the Texas Revolution, 1835-1836 (1994)
Stephen L. Moore, Eighteen Minutes: The Battle of San Jacinto and the Texas Independence Campaign (2003)
please contact Colonial Press
info at colonialpressonline dot com
from Tara Ross
Thanks for loving history with me!
© Copyright 2020 by Tara Ross.

redpajama_set_name: RedPajamaCommonCrawl


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Aspen Forest
Victor Higgins
Titles Aspen Forest (Proper)
Artist Victor Higgins, American, 1884 - 1949
Dimensions 26 x 26 in. (66 x 66 cm) frame: 33 7/8 × 34 × 3 1/2 in. (86 × 86.4 × 8.9 cm)
Credit Line Collection of the Art Fund, Inc. at the Birmingham Museum of Art; Gift of Corbin and Dodie Day, AFI.88.2011
Work Type painting
Provenance Victor Higgins, Taos, NM, 1917-1948 [see note 1]; purchased by Eulalia Emetaz, TM, a dealer, 1948-1949; purchased by Mr. Bond [see note 2], Taos, NM, 1949. With Mitchell Brown Fine Art, Tucson, AZ, by 1991. Purchased by Corbin and Dodie Day, Birmingham, AL, by 2001; their gift to the Art Fund, Inc. at the Birmingham Museum of Art, AL, 2011
[1] The painting was consigned to Milch Galleries in 1921, according to the Milch Galleries inventory cards.
[2] The buyer may be Frank Bond, Jr. Record of the purchase by Mr. Bond is documented in the inventory that Dean A. Porter believes was prepared in conjunction with the 1957 memorial exhibition of Higgins's work at the New Mexico Museum of Art. Aspen Forest was included in the inventory but not in the exhibition.


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Evenings while light! After a day of thrills at La Ronde, let the magic of lights dazzle you at night. Your friends, your customers and your business partners will be fascinated by the imagination and boundless creativity pyrotechnic competing firms. La Ronde will take all necessary steps - seats, parking, input-rides, food and drinks - so you can spend an unforgettable evening!


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Rehamed Therapy Physiotherapy Centre
At Rehamed Therapy, we provide a holistic approach to injury recovery that focuses on long-term rehabilitation and takes our patients
from initial physiotherapy through to improved fitness and health. Our team specialises in a wide range of injuries and conditions and
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Our Workplace Health Promotion (WHP) programme ultimately aims at increasing a company/body's profitability by improving the
health and well-being of its employees. By assessing and optimising the work environment and, more importantly, the employees'
interaction with it we can enhance their overall satisfaction, translating to gains in productivity and therefore company performance.
Professional Sports Rehabilitation
Our highly trained team of physiotherapists and sports scientists has vast experience treating elite national level athletes and caring
for their sports therapy and rehabilitation. It is our pleasure to provide this expertise to sports bodies and teams, national, professional
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Rehamed Therapy
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What's Hurting You?
At Rehamed Therapy, we provide a holistic approach to injury recovery that focuses on long-term rehabilitation and takes our patients from initial physiotherapy through to improved fitness and health. Our team specialise in a wide range of injuries and conditions and are looking to help you with your physical recovery needs.
These need not be sport-focused (for example, following knee surgery) but also the result of slowly developed pain such as in the lower back or every day home injuries like a twisted ankle. Ultimately, our goal is to bring you back to full mobility and health. So, what's hurting you?
Knee / Ankle / Shoulder Injury
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Orthopaedic / Cardio / Stroke Surgery
How are You Treated?
Our approach to each customer is completely individual and customised. Your body is unique in the way it is constructed, in the areas and levels of strength it has, how it supports itself and heals and how you take care of it as well. Therefore, even the same injury in two different patients will require different approaches for optimal rehabilitation.
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Book Review: 'Dragon Teeth' is a quick-paced adventure story set during one of paleontology's most infamous periods
Jim Lehane and Robert Reed
Dragon Teeth, the latest novel by the deceased Michael Crichton (9 years now), is an adventure story that takes place amongst the backdrop of one of paleontology's most infamous time periods, the Bone Wars. The Bone Wars was a historic feud between two paleontologists, Othniel C. Marsh and Edward Drinker Cope that took place during the latter half of the 18th century. Cope and Marsh had such a vicious feud that it is unknown how many fossil specimens were actually destroyed in order to thwart the other's attempt at getting the upper hand.
Dragon Teeth
Writer: Michael Crichton
Genre: Historical Fiction
Publisher: HarperCollins
Dragon Teeth takes place in 1876 and follows a rich, but lazy, student William Johnson, at Yale University who ends up with a bet that he would never be able to survive a trip to the west. In response to the bet, Johnson declares that he was already involved with the expedition west led by Marsh, a professor at Yale. Despite his boast, Johnson had nothing to do with the expedition but he managed to weasel his way in by saying he was a photographer. After months of training to actually be a photographer, the expedition sets off for the west, without the participants having any real idea as to where they were going.
During the train ride to Cheyenne, Marsh becomes suspicious of Johnson, thinking that he is a spy for his nemesis Cope, since both Johnson and Cope come from Philadelphia. Eventually, Marsh abandons Johnson in Cheyenne and heads out on his expedition without him. Luckily, Johnson is then picked up by Cope that same morning and Johnson joins their team. Cope and company proceed to travel out into the Badlands of Montana, with the help of their cook, an Indian guide, and several other students.
What follows is a riveting story as Johnson, Cope, and co. venture into Indian Territory during the heart of the American Indian Wars. The expedition eventually comes across the titular "dragon teeth" of Brontosaurus, an animal of such immense size that it exceeds the imaginations of the animal's discoverers. Preserving these bones then becomes of paramount importance and incredibly dangerous as Johnson encounters the Sioux Indians, some notorious figures of America's West, and the infamous town of Deadwood.
Jim Lehane: There is a lot that happens in this book that a simple summary just could not cover. As a paleontologist myself, I am rather well acquainted with the Bone Wars, however I don't know all of the minutiae involved with it. Dragon Teeth is presented as an elaboration of William Johnson's journal. The journal, along with a set of photographs that show two very different versions of Johnson before and after the adventures in this novel, were introduced to us within the Introduction of this real life character who had interactions with a host of other historical figures. The novel then goes off to explain what happened between the two pictures. Rob, what is your background on the subject?
Robert Reed: I'm not a paleontologist, but the subject has always been of great interest to me. When I was younger, I wanted to pursue paleontology as a career, but (perhaps ironically) it was Steven Spielberg's adaptation of Michael Crichton's Jurassic Park that turned me towards filmmaking. Paleontology, however, still remains close to my heart and the feud between Cope and Marsh in particular has been a subject of interest for me for the past year. I was initially hesitant to read Crichton's novel as I've been looking into how to fictionalize the historical events for my own purposes (fortunately, Crichton and I have different approaches and endgames).
Jim: Despite being set amidst the "Bone Wars", the Bone Wars actually only encompass a fraction of the novel. Marsh is known for generally being a dick in real life and the novel portrays him as such, while Cope is portrayed as a nervous but smart individual, often the brunt of Marsh's attacks and tactics. I was
actually surprised at the lack of paleontology in the novel itself. There is the mention of one dinosaur skeleton early in the novel in Marsh's office, then nothing really until about 100 pages later when they start the excavations. There is a cool scene within the excavation of the bones where they needed to prevent the bones from breaking. Nowadays, paleontologist wrap bones in plaster jackets to protect them from breaking but in the late 1800's they hadn't come up with anything like that, so Cope's crew boil down some rice until it was mush and use that as an infield plaster jacket. This is actually a technique that was used by Cope as mentioned by Sternberg in his real life account of the Bone Wars, The Life of a Fossil Hunter (he was also one of the assistants in the novel!).
Robert: That whole sequence is one of my favorite sequences in the novel. Crichton was extremely talented at mining the dramatic tension within scientific processes and making the fields of exploration exciting, even for laypeople.
Jim: One paleontology nitpick: despite being portrayed prominently on the cover of the book, Tyrannosaurus rex has nothing to do with the story, as many paleontologists could probably have figured out. The first partial T. rex skeleton wasn't found until 1900. Cope did find vertebral fragments in 1892 (16 years after the novel takes place) that he named Manospondylus gigas, and were later reinterpreted as T. rex material. But again, it has nothing to do with this story. The cover was obviously chosen to be a harken back to the original Jurassic Park and The Lost World book covers by Crichton, however it has no place as an advertisement for this story.
I think one of the biggest surprises in novel was how quickly it turned from a paleontologist digging story into an old fashioned western story. Once Johnson goes back for the bones and is assaulted by the Sioux, it is a nonstop chase pretty much through the end of the book. Throughout the whole thing I'm sitting there going, "I can't believe this actually happened". You have several famous names coming and going throughout the story including Robert Luis Stevenson, Wild Bill Hickok (mentioned only), and Wyatt Earp, along with several famous western localities with an entire third of the novel set around Deadwood. The hook for me was that this was just an exaggeration of the real life adventures of a year in William Johnson's life. But even though I am a paleontologist and I did enjoy the paleontological aspects of the story, when the story turned into a western was when I got hooked. The last half of the book was absolutely riveting for me. Again, I was sitting there in disbelief that this actually happened.
But alas we get to the end and (SUPER SPOILER WARNING) it's pretty much all fake. The battle between Cope and Marsh was entirely real but the actual facts were jumbled up and to top it off, Johnson was a made up individual in its entirety. I'm not really sure how I feel about that. Crichton hooked me in the
opening introduction saying that he had two pictures of this guy Johnson and he wanted to tell the story about what happened between them. He made a really compelling argument about how this was a historical novel about a year in this guy's life. But to then find out he made the whole thing up! I'm torn.
Yes, I loved the book but this afterward left a bit of a sour taste in my mouth, like I was hoodwinked for the entire story. Rob, what were your feelings on the "Afterword surprise"?
Robert: I had the fortune of reading the author's note and afterword first, so the fictitious nature of Johnson did not catch me off guard. Crichton uses Johnson well as a point-of- view for the audience, especially if one doesn't know about paleontology or its history in the Old West. As Johnson becomes more attached to his work and the bones themselves, so do we. It's a clever way to gain audience investment, especially since Marsh and Cope were already mid-obsession by the time the book takes place.
However, the knowledge that Johnson was not real did color my reading of the book, so when Crichton's narrative became a western rather than a more scientific tale, part of me rolled my eyes and went along with it. The afterword by Crichton's widow, Sherri Crichton, notes that the manuscript seems to trace itself back to 1974, which would have been only a year removed from Crichton's film Westworld. In a way, Dragon Teeth feels like a newly discovered piece in the storytelling through-line between that film and Jurassic Park.
The last third of the book is a pretty drastic change in pace from the preceding pieces. What started off as a tense, but very human story about discovery and competition shifts towards an action story set in America's West. Part of me questions how finished the manuscript was before Crichton's death. It reads as very Crichton throughout its entirety, but I can't help but wonder whether or not he would have taken another pass or two at it, further foreshadowing that genre change towards the end, as well as some of the characters that appear later in the novel.
Jim: Good point Rob, I was wondering how finished the novel was, especially since it seemed to be sitting on a shelf for nine years since his death, not to mention the 30+ years since he started the manuscript itself.
That being said, go ahead and read it. It's a fast, quick paced, adventure story set during one of paleontology's most infamous periods. Don't expect this to be a historical novel giving you 100% accurate representation of the times but I actually really enjoyed the book, until the Afterword that is.
Robert: I have to echo Jim's sentiment that this is a quick and entertaining read. For fans of Crichton, this should be a no-brainer, but the novel will appeal to anyone who is a fan of the Western genre as well.
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Intensive care unit (ICU)-acquired infections are a challenging health problem worldwide, especially when caused by multidrug-resistant (MDR) pathogens. In ICUs, inanimate surfaces and equipment (e.g., bedrails, stethoscopes, medical charts, ultrasound machine) may be contaminated by bacteria, including MDR isolates. Cross-transmission of microorganisms from inanimate surfaces may have a significant role for ICU-acquired colonization and infections. Contamination may result from healthcare workers' hands or by direct patient shedding of bacteria which are able to survive up to several months on dry surfaces. A higher environmental contamination has been reported around infected patients than around patients who are only colonized and, in this last group, a correlation has been observed between frequency of environmental contamination and culture-positive body sites. Healthcare workers not only contaminate their hands after direct patient contact but also after touching inanimate surfaces and equipment in the patient zone (the patient and his/her immediate surroundings). Inadequate hand hygiene before and after entering a patient zone may result in cross-transmission of pathogens and patient colonization or infection. A number of equipment items and commonly used objects in ICU carry bacteria which, in most cases, show the same antibiotic susceptibility profiles of those isolated from patients. The aim of this review is to provide an updated evidence about contamination of inanimate surfaces and equipment in ICU in light of the concept of patient zone and the possible implications for bacterial pathogen cross-transmission to critically ill patients.
Intensive care unit (ICU)-acquired infections are a major cause of morbidity and mortality worldwide . Infections caused by multidrug-resistant (MDR) bacteria are a worrisome healthcare problem and a daily challenge for the clinician dealing with critically ill patients [2, 3]. Contamination of inanimate surfaces in ICU has been identified in outbreaks [4–6] and cross-transmission of pathogens among critically ill patients [7, 8]. Contamination may occur either by transfer of microorganisms contaminating healthworkers' hands or direct patient shedding of microorganisms in the immediate environment of a patient's bed . MDR bacteria have been reported as contaminating microorganisms of surfaces, commonly used medical equipment and high-contact communal surfaces (e.g., telephones, keyboard, medical charts) in ICU [10–13]. It has been reported that both Gram-positive and Gram-negative bacteria are able to survive up to months on dry inanimate surfaces, with longer persistence under humid and lower-temperature conditions . Factors that may affect the transfer of microorganisms from one surface to another and cross-contamination rates are type of organisms, source and destination surfaces, humidity level, and size of inoculum [15, 16]. However, other factors playing a role in contamination and cross-transmission rate in the ICU may include hand hygiene compliance, nurse-staffing levels, frequency/number of colonized or infected patients, ICU structural features (e.g., single-bed or multi-bed ICU rooms) and adoption of antibiotic stewardship programs [17, 18]. The issue of environmental contamination may pose an even greater challenge in the ICU, where patients are critically ill, with several risk factors for nosocomial infections , and the highest standard measures for infection prevention cannot always be addressed due to impelling, life-threatening conditions. Moreover, the nearby environment of ICU beds is crowded by equipment for monitoring and support, with many hand-touch sites, requiring sophisticated and specific cleaning procedures . Identifying which sites are more frequently contaminated and what the most commonly identified contaminants are may play a major role for infection control practices and promotion of new interventions . Environmental contamination by fungi and viruses has been also described in ICU [21, 22]. However, in this review, we focused on bacterial contamination. The aim is to provide an updated evidence on contamination of inanimate surfaces, equipment, and high-contact communal surfaces in ICU, focusing on most commonly isolated bacteria, the role of contamination for ICU-acquired colonization and infection, and possible implications for care of ICU patients.
A growing body of evidence supports the contribution of inanimate surface and equipment contamination for transmission of pathogens to ICU patients. Healthcare workers' hands are the major vector of cross-transmission of pathogens, with an estimated 20 to 40 % of nosocomial infections arising from cross-infections via healthcare personnel hands [11, 23]. Bacterial contamination of caregivers' hands increases linearly over time, with a progressively higher grade of contamination with longer duration of care . It commonly occurs after direct patient contact. However, healthcare workers may contaminate their hands after contact with inanimate surfaces surrounding a patient's bed (e.g., ground, bedrails, emergency carts, and trolleys) or after usage of high-contact equipment items and objects (e.g., stethoscopes, monitors, ventilators, phones, medical charts) [9, 25, 26]. Evidence from observational studies identifies colonized and infected patients as a reservoir for environmental contamination [16, 27]. Frequently touched surfaces and objects in the immediate vicinity of patients are more frequently and heavily contaminated . The concepts of patient zone and healthcare area have been proposed as a user-centered, geographically related model designed to improve hand hygiene compliance by healthcare personnel during their daily workflow . The patient zone encompasses the patient and his/her immediate surroundings. Inanimate surfaces in the patient zone are rapidly contaminated by microorganisms after direct patient shedding of bacteria, or indirectly due to high-frequency interactions between healthworkers' hands and high-touch surfaces (e.g., monitors, ventilator buttons, bedrails), in the patient zone. The healthcare area includes all surfaces outside a given patient zone, namely the healthcare facility environment and other patient zones. Healthcare area may be contaminated by microorganisms from different patient zones . Healthcare workers, crossing different patient zones, may be responsible for cross-transmission and further environment contamination in case of poor hand hygiene compliance [16, 26, 28]. Inanimate surfaces and equipment in the patient zone (e.g., bedrails, ventilator surfaces) should be regularly cleaned due to the high and rapid contamination. Equipment in the healthcare area may be introduced into a patient zone for monitoring or therapeutic purposes (e.g., ultrasound and portable radiograph equipment) and should be cleaned before being brought in the patient zone and after being taken out from it . In a randomized cross-over study, recontamination of high-contact surfaces in ICUs occurred after 4 h from standard cleaning measures . Notably, the rate of healthcares' hand or glove contamination after surface contact is comparable to that observed after patient direct contact . Figure 1 illustrates the role of contamination of surfaces and equipment in ICU. The figure should be read as a circle process, and each stage may be considered the starting point. Possible outcomes of this process are cross-transmission of microorganisms, leading to colonization or infection of new patients (belonging to two different patient zones), and healthcare area further contamination. Notably, colonization has been identified as a risk factor for subsequent infection caused by different bacterial species in ICU [19, 27]. In this regard, cross-transmission, leading to patients colonization, should be considered a negative outcome per se [19, 31]. Moreover, in different outbreak reports  and observational studies [7, 8, 12], MDR isolates were responsible for environment contamination . These data raise concern about a potential role of contamination as a reservoir for resistant species, their selection and subsequent development of ICU-acquired colonization and infections. For these reasons, the issue of environmental contamination has been included in a recently published bundle of recommendations aiming to reduce the incidence of ICU-acquired infections caused by MDR pathogens . However, further studies are needed to elucidate the contribution of inanimate surfaces and equipment contamination to relevant patient outcomes (e.g., mortality, ICU length of stay). A higher shedding of pathogens has been observed from infected patients than from those who are only colonized, with a correlation between frequency of contamination and number of culture-positive body sites [18, 32]. Moreover, a higher environmental contamination has been observed around patients with diarrhea [33, 34]. Bacteria shed from patients are able to survive up to months on dry inanimate surfaces with a concentration sufficient to cause transmission in most cases. When we analyze the association between environment and patient transmission of microorganisms, the temporal relationship between contamination and transmission should be addressed, along with the presence of potential confounders (e.g., the quality of environmental cleaning and hand hygiene) and the reduced incidence of cross-transmission when control measures have been undertaken . The molecular identification of bacterial strains responsible for cross-transmission and/or nosocomial infection has provided useful insights about the role of environmental contamination . Notably, patients may be colonized by isolates different from those detected on surfaces or medical equipment and may result from endogenous flora spread. The same genetic profile of isolates has matched, instead, when environmental contamination has been claimed to play a role on patient colonization or infections . The role of inanimate surface contamination for acquisition of nosocomial pathogens has been further highlighted by studies investigating the role of residual contamination after post-discharge cleaning (i.e., terminal cleaning) for colonization or infection of patients occupying rooms of previously infected patients. In a retrospective study performed in eight adult ICUs at a tertiary care hospital, investigators assessed the risk of acquiring methicillin-resistant Staphylococcus aureus (MRSA) and vancomicin-resistant enterococci (VRE) from prior room occupants. Patients were screened on admission and weekly for MRSA and VRE carriage. Patients occupying rooms of carriers showed a significantly higher risk of acquisition of MRSA (odds ratio, OR 1.4, 95 % confidence interval, CI 1.0–1.9) and VRE (OR 1.6, 95 % CI 1.2–2.2). This increased risk was still observed after correction for other variables (e.g., age, comorbidities, pre-ICU length of stay) . Notably, in all participating ICUs, terminal room cleaning was performed according to recommended standards, with additional precautions adopted in adherence to local protocols. In a prospective cohort study, the risk of acquiring pathogens from prior room occupants was investigated for MDR Gram-negative bacilli. Carriage of MDR bacteria by prior room occupants was the most important risk factor for ICU-acquired Pseudonas aeruginosa (OR 2.3, 95 % CI 1.2–4.3) and the second most important independent risk factor for Acinetobacter baumannii acquisition (OR 4.2, 95 % CI 2.0–8.8), after mechanical ventilation . Viable MDR bacteria have been isolated in biofilm on surfaces and furnishings sampled after terminal cleaning in a 16-bed ICU . Biofilm may enhance bacterial survival capacity on dry surfaces and may confer resistance against physical and chemical agents. Indeed, viable bacteria within biofilms are up to 1500 times more resistant to biocides than those growing in a liquid culture . It may be hypothesized that biofilm formation may contribute to the observed residual contamination after terminal cleaning procedures currently in use. These results may highlight the lack of full eradication of contaminating pathogens after currently recommended standard for terminal room cleaning, although this inefficiency may be attributed to several factors involved in the process (e.g., type of product, sufficient time contact, shortcomings in the procedure). In summary, the patient zone of colonized or infected patients is heavily contaminated by bacteria, including MDR species. Healthcare workers' hands have a major role in environmental contamination, along with direct patient shedding . Inanimate surface contamination serves as a reservoir for patient cross-transmission of bacteria and may contribute to patients colonization and, in some circumstances, infection . In the absence of appropriate hand hygiene and other infection control measures, colonized and infected patients are the starting point of a new vicious circle [16, 28].
ICU patients are exposed daily to a number of monitoring devices and support equipment. Invasive devices are defined as those interrupting skin and mucosal integrity or being in direct contact with patient's blood and mucosa (e.g., endotracheal tubes, central venous catheters). The association between invasive devices and nosocomial infections has been clearly established (e.g., ventilator-associated pneumonia, catheter-associated bloodstream infections) . A number of reports, observational and infection control studies, highlighted the role of non-invasive ICU devices as a potential source of hospital-acquired infections [4, 37, 38]. In the majority of cases, contamination has involved electrical equipment [6, 39, 40] or difficult-to-clean items due to irregular/hidden surfaces or lacking disinfection guidelines . To date, evidence of direct contribution of environmental contamination for nosocomial infection is uncertain. In the following paragraphs, we reviewed the evidence about contamination of some, commonly used, ICU equipment items. The most commonly identified pathogens are summarized in Table 1. The following paragraphs aim to provide examples of equipment contamination in ICU. Ineffective cleaning procedures and infection control measures may similarly be responsible for contamination of different equipment items and objects in the ICU environment. It is beyond the scope of this review to provide details about cleaning and disinfection procedures in ICU. Different reviews on this topic have been recently published [41, 42].
Manually cleaned, reusable electrocardiography (ECG) lead wires are widely used in ICU. They are placed on direct contact with intact skin, but they may take close proximity with wounds, intravenous lines, surgical dressings, and injured areas. Contamination of ECG lead wires has been reported during an outbreak of VRE in a burn unit , but it has also been assessed by observational studies in which ECG lead wires have been sampled for bacterial contamination [40, 43]. Notably, ECG lead wires were cleaned and ready to use for the following patient before being sampled. ICU lead wires have been reported to be heavily contaminated with a proportion of nosocomial pathogens ranging from approximately 20  to 45 %  of total samples. Coagulase-negative staphylococci were the leading Gram-positive bacteria identified, whereas P. aeruginosa was the most commonly identified Gram-negative species . Use of disposable ECG lead wires has been claimed as a potential measure to reduce cross-transmission .
Whittington et al.  investigated the contamination of both bedside and ICU staff stethoscopes. Both diaphragms and earpieces of sampled stethoscopes used in ICU were heavily contaminated by bacteria (diaphragms; bedside stethoscopes 95 %, personal stethoscopes 67 %; earpieces; bedside stethoscopes 75 %, personal stethoscopes 100 %). Potential pathogenic bacteria were isolated from diaphragms of 14 % of bedside and 8 % of personal stethoscopes. Earpieces carried pathogenic bacteria in 21 and 23 % of bedside and personal stethoscopes, respectively. S. aureus was the leading Gram-positive pathogenic species including two MRSA isolates. Acinetobacter spp. were the leading Gram-negative pathogenic bacteria, including one isolate of A. baumannii resistant to all tested antimicrobials except colistin. Participants were asked to clean stethoscopes according to their preferred method, with alcohol swabs resulting in the leading adopted method. After cleaning, 2 % of diaphragms and 7 % of earpieces were still contaminated. When anonimously answered, compliance with cleaning procedures of stethoscopes was higher among nurses (91 % of those interviewed cleaned them after every use) compared with doctors (only 30 % of those interviewed cleaned them after every use) .
Sui et al.  investigated the bacterial contamination of surfaces of mechanical ventilator systems in a 15-bed respiratory center. Swab sampling not only involved faceplates, ventilator plates, and handrails but also the Y-pieces and water trap surfaces of the breathing circuits. Total bacterial contamination ranged from 70.6 to 100 %. S. aureus and P. aeruginosa were specifically searched. The highest contamination rate for S. aureus was observed on Y-pieces (86.7 %) followed by handrails (64.7 %). The highest contamination by P. aeruginosa was reported for water trap surfaces, with no positive cultures for mechanical ventilator surfaces. Contamination rate increased over time, with the highest contamination rate observed after 8 h from the initial surface disinfection. Notably, P. aeruginosa contamination electively involved the breathing circuit and persisted, especially on water trap surfaces, following 75 % alcohol treatment. Contact with ground surface by water traps may explain this observation .
Levin et al.  investigated the activity of radiograph technicians, focusing on adoption of infection control measures and degree of portable radiograph equipment contamination. They performed a 3-phase study, consisting on an observational phase (assessment of baseline adoption of infection control measures), an intervention phase (notification of contamination results and educational interventions), and a follow-up phase. Susceptible Gram-positive bacteria were detected in 9 % of culture sets, whereas susceptible Gram-negative bacteria were isolated in 45 % of sets. Resistant Gram-negative bacteria (A. baumannii, K. pneumoniae, P. aeruginosa, Stenotrophomonas maltophilia) were detected in 39 % of cultures, and a VRE isolate was cultured on one occasion (3 %). Notably, when a resistant Gram-negative species was cultured from the radiograph equipment, the same species was almost always isolated in surveillance or clinical cultures of at least one ICU patient. During the intervention period, promotion of infection control measures resulted in a significant reduction of radiograph equipment contamination, with a decrease of both Gram-positive- and Gram-negative-resistant strains. Radiograph equipment may represent a reservoir for bacteria, including MDR species, in ICU. Equipment and technicians may cross different patient zones during a day, with significant contribution to patients cross-transmission of pathogens when inadequate hygiene measures are undertaken before entering a patient zone. Educational interventions may increase awareness of this potential risk, and radiograph technicians should be involved in infection control programs.
The use of point-of-care ultrasound (US) has greatly increased as part of diagnosis and management of critically ill patients in both the ICU and emergency department. Moreover, several sterile invasive maneuvers are now performed under US guide (e.g., insertion of central venous line, arterial line), posing issues about decontamination and covering of the equipment. All the elements of the ultrasound machine may be contaminated by microorganisms, including probes, keyboards, cords, control settings, gel, and gel bottles [20, 47, 48]. US machines are usually used on several patients, many times per day. Although probes may be disinfected after each use or covered by sterile sheaths, it is unlikely that the entire device is disinfected after every scan . Thus, the devices could remain contaminated passing microorganisms from one patient to an operators' hands and to other patients . Most of the evidence about US machine contamination came from a study not specifically addressing echo in ICU (e.g., Emergency Department US machines, echo machines for regional anesthesia, whole hospital US equipment) [20, 50–54]. Several studies have demonstrated contamination of elements of echo machines by many types of pathogens, including both MRSA [47, 52] and methicillin-sensible S. aureus  (most common), coagulase-negative staphylococci , P. aeruginosa , Corynebacterium spp. , Acinetobacter spp. , Bacillus spp. . Notably, most of the studies collected samples from US machines during normal daily activities, including disinfection according to local protocols. There is evidence of an outbreak by extended spectrum beta-lactamase K. pneumoniae originating from contaminated ultrasound-coupling gel  and an outbreak of MDR P. aeruginosa caused by contaminated transesophageal echocardiography equipment . It has also been demonstrated that, with routine usage, bacterial growth on US machines increases over time from an initial cleaning . The available evidence describes the fact that US cleaning is frequently suboptimal. Manual cleaning is essential to eliminate potentially contaminated gel and other material residuals . It may also be considered that the widespread alcohol-based disinfectants should not be used for disinfection of echo transducers due to the potential damage occurring to the rubber head transducers . It could be recommended to follow available guidelines and manufacture's recommendation for cleaning procedures, according to the type of usage (i.e., intact skin, wounds, contact with blood, purulent material, MDR-carrying patients) . Clinicians should be aware of the importance to clean not only the probes but also all the other elements of US machines after each use inside a patient zone to reduce the risk of cross-contamination.
Medical charts are prone to surface contamination since they are handled by physicians, nurses, and other medical staff several times a day, and they are used for case notes after patient contact for physical examination or invasive procedures. Medical charts may be transferred from one ward to another and may be placed on already contaminated surfaces (e.g., beds, carts). Different studies investigated the contamination of outer surfaces of medical charts in ICU, with an observed contamination rate as high as 80–90 % [38, 59, 60]. In a recently published study, risk of pathogen contamination was two to fourfold higher in ICU compared with general ward. A higher incidence of contamination by MRSA was also reported . Teng et al.  investigated contamination of medical charts in a surgical ICU in Taiwan. Ninety percent of sampled medical charts were contaminated. The leading isolated Gram-positive bacteria were coagulase-negative staphylococci, whereas A. baumannii and K. pneumoniae were the most commonly isolated Gram-negative bacteria. A. baumannii was isolated from the corresponding patients in four out of nine contaminated charts, whereas K. pneumoniae in two out of three corresponding patients . Notably, antimicrobial susceptibility profiles of isolated bacteria were similar to those from pathogens responsible for patient colonization or infection. Given the similar use of medical charts between general wards and ICUs, it may be hypothesized that their increased risk of contamination in ICU may be due to higher patient shedding of bacteria and environmental contamination. Strict adherence to hand hygiene protocols is advocated before and after medical chart handling .
Mobile phones are the most commonly used non-medical portable electronic devices in ICU. They are not only used for communication but also for web consultation and use of applications for patient care (e.g., calculation of infusion doses, electrolytes correction formulas). Unlike fixed phones, of which contamination was also reported , mobile phones are often used in close proximity to patients and inside patient zones. A number of reports and observational studies have highlighted the heavy contamination of mobile phones by bacteria, including MDR . In different studies, mobile phone specimens were associated with sampling from the owner's dominant hand, showing a high degree of correspondence between isolated bacteria [13, 63]. In a study aiming to assess contamination of mobile phones of healthcare workers in operating rooms and ICUs, the rate of bacterial contamination was 94.5 %, with one bacterial species isolated in approxymately 50 % of cases and two or more species detected in about 45 % of total samples . Coagulase-negative staphylococci were the most frequent isolates among Gram-positive bacteria, followed by S. aureus. Non-fermenting species were the leading Gram-negative bacteria . In a study performed in Israel, A. baumannii has been recovered from mobile phones and corresponding hands. One clone was responsible for patient colonization . Hand contamination after mobile phone-use occurs rapidly; a 1 min call was responsible for 95 % positive samples of previously disinfected hands, in a study assessing the extent of mobile phone contamination among anesthesiologists .
As evidence of the role of environmental contamination for cross-transmission increases, the need for objective monitoring of the cleaning process has emerged, especially in ICU. Objective assessment provides immediate feedback and opportunities to improve hygiene procedures and educational intervention for cleaning staff and healthcare workers. In 2010, the Centers for Disease Control and Prevention (CDC) developed a tool kit providing guidance for development of a program to improve environmental hygiene . Five objective monitoring methods of environmental hygiene were included in the CDC tool kit: (1) direct practice observation of staff performance and compliance with protocols; (2) swab and (3) agar slide cultures, providing a quantitative assessment of viable microbial contamination; (4) fluorescent markers (gel, powder, lotion) used to mark high-touch surfaces; (5) adenosine triphosphate (ATP) bioliminesence, which detects the total amount of both microbial (from either viable or non-viable microorganisms) and non-microbial ATP. When incorporated in programs to improve environmental cleaning, objective monitoring of procedures contributed to significantly reduce the patient zone contamination [29, 65]. A full description of current cleaning technologies and environmental contamination-monitoring systems is beyond the aim of this review, but it has been specifically addressed by recently published reviews and guidelines [29, 41, 64].
Inanimate surfaces and equipment in ICU are heavily contaminated by bacteria, including MDR species. Bacterial contamination may contribute to ICU-acquired colonization or infection, but further studies are needed to evaluate this correlation. Clinicians and researchers should be aware of the risk of cross-transmission of pathogens from inanimate surfaces in order to adopt appropriate infection control measures.
We acknowledge the contribution of Priulla SRL, Palermo, Italy, for graphical support.
VR conceived the review, performed the initial literature search and drafted the manuscript; AC conceived the review, participated in literature review and helped draft the manuscript; SMR participated in the design of the review and helped draft the manuscript; AG participated in the design and coordination of the review and helped draft the manuscript. All authors read and approved the final manuscript.
Guh A, Carling P: Options for evaluating environmental cleaning. Centers for Disease Control and Prevention. 2010. http://www.cdc.gov/HAI/pdfs/toolkits/Environ-Cleaning-Eval-Toolkit12-2-2010.pdf. Accessed 5 Oct 2015.


SRTsyndicate > West Regional Forums > California Forums > lots o' stuff for sale!!!!
View Full Version : lots o' stuff for sale!!!!
due to turbo upgrade coming & me moving im looking to sell a few items.
i will adding more items as i find them.....pm me if you are interested!
I'll take the strut bar mike!
i JUST sold it bro.... sorry bro. how are you doing man?


I've done made some plans for later on tonight.
What's your name, little girl?
You probably know well the lyrics from Lynyrd Skynyrd's hit tune What's Your Name.
And you can see that even the legendary Southern rock band had convenience issues. They were pressed for time. We all are.
At 8 o'clock at night in Boise, and many other places, your customers will need dry cleaning. That's a fact!
More and more drycleaning services are becoming available through many options. And that's the name of this new game — omni channels.
Give your customers as many convenient ways as possible to make their life easier and more joyful. It happens with more channels and more partnerships to get the job done easier and faster for them.
Enter Gary McCracken, who, with wife Keh, owns Clothesline Cleaners in — where else? — Boise.
He is describing the operation's drive-up lane and kiosk system that enables customers to drop off and pick up their hanging orders anytime.
But Clothesline Cleaners still has "dedicated over-the-counter traffic, as well as a very steady route business," he adds. For over 30 years, it has been committed to providing clients with the highest quality care and finishing of garments.
But there are challenges in offering more services.
Because there is generally little competition in those specialty areas in its region, Clothesline Cleaners can set its own price point to maximize profit, he adds.
Many streams offer customers easy paddling to your services. But are you offering them?
"A customer can access cleaning services from many different channels today," says Kyle E. Nesbit, vice president of business development at Texas' MW Cleaners, with responsibility for brand management, marketing programs, and more.
Dry cleaners, he suggests, need to realize that the experience throughout all of the channels should be seamless and integrated.
With 37 Houston area locations, MW Cleaners prides itself as a high-quality drycleaning company that specializes in wedding gown preservation, alterations and specialty cleaning, according to Nesbit.
His company opened two state-of-the-art, fully staffed, 24/7 locker stores that it calls MW Clean Closet. A third store is in development.
At the heart of the omni channel and digital crusade is the desire to become as convenient as possible.
In still other channels, his company offers locker services in office buildings.
Single-tenant buildings have proven to be far more lucrative, he points out.
"Because management tends to view the locker service as both an employee benefit as well as a way to increase productivity by making work schedules more flexible, they are more prone to promoting it," says Nesbit.
"I no longer believe that the key for traditional dry cleaners is to simply open more stores," says Mike Bleier, owner of Greener Cleaner in Chicago, and a member of the American Drycleaner Advisory Board. There are simply too many ways that the drycleaning customer can be reached, and every little bit takes away from these traditional stores.
He started his own business, Drive Cleaning, featuring free pickup and delivery, in 2004. In 2011, he bought Greener Cleaner, which he says pioneered eco-friendly cleaning by becoming the country's first 100% wet cleaner in 1995.
He's had five different stores over the years. But times have changed, and he no longer thinks stores are the best return on investment for dry cleaners looking to expand.
Customers using the service have to understand that it is "unattended," he says. "We do not set specific appointment times, or even time ranges.
He treats everything that comes through the app as "specials" and turns them around in 24 hours, enabling customers to have their cleaning picked up Monday night and delivered on Tuesday night, for example.
Dan Miller owns Mulberrys Garment Care, based in Minneapolis, with recent expansion into the San Francisco area.
Speaking more about the revenue "river channels" of today, he weighs in: "The biggest challenge is complexity. Managing one store with set hours, as it's been for decades in the drycleaning business, is considerably easier than managing multiple stores, lockers, kiosks, and delivery drivers," he says.
To Miller, it's just the continuation of the trend of customers wanting services performed on their schedule and not the other way around.
"The businesses that recognize this will have a meaningful advantage," he says.
When drycleaning operators marry brainstorming with partnerships that fit well, profits can be had.


What time does Leicester City v Man United kick-off? Is it on TV? Which channel is it on?
The game kicks-off at 7:45pm on Saturday. It's only the second time in Premier League history that a match has been on a Saturday night. Southampton's 4-0 home win over Arsenal on Boxing Day in 2015, being the only other time.
Yes, the game will be aired on two Sky Sports channels as it will be on their Main Event channel and Premier League channels with coverage starting at 7pm. It will be City's third home game to be shown live on Sky in eight days. If you miss the game, you can catch the highlights on Match of the Day at 10.30pm with Gary Lineker. Don't forget to follow our live blog on the Leicester Mercury website.
The referee will be West Riding-based official Jonathan Moss. He was the official in Leicester City's 1-1 draw at Huddersfield in September.
He has been in charge of 14 games this season handing out 45 yellow cards and one red. The red card was in Manchester City's 5-0 Premier League win over Liverpool in September, when Sadio Mane was sent off for a high foot on keeper Ederson.
The returning Paul Pogba who has been an influential figure in Manchester United's success this season, returns from his three-match suspension after stamping on Arsenal's Hector Bellerin's ankle. The flamboyant Frenchman scored his first Manchester United goal against Leicester last season.
What is the form guide?
City will be looking to bounce back after the penalty shoot-out defeat to Manchester City and their 3-0 loss at home to Crystal Palace. Before that, Leicester had won four consecutive Premier League games.
Man United's focus seemed to be on this week with 10 changes in the midweek defeat to Bristol City. In second place, United are 11 points behind their neighbours Man City. Nevertheless, in the league they are on a good run of form, themselves, winning five of their last six games. United have won their last three Premier League away games.
Since Leicester's stunning 5-3 victory over United in September 2014 at the King Power Stadium, City have struggled against United, losing four and drawing twice in the last six encounters.
In the away game earlier this season, Kasper Schmeichel saved Romelu Lukaku's penalty but that wasn't enough to stop United from winning 2-0 with goals from substitutes Marcus Rashford and Marouane Fellaini.
United ran out 3-0 winners in the corresponding fixture last season, goals coming from Henrikh Mkhitaryan, Zlatan Ibrahimovic and Juan Mata.
No surprises that most of the money will be placed on United and they are the odds-on favourites at 5/6 to beat City.
Leicester are 17/5 for the win and you can back a draw at 13/5.
Romelu Lukaku is the favourite to open the scoring at 10/3. Whilst, Jamie Vardy's quest to become the first City player to register 50 Premier League goals for the club is a 6/1 bet to score first and 2/1 to score anytime.


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Console Games News PS VR PS4
The Drop: New PlayStation Games for August 6, 2019
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Come on in, the water's fine! Rovio's instantly recognizable avian troublemakers set off on a sub-aquatic adventure in The Angry Birds Movie 2: Under Pressure, coming to PlayStation VR next week.
But you can leave your slingshot at home; this one takes a different approach than you might expect. With one player inside the headset and four on the TV, Under Pressure is an asymmetrical co-op affair. The TV players work together to craft ammo for the VR player, who is the only one able to see outside the ship (and by extension the only one who can reel in all the wondrous treasure the ocean holds). Of course, players are able to interact with each other in helpful — and not-so-helpful — ways, which can make for chaotic, hilarious play sessions.
For a full list of new games coming to PlayStation next week, read on. And enjoy The Drop!
Age of Wonders: Planetfall
PS4 — Digital, Retail
Age of Wonders: Planetfall is the new strategy game from Triumph Studios. Build your empire with one of six unique factions, ranging from the militant Vanguard to the dinosaur-riding Amazons and the cyborg-zombies of the Assembly.
The Angry Birds Movie 2 VR: Under Pressure
PS VR — Digital
Now the birds and piggies are best frenemies, Red and Leonard team up to assemble a crack(ed) team and investigate mysterious Eagle Island. But first, they must get there in one piece — in a giant Piggy submarine. Can the birds and pigs cooperate, deep beneath the waves? Or will they get that sinking feeling as the pressure rises?
Corpse Killer – 25th Anniversary Edition
PS4 — Digital (Out 8/5)
You're stranded on an uncharted island of Death. You're zombifying from Voodoo poison. A mad scientist is on your trail. Originally developed by Digital Pictures and released in 1994, Corpse Killer has been completely rebuilt for the PS4, bringing it to a level of video quality never before seen.
Fatal Twelve
Shishimai Rinka thought her life was over… until she woke up and continued her everyday routine as if her fatal accident had never happened. Day by day, her sense of unease grew. Until a mysterious girl spoke to her in her dreams. 'A game is about to begin. This is your chance to truly be reborn.'
Gravity Ghost: Deluxe Edition
PS4 — Digital
Surf the night sky. Careen through the cosmos. Find the fox. When a ghost girl's best friend goes missing, she'll turn the whole universe upside down to find him. Gravity Ghost is a planetary platformer where orbiting is an art form. In over 100 dizzying levels, put your aerial skills to the test against planets that bounce, break, splash, and more.
Illusion of L'Phalcia
PS4, PS Vita — Digital (Cross-Buy)
Experience epic 3D battles in a fantasy RPG. Ryser and Cougar are in search of the Sword of Amal, an artifact of legend said to grant any wish. Their journey will lead them into fateful encounters with both allies and rivals only to find a mysterious truth awaiting at the end of their adventure.
Machiknights -Blood Bagos-
Get ready for an all-new hardcore multiplayer action RPG. Stage by stage, you'll unravel the mysteries of ancient technologies. Experiment with new Machi Knight equipment to change your gameplay style, and stop the evil organization of Kenos from reviving a terrible long-lost weapon known as Bagos the Giant!
Metal Wolf Chaos XD
The country is in peril as President Michael Wilson defends the nation against a full-scale rebellion led by Vice-President Richard Hawk and the mechanized legions he commands. As the 47th President of the United States, it is your sworn duty to take your country back by any means necessary and end this unjust coup d'etat!
When the members of a cult take their own lives, only you can discover the truth behind the tragedy. Inspired by real-world cults, Sagebrush is a first-person narrative-driven adventure game which thrusts players into the role of a truth-seeker who must investigate the tragic circumstances of the Perfect Heaven cult's mass suicide.
Subdivision Infinity DX
Subdivision Infinity is an immersive and pulse pounding sci-fi space shooter featuring stunning graphics and tight spaceship game play. Hunt down and destroy enemy spacecraft, crush capital ships, mine asteroids for rare minerals, and find blueprints to craft amazing new vessels!
Tactics V: Obsidian Brigade
Tactics V: Obsidian Brigade is a retro-style tactical turn-based video game in homage to console tactical RPGs from the 1990s. It's set in a fantasy setting with its own lore and magic, using techniques to convert to a 2D isometric look from 3D assets.
Wonder Boy Returns Remix
Wonder Boy was an arcade hit back in 1986, with its intuitive controls and polished game balance. This forever famous side-scrolling action game has been remixed and reborn for the PS4. Join the adventure of a boy who's doing his best to save his girlfriend Tina — updated with high-def anime-inspired visuals and more!
Wordsweeper by Powgi
A crossword puzzle solved using logic and deduction. This new word game draws inspiration from the classic puzzle game Minesweeper, and is exclusive to Powgi!
The information above is subject to change without notice.
Tags playstation games, PlayStation Music, playstation store, playstation vr, PlayStation Vue, ps store, ps vr, PS Vue, ps4, the drop
← This Week on Xbox: August 2, 2019 → PlayStation Blogcast 339: Postmodern Warfare


What Are Steps To Become A Professional Proofreader?
Do you have the ability to scan grammatical and spelling errors from a specific passage or content? Then it will be idle for you to start a career as a professional proofreader. To become an efficient proofreader, one must have vast knowledge in rectifying grammatical mistakes and thereby making a specific content error free. The first important step is to acquire valuable knowledge in the field of proofreading. To avail above skills, you can get enrolled in a proofreading course in a reputed college or may opt for the reputed online course on the above field. Studying online is the best option if you want to pursue the above course without discontinuing your current job.
To avail enough experience in the above field, it will be wise to proofread various magazines, newspapers and content on the websites. You must make a practice to identify the grammatical and spelling errors in the passages. You may also go through various reputed books that teach various ways to use verbs in a proper way. You must also make yourself familiar with the various techniques of proofreading. You must also be aware about the specific symbols that indicate the author of the content about the type of grammatical and spelling changes needed in the specific passage. The above symbols explain the type of mistake in the passage.
During the start of your career, you should try to voluntarily proofread the documents of various charitable organizations and local newspapers in your city. The above is one of the great ways to acquire some experience and valuable skills in the above field. You may even contact a local newspaper agency in your city and ask whether the editor of the agency needs the assistance of a professional thesis editor. Whenever you discover any grammatical or spelling errors in a magazine, it will be wise to ask the publication on whether they need your services. You can also register on some reputed websites that offer projects on proofreading. Completing the projects of proofreading from the above websites will help you in gaining experience and also help to build an impressive resume from professional resume writers Perth. You must also ask all your valuable clients to refer your name in order to get projects from new clients in the market.
The next important step is to properly advertise your services effectively in the market. You can distribute flyers to the various schools, colleges and universities of your city to make them aware about your proofreading services. You may also distribute the flyers with the help of the local newspaper agency in your city. You must also build a website that effectively promotes your skills and techniques in the field of proofreading. The above is one of the best ways to attract huge potential clients towards your valuable services. You must also invest in fax machine in order to get the emergency projects on proofreading from various clients. Opt for a career in the field of dissertation proofreading if you have excellent command on English grammar and start earning good amount.
How To Build Your Career As A Professional Carpenter?


Only days after inking a content supply deal with iGaming operator, Rabbit Entertainment Limited, and online casino games and solutions developer, Wazdan, has now announced the signing of a similar partnership with Microgaming.
The Malta-headquartered innovator used an official Wednesday press release to declare that this latest alliance is due to see it begin providing a selection of its 'very best titles' to Microgaming for use across the software firm's 'extensive customer base' of over 800 brands.
Andrzej Hyla, Head of Sales for Wazdan, stated that the client list for Microgaming encompasses 'some of the biggest names in the business' and that these operators will now be able to deploy a variety of his firm's mobile-friendly online video slots including favorites like Magic Stars 3, Jumping Fruit and Wild Guns.
Hyla further detailed that his firm's portfolio of over 110 HTML5-based online video slots additionally embraces such titles as Magic Fruits Deluxe, Dracula's Castle and Magic Hot 4 Deluxe that all come complete with its Double Screen Mode, Volatility Levels, Energy Saving Mode, Ultra Life Mode, Ultra Fast Mode, Unique Gamble and recently-premiered Big Screen Mode innovations.
For his part, James Buchanan, Global Operations Director for Isle of Man-based Microgaming, proclaimed that he is 'delighted' that his firm's ever-expanding list of clients will now be able to enjoy content from Wazdan.


TorontoVerve.:: Are You Toronto's Most Fashionable Film Fan?
Are You Toronto's Most Fashionable Film Fan?
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Tag: Amauri Pesek-Hickson
2Dec 2021
Blog, homepage no comments Thunder
2021 Ex-Wolverine Updates: Week 13
Zach Charbonnet
LB Jordan Anthony (Troy): Troy went 5-7 this season. Anthony made 4 tackles in a 37-10 loss to Georgia State. He finishes the season with 35 tackles and 0.5 tackles for loss.
RB Zach Charbonnet (UCLA): Charbonnet had 22 carries for 106 yards and 1 touchdown in a 42-14 win over Cal. He also caught 6 passes for 41 yards.
WR Kekoa Crawford (Cal): Cal went 5-7 this season. Crawford made 5 catches for 42 yards in a 42-14 loss to Cal. This was Crawford's final college game, as he was in his sixth year. He finishes the season with 36 catches for 491 yards (13.6 yards/catch) and 0 touchdowns. He also returned 2 punts for 18 yards and completed 1/1 passes for 34 yards.
Xavier Worthy
LB Jordan Anthony (Troy): Anthony made 3 tackles in a 45-7 loss to Appalachian State.and 0.5 tackles for loss in a 35-21 loss to Louisiana-Lafayette.
RB Zach Charbonnet (UCLA): Charbonnet had 28 carries for a career-high 167 yards and 1 touchdown in a 62-33 win over USC. He also caught 1 pass for 6 yards.
WR Kekoa Crawford (Cal): Crawford made 3 catches for 41 yards in a 41-11 win over Stanford.
LB Jordan Anthony (Troy): Anthony made 2 tackles and 0.5 tackles for loss in a 35-21 loss to Louisiana-Lafayette.
RB Zach Charbonnet (UCLA): Charbonnet had 17 carries for 67 yards and 3 touchdowns, plus 1 catch for 6 yards, in a 44-20 win over Colorado.
WR Kekoa Crawford (Cal): Cal (3-6) did not play a game this past weekend.
Otis Reese
LB Jordan Anthony (Troy): Anthony made a career-high 10 tackles in a 31-24 win over South Alabama.
RB Zach Charbonnet (UCLA): UCLA (5-4) had a bye.
WR Kekoa Crawford (Cal): Crawford caught 5 passes for 56 yards in a 10-3 loss to Arizona.
2021 Ex-Wolverine Updates: Week 9
Xavier Worthy (image via On3)
LB Jordan Anthony (Troy): Anthony made 1 tackle in a 35-28 loss to Coastal Carolina.
RB Zach Charbonnet (UCLA): Charbonnet ran 11 times for 65 yards and 1 touchdown in a 44-24 loss to Utah.
WR Kekoa Crawford (Cal): Crawford caught 2 passes for 31 yards in a 39-25 win over Oregon State.


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Home / Public Ruling PTA007.2 Contractor provisions—door-to-door sale of goods
Public Ruling PTA007.2 Contractor provisions—door-to-door sale of goods
The Pay-roll Tax (Harmonisation) Amendment Act 2008 amended the Payroll Tax Act 1971 (the Payroll Tax Act) with effect from 1 July 2008 to harmonise certain aspects of Queensland's payroll tax system with the systems of other jurisdictions.
The contractor provisions are contained in Part 2, Division 1A of the Payroll Tax Act. Under these provisions, the respective persons under a relevant contract are taken to be employer and employee and payments made under such a contract are taken to be wages for payroll tax purposes.
Although most contracts for the provision for services initially come within the meaning of a 'relevant contract' under s.13B of the Payroll Tax Act, there are certain types of contracts that are specifically exempted from the definition of a 'relevant contract'.
One of these exemptions, provided under s.13B(2)(d)(iii) of the Payroll Tax Act, relates to a contract under which a person is supplied services for or in relation to the door-to-door sale of goods solely for domestic purposes. Accordingly, payments made under such a contract are exempt from payroll tax.
The purpose of this Public Ruling is to explain the exemption for contractors engaged in the door-to-door sale of goods for domestic purposes.
The exemption for door-to-door sale of goods for domestic purposes will only apply if all the following criteria are satisfied:
the sale is not made to a body corporate
the salesperson is not an employee, but has an agency arrangement for the door-to-door sale of goods directly to the public
the goods must not be purchased for the purpose of retailing or reselling or hiring
the sale is to have taken place either at a customer's residence, or at the customer's place of work, or elsewhere than at the vendor's trade premises or a place where goods of that sort are normally offered for sale
where the sale is made away from the vendor's trade premises, this cannot have been made as a consequence of the request of the customer or the agent of the customer
the original approach (i.e. the initial physical attendance, not a telephone contact) leading to the sale was not made at the vendor's premises
the goods purchased must be used by the purchaser solely for domestic purposes, and must not include goods purchased to be further processed in the course of manufacture or goods purchased for commercial or industrial purposes
the agent must personally organise the direct sale of the goods to the end users of the goods.
The exemption applies to all credit sales and cash sales but not sales on a monthly credit arrangement.
The term 'goods' includes all moveable personal property other than money or livestock and includes any removable fixtures of real estate. It does not include services provided to any personal property or fixtures of real estate, for example, cladding and painting.
Where the sale of goods involves ancillary services, such as the installation of the goods for which a separate fee may or may not be charged or services provided under the warranty period, those ancillary services will not preclude the contract from being an exempt contract under this section.
The exemption will not apply where it has been determined by the Commissioner of State Revenue that the contract or arrangement was entered into with an intention whether directly or indirectly of avoiding or evading the payment of payroll tax.
PTA007.2 3 July 2009 3 July 2009 Current
PTA007.1 24 February 2009 1 July 2008 2 July 2009


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23. Mistrzostwa Polski w wieloboju sprinterskim odbyły się w dniach 3-4 stycznia 2004 roku na torze Błonie w Sanoku.

Kobiety

Mężczyźni

Bibliografia

2004 w polskim sporcie
2004 w sportach zimowych
Mistrzostwa Polski w łyżwiarstwie szybkim
Zawody sportowe w Sanoku

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