Monday, October 22, 2012

Off-label medications prescribed to nearly all pediatric intensive care patients

Off-label medications prescribed to nearly all pediatric intensive care patients [ Back to EurekAlert! ] Public release date: 21-Oct-2012
[ | E-mail | Share Share ]

Contact: Debbie Jacobson
djacobson@aap.org
847-434-7084
American Academy of Pediatrics

NEW ORLEANS "Off label" drugs are medications that have not been tested for safety or efficacy for a specific patient age or condition. New research presented Oct. 21 at the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans found that off-label treatments were ordered for 96 percent of all pediatric patients, and 100 percent of patients ages 13-17, in the intensive care unit of an urban children's hospital.

In "Off-Label Drug Use in the Pediatric Intensive Care Unit," researchers collected data on all patients admitted to the 32-bed pediatric intensive care unit (PICU) at Primary Children's Medical Center (PCMC) in Salt Lake City from October 2002 to February 2003, including age, diagnosis, medications ordered and indication for each medication ordered. Each drug was assessed for whether it was used in an on-label or off-label manner.

Off-label use was declared when a drug was prescribed for a patient whose age was not listed on the package label, no pharmacokinetic (PK) data was listed in the package insert, and/or if the drug was used for a non-FDA approved indication.

A total of 335 drugs were prescribed in 492 pediatric patients from birth to age 17. Ninety-six percent of patients received at least one off-label drug. Off-label prescribing occurs in almost every patient in the PICU.

"Treatment with off-label medications is the rule rather than the exception in the PICU," said study author Susan Sorenson, a doctor of pharmacy.

"Numerous problems emanate from the lack of drug data in children, including uncertainty about whether a drug is effective in children for a particular disease, questions about the side effect profile, and lack of dosing information," said Dr. Sorenson.

"It is very difficult when you stand at the bedside and want to treat a sick child with a drug and you don't know if the dose or drug you have chosen or recommended will harm the child or help the child. Everyone does the best they can to find suggested doses and do the right thing, however, it is better medicine to dose or recommend doses based on evidence.

"This study is attempting to determine the drugs that are used most frequently in our sickest patient population that do not carry dosing information, with the intent that studies of dosing, safety, and efficacy will be carried out on those drugs," said Dr. Sorenson. "More studies need to be conducted so that prescribing in our youngest and sickest patients can be done based on evidence."

###


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

?


AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


Off-label medications prescribed to nearly all pediatric intensive care patients [ Back to EurekAlert! ] Public release date: 21-Oct-2012
[ | E-mail | Share Share ]

Contact: Debbie Jacobson
djacobson@aap.org
847-434-7084
American Academy of Pediatrics

NEW ORLEANS "Off label" drugs are medications that have not been tested for safety or efficacy for a specific patient age or condition. New research presented Oct. 21 at the American Academy of Pediatrics (AAP) National Conference and Exhibition in New Orleans found that off-label treatments were ordered for 96 percent of all pediatric patients, and 100 percent of patients ages 13-17, in the intensive care unit of an urban children's hospital.

In "Off-Label Drug Use in the Pediatric Intensive Care Unit," researchers collected data on all patients admitted to the 32-bed pediatric intensive care unit (PICU) at Primary Children's Medical Center (PCMC) in Salt Lake City from October 2002 to February 2003, including age, diagnosis, medications ordered and indication for each medication ordered. Each drug was assessed for whether it was used in an on-label or off-label manner.

Off-label use was declared when a drug was prescribed for a patient whose age was not listed on the package label, no pharmacokinetic (PK) data was listed in the package insert, and/or if the drug was used for a non-FDA approved indication.

A total of 335 drugs were prescribed in 492 pediatric patients from birth to age 17. Ninety-six percent of patients received at least one off-label drug. Off-label prescribing occurs in almost every patient in the PICU.

"Treatment with off-label medications is the rule rather than the exception in the PICU," said study author Susan Sorenson, a doctor of pharmacy.

"Numerous problems emanate from the lack of drug data in children, including uncertainty about whether a drug is effective in children for a particular disease, questions about the side effect profile, and lack of dosing information," said Dr. Sorenson.

"It is very difficult when you stand at the bedside and want to treat a sick child with a drug and you don't know if the dose or drug you have chosen or recommended will harm the child or help the child. Everyone does the best they can to find suggested doses and do the right thing, however, it is better medicine to dose or recommend doses based on evidence.

"This study is attempting to determine the drugs that are used most frequently in our sickest patient population that do not carry dosing information, with the intent that studies of dosing, safety, and efficacy will be carried out on those drugs," said Dr. Sorenson. "More studies need to be conducted so that prescribing in our youngest and sickest patients can be done based on evidence."

###


[ Back to EurekAlert! ] [ | E-mail | Share Share ]

?


AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.


Source: http://www.eurekalert.org/pub_releases/2012-10/aaop-omp101212.php

dianna agron million hoodie march tebow trade mike the situation jacksonville jaguars jacksonville jaguars benjarvus green ellis

Fishy physics: Adaptation lets silvery fish reflect light without polarization, may help them evade predators

ScienceDaily (Oct. 21, 2012) ? Silvery fish such as herring, sardine and sprat have evolved special skin that gets around a basic law of physics, according to new research from the University of Bristol published Oct. 21 in Nature Photonics.

Reflective surfaces polarize light, a phenomenon that fishermen or photographers overcome by using polarizing sunglasses or polarizing filters to cut our reflective glare. However, PhD student Tom Jordan and his supervisors Professor Julian Partridge and Dr Nicholas Roberts in Bristol's School of Biological Sciences found that these silvery fish have overcome this basic law of reflection -- an adaptation that may help them evade predators.

Previously, it was thought that the fish's skin -- which contains "multilayer" arrangements of reflective guanine crystals -- would fully polarize light when reflected. As the light becomes polarized, there should be a drop in reflectivity.

The Bristol researchers found that the skin of sardines and herring contain not one but two types of guanine crystal -- each with different optical properties. By mixing these two types, the fish's skin doesn't polarize the reflected light and maintains its high reflectivity.

Dr Roberts said: "We believe these species of fish have evolved this particular multilayer structure to help conceal them from predators, such as dolphin and tuna. These fish have found a way to maximize their reflectivity over all angles they are viewed from. This helps the fish best match the light environment of the open ocean, making them less likely to be seen."

As a result of this ability, the skin of silvery fish could hold the key to better optical devices. Tom Jordan said: "Many modern day optical devices such as LED lights and low loss optical fibres use these non-polarizing types of reflectors to improve efficiency. However, these human-made reflectors currently require the use of materials with specific optical properties that are not always ideal. The mechanism that has evolved in fish overcomes this current design limitation and provides a new way to manufacture these non-polarizing reflectors."

Share this story on Facebook, Twitter, and Google:

Other social bookmarking and sharing tools:


Story Source:

The above story is reprinted from materials provided by University of Bristol.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.


Journal Reference:

  1. T. M. Jordan, J. C. Partridge, N. W. Roberts. Non-polarizing broadband multilayer reflectors in fish. Nature Photonics, 2012; DOI: 10.1038/nphoton.2012.260

Note: If no author is given, the source is cited instead.

Disclaimer: Views expressed in this article do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/~3/7_bS-SJCv4w/121021133911.htm

jim carrey san francisco chronicle kourtney kardashian pregnant kourtney kardashian pregnant chip kelly billy cundiff super bowl tickets

Cafe's one-way mirror allows peeks into restroom

(AP) ? An Austrian artist has installed a one-way mirror in a Vienna cafe that allows men to peek from their restroom into the ladies room.

Alexander Riegler told the daily Heute newspaper Monday that the mirror is an attempt to "stir people into a discussion of voyeurism and surveillance," in an era when almost everyone is being watched.

Cafe employee Alexander Khael-Khaelsberg says the mirror only shows women at the sink and does not offend anyone's private sphere. He told the daily Heute newspaper Monday that women will get their turn in January, when the mirror is reversed to let them look at men's faces while they stand at the urinal.

The restaurant recently put up a sign advising women that they are part of an "art project" after complaints.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/cae69a7523db45408eeb2b3a98c0c9c5/Article_2012-10-22-Austria-Peeping%20Toms/id-2ea2ed285cf94969bfdda26f59778760

duke university platypus platypus overboard east of eden weather radio indiana

New Construction Homes in Bonaire GA, Southfield Plantation ...

New Construction Homes in Bonaire GA, Southfield Plantation Subdivision

Although not yet completed, this luxurious new construction home in Bonaire GA in the Southfield Plantation Subdivision is ready for prospective buyers to?preview.? If you are looking for a home close to Robins Air Force Base with all the extras the builder, Jon?s Custom Homes?provides,??then this is the home for you!

Listed at $350,000, this custom all-brick property at 404 Windstone Place will have 3,328sq ft of living space.? This home has 5BR/4BA, large rooms throughout,?2 gas log fireplaces, keeping room, noise baffling insulation between bedrooms and living area,?a security system, oversized trim,?stainless steel appliances, covered patio, sprinkler system, 3-car garage,?and many more features, all with a cul-de-sac location!

The Houston County Public Schools for this?fantastic Bonaire home are Bonaire Elementary, Bonaire Middle, and Veterans High School.

Anita Clark Realtor at Coldwell Banker SSK Realtors in Warner Robins GA has teamed up with Jon?s Custom Homes to showcase new construction homes in the Southfield Plantation Subdivision.? Jon Gausche is a well respected local builder who has built quality custom new construction homes all over the Houston County area.? As his site says, ?building quality custom homes and having the most satisfied customers is our top priority?.? View one of his homes and you are a believer!

With several floor plans to choose from, and available lots, NOW is the time to become a satisfied buyer in the Southfield Plantation Subdivision!? Call me at (478) 960-8055 so we can get you in for a preview.

New Construction Homes in Bonaire GA, Southfield Plantation Subdivision

?

About Warner Robins Real Estate

Anita Clark has written 801 posts on this blog.

Anita Clark Realtor sells Warner Robins Real Estate and provides community information as a service to the public. You can contact her at (478) 960-8055 or via email at anita@cbssk.com.

Source: http://sellingwarnerrobins.com/2012/10/new-construction-homes-in-bonaire-ga-southfield-plantation-subdivision/

florida state meghan mccain wilson chandler bristol motor speedway puerto rico prometheus grand canyon skywalk

Laptop or computer Technology In Hospitals | Personal Tech and ...

Laptop or computer Technology In Hospitals

Every person knows that this is a very wide subject due to the fact now a day?s Laptop or computer technology is playing a massive element in hospital performs. Therefore, we deemed Agha Khan University Hospital due to the fact it is nicely knowed and respected hospital in Karachi.

We also like to thank the administration of Agha Khan University Hospital for their helping hand, particularly to Mr. Saleem Quershi (Manager ISD Dept.AKUH), Mr. Sikandar Khan (Manager Bio-Healthcare Dept.AKUH) and Mr. Dilawar Khan (Asst. Manager Bio-Health-related Dept.AKUH).

4 WIDE Locations OF AKUH

Agha Khan University Hospital is utilizing Personal computer technology in 4 wide Places. Those Places can be defined as the backbone of AKUH?s administrative and decisional operates.

1. Software program.

two. Servers.

three. Networks.

Four. Bio-Medicals.

1. SOFTWARES: ?

In this location AKUH are working with 3 Application programs which are as follows:

1.1. Patient Care.

1.two. Administrative.

1.three. Economic.

1.1. PATIENT CARE Programs: ?

In this Computer software AKUH keeps record with regards to 3 varieties of individuals, i.e. Out-individuals, In-individuals and Outdoors referrers.

Out individuals are these who go to a physician for normal checkups and therapy in clinics. The records are kept in the database, which AKUH utilizes for those individuals.

In individuals are individuals who are admitted in emergency instances like burnout, heart attack, fracture and other serious and dangerous circumstances. When a patient is admitted his/her admission date, day and month are updated in this Application Computer software along with bed and ward quantity. A medical doctor and ancillary staff are appointed to that particular patient. The medicine which is prescribed to that patient, the variety of remedy the patient will purchase, the meal he/she will be provided are all updated in this Application Computer software.

Outdoors referrers are these individuals which are prescribed to take X-rays, lab test, and other form of checkups by these medical doctors which are not a element of hospital staff.

1.two. ADMINISTRATIVE Programs: ?

Via this Software AKUH keeps the record of the equipments that are they operating well. The info about current medical doctors, nurses, ancillary staff along with division specifications and requirements. The nutrition records of individuals are also kept here.

The fundamental objective of this Software is to administrate and manage the activities, which are held daily in hospital premises.

1.three. Monetary Programs: ?

In this Software program AKUH keeps the record concerning Economic activities of individuals and hospital. For e.g.

If a patient is admitted in hospital for surgerical objective than how considerably payment he/she had created or how considerably balance has left of his/her actual payment. All the Economic record of individuals is kept in this Software.

Like any other organization entity AKUH also keeps its record, for e.g. how significantly machinery, food and other inventory stuff are left. They also prepare and follow accounting cycle which entails common journal, ledger, trial balance, adjustment, Monetary statement.

two) SERVERS:-

AKUH is working with much more than 200 servers in its network. Some are as follows:

two.1. Database servers

two.two. Computer software servers

two.three. Web servers

two.1. DATABASE SERVERS: ?

To create database server AKUH utilized some language with the passage of time. The languages which they are working with described as beneath.

?? SQL server

?? Oracle

?? Visual Fundamental

?? ASP.NET

?? JAVA

AKUH applied SQL server to create Computer software Software program associated to patient care just before 1980?s. They utilised oracle language as a server to create Application Software associated to patient care and Economic Places in mid 1980?s. In 1995, AKUH employed third generation language to create programs of patient care, administrative and Economic Locations.

These days AKUH are utilizing Visual Standard, ASP.NET and Java to create Computer software softwares.

two.two. Computer software SERVERS: ?

Individuals servers are produced to manage or manage Software softwares connected to patient care, administrative, Monetary and human resource departments. Those servers manage the flow of entries at the time of storing and retrieving info.

two.three. INTRANET: ?

Online servers, communication servers and exchange e-mail server individuals servers are related to the intranet of the hospital to communicate just about every medical doctor and staff member to every single other. They can share reports and other needed facts relating to individuals. AKUH has offered links to its clinics and franchises Outdoors the hospital to communicate, monitor and fulfill their specifications and requirements of machinery connected activities.

three) NETWORKS: ?

AKUH is working with CAN (Campus Region Networking) which is spread in 3 diverse Places but interrelated to just about every other by switches.

Essentially PACS (Image Archiving and Communication Method) is a new technology and only AKUH is utilizing it in Pakistan. It is associated to RIS (Radiology Info Method). Those systems are additional associated to other departments and machinery.

Archiving indicates ?Storage? so, Via this associated networking hospital administration shops any facts relating to a patient which is updated to the network and that patient can retrieve his/her facts by a MR quantity (MR # is an I.D offered to a patient for retrieving details).

PACS is also employed to capture and shop pictures digitally from exactly where medical doctors and surgeons access By means of their thin customers. This technology replaces the old film rule in which an x-ray of a patient is obtained by capturing an Picture on a sheet it was damaging for human health and physique. Right after all this method the info is stored in SAN (Storage Location Network). AKUH has made SAN to facilitate its functioning.

Four) BIO-Health-related: ?

It is a distinct division of AKUH which purchases and monitors the overall performance of Health-related equipment and machinery. This division is additional divided into 4 sub departments which are as follows:

Four.1. Healthcare MANAGEMENT EQUIPMENT: ?

This division bargains with 3 goal which are life saving, therapy and monitory.

In life saving and help, the equipment associated to remedy complicated and important decease are monitored and maintained.

In therapy, all the equipments and machinery utilized to treat an in-patient are monitored.

In monitory, the efficiency of all the equipment and machinery employed by physicians, surgeons and ancillary staff are maintained and monitored.

Four.two. Acquire Division: ?

In this section members of bio-Health-related division have to see that what are the equipment they have to Obtain, Immediately after the decision, 1st they Bought the needed equipment Following acquiring the equipment they saw the technical Instruction to that equipment that how to install that equipment and how to utilised that equipment. Then they create a strategy that how to maintain individuals equipment and if there is a uncertain breakdown happens in the equipment how to manage individuals uncertain breakdown. Soon after all individuals measures the subsequent step is to put the equipment in the appropriate place, Right after the collaboration and expansion of the equipment they train all the unique medical doctors have to employed those equipment that how to employed and deal with individuals equipment. Bio-Healthcare works is to monitor all the equipment individuals are in use in the hospitals. Immediately after monitoring the subsequent step is to replace that equipment. In this replacement section when some equipment comprehensive it life or the equipment is completely depreciated they replace all these equipments. This is what the responsibilities of the Bio-Healthcare acquire division.

Four.three. RESPONSIBILITY: ?

Bio-Health-related division has 3 critical responsibilities which are important care, imaging group and LAB.

Important care includes the staff which is accountable for reporting the failure of a machine and to eliminate the complication which arises in ancillary staff or nurses due to some complicated function of equipment.

Imaging group Essentially functions as a channel or a link amongst vital care and LAB.

LAB is an location exactly where all individuals equipment are treated which occurred a failure to some purpose.

5) E-HEALTH: ?

AKUH has began to create a Online based Software Technique named ?E-Health?. It is probably to be implemented in practically 5 years. E-Health will facilitate the clientele and individuals. As its name means it will give the clients the chance to take reports and appointments World wide web. It will also help AKUH to run applications like awareness of gastro, dengue virus and other dangerous and harmful deceases.

Keep Updated With techmobiz

Source: http://www.techmobiz.com/laptop-or-computer-technology-in-hospitals.html

Revolution TV Show Carly Rae Jepsen bankofamerica nfl schedule revolution rosh hashanah rosh hashanah

Why Small Businesses Hate Google+ Local [Comicgraphic]

Lengths small businesses go to for Google reviewsThe latest Google and Your Business Forum Wrap-up and the Skype roar of frustration about missing Google reviews earlier this week brought to mind this fab comicgraphic from Nifty Marketing.

Business owners who have jumped through the hurdles and hoops trying to get reviews only to have them disappear will know just how close to the truth this comicgraphic is!

?Here?s the Google+ Local Review Comicgraphic, shamelessly borrowed from the Nifty Marketing blog.? Why Small Businesses Hate Google+ Local

  • Don?t try to game the system by buying reviews
  • Don?t use a review service to enter reviews from surveys and review cards
  • Don?t use on-site review stations
  • Don?t encourage people to create a Google Plus account just to leave you a review
  • Space out reviews.? Reviews in waves can trigger the spam filter
  • Encourage Google+ Local reviews through a mobile device
  • If your customer doesn?t have a Google Plus account, ask for reviews other third-party sites such as Freeindex, Qype, Yelp and others

Does the comicgraphic reflect your experiences with Google+ Local reviews?? I?d love to hear your thoughts in the comments!

Enjoy this Post? Please Share:

Source: http://www.mylocalbusinessonline.co.uk/small-businesses-hate-google-local-comicgraphic/

there will be blood there will be blood nigel barker 420 secret service fenway park coachella

Swiss Family Kahn finds their tree house in Southern Cambodia ...


Cambodian Capital + Coastal Cambodia

Apart from the opportunity to meet up with friends and contacts in Phnom Penh, the city wasn?t filled with all that much to do. Once the royal palace visit was out of the way- an activity that took us 45 generous minutes at best, we were hard pressed to find ways to keep the kids entertained and interested. After the impressive sights on offer in Siem Reap, a stroll along the river and across the one temple vaguely worth a visit in town (Wat Phnom) simply didn?t impress them much (nor us!) Luckily, there were some fun restaurants to check out that were very family-friendly, such as Le Jardin with a bamboo playhouse complete with a slide that ends in a giant sandpit- filled with beach toys (yes, we spent the better part of a day here- thank goodness the food was also pretty fantastic) and Caf? Java that had a whole playroom reserved for kids (not to mention great sandwiches and? bagels!!) We also loved the all-organic caf? belonging to the trendy 240 Guesthouse. In fact, trendy is a word we found ourselves using surprisingly often to describe many of the restaurants

and hotels we came across in Phnom Penh, including the one where we were staying: The 252, designed by a French/Khmer design group called ?Tendance Khmer?. As a result, Lea suffered from her first attack of shopping withdrawal, having to fight a strong urge to hit the local markets to buy up some of the gorgeous ikat silks Cambodia is so famous for. Luckily (or not- depending on who?s perspective you take) luggage and time constraints prevailed and so Lea ultimately remained souvenir-free.

Another worthwhile activity in PP, but reserved for adults (so only Lea went) is a visit to the Tuol Sleng Museum, known as S21 (for Security Prison 21). This is where proof of the Khmer Rouge genocide is all too apparent and heart breaking. It was originally built as a school and you can still find classrooms with blackboards on some floors of the 4 buildings, but most of the classrooms were transformed by the Khmer Rouge into torture chambers and prison cells. These were difficult to walk through and as one strolls the halls, it is not uncommon to come across a tourist (or, as in Lea?s personal experience, a big burly

Australian dude) having to take a minute to ?regroup?. A visit to this place is not for the faint-hearted and Lea was as poorly equipped as the said Australian. But it certainly put the country and its struggles in context. It?s incredibly hard to wrap one?s head around the absolute misery the Khmer people were dragged through and just how much damage 4 years under a regime such as that of Pol Pot could do, both physically and psychologically. Even though the population of Cambodia seems to not only have survived, but is happily thriving today, evidence of this all too recent rough past pops up frequently as we cross the country- from mine warnings, to random barbed wire fences in the middle of rice paddies, to countless abandoned French colonial homes (especially in the coastal areas of Kampot and Kep?) But the most unexpected evidence came in the form of local reactions to the royal family?s loss of their patriarch.

Earlier this week, the King?s Father died. We were surprised how such an event, concerning so prominent a figure in Cambodian history, could occur with so little reaction on the part of the local population and

press. In fact, we found out about it through the international media and hardly heard mention of it by Cambodians, other the occasional exhibit of incense burning near his photo. It then occurred to us that the man that was King during the country?s string of oppressive occupations might not be as loved and appreciated as his photos on the wall of each business place might lead you to believe. In truth, though he and his family also suffered at the hands of Pol Pot, King Sihanouk nevertheless played an instrumental role in the rise of the Khmer Rouge and clearly, not all is forgiven. The Cambodian way to deal with this issue appears to be simply not to discuss it, and so we were unable to get much of an explanation or opinion expressed by anyone in his regard? nor, for that matter, on his son, the now reigning King- though possibly for significantly different reasons. What we did find out is that the current King is in fact, a queen. And while Cambodia seems relatively gay-friendly, sexuality remains a taboo subject. So this may further explain why locals simply don?t have much to say about their ballet-loving, still single, aging King as he mourns the passing of his controversial father. And the future of the monarchy remains equally vague to us.

With all due respect to the Cambodian royal family, we elected to carry on our joyous journey, actively exploring the South of the country after a peaceful 3 hour drive from the capital to the sleepy provincial town of Kampot, at the foot of Bokor Mountain and on the banks of the Teuk Chhou River. Here, we found relief in the last-minute renouncement of staying in a slightly too-rustic 10$ a night riverside grass hut in favour of the very comfortable, if nevertheless basic, Soleil D?Or Guesthouse- a lovely little renovation of a French colonial 2- level townhouse in the middle of Kampot. As we were hitting town during a religious holiday that offered all a 3-day weekend, we struggled to find available lodging in this popular getaway town. Our first choice would have been the fantastic Rikitikitavi guesthouse (which nevertheless became our daily canteen), but it was sold out, as were our second and third choices. Out of despair, we decided to book ourselves into a true backpacker refuge called Ollie?s Place and

were only saved by a last-minute cancellation at the slightly more upscale Soleil D?Or. When we nevertheless opted to lunch at Ollie?s we realized just how lucky that cancellation was. Ollie?s was? to put it mildly? a rundown collection of dirty shacks without plumbing. We had our confirmation that no matter how adventurous we wish to be, there is a certain line we?d rather not cross?or rather, we are simply not cut out to cross. And we were looking at it. From this point on, anything marketing itself with the words ?rustic? or ?backpackers? was to be avoided.

After four days spent swimming in rivers, roaming through rice paddies, and visiting pepper plantations, mango orchards and limestone caves, we moved on to the coastal resort town of Kep, just an hour away. Despite the beachside location of this French colonial remnant, most of the accommodations are built into the hills overlooking the sea. This was also the case for our selection: a Robinson Crusoe-like hotel, the Veranda Natural Resort , consisting of multiple elevated wooden structures built into the trees, offering a spectacular view of the Gulf of Thailand and the not-so-distant Vietnamese island of Phu Quoc-

our next destination. The one small swimmable beach in Kep is not much of an attraction and most visitors, including our little family, opted for a 20minute boat ride out to one of the nearby islands, such as Koh Tonsay (known popularly as ?Rabbit Island?.) On the island, there are a few local families willing to cook for you and rent you a straw surface to lay your towel on. Given their limited English, ordering lunch can be somewhat of a crapshoot. For example, when Lea asked for Coca-cola, she was brought a lovely freshly cut coconut, which she happily accepted and thoroughly enjoyed. Other noteworthy meals in Kep, included a crab dinner on the waterfront at the locally owned Kimly Restaurant (turns out our kids, unlike their mother, absolutely love shellfish?), a thoroughly nostalgic dinner at the Swiss-owned Kep Lodge consisting of rosti, spatzli, and sausage, as well as a bug-infested dinner at the attractive yet suspiciously empty Breezes restaurant. Additional highlights of our stay in Kep would be the free massages offered to the kids- perhaps a terrible foolish mistake in Mimi?s case, as she now asks for them every day? and the hotel?s fabulous salt water pool which kept the children thoroughly entertained and refreshed for 5 days, while Arnaud and Lea made friends with a variety of hotel guests full of good advice for our onward travels.

A few more lessons learnt the hard way during our travels to date:

1. Just because a hotel has a sign that says ?Against sex tourism? doesn?t mean it won?t be filled with sad little European men entertaining pretty young local girls (and believe me, observant little 4 year olds WILL notice and comment on it? ?is she a grown up?? or ?is he her daddy??)

2. Mosquito repellant bracelets draw ants.

3. When you are trying to stick to a budget, massages, babysitting, and desserts are the top items to get cut.

4. ?Not so spicy? is Khmer for ?super spicy? and ?I don?t know? is Khmer for ?you can?t handle the truth.?

5. When you are staying in a tree house with centimeter-wide gaps between the floorboards, handle your suitcase keys with care. Same goes for kids crayons.

6. Basic and natural in Cambodia means bugs (BIG bugs) and no air

conditioning. (Halleluiah for mosquito nets?)

There are more photos below

Photos: 25
Displayed: 25



Source: http://www.travelblog.org/Asia/Cambodia/South/Kep/blog-751180.html

new ipad solar flare joseph kony 2012 arian foster dennis kucinich apple ipad kony