text:
Engaging the Quiet Kids
By Susan Cain and Emily Klein
Why do so many introverts look back on high school as the worst time of their lives - and why do we accept this reality as normal and "OK"?
This question raises a corollary: Do professional educators have a full understanding of how tough a place an American school can be for introverts? Do we realize what an extroverted act it is, in the first place, to go to school all day long in a classroom full of people, with constant stimulation, precious few breaks, and almost no quiet or alone time? Even for introverted kids who like school, it's still an over-stimulating environment - not unlike an all-day cocktail party for an introverted adult (but without the alcohol).
As adults, we choose the careers, spouses, and social circles that suit us. Bill Gates and Bill Clinton thrive in very different work environments. But for schoolchildren, it's one size fits all - and the size is usually extroverted.
The saving grace, of course, is those teachers who get it - those who connect with the quiet kid in the back row, the kid who thinks amazing thoughts but is too uncomfortable to share them aloud with classmates. We've both spent countless hours observing classrooms and have met many sensitive and thoughtful teachers. One of us (Emily) is an associate professor of secondary and special education and knows firsthand how big a challenge it is to direct and engage a classroom when students are reluctant to participate (and how heavy the pressure for cooperative learning as a primary pedagogical strategy).
But it's obvious that too many of our classrooms fail to accommodate the one-third to one-half of our students who are introverts. Studies show that the vast majority of teachers believe that the "ideal student" is an extrovert1 - which is extraordinary, when you consider how many of our greatest thinkers and creators were introverts. Charles Darwin, Albert Einstein, George Orwell, Steven Spielberg, Larry Page, Steve Wozniak, J.K. Rowling: None of them would have made "ideal" extroverted students.
The bias against introverted students is embedded in our educational system: years of unrelenting focus on cooperative learning, thinking aloud, and talking-as-learning, with grades for class participation, required public speaking (often now as a disproportionate pedagogical focus displacing more traditional forms of scholarship and substantive mastery), and a pervasive, almost normative, value placed on being social and well liked, particularly in a large-group context. In sum, the classroom focus is now too often on "doing," in sacrifice to "thinking."
But the pendulum has begun to swing back (just google "introversion" and "school") toward accommodating a more balanced and differentiated approach to temperament. If we had one wish for a positive result from the conversations that the publication of Susan's book, Quiet: The Power of Introverts in a World That Can't Stop Talking, and Susan's subsequent TED talk ignited, it would be to reverse the stigma of introversion for schoolchildren, so that the next generation of introverted students won't grow up with the secret self-loathing that plagues so many introverted adults today.
WHAT WE NEED TO KNOW ABOUT INTROVERTS
While we are glad that the discussion of introversion and extroversion in the classroom has entered the public consciousness recently (as another example, see the explosion of commentary around writer and teacher Jessica Lahey's recent piece, "Introverted Kids Need to Learn to Speak Up at School," in The Atlantic), one area that has not been introduced nearly enough into the classroom discussion is the brain science behind temperament. Emerging brain research suggests that physiological differences profoundly influence temperament - and therefore the classroom experiences of students.
While some of the qualities associated with introversion are less biologically based than others, introverts and extroverts clearly differ in the activity levels of their dopamine-based reward networks. Dopamine is often referred to as the brain's "reward chemical," and these reward networks become activated in response to the prospect of something pleasing - from applause to a winning lottery ticket. For extroverts, the brain's reward networks tend to be stronger than those of introverts.
Specifically, extroverts show greater activity in brain areas associated with processing potential rewards in the environment, including the orbitofrontal cortex (OFC), amygdala, nucleus accumbens, and ventral striatum. Although extroverts and introverts both have the same amount of dopamine, the brain of an extrovert will release more dopamine in response to external rewards (such as money, status, high-profile projects, etc.). As psychologist and writer Scott Barry Kaufman points out, "this probably explains why many introverts notice that they often need to be alone to recharge their batteries after vigorous social interactions, whereas extroverts appear to gain energy from social interactions." Because introverts have a less active reward system, according to Kaufman, situations that would be energizing to extroverts are exhausting for introverts - these experiences are, quite literally, "unrewarding" to them from a brain physiology point of view. And while extroverts and introverts are equally warm and loving (dispelling the myth that introverts are somehow antisocial), extroverts are more likely to respond to the reward value of a social situation. As a consequence, they tend to seek positive social attention.
Now think about schools and classrooms. Schools are governed by external rewards (grades, social status), and positive social attention is often a key to objective assessments, as well as the subjective experiences of "success." The more positive social rewards extroverts receive, the more they are energized. So, school often fits this temperament comfortably and well.
In contrast, contemporary American schools are poorly suited to introverts' learning needs. This is why rethinking the classroom based on this personality trait (as opposed to the other "Big Five" personality traits: agreeableness, conscientiousness, neuroticism, and openness to experience) is so urgent. From grading students for participation (almost exclusively defined as raising one's hand and speaking, rather than engaging quietly with the material), to an emphasis on cooperative learning and group discussion, to subtle and informal but powerful incentives for being well liked and socially active, schools reward outgoing students and penalize quiet ones. Since many schools are already structured around this one trait - extroversion - it's time to think about how to reorganize schools for a more balanced experience for all learners.
What would a more balanced classroom look like - one that serves the needs and experiences of both introverts and extroverts? At Greenwich Academy, an all-girls pre-K-12 school in Connecticut, a group of students read Quiet and launched an initiative encouraging their peers and teachers to do the same. The teachers then came together to reflect on some of the classroom changes they made as a result of this work, including in surveys they shared with us. Some interesting themes emerged.
Grading for participation
Many Greenwich Academy teachers wrote about the importance of rethinking the practice of grading for participation. "I became much less inclined to write, 'A goal is for ________ to participate more consistently during lessons,' " wrote one teacher. Another wrote, "I became more aware of just how many introverts I had in my classes and that the extroverts will take over unless I make an effort to change up the activities in order to give the introverts different channels to participate." Others said they were revising their policies of grading in a manner that privileges extroverts over introverts.
As Emily and her colleague Meg Riordan observe in "Participation Penalizes Quiet Learners" on Quiet Revolution's website, quietrev.com, "When class participation becomes mixed into one grade with academic achievement, overall academic grades no longer communicate what we believe they should communicate: evidence of learning. Instead, participation becomes a motivator for a portion of expressive, extroverted students and a roadblock for less verbally communicative, but no less knowledgeable or interested, learners."2Klein and Riordan suggest that including participation in a grade intended to reflect evidence of learning results in a murky understanding of a student's achievement - and reinforces classroom participation that supports superficial conversation. Students are encouraged to talk for the sake of "earning points," while introverted students who might be listening are penalized. Meanwhile, space for thinking and reflection is lost.
We encourage teachers to separate grades for learning from grades for participation. Why not give one grade for mastery of the material and a separate grade for character? These character-based grades would reward students who contribute meaningfully to class discussion (not just those who speak up to hear themselves talk). They would also value other personal characteristics such as empathy, courage, persistence, listening skills, and respect for others. Grades should assess a child's proficiency at math or science or history, not his or her ability to speak in front of a large group. Knowledge matters. Deep thought matters. Mastery of a subject matters - even in a world that can't stop talking.
Rethinking participation
But changing assessment policies is not enough to shift the extrovert paradigm in schools. A number of Greenwich Academy teachers began to broaden their notion of what kinds of participation count. Many said that they altered course policies to read "class engagement" rather than "class participation" because the latter seemed to reward frequency of speaking and the former addressed how absorbed in the various tasks of the class a student was. Others mentioned changes in the kinds of activities they relied on in the classroom. Instead of large-group discussions, teachers used the "think, pair, share" technique in which students would reflect or write an answer to a question, then discuss it with a single partner, before one of the two would share with the whole class. This method provides a forum for sharing ideas with peers without engaging in a full class discussion. This is also important for extroverts, who are more likely to speak in public without reflection, and may be better served by being "pushed" periodically to slow down their thinking process and engage in a deeper, more substantial dialogue one to one with a peer. Creating a more balanced classroom requires pushing both the introverts and the extroverts out of their comfort zones while ensuring that some assignments also play to their strengths.
One consequence of the recent push to implement literacy-based strategies across the curriculum has been an increase in reading and writing in all subject areas, something that we believe can be extended further so more students have opportunities for quiet learning. One example of a content area literacy strategy for rethinking participation is a "silent dialogue" or "silent conversation" in which students participate in the form of written communication. A variation on this for an English classroom (although we have seen it in math and science classrooms as well) is for the teacher to post a number of quotes or prompts on large poster paper around the room. Students rotate from sheet to sheet, responding both to the prompt and then to their peers' responses on posters along the wall. In this way they are "conversing" and engaging in a way that supports reflection and quiet learners.
Rethinking introverts as individuals
Finally, a number of teachers at Greenwich Academy began to reframe their ideas of who their introverted students actually were - finding ways to connect individually with those students. One teacher wrote, "I was more intentional to make warm eye contact with them, smiles that let them know that I know they are with me, even if they are not sharing as much. [I tried to] give them space and acknowledge them more." Another wrote, "The issue definitely stayed with me through the year, making me more conscious of quiet students in the class, quiet colleagues, and quiet students outside class - how we encourage [different] voices, how we create safe spaces, and what qualities quiet leaders add to groups."
We know that connecting individually with students is one of the most powerful ways to support all students emotionally, socially, and academically.3
FOUR SKILLS TO ENGAGE THE QUIET KIDS
Beyond the revolutionary work leaders at Greenwich Academy have been doing in regard to being more "intentional" in encouraging the quieter half of their kids to participate in class, we would add the following four additional ideas for more skillfully engaging quiet students.
1. Wait before calling on students.
After posing a question to the class, wait five or ten seconds before calling on students for an answer. This gives reflective kids a chance to think and shy ones time to gather their courage. Research has shown that this method increases participation substantially.
2. Use social media in the classroom as bridge to participation.
Quiet kids may feel more comfortable advancing their ideas in the form of an online response or blog entry. Once their written thoughts have been validated by the class or the teacher, they may gain the confidence to discuss them in a group setting.
3. Strategize with the student.
Teachers can work with a student one on one to offer strategies for participation - such as planning to make a comment early in class, before anticipatory anxiety grows too strong, or to come to class prepared with a specific question memorized or written out in advance, to help break the participation ice.
Especially for younger students, informed parents can play a pivotal role in advocating with teachers on behalf of their quieter kids, creating a productive collaboration between parents and school that can work wonders. (We have created an e-course, Parenting Quiet Kids, in order to encourage this kind of parent-teacher teamwork. A preview is available at quietrev.com/parenting-course).
4. Create groups for students who are anxious about public speaking
In a classroom swirling with social and, in the later grades, sexual politics, practicing public speaking can be so frightening that it becomes counter-productive. Desensitizing the fear in small, supportive settings is crucial for students who are afraid of the spotlight.
Rethinking class participation is the theme that consistently provokes the most passionate cri de coeur from quieter students, and those teachers and administrators thinking hardest about how to better nurture their talents in the classroom. But class participation is only one major obstacle to accommodating quiet kids in school.
For example, we think recess should be reformed. For many kids, it's a highlight of the day, but for others, it's poorly constructed. It's unnecessarily chaotic, and uninteresting. Students should be permitted to play board games in small groups or recharge by reading alone. The notion that all students should restore themselves, each and every day, by running out into a big noisy yard is very limiting, and frankly unimaginative.
Another example is the cafeteria. Most are arranged with rows of long tables, a design which clearly expects all students to be comfortable eating in a large group of 10 or 12 kids. But we know that approximately half those kids would much rather socialize in smaller, more intimate and, yes, quieter groups of two or three. We don't expect adults to lunch in such a cacophonous setting (nor do we expect our own faculty to socialize this way in our own school lounges). So why can't student cafeterias be rearranged to accommodate such an obvious and human preference - and, in fact, need?
Recess and cafeterias are relatively easy to reconsider and reconfigure. A more fundamental, and perhaps insoluble, problem from introverts' perspective - but nevertheless worth pondering - is that, as currently structured, school itself may not be the best forum for a large percentage of kids to learn in the first place. Research shows that learners often perform better in settings that are more solitary than American schools can typically accommodate - by working on their own on problems just out of their (unique, individual) reach. According to research psychologist Anders Ericsson, who has famously studied expert performers in a variety of fields to understand how people get to be great at what they do, "serious study alone" is a key predictor of talent and expertise.
When Susan interviewed Ericsson for Quiet, he explained why. It's only when you're alone that you can engage in something called "deliberate practice." During deliberate practice, you identify the tasks or knowledge that are just out of your reach, strive to upgrade your performance, monitor your progress, and revise accordingly. Deliberate practice is best conducted on one's own because it involves working on the task that's most challenging to you personally. Only when you are alone, Ericsson told Susan, can you "go directly to that part that's challenging to you. If you want to improve what you're doing, you have to be the one who generated the move. Imagine a group class - you're the one generating the move only a small percentage of the time."
Cooperative learning has its place in education, of course. That's where and how students learn to share, explore, and debate ideas together, which, indeed, for better or worse, they will be forced to do continuously later in life. But we also know that as expensive, time consuming, and just downright hard as this is to administer in a classroom, the more time alone for deliberate practice motivated learners can be given - especially the quieter half - the more they will learn.
Finally: noise itself. In a remarkable piece of research, the psychologist Russell Geen gave learning tasks to people together with varying levels of ambient background noise. He found that extroverts did best when the noise was louder, and the introverts did better when the noise was softer. This research clearly illuminates the idea that a one-size-fits-all classroom is a mistake. In order to flourish, quiet students need to have the ability, for at least part of the day, to have some control over the amount of stimulation that is right for them to optimally learn.
So we'll end with a rather uncomplicated plea: some quiet, please!
1. Charles Meisgeier, et al., "Implications and Applications of Psychological Type to Educational Reform and Renewal," Proceedings of the First Biennial International Conference on Education of the Center for Applications of Psychological Type, Center for Applications of Psychological Type, Gainesville, Florida, 1994.
2. Complete article is available at www.quietrev.com/participation-penalizes-quiet-learners/
3. See, for example, Sara Rimm-Kaufman and Lia Sandilos, "Improving Students' Relationships with Teachers to Provide Essential Supports for Learning," American Psychological Association, www.apa.org/education/k12/relationships.aspx
Susan Cain is the author of Quiet: The Power of Introverts in a World That Can't Stop Talking (2013).
Emily Klein
Emily Klein is an associate professor of secondary and special education at Montclair State University, New Jersey. Some of the material in this article first appeared in Susan Cain's blog, quietrev.com, and on theatlantic.com.
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Bruce Falcon who is popularly known by his stage name, Blood Raw was born on April 17, 1975 and his current age is 40. He is an American rapper who is from Panama City, Florida, United States of America. In 2010, before he left Corporate Thugz Entertainment, he was also a part of the rap group named U.S.D.A. some of his debut albums are my life: My Life: The True Testimony which reached to number five on the Billboard Top R&B or Hip-Hop Albums chart. On the Billboard 200, it also reached number 29. He began his rap career while serving a six-year bid in Florida prison during the mid-90s. He developed his rhyme skills in the jail and also earned the "Blood Raw" title.
Blood Raw is a local slang that stands for "The Truth". In 1998, during his release, he moved to Atlanta to work for uncle there in a local rap hotspot called the Hip Hop cafe. In 1999, he again moved back to Panama to start his own new rap crew. He then eventually met Young Jeezy performing at the same show and then, he joined Jeezy's U.S.D.A outfit and signed with the Atlanta's rapper's group, Thugz Entertainment in the year 2004. Nearly after two years of time, he was again arrested by the law and had to face federal drug trafficking charges. In 2006, he finally end up all his charges and began to promote the official, U.S.D.A. He also hit the southern mix tape scene with a few solo street albums which includes the DJ Smallz helmed The Street Love Blood Raw and DJ Drama assisted Indictment Papers, in anticipation of his CTE debut.
Blood Raw has an estimated net worth of $300 thousand dollars. He earned his net worth with his successful and popular songs. Most recently he is signed to Powerhouse Big Cat Records and released his album Raw Redemption on October 9, 2012, which directly picked number 40 at the R & B an U.S chart.
The tall artist's personal information are not made public. It has come in rumors that he has been dating with someone and has a girlfriend but we are not sure about this. Well, in this case, we cannot say if he is married or not. News have also arouse of he, being married and having a wife in the past but had a divorce. As we don't know anything much, it has left us in dilemma. One thing is sure that he has no children yet. But he may not be a gay.
His fan following has a very large scale. It can be clearly seen through his social networking sites like Facebook, twitter and Instagram. He has 14.6K followers in twitter, which is huge itself. Well, he also never fails to disappoint his fans by uploading thousands of pictures. He has 2416 photos and videos and 33.6K tweets in twitter.
Data related to his height and ethnicity is not provided. Blood Raw's musical biography is interesting but many of his information in his wiki are not made public, maybe he prefers privacy to his personal life.


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Research Scientist Google Brain
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The Google Brain teams research focuses on methods that can learn multiple layers of rich, non-linear feature extractors and can scale to large amounts of data. Much of our work is best understood as part of the deep learning subfield of machine learning, but we are interested in any methods capable of efficient and effective feature learning that get good results on challenging problems.
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Participate in cutting edge research in machine intelligence and machine learning applications.
Develop solutions for real world, large scale problems.
PhD in Computer Science, related technical field or equivalent practical experience.
Experience in Natural Language Understanding, Computer Vision, Machine Learning, Algorithmic Foundations of Optimization, Data Mining or Machine Intelligence (Artificial Intelligence)
Programming experience in one or more of the following: C, C++, Python
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Role : Software Engineering
Seniority Level Associate Industry Computer Employment Type Full-time Job Functions Engineering Skills Machine Learning Engineer | AI Research Engineer
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It offers services designed for work and productivity (Google Docs, Sheets and Slides), email (Gmail/Inbox), scheduling and time management (Google Calendar), cloud storage (Google Drive), social networking (Google+), instant messaging and video chat (Google Allo/Duo), language translation (Google Translate), mapping and turn-by-turn navigation (Google Maps/Waze), video sharing (YouTube), notetaking (Google Keep), and photo organizing and editing (Google Photos). The company leads the development of the Android mobile operating system, the Google Chrome web browser, and Chrome OS, a lightweight operating system based on the Chrome browser. Google has moved increasingly into hardware; from 2010 to 2015, it partnered with major electronics manufacturers in the production of its Nexus devices, and in October 2016, it released multiple hardware products (including the Google Pixel smartphone, Home smart speaker, Wifi mesh wireless router, and Daydream View virtual reality headset). The new hardware chief, Rick Osterloh, stated: "a lot of the innovation that we want to do now ends up requiring controlling the end-to-end user experience". Google has also experimented with becoming an Internet carrier. In February 2010, it announced Google Fiber, a fiber-optic infrastructure that was installed in Kansas City; in April 2015, it launched Project Fi in the United States, combining Wi-Fi and cellular networks from different providers; and in 2016, it announced the Google Station initiative to make public Wi-Fi around the world, with initial deployment in India.
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redpajama_set_name: RedPajamaCommonCrawl


Aerobic, Gram-positive cocci [Fig 1], usually seen in clusters.
Easily grown on blood agar or other conventional media.
S. aureus: coagulase positive and thermonuclease positive.
Blood agar with a novobiocin (NB) disc: creamy, gold colonies; β-hemolysis, novobiocin sensitive.
Antimicrobial resistance: rare isolates remain penicillin susceptible. In many areas, MRSA > MSSA.
Penicillin resistance (MSSA) conferred by penicillinase production, which can be overcome by the addition of a beta-lactamase inhibitor (e.g., amoxicillin/clavulanate, ampicillin/sulbactam) or use of penicillinase-resistant penicillin (e.g., oxacillin, nafcillin).
Use of penicillin Vk or G for serious infections discouraged as the reliability of PCN susceptibility is questionable without detailed testing; suggest using agents typically employed for MSSA.
< 5% of isolates in the U.S. are apparently susceptible to penicillin.
Methicillin resistance (MRSA) conferred by the presence of mecA gene that encodes penicillin-binding protein 2a, an enzyme that has low affinity for beta-lactams and thus leads to resistance to methicillin, oxacillin, nafcillin, and cephalosporins.
Community-acquired MRSA (CA-MRSA) isolates (less noted now as MSSA and MRSA now nearly equivalent in many hospitals/communities): often maintain susceptibility to tetracyclines (tetracycline, doxycycline, minocycline, tigecycline) and TMP/SMX.
Clindamycin susceptibilities vary geographically. If the isolate is erythromycin resistant, must confirm clindamycin susceptibility with D-test.
VISA, VRSA: vancomycin resistance remains rare, and seen mostly in patients with long-term vancomycin therapy (e.g., ulcers in diabetic dialysis patients).
Carried normally in anterior nares by 20-30% of U.S. population.
Higher carriage rates seen in diabetics, injection drug users (IDU), HIV or dialysis patients.
Carriers have a greater risk of subsequent infection.
Risk factors: skin disease, venous catheters, other foreign bodies (e.g., prosthetic joints, pacemakers), IDU, hemodialysis, recent surgical procedure.
Methicillin-resistance is now common in both community and many hospital settings in North America (much less in some Northern European countries).
MRSA traditionally associated w/ healthcare system interaction; CA-MRSA has emerged as a significant pathogen in 1990s, especially in children, prisoners, IDUs (although rates were also increased in adults with no clear risk factors). However, in many communities, rates of MRSA ~50% or higher and no longer epidemiologically as important.
Most skin/soft tissue infections; these are relatively benign with good response to I&D ± antibiotics, although recurrent infections can occur. in some.
Rarely, serious disease with or necrotizing fasciitis may occur.
Probably not a frequent cause of cellulitis in the absence of purulence (abscess) or wound, as uncomplicated cellulitis is mostly streptococcal in origin.
Pneumonia: especially suspect with influenza-associated infection.
Dx: positive cx from a sterile site (blood, joint, CSF), abscess or wound.
Positive cx or test from nares (MRSA screening) = colonization, not an infection.
Staphylococcal toxic shock syndrome (see separate module) caused by TSST-1 or other enterotoxin producing strains.
A constellation of fever, low BP, red rash and multiorgan failure.
Risks: tampon use, nasal packing, surgical wounds.
Diarrheal disease: ingestion of preformed Staphylococcal enterotoxin causes acute, self-limited gastroenteritis. Incubation is rapid: 2-6h.
Uncommonly diagnosed, except in outbreak situations.
Some common presentations, list by no means comprehensive.
Bloodstream: primary risk is the presence of an intravascular catheter, which should be removed.
May occur without apparent focus or entry site at any age but especially older adults.
Skin/soft tissues: folliculitis, cellulitis, furuncle [Fig 2] carbuncle, abscess, impetigo (may occur in combination with Streptococcus pyogenes).
Cardiac: endocarditis, occurs in 6-25% of S. aureus bacteremia; afflicts both native and prosthetic valves.
Bone: osteomyelitis (S. aureus leading cause, most common is vertebral osteomyelitis secondary to bacteremia/discitis).
In severely ill, or risk for MRSA, empiric coverage traditionally with vancomycin IV, although daptomycin, ceftaroline or linezolid among others would potentially service depending on the clinical presentation.
Anti-staphylococcal penicillins and cefazolin appear superior to vancomycin and other lipo/glycopeptides, if susceptible.
Severe MRSA infections with vancomycin MIC 1.5-2.0 (so-called hVISA) not responding to vancomycin therapy, consider an alternative agent (e.g., daptomycin or ceftaroline).
Several studies have worse clinical outcomes with vancomycin in these settings. This remains controversial.
Vancomycin does have dose-related nephrotoxicity especially with maintaining 15-20 ug/mL troughs.
More recent evidence suggests troughs are not an ideal surrogate for a target AUC:MIC ≥400 , with many patients able to achieve a goal AUC:MIC with troughs less than 15 mg/L.
Daptomycin: caution for use with vancomycin MIC > 1.0, especially if switching from vancomycin therapy due to higher rates of non-susceptibility of daptomycin and clinical failures.
VISA and VRSA infections remain rare, which is much different than with the Enterococcus (VRE).
VRSA: vancomycin MIC ≥16 µg/mL due to resistance genes (vanA operon, codes enzymes that modify or eliminate the vancomycin binding site, derived from VRE.
First identified in 2002, only 14 isolates described (2015).
Perform detailed history and physical to detect the source and if metastatic spread has occurred. Infectious diseases consultation recommended in most cases.
Remove foci of infection whenever possible; remove implicated venous catheter if present.
May occur without apparent focus or entry site.
Evaluate if without focus for endocarditis (TTE (transthoracic echocardiography)/TEE (transesophageal echocardiography), mycotic aneurysms or other deep infection, e.g., abscess, spinal involvement (discitis, vertebral osteomyelitis, epidural abscess).
Rule out endocarditis with echocardiography (TTE/TEE).
Mortality rates of up to 20-40% (MRSA > MSSA).
The appropriate duration of therapy improves outcomes.
Risks for poor outcomes include age, SOFA score, cirrhosis.
MSSA: superiority of β-lactams make clear favorite over using vancomycin.
Cefazolin can be given to hemodialysis patients: 2 gm after dialysis if next dialysis in 2 days and 3 gm after dialysis if next dialysis in 3 days.
Note: inoculum effect may occur in MSSA Type A Bla that hydrolyze beta-lactam bonds of cefazolin but not oxacillin or nafcillin. Perhaps 10-30% may exhibit inoculum effect and this could be associated with worse outcomes.
Some limited data suggest outcomes may be worse with cefuroxime or ceftriaxone compared to semi-synthetic penicillins.
MSSA Type C Bla inoculum effect can contribute to worse outcomes if using ampicillin/sulbactam or piperacillin/tazobactam.
Consider oxacillin/nafcillin desensitization for life-threatening Type 1 PCN allergy (hives/anaphylaxis).
Consider loading dose for severe infections: guidelines recommend 25-30 mg/kg, although at Johns Hopkins, favor 20-25 mg/kg, particularly in patients with any baseline or anticipated renal dysfunction.
Alternatives: for severe allergy or treatment failure, consider infectious diseases consultation. Little robust data to guide choices. Unclear if monotherapy or combination therapy needed for salvage therapy (see below). With the exception of daptomycin, none of the below regimens approved for treatment of bacteremia.
FDA approved for S. aureus bacteremia and right-sided endocarditis, preferred in most instances; some experts recommend higher doses 8-10 mg/kg daily for severe infections.
Not FDA approved for S. aureus bacteremia, black box warning has to do with increased mortality seen in patients with Gram-negative not Gram-positive bacteremia.
No routine role for employing aminoglycosides or rifampin in combination.
Bacteremia: 28d is the standard course of therapy.
Some avoid short course in patients that meet short-course criteria but have multiple co-morbidities, e.g., diabetes, liver or advanced renal disease, immunosuppression.
Endocarditis or epidural abscess: 42d minimum.
Perform detailed history and physical to detect a potential source and metastatic spread.
Diagnostic and therapeutic considerations: most use Duke criteria (see endocarditis module), positive blood cultures documented.
Remove or drain foci of infection whenever possible.
Obtain brain and CNS vessel imaging if neurologic symptoms or persistent headache present.
Consult cardiac surgery if the patient has persistently positive blood cultures, evidence of heart failure or ongoing embolic disease.
Evaluation especially recommended if vegetation > 10mm, new heart block, worsening heart failure, persistent fevers.
Obtain MRI w/ contrast spinal imaging if back pain present to assess for discitis, vertebral osteomyelitis or epidural abscess.
Echocardiography recommended, TTE as initial with TEE if moderate to high clinical suspicion, difficult TTE imaging of prosthetic valves.
Gentamicin: no longer recommended for native valve endocarditis (right or left sided, MSSA or MRSA).
The utility of combination, empiric therapy (e.g., vancomycin + cefazolin) is not well evidenced.
Endocarditis caused by PCN-susceptible isolates should still be treated with antistaphylococcal abx (nafcillin, oxacillin, cefazolin) since many labs not able to detect PCN susceptibility.
Clindamycin not recommended due to increased risk of relapse.
Routine use of rifampin not recommended due to observations of worsened outcomes with combination therapy.
Dosing is higher than FDA-approved 6 mg/kg.
If brain abscess present, nafcillin or oxacillin favored rather than cefazolin.
MSSA, native valve, right-sided involvement ONLY: pt w/o AIDS, vascular prosthesis or embolic dz other than septic pulmonary emboli.
Use of synergistic gentamicin no longer recommended for short course therapy as no impact on outcomes and associated with nephrotoxicity.
Alternate oral regimen: only for IDU, TV MSSA endocarditis.
Ciprofloxacin 750 mg PO twice daily PLUS rifampin 300 mg PO twice daily for 28 days, if isolate proven susceptible to both agents.
Many experts state that though this is a well-studied regimen, concern for emergence of FQ-resistance deem this a problematical choice.
Some experts recommend higher doses: 10-12 mg/kg daily.
TEE recommended for all cases to evaluate for significant perivalvular abscess, leak or if other valves involved.
FDG-PET may be helpful in confusing situations, Ao-grafts, concomitant cardiac device presence.
Early evaluation for potential valve replacement suggested.
See diagnostic and therapeutic considerations listed above.
Oxacillin or nafcillin 2g IV q4h for ≥ 6 weeks PLUS gentamicin 1 mg/kg IV q8h (or 1.5 mg IV q 12h) for 1st 2 weeks PLUS rifampin 300 mg PO q8h for ≥ 6 weeks after blood cultures have cleared; confirm susceptibility to all agents.
Vancomycin 15 mg/kg IV q12h for ≥ 6 weeks PLUS gentamicin 1 mg/kg IV q8h (or 1.5 mg IV q 12h) for 1st 2 weeks PLUS rifampin 300 mg PO q8h for ≥ 6 weeks after blood cultures have cleared; confirm susceptibility to all agents.
Always consider unknown source if persistently bacteremic.
Little quality evidence to guide and judge the effectiveness of such switching to combination therapies. Available studies are a mix of in vitro and observational data. Drugs often used in combination although reports of monotherapy working in such situations also documented.
Daptomycin 8-10 mg/kg IV q 24h + ceftaroline 600 mg IV q8h.
Not terribly successful as reported in left-sided endocarditis.
Surgical drainage for any collection. For cutaneous abscess, I&D may be sufficient.
Recent RCT did suggest better outcomes if clindamycin or TMP/SMX were used in addition to I&D.
For non-purulent cellulitis, this usually is due to β-hemolytic streptococci rather than S. aureus.
Antibiotics indicated for severe/rapidly progressive infections, signs and symptoms of systemic illness, diabetes or other significant immunosuppression, advanced age, location of abscess in an area where complete drainage is difficult, lack of response to initial I&D (also assess for the need for additional I&D, surgical consultation for necrotizing fascitiis), extensive abscess-associated cellulitis.
If antibiotics employed, obtaining cultures recommended to help guide therapy.
Parenteral: IV antibiotics generally not needed unless severe infection, concomitant bacteremia or systemic toxicity.
MRSA: check susceptibilities, includes options for CA-MRSA with TMP/SMX and tetracyclines most likely susceptible.
Duration of therapy: depends on the extent of disease, usual range 5-10 days.
Recurrent soft tissue infections: education regarding hand hygiene and personal hygiene (e.g., regular bathing, no sharing of personal items, clean personal sporting equipment, avoid shaving).
Clean high-touch areas in contact with bare skin (e.g., counters, sinks, door knobs, tubs, toilet seats, etc) with commercial cleaners or dilute bleach.
Indications for decolonization include recurrent infection despite optimal hygiene or household transmission. Evaluate contacts for evidence of S. aureus infection. Routine screening cultures of nares not recommended.
Mupirocin 2% ointment to nares twice daily for 5-10 days. Some repeat for a period of months, e.g, first five days of each month.
Mupirocin 2% as above + chlorhexidine (Hibiclens) washes daily for 5-14d or dilute bleach bath (1 tsp/gallon, ¼ cup per 13 gallons) twice weekly x ~3 months.
Oral antibiotics not usually recommended. Some use if above measures fail. Typically choose one drug from oral MRSA regimen above plus rifampin (e.g., doxycycline 100mg twice daily + rifampin 600mg daily x 7-10d).
Some clinicians add rifampin to oral agents for MRSA for patients with recurrent soft tissue infections; rifampin should NEVER be used as monotherapy; the efficacy of this strategy is unproven and rifampin is associated with significant drug interactions so we do not recommend it in most cases.
Consider MRSA pneumonia in any patient with severe CAP (e.g., ICU admission, necrotizing/cavitary disease, empyema) pending sputum or blood culture results.
Treatment: use susceptibilities to help guide final choice. Linezolid may have better PK/PD data in lung compared to vancomycin; study shows better initial clinical success than vancomycin, but similar 60d mortality.
Daptomycin cannot be used for pulmonary infections because it is inactivated by surfactant.
Drain or proceed with thoracic surgical consultation for empyema.
Duration of therapy: 7-21d course, depending on severity; many cases of ventilator-associated pneumonia can be treated for 8d; necrotizing pneumonia usually requires longer courses ≥ 14d; bacteremic pneumonia, at least 14d.
MRI with gadolinium often the best study to employ to diagnose infection in vertebral bones, discs or feet. CT or if plain films positive, sufficient for larger bones.
Drainage and debridement of devitalized bone should be done if possible.
No clear data to suggest preference regarding the parenteral or oral route of antibiotic.
Some add rifampin to any of the above dosings as 600mg once daily or 300-450mg PO twice daily. If patient bacteremic, only add rifampin after bacteremia clear to avoid the emergence of resistance.
Potential oral approaches include monotherapy using TMP/SMX, doxycycline, minocycline, clindamycin OR combination levofloxacin or moxifloxacin with rifampin.
Duration: unclear best course, many choose 6-8 wks, the IDSA vertebral osteomyelitis guideline suggests 6 wks.
Some treat for additional 4-12 wks especially if OM of longstanding nature or if complete debridement not achieved, ESRD patient or hardware is present that also may require consideration of suppressive therapy.
ESR/CRP may be used to follow response.
Always drain or debride joint.
Repeat closed drainage as needed or open drainage, no clear preference.
Treatment: select from MSSA or MRSA choices as above.
Prosthetic joint infection: see the module for additional details.
Select abx guided by susceptibilities, from OM choices above + rifampin 600mg or 300-450mg PO twice daily x 2-6 wks.
Follow by TMP/SMX, fluoroquinolone, tetracycline or clindamycin + rifampin x 3-6 months.
Late (> 2 mos post-op): or if unstable, later-onset infection or > 3wks symptoms--remove hardware and administer abx as above.
Duration: 6 wks (or until inflammatory markers normalize), may consider suppressive therapy.
MSSA: nafcillin or oxacillin 2g IV q4h.
Preferred: vancomycin 15-20 mg/kg IV 12h (consider loading dose; guidelines recommend 25-30 mg/kg, although we favor 20-25 mg/kg, particularly in patients with any baseline renal dysfunction). Strive for trough level ~20 µg/mL.
Linezolid 600mg IV q12h (limited data for meningitis but has good CNS penetration).
TMP/SMX 5mg/kg (trimethoprim component) q8-12h.
Some add rifampin 600mg PO/IV q24 or 300-450mg IV/PO q12h.
Refractory infection: consider intrathecal vancomycin, 5-20mg daily.
CNS shunt infection: remove the device. Replace only when CSF cultures repeatedly sterile.
Consult neurosurgery urgently for drainage.
Would not use cefazolin for MSSA given poor CNS penetration.
See Staphylococcal TSS module for details.
Remove focus of staphylococcal colonization or infection.
Stabilize blood pressure w/ aggressive hydration +/- pressors.
MSSA: oxacillin or nafcillin 2g IV q4h PLUS clindamycin 600mg IV q8h.
MRSA: vancomycin 15-20 mg/kg IV q12h PLUS clindamycin 600mg IV q8h (if susceptible) or linezolid 600 mg IV/PO q12h.
Consider intravenous immunoglobulin infusions, though data most supportive for streptococcal TSS.
Good activity against MSSA and other Gram+ organisms (not MRSA). Useful for skin and skin structure infections when some Gram (-) and anaerobic coverage is also desirable (bite, mixed abscess). Not recommended for S. aureus bacteremia or endocarditis.
A good choice for skin and skin structure infections due to S. aureus, though for CA-MRSA susceptibilities to clindamycin vary by geographic location. Erythromycin resistance predicts inducible clindamycin resistance in many isolates; thus, the microbiology lab should perform a D-test to assess for clindamycin susceptibility. Excellent oral absorption, although GI intolerance (including C. difficile) is more likely with higher doses. Not recommended for S. aureus bacteremia or endocarditis.
A good choice for skin and skin structure infections due to S. aureus, particularly CA-MRSA; poorer anti-streptococcal activity. Has the best in vitro Gram+ activity of the tetracyclines. Side effects include photosensitivity, reversible vestibular dysfunction, and blue skin discoloration. Often used for long-term suppressive therapy in orthopedic infections, sometimes in combination with rifampin. Not recommended for S. aureus bacteremia or endocarditis.
Well-established agent for serious systemic S. aureus infections (not MRSA). No dose adjustment for renal failure. Main toxicity is neutropenia. The agent is administered intravenously q4h or by a pump for home therapy.
Well-established agent for serious systemic S. aureus infections (not MRSA). No dose adjustment for renal failure. Main toxicity is the elevation of hepatic enzymes. The agent is administered intravenously q4h or by a pump for home therapy.
Activity against MSSA and other Gram+ organisms (not MRSA) as well as most Gram (-) organisms. Useful for broad-spectrum empiric therapy when MSSA, streptococcus, enterococcus, Gram (-), and anaerobic coverage is desirable. Not generally recommended for S. aureus bacteremia or endocarditis due to lack of robust clinical data, but probably would work if not expressing Bla C. [J Antimicrob Chemo 1993;Suppl A 97-104, bacteremia 15/17 cured, 2 failures ascribed to lack of source control] .
Combination streptogramin antibiotic is active against MRSA and Vancomycin-resistant Enterococcus faecium. E. faecalis is intrinsically resistant. Not FDA approved for S. aureus bacteremia. Must be given IV via a central line because of phlebitis risk. Other side effects are severe arthralgia and myalgia. Has a variety of drug-drug interactions mediated via the cytochrome P450 system. No dose adjustment is required for renal or hepatic insufficiency.
Excellent bactericidal agent against S. aureus but SHOULD NEVER BE USED AS MONOTHERAPY because of the rapid development of resistance. Can be used in combination with fluoroquinolones, TMP/SMX, clindamycin, or minocycline after a course of appropriate IV therapy for complicated bone and joint infections requiring long-term therapy/suppression. Also used as part of combination therapy for PVE. No robust studies have proven beneficial role independently, and some have suggested use equates with poorer outcomes.
A good choice for skin and skin structure infections due to S. aureus, particularly CA-MRSA; poor anti-streptococcal activity. Use compared to vancomycin has been studied in a cohort of injection drug users with MSSA and MRSA infections with good clinical results, particularly with MRSA. Not usually recommended for S. aureus bacteremia or endocarditis except in salvage situations in conjunction with infectious diseases consultation. A recent study of severe S. aureus infection suggested TMP-SMX was not inferior and those receiving had higher mortality compared to vancomycin. Some studies support the treatment of bacteremia, and if so, would use higher dosing (5mg q 8, trimethoprim).
Active against MRSA and MSSA (but less effective so if MSSA, prefer beta-lactam therapy for serious infections).
The clinical failure rate is higher for staphylococcal endocarditis treated with vancomycin than with alternate beta-lactam agents. Use is thus reserved for MRSA or for patients with documented severe beta-lactam allergy.
Must be given IV (no oral absorption).
For serious infections, trough suggested 15-20 mcg/mL, with 20 mcg/mL goal if CNS, though upcoming vancomycin guideline revision may suggest AUC:MIC dosing strategy with lower resulting troughs, and less toxicity.
When using this agent it is prudent to follow serum trough levels (aiming for a trough of 15-20 mcg/ml for serious infections). No single dose should exceed 2g. Loading dose can be considered in patients who are critically ill.
Trough concentrations are the most accurate method to guide dosing; obtain after steady state likely following 4th or 5th dose. For routine SSTI infections, 1g q12h dosing should be adequate.
An oxazolidinone antibiotic is available both orally and intravenously with activity against both MSSA and MRSA as well as VRE. No dose alteration required in renal or hepatic insufficiency.
Not FDA approved for S. aureus bacteremia.
Side effects include thrombocytopenia, anemia, neutropenia as well as optic neuritis and irreversible peripheral neuropathy. Side effects are more common in patients receiving the drug for > 3 weeks.
Because it is a monoamine oxidase inhibitor (MAO-I), it should not be used with MAO-Is and should be used with caution with serotonergic drugs (SSRIs) given case reports of serotonin syndrome. Patient on both drugs should be monitored for mental status changes, myoclonus, diaphoresis and other symptoms of serotonin syndrome. If the concern of serotonin effect may consider instead tedizolid which has a much lower risk of interaction.
A lipopeptide antibiotic FDA approved for MSSA and MRSA bacteremia and right-sided endocarditis and complicated skin and skin structure infections due to MSSA, MRSA, GAS, and VSE.
It is inactivated by pulmonary surfactant and cannot be used for pneumonia.
The dose is 6 mg/kg/day when used for S. aureus bacteremia or endocarditis and 4 mg/kg/day when used for skin infections. Many experts recommend higher doses (8-10 mg/kg daily) for MRSA bacteremia and endocarditis. Dose reduction required for CrCl < 30mL/min (same doses but administered every other day).
The main side effect is myopathy; CK must be checked at least weekly.
Cases of the emergence of resistance during therapy have been reported, particularly in patients without source control who have received prior vancomycin; monitor for recurrent positive blood cultures during therapy.
A good choice for skin and skin structure infections due to S. aureus, particularly CA-MRSA but has poor anti-streptococcal activity. Side effects include photosensitivity (patients should be warned to avoid the sun). Often used for long-term suppressive therapy in orthopedic infections, sometimes in combination with rifampin. Not recommended for S. aureus bacteremia or endocarditis.
FDA approved for skin and soft tissue infections. Low serum levels make this a drug not typically employed for bacteremia. FDA warning issued based on a review of clinical trials warned of increased mortality with its use.
Lipoglycopeptide that was initially FDA approved for SSTI on the basis of non-inferiority studies compared to vancomycin. Unclear if lower MRSA MIC of telavancin compared to vancomycin has clinical significance.
May cause red man syndrome and should not be used in pregnancy.
Maybe slightly more nephrotoxic than vancomycin.
After an absence, the drug is now again available in the US.
In 2013 FDA approved the drug to be used for HAP but only when other alternatives are not suitable, i.e., not a first line agent. Concern with the drug is that studies have suggested a substantially higher rate of mortality in patients with diabetes or renal failure compared to those treated with vancomycin.
New-generation cephalosporin with MRSA activity as well as Gram-negative spectrum similar to ceftriaxone. FDA approved for CAP and SSTIs, but some clinicians using off label with success in the treatment of difficult MRSA infections including persistent bacteremia (typically dosed 600mg IV q 8 +/- another agent [e.g., TMP/SMX] in salvage situations).
Oral and parenteral oxazolidinone FDA approved for short course therapy (6d) for skin and skin structure infections. Utility for bacteremia or other Gram-positive infections unclear but has activity against both MSSA and MRSA. Would consider higher dosing 400 mg daily for serious infections if used. The drug has a much lower risk of potential induction of serotonin syndrome compared to linezolid.
Long-acting glycopeptide, FDA approved for skin and soft tissue infections. Little data regarding use for bacteremia or other causes.
Long-acting glycopeptide, FDA approved for skin and soft tissue infections. No data regarding use for bacteremia or other causes.
For patients with bacteremia or endocarditis, follow-up blood cultures should be obtained to document clearance of bacteremia while on therapy.
Always search for focus of infection or removal of any devices.
Salvage regimens not well studied, but options include both changing therapy and using combination therapy.
Use susceptibilities to guide, see section above.
If organism has reduced susceptibility to daptomycin or vancomycin: considthe er use of the following agents, in combination.
For patients with serious S. aureus infections treated with vancomycin, trough levels should be 15-20 mcg/ml (20 mcg/ml for CNS infection and severe pneumonia).
Mortality associated with S. aureus bacteremia is 20-40%.
S. aureus bacteremia is associated with heart valve involvement in 25% when studied with transesophageal echo (TEE). Clinicians must rule out endocarditis before treating S. aureus bacteremia with short (i.e. 2 week) course antibiotics.
All patients with S. aureus bacteremia should undergo at least a good quality transthoracic echo (TTE). TEE is preferred for patients with prosthetic valves or with inadequate TTE.
Be alert for the development of metastatic abscess formation w/ any S. aureus bacteremia. S. aureus in urine cx should alert to the possibility of associated bacteremia.
Patients with MRSA colonization or infection should be placed on contact precautions.
Comment: Most recent guidelines addressing S aureus endocarditis.
Comment: Latest set of guidelines from the Infectious Diseases Society of American, incorporating recommendations for MRSA infections.
Comment: Guidelines looking at the MRSA compendium of diseases with recommendations that also include vancomycin dosing recommendations.
Comment: New guidelines for vancomycin dosing and monitoring.
Comment: Among 302 MSSA isolates in this South Korean study representing hospital isolates, 254 (84.1%) were positive for blaZ; types A, B, C and D were 13.6%, 26.8%, 43.4% and 0.3%, respectively. Mean HI MICs of all tested antibiotics were significantly increased and increases in HI MIC of piperacillin/tazobactam (HI, 48.14 ± 4.08 vs. SI, 2.04 ± 0.08 mg/L, p < 0.001) and ampicillin/sulbactam (HI, 24.15 ± 1.27 vs. SI, 2.79 ± 0.11 mg/L, p < 0.001) were most prominent. No MSSA isolates exhibited meropenem InE, and few isolates exhibited cefepime (0.3%) and ceftriaxone (2.3%) InE, whereas 43.0% and 65.9% of MSSA isolates exhibited piperacillin/tazobactam and ampicillin/sulbactam InE, respectively. About 93% of type C blaZ versus 45% of non-type C exhibited ampicillin/sulbactam InE (p < 0.001) and 88% of type C blaZ versus 9% of non-type C exhibited piperacillin/tazobactam InE (p < 0.001). A large proportion of MSSA clinical isolates, especially those positive for type C blaZ, showed marked ampicillin/sulbactam InE and piperacillin/tazobactam.
Comment: Although early valve surgery advocated by many, this series did not find significant benefit.
Comment: Among different hospitals, mortality rates among the pooled 1851 patients with a median age of 66 years (64% male) were analyzed. Crude 90-day mortality differed significantly between hospitals (range 23-39%) which authors attributed to many factors.
Comment: Randomized trial of 509 adults with staphylococcal bacteremia, use of an algorithm compared with usual care resulted in a clinical success rate of 82.0% vs 81.5%, respectively--showing little difference and similar serious adverse events occurred in 32.5% vs 28.3% of patients, a difference that was not statistically significant but with wide confidence intervals. The trial used 14 +/- 2 d for short course vs. 28-42 days for complicated. Trial suggests that staphylococcal bacteremia can be treated by the algorithm if diagnostic and therapeutic recommendations are followed. An interesting sidebar is in the uncomplicated, short-course group, the failure rate was 25-30%.
Comment: Rather surprising results from this study that is in contrast to the "no antibiotic needed" dogma for uncomplicated, drained S aureus abscesses. Study suggested higher cure rates in 507 of 630 participants (80.5%) in the trimethoprim-sulfamethoxazole group versus 454 of 617 participants (73.6%) in the placebo group (difference, 6.9 percentage points; 95% confidence interval [CI], 2.1 to 11.7; P=0.005).
Comment: Guidance document suggesting 6 wks of parenteral or highly bioavailable oral therapy for native (no hardware) vertebral osteomyelitis. First line choices for MSSA, recs include nafcillin, oxacillin, cefazolin or ceftriaxone. For MRSA, vancomycin or daptomycin.
Comment: Reasons for limited development of VRSA is unclear (compared to enterococci); however, only 14 isolates described since 2001. Last four have been from the state of Delaware.
Comment: As TMP/SMX often thought of as a better staph than strep agent, this study found no different between clindamycin or TMP/SMX in those with either abscess, cellulitis or mixed infection. This suggests that fretting about choices if more celllulitic vs. abscess scenarios is not necessary for those with mild-moderate infections.
Comment: For those with severe infections including bacteremia especially, TMP/SMX did not acheive non-inferiority compared to vancomycin. Multivariable logistic regression had trimethoprim-sulfamethoxazole significantly associated with treatment failure (adjusted odds ratio 2.00, 1.09 to 3.65). The 30 day mortality rate was 32/252 (13%), with no significant difference between arms. Among patients with bacteraemia, 14/41 (34%) treated with trimethoprim-sulfamethoxazole and 9/50 (18%) with vancomycin died (risk ratio 1.90, 0.92 to 3.93).
Comment: Available in some European and other countries, this small study examined S aureus bacteremia or endocarditis and found that fosfomycin [2g IV q 6] + imipenem appeared to be helpful in those failing regimens including vancomcyin, daptomycin and others. Success rate was 69% of the 16 patients.
Comment: Five cohorts of S. aureus bacteremia with adjusted HR mortality in this group of 3346 with 30d mortality = 21%, 90d mortality = 29%.
Comment: Interestingly this trial did not suggest that adding an agent with activity against CA-MRSA (TMP/SMX) did not substantially improve outcomes [82% cephalexin alone, 85% combination]. This suggests that MRSA is not a common driver of cellulitis in the absence of purulence.
Comment: Fairly large trial in a difficult to study condition. RCT examined linezolid (600 mg every 12 hours) or vancomycin (15 mg/kg every 12 hours) x 7-14d. Enrolled pts numbered 1184, 448 (linezolid, n = 224; vancomycin, n = 224) were included in the mITT and 348 (linezolid, n = 172; vancomycin, n = 176) in the PP population. In the PP population, 95 (57.6%) of 165 linezolid-treated patients and 81 (46.6%) of 174 vancomycin-treated patients achieved clinical success at EOS (95% confidence interval for difference, 0.5%-21.6%; P = .042). Howvever, all-cause 60-day mortality was similar (linezolid, 15.7%; vancomycin, 17.0%), as was incidence of adverse events. Nephrotoxicity occurred more frequently with vancomycin (18.2%; linezolid, 8.4%). This study suggests that the PK/PD elements favoring linezolid may in fact have clinical efficacy favorable over vancomycin but the larger 60d picture is not telling. For the very ill with potential for added complications such as renal failure, linezolid may be the better option.
Comment: Study of 115 patients with staph or strep bacteremia using FDG-PET/CT technology looking for metastatic infections found foci in 84 of 115 (73%) patients: endocarditis (22 cases), endovascular infections (19 cases), pulmonary abscesses (16 cases), and spondylodiscitis (11 cases) were diagnosed most frequently. Signs or symptoms directing a diagnostic work-up were only present in 41%, suggesting that additional studies may be helpful even in absence of specific findings: for example in this study PET was the first to detect problems in 30%.
Comment: Important to note that only 16 studies with < 1500 patients in RCTs form basis for guidance in this difficult infection. Authors rightly point out that much guideline recommendations are based on observational or limited case studies. Key questions that remain to be answered in their opinion include: 1) How should SAB be defined?, 2) Is identification and removal of infection focus important? 3) Should all SAB pts have echocardiography? 4) Are glycopeptides equivalent to beta-lactams? 5) Are cephalosporins equivalent to penicillins?, 6) Is teicoplanin as effective as vancomycin? 7) What is the optimum duration of treatment for SAB? 8) Is oral therapy the equivalent to parenteral? 9) Is combination therapy better than monotherapy? 10) what is the role of linezolid, daptomycin and newer antimicrobials?
Comment: Authors able to clear persistent bacteremia in 7 pts with combination of daptomycin and oxacillin or nafcillin (2g IV q4h) in seven patients. Mechanism not entirely clear but may be due to enhanced membrane binding of daptomycin in the presence of the beta-lactam.
Comment: Best data regarding decolonization efficacy exists in pre-surgical patients and those on dialysis. Efficacy for decreasing CA-MRSA recurrent infections doesn't yet exist in robust fashion.
Comment: Evidence for nephrotoxicity associated with short course synergy dose gentamicin in the treatment of S. aureus bacteremia and endocarditis.
Comment: Single center study evaluating the safety of higher doses of daptomycin.
Comment: Recent publication demonstrating that daptomycin is not inferior to standard therapy in the treatment of S. aureus bacteremia and right-sided endocarditis.
Comment: Review of the epidemiology, diagnosis, and management of patients with S. aureus with reduced susceptibility to vancomycin.
Comment: A study that elucidates the clinical and microbiologic differences between healthcare-associated MRSA and community-associated MRSA.
Comment: A study demonstrating the presence of endocarditis in 25% of patients with S. aureus bacteremia when evaluated with TEE.
Comment: A study comparing standard therapy for right-sided endocarditis to oral ciprofloxacin and rifampin for 4 weeks that demonstrates the efficacy of the oral regimen.
Comment: A review of the option of shorter course antibiotic therapy for right-sided heart infections in injection drug users.
Comment: A study of 101 injection drug users with S. aureus infection of whom 65% were bacteremic. The success rate for therapy of MRSA infections was equivalent for the TMP-SMX and vancomycin groups, although vancomycin was marginally more successful as a therapy in the non-MRSA group. The authors thus suggests that TMP-SMX may be a viable alternative to vancomycin for MRSA infection in this group of patients. Failures with TMP/SMX were seen only in the group with endocarditis but not those with straight (or supposedly straight) bacteremia.
Comment: A review of GI tract infections caused by ingestion of certain toxin-producing strains of S. aureus.
Comment: The classic paper describing the presence of S. aureus bacteriuria in 27% of patients with S. aureus bacteremia in the absence of obvious renal infection.
Typical Gram Positive appearance, often with organisms in grape-like clusters.
Typical boil or furuncle (soft tissue abscess) draining pus which grew S. aureus.
Staphylococcus aureus is a sample topic from the Johns Hopkins ABX Guide.
Auwaerter, Paul G. "Staphylococcus Aureus." Johns Hopkins ABX Guide, The Johns Hopkins University, 2019. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540518/all/Staphylococcus_aureus.
Auwaerter PG. Staphylococcus aureus. Johns Hopkins ABX Guide. The Johns Hopkins University; 2019. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540518/all/Staphylococcus_aureus. Accessed April 20, 2019.
Auwaerter PG. Staphylococcus Aureus [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2019. [cited 2019 April 20]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540518/all/Staphylococcus_aureus.


text:
izzy stradlin house
She said she will particularly miss the peacefulness of the property, which overlooks a pond and has a guest house, when it is sold. Three years and a half a billion dollars later, it seems like GNR is happy as can be with its current lineup. Rare Early "Banned" LP Cover Award The "Appetite For Destruction" LP Was Released In 1987 On Geffen Records. McKagan recently confirmed that it took a while, but Stradlin did indeed resurface as the band was preparing for its record-breaking reunion. Help us improve our Author Pages by updating your bibliography and submitting a new or current image and biography. "...The second month of rehearsal came by, and we're talking to him: 'We're getting close, Iz. "My non-participation was simply not being able to reach a happy middle ground through the negotiation process," he told the Wall Street Journal. Please log in if you don't want to post According to Roberts, the home was once owned by Izzy Stradlin, best known as the co-founder and guitarist for Guns N' Roses. There might be only one person who really knows why Izzy Stradlin didn't return to Guns N' Roses for its 'Not in This Lifetime' tour with his fellow classic GNR-era band mates Slash and Duff McKagan, and it's not McKagan. Please try your request again later. Slash has said he's ultimately pleased that Rose didn't have to replace the entire GNR lineup to make the reunion work. The residence was placed on the National Register of Historic Places on Oct. 8, 1976. Now just wasn't the time for him. "I love that dude, but I gotta say that [GNR guitarist] Richard Fortus is a hell of a player and we couldn't ask for a better guy.". Pershing and her husband, Sheldon, were married in front of the fireplace in November 1921 and restored the home in 1972. Original Guns N' Roses guitarist Izzy Stradlin discussed why he opted out of the band's ongoing reunion tour in a short statement to The Wall Street Journal. Since leaving Guns N' Roses in 1991 for various reasons — including disputes over royalties and his band mates' substance abuse — Stradlin released 11 solo albums. "We had amps for him, ready to go..." McKagan recalled. "Something must have really upset him because he left after the soundcheck, and never turned up for another one or an appearance." She also noted an interim report published in 1990 by the Historic Landmarks Foundation of Indiana that identified at least two homes in Lafayette built in the early 1840s that are older than the Ely Homestead. anonymously (anonymous users cannot post links). You still have your privacy, but you have your neighbors.". Music, radio and podcasts, all free. "The reason he came here is because the land was so rich for farming.". ""Appetite For Destruction" Was Guns N Roses 1st Studio Album. Written-By – Izzy Stradlin: 2: Cuttin' The Rug Written-By – Izzy Stradlin: 3: Jivin' Sister Fanny Written-By – Jagger-Richards: 4: Time Goes By Written-By – Izzy Stradlin, Rick Richards: 5: Highway 49 Written-By – … "There's been a lot of blood, sweat and tears put into this house. If that doesn't appeal to prospective homebuyers, the celebrity of a former owner just might. "Appetite For Destruction" Was Certified Gold And Platinum In 1988 … Izzy Stradlin + Follow Similar authors to follow + + + See more recommendations Something went wrong. Since 2010, Stradlin has been more keen than ever about maintaining his privacy. Music, Film, TV and Political News Coverage. The bassist tells Classic Rock magazine that Stradlin made contact with GNR after the revamped version of the band had been rehearsing for about a month. The Federal style brick home built in 1847 has been put on the market by Roberts, who has owned it for the past 10 years. "There was all this noise and then there's this really intense high voice over the top of it. Your California Privacy Rights / Privacy Policy. Homes - Celebrity - Entertainment - Musicians. "I just hope this house will be passed onto someone who sees the beauty of it," she said. While Roberts said she was told it is the second oldest home in Tippecanoe County, that could not be confirmed by Quentin Robinson, a historian who volunteers with the Tippecanoe County Historical Association. "It's been a really great experience. Known as the Ely Homestead, the home was constructed by Henry Ely and his wife, Mary, after Ely relocated to Indiana from Pennsylvania in 1825. For comparison, the city of Lafayette was founded in 1825, according to Kathy Atwell, the organization's executive director. The guitarist and songwriter for many of the band's most successful early singles, acknowledged that the reunion was a massive success. Archival records from the Tippecanoe County Historical Association indicate Ely's great-granddaughter, Geneve Pershing, was born in the home. It's a part of my life and I was hoping at one point to die here, but things change.". All rights reserved. Axl Rose has also insisted that he was surprised that Stradlin did not take part in the reunion. The band plans to begin work on new music later this year. cache 5h 1m Ely and his wife received the third marriage license issued in Tippecanoe County in 1826, according to a Journal & Courier newspaper article about the home. The residence was built in 1847 by Henry Ely and his wife, Mary, who had 11 children together. Lafayette resident Donna Roberts hopes the next person to occupy her historic home will create as many memories as she has. © 2020 www.jconline.com. Official In-House Gold Record Award Presented To Izzy Stradlin (Guitarist) From Geffen Records. Listen online or download the iHeartRadio App. It also was given a preservation award by the Tippecanoe County Historical Association in 1973, according to an emblem placed outside the front door. Things looked good initially. 23ms. Bricks used to construct the home were fired on the farm. Roberts admits that wasn't something important to her when she saw the residence. "Appetite For Destruction" Reached #1 On The US Charts. In a newly released excerpt from a book by Sarah Huckabee Sanders, the former White House press … pleased that Rose didn't have to replace the entire GNR lineup. Niven explained. The musician, best known as the lead songwriter and rhythm guitarist of the hard rock band Guns N' Roses from 1985 to 1991, lives here. Former GNR manager Alan Niven made news last year when he revealed that Stradlin actually showed up at a GNR gig, apparently with the intension of performing but ended up leaving before the show. "That's life; sometimes things don't work out. It was purchased in 1971 by Ely's great-granddaughter, Geneve Pershing, and her husband, Sheldon, who restored the home in 1972. OK Follow to get new release updates and improved recommendations Are you an author? The musician, best known as the lead songwriter and rhythm guitarist of the hard rock band Guns N' Roses from 1985 to 1991, lives here. "You feel like you're stepping back in time," she said. | Roberts said she decided to put the home at 4106 E. County Road 200 North up for sale in an effort to downsize. '", "I guess he just didn't want to tour this big and for so long," McKagan surmised. with this post, location or person. According to Roberts, the home was once owned by Izzy Stradlin, best known as the co-founder and guitarist for Guns N' Roses. "I just think it has so much character to it," Roberts said. She said the home was previously owned by Tom Hayden and had sat empty for two years before Hayden purchased it. Note: VirtualGlobetrotting is an entertainment website is and is not associated The three-bedroom home, which has four fireplaces and three and a half bathrooms, sits on 3.38 acres. There might be only one person who really knows why Izzy Stradlin didn't return to Guns N' Roses for its 'Not in This Lifetime' tour with his fellow classic GNR-era band mates Slash and Duff McKagan, and it's not McKagan.. McKagan recently confirmed that it took a while, but Stradlin did indeed resurface as the band was preparing for its record-breaking reunion. It turns out it was guitarist Izzy Stradlin who introduced him to the voice of the singer as he would reveal the following: "The first time was on a cassette that Izzy brought over to my house," he said. But for now, Roberts continues to enjoy life in the 169-year-old home until it finally changes hands. ", An earlier post on Stradlin's non-verified Twitter account wrote more tersely that his band mates didn't want to "split the loot equally.". About two years into the 'Not in This Lifetime tour' in 2018, Stradlin released his first official statement regarding his absence.
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Forums / Melbourne Metropolitan & Regional Victoria discussion / Projects & Construction / SOUTHBANK | One Queensbridge Street | 1-23 Queensbridge Street | 323m | 90L | Residential
Projects in this thread
One Queensbridge Street - 1-23 Queensbridge Street, Southbank
Height(s): 323
Floors: 90
Suburb: Southbank
Developer: Crown Limited, Schiavello
Architect: WilkinsonEyre, Architectus
629 posts in this thread / 0 new
SOUTHBANK | One Queensbridge Street | 1-23 Queensbridge Street | 323m | 90L | Residential
Melburn21 wrote on Mon, 21/01/2013 - 12:43
Peter Maltezos wrote on Tue, 19/02/2013 - 16:23
Love the curves!
Dare I say it, if built, would probably look better than Prima/Pearl (one of its neighbours).
I collect, therefore I am. thecollectormm.com.au
melbourne wrote on Fri, 31/05/2013 - 14:30
New application has been submitted for this with Schiavello apparently purchasing 17-23 Queensbridge Street - previously owned by Australand at some stage for Freshwater Place.
I have a feeling the design will have changed, with the application mentioning Disengo which is the architect of PDG, opposed to Bates Smart who have designed this tower. Disegno also designed Prima. I reckon with a bigger site, it could possibly be taller than the previous proposal too.
http://dsewebapps.dse.vic.gov.au/dse/planning/phbppat.nsf/InternetAppLis...
Paul_D wrote on Fri, 31/05/2013 - 15:10
So is 23 Queensbridge "The Falls" or do I have the wrong spot? A combo on two with potential bigger setbacks would be ideal, and especially if even taller. I am a fan of the Bates Smart proposal though
It's the building in between this site and the Falls site.
Wow thanks just looking on Google Maps, QB incorporating a footprint all the way up to and including 23 Queensbridge is enormous. It's virtually the size of Eureka or Freshwater (including all it's base). Potentially something very exciting coming our way even though I love the current design :)
Nicholas Harrison wrote on Sat, 01/06/2013 - 14:15
I think it is more likely that it will be shorter as they will be able to have larger floorplates. Hopefully I am proven wrong :-)
Andrew Mck wrote on Wed, 05/06/2013 - 16:05
Thats a horrid thought, i'll be pleased too if you're ''proven wrong''
melbourne wrote on Thu, 06/06/2013 - 00:25
Looks like you might be proven wrong: "Australia's 2nd tallest building"...interesting.
AFR:
Australia's second-tallest building bulks up in new plan
Schiavello and PDG look to expand Southbank development with new $350 million dollar plan which will include 604 apartments, 408 hotel rooms and 20 serviced apartments.
Mark Baljak wrote on Thu, 06/06/2013 - 06:21
Snippets from AFR
Rebecca Thistleton
>Plans for one of Australia's tallest buildings have been bulked up, with Schiavello and PDG now planning several towers and a hotel under a fresh, $350 million plan for their site in Melbourne's Southbank.
>New plans, which include 604 apartments, 408 hotel rooms, 20 serviced apartments and 630 car spaces, include a 'number of towers'.
>The main tower's height has not changed from the approved 71 storeys. It will be Australia's second-tallest building to roof height once finished.
>The project partners declined to comment on the amended plans, which have been designed by architectural firm Bates Smart and Disengo.
Wow multiple towers
Chris Peska wrote on Thu, 06/06/2013 - 07:38
Wow great news. That disproves Nicks theory then :-) wonder if they have adjusted the scheme and moved the tallest tower a bit further south to appease the South bank residents group (aka the West facing Freshwater Place residents group)? Looking forward to seeing the renders!!
Observe. Design. Build. Live.
Glad the Bates Smart tower is staying, guessing this will be next off the block once Prima/Abode get closer to finishing up.
Nicholas Harrison wrote on Thu, 06/06/2013 - 13:25
I don't think it would be physically possible to get more than two towers on the site.
They had to move it 2 metres further from FWP as a condition of the planning permit.
Peter Maltezos wrote on Fri, 07/06/2013 - 08:33
Eager to see some new renderings.
Mark Baljak wrote on Fri, 07/06/2013 - 09:09
they won't be too far away
Nicholas Harrison wrote on Fri, 07/06/2013 - 11:24
They should have bought the falls site as well and build two massive twin towers :-)
Andrew Mck wrote on Tue, 11/06/2013 - 12:56
I cant wait for the new renders, its going to be a great night when i get my 1st glimps..
still one tower, but it's a biggin!
You can't do that to us!!! I'm on the edge of my seat
ahhh yes ryan scored the planning application
Dean wrote on Fri, 14/06/2013 - 19:24
So it's now 100 levels and 350m??? lol
Michael Berquez wrote on Fri, 14/06/2013 - 21:22
I'm kinda beside myself now.....
melbourne wrote on Sat, 15/06/2013 - 00:30
Still the same height. Article coming soon.
Images © Bates Smart
quote - "the schiavello showroom will be one of the world's most exciting furniture enviornments"
open mezzanine design might just be special
Chris Peska wrote on Fri, 21/06/2013 - 07:53
Must be one of the most interestingly shaped floor plates going around. Looks great.
Andrew Mck wrote on Fri, 21/06/2013 - 11:09
Walking along the Crown promenade will be amazing with this towering beauty looming overhead.
The new design reminds me of Lakeside in Chicago, beautiful..


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Yet more writing opportunities
I love Funds for Writers:
SUNKEN GARDEN NATIONAL POETRY COMPETITION
http://www.hillstead.org/activities/poetry_adultcomp.html
$20 ENTRY FEE – First prize $1,000. Chapbook publication and publication in Connecticut Review. Future reading in the Sunken Garden Poetry Festival, summer 2006. Second prize $400. Introductory reading in the Sunken Garden Poetry Festival, summer 2006. Publication in Connecticut Review. Honorable Mention publication in the Review. Deadline February 1, 2006. Must be 18 years of age.
THE WE PROJECT POETRY CONTEST
http://home.earthlink.net/~theweproject/
$10 ENTRY FEE – The Writing Empowerment Project announces its inaugural Poetry Contest, with adult and youth divisions. This year�s theme is The Landscape Politic -The impact of geography and environment on the body, politics, community, love, connection, empowerment and change. There is a $10 reader�s fee for the adult division. The youth division has no fee. For the Adult division, the first prize award is $300, second prize is $100. There will be 15 honorable mentions. The Youth division prizes include a first prize award of a $100 gift certificate (TBA), a second prize award of a $50 gift certificate, and seven honorable mentions. All winners, adult and youth divisions, will be included in the published contest anthology, and will receive 5 copies. Youth division winners will receive a framed certificate. Deadline February 15, 2006 (received).
THE DRAMATIC DEVELOPMENTS SHORT PLAY AWARD
E-mail: ccook2@boston.k12.ma.us
http://www.artistresource.org/writcomp.htm
NO ENTRY FEE – Dramatic Developments, a U.S. Department of Education Research and Dissemination Grant program implemented through the Boston Public Schools' Arts Office, invites playwrights to submit original short plays that address present-day issues facing Boston's middle-school students. Three scripts will be selected for use in classroom and afterschool student
performances. The playwrights of each of the three selected scripts will receive a $2,000 prize, to be presented in April 2006. Plays should be 20 to 30 minutes in performance length. Playwrights must be U.S. citizens or permanent residents of the U.S. Submissions must be postmarked by March 1, 2006. Scripts must be relevant to middle-school students and appropriate for classroom use and performances for 6th, 7th and 8th graders (approximate ages: 11-14).
ARTIST-IN-RESIDENCE – HERBERT HOOVER NATIONAL HISTORICAL SITE, Iowa
110 Parkside Drive
West Branch, Iowa USA 52358
319-643-2541 CST
E-mail: dan_peterson@nps.gov
http://www.nps.gov/volunteer/air.htm
Residencies open to two-dimensional visual artists, photographers, sculptors, performers, writers, video/filmmakers, composers, craft artists. Application deadline: March 3. Residency period: May 1 through October 31. Number & length of residencies: Two of two to three weeks each.
ARTIST-IN-RESIDENCE – GRAND CANYON NATIONAL PARK, North Rim, Arizona
Jennie Albrinck
Grand Canyon, AZ 86023
E-mail: Jennie_albrinck@nps.gov
Residencies open to two-dimensional visual artists,photographers, sculptors, performers, writers, video/filmmakers, composers. Application deadline: January 1 – April1, 2006. Residency period: Late September – early October 2006, mid-May – end of May 2007, mid-July – end of July 2007. Number & length of residencies: Three in total, three weeks each.
ARTIST-IN-RESIDENCE – GOLDEN GATE NATIONAL RECREATION AREA
Headlands Center for the Arts – California
Holly Blake
Headlands Center for the Arts
944 Fort Barry
Sausalito, California USA 94965
415-331-2787, ext. 24, PST
E-mail: hblake@headlands.org
Residencies open to: California, North Carolina, New Jersey, and Ohio. Two-dimensional visual artists, photographers,sculptors, performers, writers, video/filmmakers, composers (Each state has individual eligibility requirements). Application deadline: First Friday in June. Residency period: February through November. Number & length of residencies: Thirty of one to eleven months each.
DELICIOUS LIVING
http://www.deliciouslivingmag.com/index.cfm?fuseaction=writersguide
Delicious Living is the leading consumer magazine in the natural products industry. It is carried by more than 1,300 top natural products stores and is read by more than one million readers each month. The first step in getting an article published in Delicious Living magazine is to send a query letter, resume, and published clips to the editors. Queries should reflect magazine's content and tone. Stories that present new information about or a fresh angle on integrative medicine, women's health, nutrition, disease prevention, natural cuisine, profiles, or personal care are among the most desirable topics. While we accept freelance queries for most of our features and departments, we do not read unsolicited material. Pays up to $700 for assigned items.


7 Hidden Destinations You Probably Didn't Know Existed!
Vacations are always exciting! Inspired by incredible destinations yet to be explored by tourists, we have created a list of bunch of overrun places for you upcoming holidays.
From the beautiful beaches to ocean connecting two different continents we have bucket listed all the amazing destinations for you!
Its a 60 miles' lake that stretches from India to China, making it one of the largest lakes in Asia. The most amazing part of this lake is that it holds very clear water, good enough that you can see the reflection of beautiful surroundings and mountains in it. This view is a striking sight for tourist to enjoy.
Those who have explored this place called it as "Stairways to Heaven". As said this place fairly describes those stairs in real world.
The secret purpose to built these stairs in 1942 was to transmit radio signals to Navy ships across the Pacific. The stairs counts to as high as 3,922 steps. Do you think you can climb up these stairs to reach the top?
When it comes to beaches the first choice people look for is Philippines. This place is gradually showcasing its beauty one island after the other. Everyone is aware of Boracay, Palawan or Siargao islands. But Philippines have lot more to offer.
Popularly known as Hinatuan River is like a fairy tale river darted behind the huge mountains of a of a small province called Surigao Del Sur. Its beauty is so hard to believe if its real? People all around the world come in and dive to explore its depth and caves.
Since Philippines are most popular during the dry season, between November and April, hence I would suggest to book your luxury resorts in budget soon by using MakeMyTrip promocodes available online.
It's a vibrant pink color lake in Australia. The lake is maintaining its color round the year, for some tourist it's a miracle and for some it's color is a mystery that is yet to be determined. According to scientist it can be result of its high salt content mixing with the presence of a pink bacteria species.
In case you are planning a trip to Australia, you can enjoy a discounted Flight tickets via MakeMyTrip Coupons present at coupon website TalkCharge.
Apostle Island is situated at the northern part of Wisconsin. This archipelago standstone walls are about 60 foot high. The most astonishing part about these islands is, its impossible to image how they are naturally made. This place is a must visit. In case you get this opportunity to be there don't miss to click the best of your shot!
As the name suggest, Aquarium in Rangiroa is a naturally made aquarium. The entire view is breath-taking. This is a must try place for Divers. If you are one, then we would suggest to add Rangiroa Aquarium in your bucket list.
Isola Bella is a place of brilliance been brought to a barren land in the middle of Lake Maggiore. Its present blooming baroque gardens and a palace with priceless architecture is a treasures to many. Visiting this place allows you to live a normal day of a long-gone era. This stunning beauty is creating a sight for many sore eyes!
Apart from these there are destinations like Svalbard, an archipelago between Norway and the North Pole or an unexplored "Door to Hell" in Derweze, Turkmenistan or the Marieta Islands' "Hidden Beach" and many more unexplored, hidden place where you can plan your travelling itinerary and relax the peace and serenity of such places. Hope you enjoyed reading, now get ready, get packed and explore the unexplored!


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What's Buggin' Bailey?
By Rob McGowan January 29th, 2011
Josh Bailey was drafted 9th overall in the 2008 NHL Entry Draft by the New York Islanders (sykora93/Flickr)
Josh Bailey was selected 9th overall by the New York Islanders in the 2008 NHL Entry Draft, a choice that would cause plenty of discussion, different opinions and at first, harsh criticism of the relatively new General Manager, Garth Snow.
It was Snow's first taste of the first round at the NHL draft since the previous year's first round pick had been traded in the Ryan Smyth deal to the Edmonton Oilers. Snow dropped from the 5th overall selection, to 7th and then 9th while adding picks in the later rounds. Most notably, Snow passed on physical blue-liner, Luke Schenn who was taken by Toronto. But by the end of the day, many were saying that Garth Snow might have stolen the draft since he managed to get several highly rated prospects and even took Kirill Petrov with a third-round gamble.
But Bailey was the player that the Islanders had wanted all along and was immediately rushed into the NHL at eighteen years old. He could have been returned to his junior team; the Windsor Spitfires of the OHL. It had been speculated that he would have been named captain and would have had another full season of Junior hockey under his belt. He ended the 2008 season in Windsor with scoring 29 goals and 67 assists for 96 points. The only player to have more points than Bailey that was taken from the OHL in the same draft class was the first overall selection, Steven Stamkos. So keeping the young forward in an orange and blue jersey seemed promising.
He finished his rookie season with 25 points and followed up his sophomore season with 35 points. Last year he seemed more comfortable at the wing position and went on an impressive streak where he was seen on the stat sheet in what seemed like every night. This year has hardly been the same.
With Tavares hurt early on after the first game of the season, Bailey was forced to step up his game in order to keep his team competitive. He had three goals and three assists for six points in his first five games played, combining with Blake Comeau for a deadly duo every time they were on the ice. But the strong start was followed with an invisible shield; he went on to go scoreless in his next thirteen games, prompting a demotion to the Bridgeport Sound Tigers. It was a last minute move; Bailey's waiver-free two-way status would have been erased if he played one more game in the NHL.
Josh Bailey lines up for a face-off while playing wing, a switch that was made in attempt to spark his offense (MVerminski/Flickr)
With the Sound Tigers, Bailey tallied six goals and eleven assists for seventeen points in only eleven games played. The player that they had always wanted was starting to show that he could score the clutch and timely goals they thought he would and was playing with strength, energy and passion. In addition, the theory that his hip pointer injury that he suffered in early October was still nagging him and hampering his play had been pretty much put to rest with his impressive stint in the AHL. It was time to call him back up for another shot. He went pointless in his first game back but then recorded a three point night against Martin Brodeur and the New Jersey Devils. Things were starting to look up for the 21-year old center.
There have been spurts here or there for Bailey, but he has only amassed another six points (one goal and five assists) over the last seventeen games played. The Islanders cannot send him back down to Bridgeport without placing him on waivers and another NHL team would be sure to take a chance on the young forward. Therefore Bailey is likely stuck with the Islanders for the rest of the year and is forced to find his way out of a slumping season on his own.
Could this have been avoided? Probably. An easy guess would have been that Bailey's development would have began smoother had he been sent back to the Windsor Spitfires. At the very least, in a 2009 season where the Islanders were destined to finish last and select John Tavares, the Islanders should have sent the 18-year old to the World Junior Championships. Instead, they opted to keep him with the team instead of putting him in a competitive environment where he would have been striving for a gold medal; an experience that surely would have been rewarding regardless of the finish.
There is another hiccup with this season for Bailey; this is the third and final year of his entry-level contract and the February trade deadline is slowly creeping forward. Garth Snow has made decisions in the past with players that were given time to prove themselves but never were up to the task, such as Sean Bergenheim and Jeff Tambellini. But would Snow trade a player that is considered a core member of the youth movement that still may eventually break out into the second-line forward they expected him to be? If not, how long does Snow extend him for when he has to worry about re-signing Kyle Okposo as well as several others?
It clearly hasn't been an easy road for Josh Bailey and a very uncertain future lies before him.
-Rob McGowan
http://twitter.com/IslesRM
2008 NHL Draft
Garth Snow
Jeff Tambellini
Josh Bailey
Kyle Okposo
Luke Schenn
Sean Bergenheim