text:
Ansible Configuration Management
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- Starts with the most simple usage of Ansible and builds on that
- Shows how to use Ansible to configure your Linux machines
- Teaches how to extend Ansible to add features you need
- Explains techniques for using Ansible in large, complex environments
Book DetailsLanguage : English
Paperback : 92 pages [ 235mm x 191mm ]
Release Date : November 2013
Author(s) : Daniel Hall
Topics and Technologies : All Books, Other, Open Source
Table of ContentsPreface
Chapter 1: Getting Started with Ansible
Chapter 2: Simple Playbooks
Chapter 3: Advanced Playbooks
Chapter 4: Larger Projects
Chapter 5: Custom Modules
- Chapter 1: Getting Started with Ansible
- Installation methods
- Installing from your distribution
- Installing from pip
- Installing from the source code
- Setting up Ansible
- First steps with Ansible
- Module help
- Summary
- Chapter 2: Simple Playbooks
- The target section
- The variable section
- The task section
- The handlers section
- The playbook modules
- The template module
- The set_fact module
- The pause module
- The wait_for module
- The assemble module
- The add_host module
- The group_by module
- Summary
- Chapter 3: Advanced Playbooks
- Running operations in parallel
- Looping
- Conditional execution
- Task delegation
- Extra variables
- The hostvars variable
- The groups variable
- The group_names variable
- The inventory_hostname variable
- The inventory_hostname_short variable
- The inventory_dir variable
- The inventory_file variable
- Finding files with variables
- Environment variables
- External data lookups
- Storing results
- Debugging playbooks
- The debug module
- The verbose mode
- The check mode
- The pause module
- Summary
- Chapter 4: Larger Projects
- Includes
- Task includes
- Handler includes
- Playbook includes
- Roles
- New features in 1.3
- Speeding things up
- Tags
- Ansible's pull mode
- Summary
- Chapter 5: Custom Modules
- Writing a module in Bash
- Using a module
- Writing modules in Python
- External inventories
- Summary
Code Downloads
Download the code and support files for this book.
Submit Errata
Please let us know if you have found any errors not listed on this list by completing our errata submission form. Our editors will check them and add them to this list. Thank you.
Errata- 4 submitted: last submission 21 Jan 2014
Errata type: Code | Page number: 12
The command: $ ansible machinename -m copy -a 'path=/tmp/fstab mode=0700 owner=root'
Should be: $ ansible machinename -m copy -a 'src=/etc/fstab dest=/tmp/fstab'
Errata type: Technical | Page number: 27
Tomcat's init script returns immediately before opening the port. The Tomcat service opens the port before the Java application starts.
Errata type: Code | Page number: 45
The output line should read: TASK: [Print interface] *************
Instead of: TASK: [Print IP address] *************
Errata type: Layouts | Page number: 60
The line "First, we( )installed"
should be "First, we installed"
Sample chapters
You can view our sample chapters and prefaces of this title on PacktLib or download sample chapters in PDF format.
What you will learn from this book
- Configure your systems and services with Ansible
- Use Ansible command line tools to interrogate systems
- Script Ansible to perform multiple actions with one command
- Build maintainable configurations for large environments
- Learn how and when to use advanced features of Ansible
- Use an inventory that is dynamically generated
- Understand the use of Ansible roles to split your configurations into logical parts
- Extend the functionality of Ansible by writing your own module
In Detail
Ansible provides a clear and concise way to manage the configuration of your Linux infrastructure. It can help in making your infrastructure more maintainable, quicker to deploy, and easier to understand.
"Ansible Configuration Management" will take you from your very first command all the way to extending the very capabilities of Ansible itself. It takes a practical approach with hands-on examples, which ensures that the readers walk away with all the knowledge and skills they will need to harness Ansible.
"Ansible Configuration Management" starts with an explanation of the basics and builds the reader's knowledge through step-by-step guidelines.
The book concentrates on discussions related to realistic worked examples. Using this approach we discuss how to perform ad-hoc actions, script actions together to set up services, and how to script more complicated tasks. The discussion carries onto explanation of organising your configurations for large deployments and warps up with examples of how to extend the capabilities of Ansible.
"Ansible Configuration Management" provides the knowledge you require to effectively manage your systems in a simple, quick, and maintainable way.
"Ansible Configuration Management" is a step-by-step tutorial that teaches the use of Ansible for configuring Linux machines.
Who this book is for
This book is intended for anyone looking to understand the basics of Ansible. It is expected that you will have some experience of how to set up and configure Linux machines. In parts of the book we cover configuration files of BIND, MySQL, and other Linux daemons, therefore a working knowledge of these would be helpful but are certainly not required.


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I welcome you to our blog Riding the Tiger: The Presidential Election in Context. The Miller Center is a non-partisan research institution that seeks to expand understanding of the presidency, policy, and political history, providing critical insights for our nation's governance challenges.
We intend to take the news and issues of the election campaign coverage and mine our resources to provide historical context to those issues. Our goal is to show when similar issues or situations have confronted presidents or presidential candidates, how they have responded—and how the lessons learned from those attempts, whether failed or successful, impact the decision-making by candidates today.
There is no doubt that the national presidential election makes 2012 a critically important year for the U.S. and its future. Not only do we have deep governance challenges, but they must be addressed at a time when our political parties hold widely divergent opinions on the best way to approach them.
Many of the most pressing issues—the economy, foreign policy, to name a couple—feature prominently in any presidential election. Presidents have been confronted with making important, sometimes transformative decisions in these arenas for most of our national history. There are other issues unique to 2012, but their genesis and proposed solutions do not operate within a vacuum. History can often provide insight into the ways in which presidents must address or mitigate emerging problems.
In short, we believe that the lessons of history have much to teach us and the candidates.
With these blog entries, contributed by our scholars and designed to highlight existing materials and make them accessible to the public and press, the Miller Center intends to apply our resources and scholarship to add depth and dimension to the discussion of the day's issues.
It is our hope that voters will turn to the thoughtful, informed and nonpartisan entries contained here for insight, guidance, and clarification as the election of 2012 unfolds. We also encourage you to contact our Riding the Tiger team with questions and suggestions, since this is a site designed to be flexible and adaptable as the most pressing or perplexing issues of the election unfold.
We hope you will visit Riding the Tiger frequently!
Gerald L. Baliles

subset: commoncrawl


text:
Some things bear repeating; like these recipes that we ran last New Year and we're running again now. The South is steeped in tradition and many of those traditions revolve around food. Two of the dishes that have been prepared through the years as we ring in the new year are Hoppin' John and greens.
Hoppin' John is a black-eyed pea dish. The peas symbolize coins. A shiny dime, thrown into this black-eyed pea and rice dish, is said to bring good luck to the person who finds the dime in his serving. Of course, if the recipient bites down on the dime, then the good luck only comes to his dentist.
Turnip, or other greens, are another traditional Southern dish which is often served along with the Hoppin' John. They make a great pair. The color of the greens represents money and is said to bring a prosperous year. There could be more to having a prosperous year than eating greens but I'm willing to give it a try.
I like the following recipe because it's made in the crock-pot and can be started the night before. If, for some reason, it seems hard to get out of bed on New Year's day, you'll have at least one thing already going for you.
Hoppin' John
• 2 cups dried black-eyed peas (sorted, rinsed and drained. You may ask, "Why do I need to sort through my dried peas?" Because, they may have small rocks in them. I don't know who puts them there but you need to get them out.)
• 4-5 cups chicken broth or water
Next morning:
• 2 bay leaves
• 1 ham hock or ham bone ( Pigs prefer that you call them hocks. Who knew?)
• 1 large onion, chopped
• ½ cup celery
• 3 cloves chopped garlic (better), or equivalent of garlic powder (easier)
• salt and pepper, to taste
• cooked rice
The evening before, place washed beans and broth into crock-pot, turn on Low.
Next morning, whenever that starts for you, brown onions and celery in a little olive oil. Big news; you can skip this step if you want to. I'm easy.
Add all ingredients except rice to the crock-pot.
Add more liquid if necessary. You want the dish to be a little mushy but not like soup.
Turn crock-pot on High for 2-3 hours, and then down to Low until you're ready to serve.
Serve over prepared rice.
Here's my secret recipe:
For many years I've cooked turnip, or mixed greens, in a variety of ways and have enjoyed them. But, about five years ago I discovered Margaret Holmes canned (Hate to admit it.) seasoned mixed greens. They are yummy! Two years in a row I put them in my crock-pot (Again with the crock-pot.), added nothing (My favorite ingredient.), heated them on High for a couple of hours and got rave reviews. You can heat them on top of the stove if you prefer.
"Can I have your greens recipe?" several people asked. "These are so good." There is the dilemma. Are you going to cough up your 'secret recipe' or keep them guessing? I always tell because I'm so proud of my latest find. But you don't have to. Your secret's safe with me.


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Devon Werkheiser
• David Bowie To Guest Star In SpongeBob's First TV Movie
Birth Name: Devon Werkheiser
American actor Devon Werheiser, nicknamed Dev Monster, was born on March 8, 1991, in Atlanta, Ga. At the age of 10, Devon appeared in his first movie "We Were Soldiers" as Mel Gibson's son. He later had a part in the independent film "Recipe for Disaster," but he is most known for his lead role of Ned Bigby in Nickelodeon's "Ned's Declassified School Survival Guide." When not acting he likes to play ice hockey and play guitar.
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Panama City Beach, Panama City Beach2014 3rd Annual Panama Urban Beach Bike Weekend Schedule "EDITING The Game WEEKEND" October 2-5, 2014 (Thursday - Sunday) Purpose: the Urban Beach Bike Weekend(Oct 2-5, 2014)...
Panama City shopping events
Panama Urban Beach Bike Weekend
Monday, Oct 6 4:00p
Parents Day 5K
Sunday, Jul 27 8:00a
Destin Commons, DestinBoys & Girls Clubs of the Emerald Coast and D estinCommons join forces to bring to you the inaugural Parents Day 5K!! Grab the family and friends and head over to Destin Commons on July 27th to spe...
Face Painting with Arts on the Beach @ Harborwalk Village
Thursday, Jul 31 6:00p
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Mon 10/6 4:00p
Sun 7/27 8:00a


text: Includes volumes 1, 2, 3, 4, and 5 of the YBCR DVDs in Latin American Spanish, 5 sets of the sliding double-sided word & picture cards in Spanish, and 5 lift-the-flap books in Spanish. Includes Baby's First Teacher box with 166 words (on 83 double-sided cards) in Spanish and instructions for games. Includes the viewing schedule in Spanish along with the Parents' Guide in Spanish. Includes the bonus gift of Your Baby Can Speak Lyric Language DVD with 21 bilingual (Spanish/English) songs with lyrics. Ages 3 months to 7 years. (Appropriate for older children who are learning a second, third, or fourth language.) The program should be great for introducing your child to Spanish since research shows that babies who use YBCR in English learn new vocabulary from the program, in addition to learning reading skills.


text: You've never experienced an outdoor carnival like this one! Our carnival features more than 100 exhibitors, including world-famous Little Baby's Ice Cream, offering non-stop, family-friendly experiments, interactive activities, games, and a packed line-up of live entertainment. Enjoy liquid nitrogen ice cream, make gak, meet live zoo animals, check out the inner-workings of robots, take a tour of a helicopter, extract DNA from a strawberry, test a "crime scene" for forensic evidence, and so much more!


text:
Serious Eats - seriouseats.com
This Week at Serious Eats Headquarters
Snapshots from office happenings each week.
This Week at Serious Eats World Headquarters
This week we ate a six-pound whoopie pie (well, part of it), hung out at Kenji's apartment and feasted on grilled corn and chicken, put a wig on a jar of mayo, and more.
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The Salem News
---- — SALEM — A man was arrested yesterday after he allegedly broke the window of a car his girlfriend was trying to drive away, grabbed the wheel and swerved the vehicle into a tree.
No injuries were reported.
Lt. Scott Englehardt said the altercation at 4 Heritage Drive occurred during a domestic dispute. Police first responded to the address after a 9:10 a.m. report of a motor vehicle accident.
Officers determined that the man dragged the woman from the vehicle after it struck the tree, Englehardt said.
Jonathan Torres, 31, of 4 Heritage Drive, Salem, was arrested on charges of domestic assault and battery, assault and battery by dangerous weapon, intimidation of a witness, and malicious destruction of property over $250.
— Neil Dempsey


text:
deductive tableau
<tool> A theorem proof system consisting of a table whose rows contain assertions or goals. Variables in assertions are implicitly universally quantified and variables in goals are implicitly existentially quantified. The declarative meaning of a tableau is that if every instance of every assertion is true then some instance of at least one of the goals is true.
Last updated: 1994-12-07
Try this search on Wikipedia, OneLook, Google
Nearby terms:DED « dedicated line « deductive database « deductive tableau » Deep Blue » deep hack mode » deep magic


text:
More than two weeks after a massive leak of coal ash from a Duke Energy power plant poured into a river along the North Carolina-Virginia border, the full extent of damage to the environment is still unfolding.
On Tuesday, state regulators said a second stormwater pipe at the companys plant is spilling elevated levels of arsenic into the Dan River. And federal officials issued their first assessment of the disaster, raising the specter of long-term harm to aquatic life, reaching as far as Kerr Lake.
The N.C. Department of Environment and Natural Resources on Tuesday afternoon ordered Duke Energy to immediately halt discharges from the second pipe. Tests revealed the water was toxic, and a camera snaked into the pipe showed leaks ranging from a trickle to gushing where sections of the pipe joined together.
The state agency had expressed concern about the second leak on Friday, but regulators didnt know what was in the water that was coming through the pipe and into the river until Tuesday.
The Feb. 2 spill occurred when a 48-inch reinforced concrete and corrugated steel stormwater runoff pipe beneath the ash pond broke, drawing water and between 30,000 and 39,000 tons of coal ash into the river. The second pipe, 36 inches in diameter and built in 4-foot sections, also ran under the pond. The pond has been emptied of water, but coal ash remains.
In the interest of transparency, DENR on Tuesday posted online the video inspection of the pipe at http://alturl.com/yx5zq. The department is having a briefing for reporters on Wednesday to answer criticism.
Environmentalists and others have complained of a cozy relationship between Gov. Pat McCrorys administration and Duke Energy, noting McCrory worked for Duke for 28 years. The U.S. attorneys office has subpoenaed records between DENR and Duke going back to 2010.
Democratic legislative leaders on Tuesday called on McCrory to release his correspondence with Duke Energy since he declared his candidacy for governor in 2011.
Rare species endangered
At a legislative committee meeting Monday, a Duke Energy representative said the smaller pipe would be removed even if it wasnt found to be faulty. He said the states other coal ash ponds did not have stormwater pipes running beneath them.
Tuesdays developments came a day after state regulators and Duke Energy told state legislators that the spill fell short of being catastrophic, since no fish kills had been discovered and the river posed no health threat downstream. The agency did say there was a danger to aquatic life as the ash settled onto the river bottom.
On Tuesday afternoon, the U.S. Fish and Wildlife Service issued its first public assessment, reporting it has found extensive sandbar-like deposits of ash in the Dan River and traces of it all the way to Kerr Lake, about 65 miles north of Raleigh and 70 miles downstream of the spill, with the potential to bury fish, mussels and other aquatic life that survive in river bottoms.
The stretch of river is home to a rare fish and mussel that have been declared endangered, and another mussel that is being considered for protection under the Endangered Species Act, according to Fish and Wildlife.
Though no dead fish have been found, Fish and Wildlife reported that exposing fish and mussels to coal ash could also harm gill tissues, and there could be longer-term harm because of elevated concentrations of metals in the water, Fish and Wildlife said.
The danger that the ash poses by settling on the river bottom is that it disrupts the habitat of species at the bottom of the food chain, which eventually works its way up the food chain.
If it kills off the base of the food chain, you risk having the whole ecosystem start to collapse, said Rick Gaskins, executive director of the Catawba Riverkeeper Foundation. Even if you dont kill them off, heavy metals accumulate, and that shows up in the fish people are putting on their table.
Fish and Wildlife officials have not been able to confirm public reports of dead turtles at two parks in Virginia. The agency found too-high levels of arsenic, selenium and copper but couldnt say whether it was connected to the spill.
Crews also found a coal ash bar 75 feet long, 15 feet wide and up to 5 feet deep composed of ash and sand, as well as smaller bars at 2 miles and 9 miles from the spill.
The agency says it doesnt know whether the ash bars will stay where they are or move when river flows increase, as happened in the recent snow melt.
Virginia issues warnings
The Department of Environment and Natural Resources also reported that it is still testing along the river, and finding metal levels continue to decrease. The agency is also monitoring Kerr Lake.
Virginia authorities are also monitoring the waterways. That states health department issued an advisory last week saying short-term exposure isnt likely to pose a threat. But while drinking water has been filtered in Danville and is considered safe, officials urge people to be cautious if boating, kayaking or swimming in the river because it might cause skin irritation.
Virginia already has an unrelated advisory from Danville to Kerr Lake, which includes parts of the Hyco River and Banister River, because fish in the two rivers have been found to have higher-than-normal levels of PCBs, a cancer-causing toxin.
Duke Energy spokesman Jeff Brooks said the company is cooperating with the various agencies involved. The U.S. Environmental Protection Agency is also investigating.
Were all taking samplings at different points and of different types, Brooks said. All will be essential to develop a plan for the next step.
Gaskins, from the Catawba Riverkeeper, welcomed the information from the Fish and Wildlife Service.
Its helpful to have an organization with the credibility of the Fish and Wildlife Service go in and thoroughly go through it, Gaskins said. It raises a lot of issues.
Although the Catawba River basin is in the southwestern part of the state, nowhere near the Dan River, Gaskins said his group is concerned because a cluster of coal ash ponds is located along the Catawba.
Jarvis: 919-829-4576; Twitter: @CraigJ_NandO


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Analysis: 'Al Gore's 10-Year 'Scorching' Prophesy Emerging As A Grand Hoax…Global Temperatures Declined Over Last Decade'
Read the Full Article
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Climate Depot
March 11, 2014 9:06 AM
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text:
July 31, 2014
Florida State University will appeal the part of an NCAA sanction that would take away wins in 10 sports, including as many as 14 in football.
President T.K. Wetherell will announce the school's appeal
Trustees chairman Jim Smith says the board is 100 percent behind
the decision. "It's certainly unfair to coach (Bobby) Bowden,"
Smith said Monday. "It was a breakdown in academics, a breakdown
that none of us condone."
The NCAA earlier this month took away scholarships and put the
school on four years' probation as part of the punishment for 61
athletes who took a music history class where test answers were
provided and other prohibited help was received.
Copyright 2014 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.


text:
FORT MILL TOWNSHIP — A man, his smile beaming from cheek to cheek, entered the stage at The Barn on Regent Parkway late Saturday night. His gait was slow, but purposeful; calm, but confident.
Then, the smile turned into a wiggle, with glee spreading from his face to his hips, and for the fifth decade running, he began to do "The Twist."
Singer-songwriter and 1960s music legend Chubby Checker had arrived.
With every appearance, Checker lit up a standing-room-only crowd that packed The Barn to be a part of the taping of the third Artists Music Guild Heritage Awards. As the honorary host for the night, he and AMG president David L. Cook presented several music legends with Lifetime Achievement awards, including pianist Dino Kartsonakis ("Chariots of Fire") and singers Terri Gibbs ("Somebody's Knockin') and Naomi Sego of gospel group Naomi and The Segos.
Even Chubby got one.
"I've been so fortunate throughout my career to work with the best in the music field, and tonight is no different," said Checker, an S.C. native.
Rhythm and blues artist Dee Dee Sharp ("Mashed Potato Time"), who was on hand for a surprise guest performance, presented Checker with his award, as Cook said he didn't "feel worthy to present it to [him]." Sharp, a recording professional since the early 1960s, worked with Checker on a highly successful single, "Slow Twistin'," which hit No. 3 in the Billboard Hot 100 Top 10 hits.
The Artists Music Guild is the brainchild of several corporate CEOs who hope to keep younger artists from being taken advantage of in the music industry. They provide quality video production, staffed teams, professional tax services and legal help to all members.
"We wanted to have a safe haven for the artists," said Cook, a seven-time Emmy Award winner and member of the Country Gospel Music Hall of Fame. "Every artist knows they can get help here, so they don't have to be a part of predatory practices. In three short years, look at what we've done and it's only going to get better."
Fort Mill-based dance troupe "The Eddie Mabry Dancers" was awarded 2013 Dance Group of the Year, while Stella Parton (sister of Dolly) was given the Author of the Year award. Greer native and one-time "American Idol" contestant Dylan Arms accepted his awards for New Artist and Male Vocalist of the Year, while contemporary Christian singer Cindy Hughlett was awarded Female Vocalist of the Year honors.
The Heritage Awards have taken place in Fort Mill since 2011, but moved to The Barn this year. If the event keeps growing, it might one day need a larger venue, officials said.
"We're hoping that in the next few years, it's big enough that we can move these awards to an even bigger place than Fort Mill," said AMG board member Phillip Irish. "That'd be just great."
After the show, Checker stayed and spoke with artists, young and old, backstage. The 72-year-old is a native of Spring Gulley in Williamsburg County. Prior to the awards, he had never been to Fort Mill, but said he was excited to be back "home" in S.C.
"I'm just so thrilled to see these young kids play with such passion and love," he said. "It's just great to see that in the next generation. That's what it's all about."


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By Phil Dzikiy
At this rate, George Winston reckons he'll be back in Buffalo, by, oh, 2022. So if you want to see him perform live, Friday night's your chance.
Winston is a solo instrumentalist, mostly known for his work as a pianist. He's recorded more than a dozen solo piano albums. All Music Guide describes him as "among the earliest and most successful proponents of the genre of contemporary instrumental music later dubbed new age." And though he hasn't been in Buffalo since the late 1990s, he's joking about the amount of time it might take him to make a return trip after his upcoming show at Buffalo State College's Rockwell Hall.
"I've been (to Buffalo) eight or nine times over the years," Winston said. "(It's) always great to be back."
But The City of Good Neighbors isn't the only city on his mind recently. The plight of New Orleans still weighs on his conscience as The Big Easy fights back from some tough times. Winston's most recent album, 2006's "Gulf Coast Blues & Impressions: A Hurricane Relief Benefit," offers proceeds to a few of the region's organizations helping with the rebuilding effort after Hurricane Katrina.
"I just wanted to do something to help the coast of New Orleans, like everybody did," Winston said. "The news from down there is 'back in business,' but there's a lot of work to still be done. It will come back. It's just going to take consistent work."
As expected, the album is done in the jaunty New Orleans R&B; piano style. It features six original Winston compositions and a few covers, including a lengthy reworking of "When the Saints Go Marching In." The first song on the album is titled "New Orleans Shall Rise Again."
Winston works in three different styles of piano playing — the aforementioned New Orleans style, the jazzy stride piano style and the melodic style he calls "folk piano."
Winston will touch upon all three of these styles during his performance, as his concerts show "just where I'm coming from musically right now."
So though audiences can expect a mix of piano styles and songs, no one should expect anyone else to be on stage with Winston.
"Never," Winston said of playing with accompaniment. He realized long ago that he was a solo performer. "Once in a great while, I might back up someone on a record. It's not something I really enjoy."
Even when performing guitar or harmonica concerts, which happen less frequently than his piano concerts, Winston works alone.
"It seems to fit," he said. "Whatever I play, I play by myself."
Winston's next album should hit stores around Valentine's Day, he said. In 1996, he tackled the music of one of his favorite composers on the album "Linus & Lucy: The Music of Vince Guaraldi." He'll revisit Guaraldi's music on the upcoming "Love Will Come: The Music of Vince Guaraldi."
"(It's the) second and final volume I'm going to do of his pieces," Winston said. "I love his compositions ... he had a particular language in his compositions."
For Winston, part of the appeal in playing Guaraldi's work involves the differences between the playing styles of the two men. Winston gets to bring R&B; flair to Guaraldi's jazz style.
"I've tried to play every one of (Guaraldi's) pieces over the years," Winston said. The other composers to attract Winston so thoroughly are the great New Orleans pianist Professor Longhair and the Doors.
Guaraldi is known by many as the "Peanuts" composer, and Winston may play a few of those tunes at Friday's show. After all, Winston has always placed an emphasis on seasons — his albums include "Autumn," "December," "Winter into Spring" and "Summer."
"This will be the winter show," Winston said of the upcoming performance.
At each of his concerts, Winston holds a canned food drive. Audience members are urged to bring cans of food to the show. Friday's performance will benefit the Food Bank of Western New York.
WHAT: George Winston solo piano performance
WHEN: 8 p.m. Friday
WHERE: Performing Arts Center at Rockwell Hall, Buffalo State College, 1300 Elmwood Ave., Buffalo
MORE INFORMATION: Tickets start at $27 for non-students. Call 878-3005 or visit www.buffalostate.edu/pac/


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The grants are aimed at strengthening the country's health system and the fight against AIDS, will be implemented by the National Aids Council; the Ministry of Health, Prevention and Public Hygiene; and Alliance Nationale Contre le SIDA (ANCS).
Over the next five years the project expects to reach:
In addition to strengthen Senegal's health system, 234 health structures will be rehabilitated, and 100 nurses and midwives will be recruited. In a comment for the new Alliance blog, Magatte Mbodj, Executive
Director of ANCS (Alliance linking organisation in Senegal) describes
the impact of the Global Fund on the civil society response in Senegal.
her comment piece, Magatte Mbodj explains how the support of the Global
Fund in Senegal over the last five years has shown substantial results
despite the major challenges that are faced in Senegal.
describes the achievements to date and how this has contributed
significant results around targets related to Universal Access,
illustrated by the fact that the HIV prevalence rate has been maintained
at less than 1% in the general population.
Magatte then goes on to stress the ongoing challenges to the response to HIV in Senegal. Particularly around reducing stigma and discrimination, scaling up services for key vulnerable populations and building civil society capacity.
Her comment stresses the importance of having a capable, committed civil society with the necessary means for service delivery in order to build on the achievements of the last five years.
Read the full article.
For more information, contact:
Ann Noon
Media Manager
International HIV/AIDS AllianceTogether to end AIDS
This website complies with W3C Accessibility GuidelinesRegistered British Charity No. 1038860The Alliance is a UNAIDS collaborating centre
Designed and built by
Photolink Creative Group


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Photo slideshow for 5/4
By Ben Enos
Monday, May 4th, 2009 at 11:34 am in Uncategorized.
Here is this week's photo slideshow, courtesy of Ray Saint Germain and the photo staff. Click on the photo of Antioch's Paris Imholz to view.
[You can leave a response, or trackback from your own site.]


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All Bishop Walsh freshmen received iPads this week to start using in the classroom, with plans to expand to other high school grades in the near future. The iPad initiative, funded by a private donation, is part of the ongoing Bishop Walsh Technology Plan, which also included a state-of-the-art, touch-screen computer lab for elementary students that was introduced in the fall.
Local News
iPad initiative at BW
- Local News
Gardeners overcome chaotic weather to put on colorful fair flower exhibit
In keeping with the spirit of Oliver Wendell Holmes, the exhibit hall at the Mineral County Fairgrounds was filled with colorful flowers, including African violets, lilies and marigolds despite the chaotic weather.
Three area schools remain without fiber connection
The Allegany County Board of Education, with three of its schools still without fiber optic cable, continues to move forward with an effort to extend the high-capacity lines to all 22 county schools.
Hyndman youth hopes to net tennis court funds
One of the many unique aspects of the HOPE for Hyndman Charter School is the integration between the students and the community.
- Mystery woman
- Wild Wonderful Wednesdays to be held
- Marching band prepares for tournament
- Renovations planned for South Cumberland Library
- Bedford teen killed in crash
3 sites make shortlist for new FBI headquarters
WASHINGTON (AP) — The federal government has named three sites as finalists for the new FBI headquarters — two in suburban Maryland and one in northern Virginia.
Man charged for urinating on Art Modell's grave
BALTIMORE (AP) — Baltimore County authorities say they will charge a man with disorderly conduct in a cemetery for allegedly urinating on the gravesite of former Baltimore Ravens owner Art Modell.
- More Local News Headlines
- Gardeners overcome chaotic weather to put on colorful fair flower exhibit


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An Apple Valley man has been charged with choking a woman, threatening to stab her with a kitchen knife and being in possession of an illegally altered gun.
Dwayne Washington, 41, is charged with three felonies: making terroristic threats and possession of a firearm with an altered or removed serial number, each of which carries a maximum penalty of five years in prison and a $10,000 fine, and domestic assault by strangulation, for which the maximum penalty is three years in prison and a $5,000 fine.
According to the criminal complaint, a woman reported to Apple Valley police Oct. 23 that Washington had strangled her earlier that afternoon.
The victim said Washington met her in her driveway when she returned home earlier that day and began arguing with her about money. She said that once they were inside, Washington told her he wanted to kill her. He grabbed her by the neck and squeezed so she was unable to breathe for about 10 seconds.
As the argument continued, Washington grabbed the victim by both arms and squeezed, leaving bruises, according to the complaint. Washington then grabbed her by the throat again and squeezed for 10 seconds, cutting off her breath, the victim told police.
At one point, Washington picked up a kitchen knife and told the victim, "I just want to put this through your heart," according to the complaint. She told police that she gathered her two children and told Washington she was taking them to get some food, but instead drove to the police station.
Police found Washington at the home and arrested him. He told officers that the victim was his "high school sweetheart," that he had put a lot into the relationship and "felt he deserved more from her," according to the complaint. He admitted putting a hand on the victim's neck and telling her, "This is what can happen," but denied applying pressure, the complaint says.
Washington also admitted that he yelled at the victim while clenching his fist, but denied that he had attempted to scare her, according to the complaint.
The victim told police that two weeks earlier, Washington loaded a gun in front her, telling her first that he wanted to shoot her, then that he wanted to shoot himself instead. The victim led officers to a bedroom closet and showed them the gun, which had its serial number scratched off.
Washington has been released from custody on bond, with the stipulation that he stay away from the victim's home and place of employment. An omnibus hearing in his case is scheduled Jan. 29 in Dakota County District Court in Hastings.


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Verisign Labs operates research facilities in Reston, VA, where we are able to recruit from a tremendous pool of talent and collaborate with industry leaders. Visit LinkedIn to find out more information about available positions at Verisign Labs.
- Dr. Burt Kaliski, Jr.
Senior Vice President & Chief Technology Officer
As Verisign's chief technology officer, Dr. Burt Kaliski is responsible for the company's long-term technology vision. He is the leader of Verisign Labs, which focuses on applied research, university collaboration, industry thought leadership and intellectual property strategy.Read More


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Frequently Asked Questions
What do I do if no coffee is brewed?
What if the coffee is not hot enough?
What if the lever cannot be lowered?
What do I do if I can't access, drain or descale feature?
The water tank is empty, the indicator light is on red
Fill the tank with fresh water
Make sure the tank is correctly positioned.
You should see bubbles in the water rising to the top
Press the desired coffee button
The button may not have been pressed firmly to activate the brewing cycle
Preheat the cup
- Place a cup under the dispensing spout. Ensure NO capsule is inserted in the capsule compartment.
- Press the desired coffee button once. The selected coffee button will blink. The appliance will stop dispensing on reaching the programmed quantity and emit a beep.
- Discard the water from the pre-warmed cup or mug, dry and place back under the dispensing spout. Your machine is ready.
The cup may be cold or there may be a build up of scale in the machine
Descale the machine as per the instruction manual
The used capsule drawer may be full or there may be a capsule stuck inside the machine
- Empty out the used capsule drawer
- Remove the used capsule
Reset the function
- Press down in the centre of the button
- Ensure you feel the button engage
- See active button zones highlighted


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Looking for a place in the North Shore communities to enjoy the big game on Sunday? Here's a list of our readers' picks for best beer list, burgers, pizzas and pubs. And may the team of your choice win and make you prosperous in the football pool.
Best Beer List or Supply — Restaurant or Bar
- Winner: Three Lions Pub
- 2nd Place: Cafe Hollander
- 3rd Place: Big Bay Brewing Company
Best Burger
- Winner: Three Lions Pub
- 2nd Place: Solly's Grille
Best Pizza
- Winner: Zaffiro's Pizza
- 2nd Place: Lisa's Fine Foods
Best Pub
- Winner: Three Lions Pub
- 2nd Place: Village Pub
- 3rd Place (tie): Harry's Bar & Grill, Big Bay Brewing Company


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Opening of the Koslow Center for Marriage and Family Therapy Creates Flurry of Activity for MFT Department
April 8th will mark the ribbon cutting ceremony to celebrate the opening of the new Kathryn P. Koslow Center for Marriage and Family Therapy. Fairfield University President, Jeffrey P. von Arx, S.J. will lead the ceremony, which will be followed by an open house and reception.
Through a generous donation by alumna Kathryn P. Koslow '05, who is also a member of the GSEAP and Marriage and Family Therapy Advisory Boards, the University renovated Southwell Hall and installed state-of-the-art technology to create a new training facility for Marriage and Family Therapy (MFT) graduate students. Under the supervision of professional faculty and supervisors, advanced graduate candidates provide clinical mental health services to individuals, couples and families from the greater Fairfield community.
The official opening for the Koslow Center is also getting attention from campus and local newspapers : http://fairfieldmirror.com/2011/03/16/marriage-and-family-therapy-training-center-brings-opportunities-to-fairfield/), which has produced a steady stream of interest from the greater Fairfield community.
In addition to the activity surrounding the Koslow Center, some marriage and family therapy graduates have been highlighted on campus. The Fairfield University Magazine recently published an article about Loren Smith '08 and Michael Becker '10 integration of the MFT degree and their divorce mediation practices. To learn more about Loren and Michael, you can read the full article at: http://blog.fairfield.edu/magazine/?p=1322


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Home > The City > Matrimandir > Visiting the Matrimandir
The Soul of Auroville
Visiting the Matrimandir
Please be reminded
Matrimandir Access Policy for Visitors
Understanding the Matrimandir
The Park of Unity, located at the centre of the international township of Auroville, includes:
The Matrimandir is a shrine of the Universal Mother and the Soul of Auroville; it is meant for those who, in the Mother's words, are sincere and serious and truly want to learn to concentrate. The Matrimandir is not a temple in the conventional sense of the word; it is neither a place of worship, nor to be associated with any religion, whether ancient, present, new or future.
For better understanding please look up 'Understanding the Matrimandir Access Policy'.
Access to the Matrimandir Viewing Point
The Matrimandir Viewing Point, south of the Park of Unity, is a raised garden area which provides visitors with a beautiful view of the Matrimandir and its surroundings.
• Timing for issuing of Passes at the Visitors' Centre:
• Opening hours of the Matrimandir Viewing Point:
• Please note: The Matrimandir Viewing Point remains closed on Sunday afternoons.
• Way to the Matrimandir Viewing Point:
Access to Matrimandir and surrounding areas
The Matrimandir Access Policy is based on the Mother's guidelines.
General conditions:
1) First time visitors to Matrimandir for concentration
The following conditions apply to all first time visitors for concentration.
Please note that it is not possible to accommodate late comers.
2) Visitors who have previously concentrated in the Matrimandir
Concentration time in the Petal Meditation Rooms
Please note:
Home > The City > Matrimandir > Visiting the Matrimandir
|Auroville Universal Township


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See All
My Communities
My Discussions
My Email Digests
Take Care & Rock On,
Cindy AKA CinBad
I have read that there are *millions of us FMers* now who suffer from the mean and ugly illness....so I am sure that research will indeed continue. I think it is good that more and more doctors are at least now learning that FM is a real illness....instead of trying to tell us that it is all in our heads...(although most of us already know it has something to do with our brains anyway and our central nervous system).
So I have to ask you....have you found anything at all that has helped you? Have you tried any of the *medicines* to help ease your pain? Have you tried any vitamins and supplements?
A lot of our members join and then just disappear....I often wonder what happens to them. It is good when an old member returns and at least tells us that they were here earlier and have not been here in a while. It is always good to hear from these people.
I hope things are going well with you and that you will share more of what you have found to help you cope better, if indeed you are.
Take care and good luck.
My personal exchanges are Vitamin D and Pain and Wrath of the Dragon....if you care to visit..
Have been taking vitamin D for a while now. I saw you campaign for that a few years ago...at least I think it was you. You know, the whole Fibromyalgia and memory loss thing and all...LOL
I can't speak for anyone else, but I only make an occasional appearance on here for 2 reasons: 1.) I have pretty much given up hope. 2.) People can get a little vicious on here if you type or do something they don't like...like going off topic.....LOL
Thank you for responding MiMi. Take care & rock on.
Cindy AKA CinBad
I was also taking a placebo as well....(which at the time I did not know for sure - but I was able to comment on whether or not I thought it was the medicine or the placebo....I guess right....they told me long after I had finished the study since I had indicated that I would like to know.
OK....yes....you are correct....it was me who sounds off about Vitamin D....I have been on a mission now for a very long time about it. I think Dr. P was actually unaware of just how important Vitamin D is to us FMers....he is no longer here but his *posts* are still with us....you might want to review some of them. He was a wonderful *asset* to our community.
I am one of the FMers here who also has the chronic fatigue and I have not been able to find anything which has improved this as well. There are some days which are better than others and I can NOT pinpoint as for the reason of this. I continue to try different things though that I come across on the internet....hopefully one day I will find something that will help this.
Don't know how long you have been taking Vitamin D....or IF you have researched it any...don't know just how much your level was but it took me a very long time to get my level back up to within the normal range....it was well over a year....and my level was still in the low range.
Sorry that you had a *bad experience here*....but the website is for all of us to learn from one another. There are a lot of new people here....and a lot of people come and go....but I hope you will feel free to post when you want to. There is someone here most of the time....24/7....and we do understand just what you are dealing with.
Take care.
My personal exchanges are Vitamin D and Pain and Wrath of the Dragon....if you care to visit..
I thought you were the Vitamin D advocate. If I remember correctly I recently saw on the news that it was stated that Vitamin D was recently shown to not be a valuable supplement to take after all ....Personally, I am going to continue taking it because I don't think it could possibly hurt although my Vitamin D levels are okay. I also take Mega Red Fish Oil and an aspirin every day.
Some find it strange that I complain more about the fatigue than the pain. I am glad others understand about the fatigue.
I continue to have a high sed-rate. But I do have osteoarthritis, a uterine fibroid tumor and a tumor in my femur....all noncancerous. Just curious, do you have any of these things as well? If I remember correctly you have a little more than Fibromyalgia going on as well.
As for as the bad experience on here....live and learn right. It's all good. Thank you for all of your kind words.
I am dealing with other health issues as well. I have had 4 right knee surgeries....(due to an injury in the 80's) 7 hand surgeries....parathyroid surgery, right elbow surgery and cervical (neck) surgery as well. I do take a joint supplement which helps my knees. I have also had the synvisc injections in my knees as well. I have had injections in both hips as well.
I do want to tell you that after I had a hysterectomy my pain levels got better for a while....(this was before I met the wrath of the dragon, aka FM).
I also take Omegas as well. I know that they have helped me. In fact, I depend upon the vitamins and supplements every day. I know that I am now better off taking them than I was before I started. I have also learned through all of this that vitamin and supplements are just like medicines...they are NOT ALL THE SAME....so if you think what you are taking perhaps you need to switch brands and find out if another brand will work better for you. I learned this by experimenting with different brands.
Take care and good luck.
My personal exchanges are Vitamin D and Pain and Wrath of the Dragon....if you care to visit..
I had a terrible winter. I didnot sleep for 8 weeks and the pain came increasing worse.I was in and out of the ER will dehydration finally I switch hospitals and MD's.They placed me on Remeron for sleep and pain and it worked.I also saw a pain specialist and was put on Gralise (long acting Neurotin) and I am 90% pain free so don't give up hope .Hoefully this will last and I am back to doing normal things.Out there is a MD who will help. Gentle Hugs. Fran
I am sorry you had such a difficult winter. I am so happy and excited for you concerning the relief you are getting now!!!!! Believe me, I will be asking my doctor about these medications! It's definitely worth a try!
Thank you so much for responding and giving me this information. I sincerely appreciate you're kind words of encouragement!
Take Care & Rock On,
Cindy AKA CinBad
You might go back into the section on tips or resources and look for the member post...called member toolbox...started by Nancy B...and see if anything is helpful there..also...there is one there somewhere by Amy.(I think she called hereself Meme) that was a good resource on different meds..
hope that is helpful..
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James Madison University administers a wide variety of student financial aid programs and funds. State and/or federal laws and requirements govern most of these programs. This section outlines the responsibilities and procedures necessary to allow the University to comply with those requirements. Information in this section applies to all departments involved in the administration of financial aid funds.
Many of the aid programs administered by the University are "need-based". This means that the Office of Financial Aid and Scholarships makes an analysis of the student's available resources and income. The portion available for educational purposes is compared to the anticipated educational expenses. The difference is considered unmet need. The student's financial aid award is then determined based upon this unmet need. Any awards, scholarships, or college work-study employment received after the calculation of this need may affect the amount of award that a student is entitled to receive from need-based financial aid programs. Since the University is ultimately responsible for any amounts improperly awarded in need-based programs, it is extremely important that departments comply with the following procedures.
Many of the University's financial aid programs have a large number of award recipients. To facilitate the processing of these programs, the University has developed an automated process called "direct application of financial aid".
The Financial Aid and Scholarships Office initiates this process by entering approved financial aid awards for individual students into the Student Information System. Various departments use these entered awards in calculating the amounts personally due from each student. Then, at a designated time, coordinated between the Office of Financial Aid and Scholarships and the University Business Office, direct application of specific aid program(s) are processed.
This process disburses the financial aid and creates an account entry for posting to the student's financial account. Once these entries are reconciled to disbursement data and funds available, the entries are actually posted to the student's account. The University Business Office then processes credit balances created from overpayment of institutional charges (tuition and fees, room and board). These refund entries are posted to Accounts Payable by an electronic download process.
Finally, the University Business Office completes the paperwork to formally request the processing of the download and to generate a single check to the Treasurer of Virginia to cover charges paid by the aid application. The student then receives notices of their rights to cancel the aid award (loans only) and is notified that either 1) a direct deposit to their bank account has been made, or 2) a check has been processed and will be mailed to their home address.
• Contacts the Office of Financial Aid and Scholarships to explain the awards contemplated in order to determine the impact, if any, of the proposed award on the student's need-based financial aid and outline the provisions for distributing the money to the student.
• Processes and returns all documentation required by the Office of Financial Aid and Scholarships and the University Business Office for aid disbursement.
• Contacts the University Business Office immediately to establish an exact date for the award, if necessary.
• Administers all financial aid programs in accordance with Federal, State and University regulations.
• Assists students and departments by explaining procedures and providing necessary forms.
• Determines the impact of proposed awards on the student's need-based financial aid package.
• Determines the eligibility of the student to receive financial aid funds.
• Conducts exit interviews with Stafford Loan fund recipients.
• Notifies the University Business Office of the eligibility of students for an aid program so that awards are credited to the student's account and individual student refunds generated at the appropriate time.
• Administers all financial aid programs in accordance with Federal, State and University regulations.
• Provides University departments and other state agencies with forms and instructions for the aid disbursement procedure.
• Administers required billing and collection procedures in accordance with Federal, State, and University policies.
• Approves exceptions to the daily procedures, as appropriate.
• Conducts exit interviews with Perkins and Nursing loan fund recipients.
• Ensures that financial aid funds are on hand prior to disbursing awards.
• Issues refund checks to students or lending institutions, as appropriate.
• Provides information regarding the amount, type of aid to be awarded, and proposed recipients to the Office of Student Financial Services and the Office of Financial Aid and Scholarships and the Office of Financial Aid and Scholarships.
• Approves and returns required forms, with proper authorizations, to the University Business Office and the Office of Financial Aid and Scholarships for processing.
• Determines eligibility of students for awards.
• Determines the amount of award to which each student is entitled.
• Enters proposed and approved award amounts in the Student Information System.
• Notifies the University Business Office when awards can be applied and refunds issued.
• Verifies Aid Disbursement-Preview received from Office of Financial Aid.
• Verifies availability of funding for proposed student aid awards.
• Provides department/agency with the appropriate forms and instructions required for aid disbursement.
• Verifies department/agency authorizations on prepared forms (Agency Transaction Vouchers, and Invoices).
• Enter appropriate information into Student Financial Information System to apply aid to students' accounts.
• Deposits the University portion of applied aid in the appropriate bank account and distribute revenue to the proper department and revenue source codes.
• Requests and verifies refunds for students, either through direct deposit to a bank account or by check request to the student's home address, as appropriate.


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Zach Hale
Listening to Horse Thief's previous release — the haphazardly melodramatic Grow Deep, Grow Wild — felt like a chore. Whatever potential the Oklahoma City folk-pop act demonstrated on the EP was obscured behind a formulaic, contrived and ultimately hollow cloud. But it at least offered a glimmer of promise for a band consisting of, frankly, five pretty talented dudes. Critics saw it; the band's management saw it; its current label, Bella Union, saw it; and its increasingly fervid fan base saw it.


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We're fat. No, it's more than that. We're very fat.
According to the Centers for Disease Control, 25.2 percent of Floridians are obese, according to a survey.
But, the CDC says, the rate could actually be 7 percent higher. That would make a third of us overweight.
The story has some suggestions to how to cut down on the problem. Basically it comes down to eating healthier and exercising more. Is that a surprise?
The problem is not just one for the health of people who are overweight. It costs all of us financially, too, to the tune of $150 billion annually for ailments related to obesity.
That raises the medical insurance costs for everyone.
Folks are not just eating too much food. They're eating our money, too.
Gobble. Gobble.


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By Mannix Porterfield
Register-Herald Reporter
For the first time in history, Republicans wield the majority on the three-member Raleigh County Commission, and that means a big change is coming next week — Dave Tolliver is destined to serve as president.
Nothing is official until the formal vote comes off Tuesday at the commission's organizational meeting, but with the Republicans occupying two of the seats, the outcome is certain.
All three commissioners met Friday to discuss protocol for the coming year and changes that are in the works.
Tolliver described the get-together as amicable and said he and Commissioners Pat Reed and Linda Epling covered much ground.
"Tuesday, there are going to be some announcements," he said, without tipping his hand.
"There are going to be some changes. We just had a get-acquainted meeting with each other and went over some things we'd like to change. It was an excellent meeting. We expressed some changes we would like to see made. We just discussed them. It went really well."
Reed is a long-time commissioner and now the lone Democrat, while Epling, the other Republican, won the post in the November general election in a race against Democratic rival Sherrie Hunter.
Tolliver vowed that partisanship wouldn't become a hallmark of the new commission, once it settles down to business.
"My greatest desire is for communications, that everybody, all three of us, will know exactly what's going on," he said.
"Whether we all agree on something, at least everyone will know what's going on. Communications between the commissioners hopefully will be glad. Obviously, we're not going to agree on everything. You can disagree but don't be disagreeable."
Epling succeeds Democrat John Aliff, who decided against seeking re-election last year after a 12-year tenure to attend to his wife's medical needs.
Tolliver was elected in 2010, defeating incumbent Democrat John Humphrey, who then was hired as the county administrator.
Since his arrival, Tolliver has been an outspoken commissioner.
"In two years I've been here, a lot of things have come up and I have expressed my opinion on several things I didn't think were appropriately done," he said.
"But they passed, so you go on."
Tolliver said his main goal is that the commission be good stewards of the citizens' money.
"Obviously, you're not going to satisfy everyone," he said.
"But you do what you feel is the best and vote the way you feel. I'm sure somewhere down the road there'll be some disagreement."
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Welcome back to one of the best years to come in Summit Hill School District! We sincerely hope that the summer gave Summit Hill families some wonderful opportunities to connect with those who matter. Staff members are looking forward to once again embarking on the most meaningful mission on the face of this earth - the teaching of children. Our goal on Day One is for our schools to be so welcoming, so inviting, and so comfortable that every person who walks through our doors believes they are about to have an amazing experience! We look forward to seeing you soon!
Notice of Public Hearing
Notice is hereby given by the Board of Education of Summit Hill School District #161 in the County of Will, State of Illinois that a public hearing on a waiver permitting the use of Pulaski Day as a student attendance day if deemed necessary, will be held at 7:00 p.m. on August 13, 2014 at the Summit Hill District Administrative Center, 20100 W. Spruce Drive Frankfort, Il 60423.
David Faber, Secretary, Board of Education Will County School District 161


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New Strategies for the Treatment and Supportive Care of Veterans with Hepatitis C Conference
San Francisco, California. January 16-18, 2002
Alan Franciscus
Part I
A very important conference on the treatment and care for Veterans with HCV was held in San Francisco, CA on January 16-18, 2002. The conference was particularly important and timely because the Veterans Health Administration recently issued new treatment guidelines for Veterans with HCV. Such guidelines by the Veterans Health Administration are a widely utilized resource outside of the VA by other health entities such as the Departments of Corrections, Managed Care Organizations and State and Federal Health Systems looking to implement their own disease state management and treatment guidelines for hepatitis C.
Coverage of this conference by the HCV Advocate will be broken up into various postings with an in-depth review in the areas of New Treatment Strategies and Treatment in Special Populations. Coverage by the HCV Advocate of the conference sessions that focused on End Stage Complications will be summarized following these in-depth reviews.
Opening remarks to the conference were by Lawrence R. Deyton, Chief Consultant of Public Health for the Department of Veterans Affairs and Director of the Public Health Strategic Health Care Group (PHSHG), which oversees the VA's hepatitis C program.
In its continuing efforts to provide care to more than 80,000 veterans infected with hepatitis C, the Department of Veterans Affairs (VA) on Jan. 1, 2002, funded four new centers to evaluate and improve hepatitis C screening, testing, clinical care and education. Each of the centers will receive annual funding of up to $500,000 for five years, plus start-up costs. The centers are located in Minneapolis, San Francisco, West Haven (Connecticut) and Seattle in conjunction with the Portland, Ore. VA medical center.
Dr. Deyton acknowledged the four new centers and described the Veterans Affairs commitment to hepatitis C as follows:
"The VA screens, tests and treats more people with hepatitis C than anyone else in the country," said Dr. Lawrence Deyton. "Even so, VA continues to explore new ways to improve its programs. These new centers will function as field-based clinical laboratories to evaluate current practices and develop new tools for improving the quality of care". The new centers will build on the success of the previous Centers of Excellence in Hepatitis C program, established by the VA in 1999.
Session One
"New and Emerging Treatments for Hepatitis C: A focus on Pegylated Interferons" Dr. Timothy Morgan, Chief of Hepatology, Long Beach VAMC
Dr. Morgan opened his presentation discussing the current standard of care in the treatment of hepatitis C; combination therapy with Intron A plus ribavirin (Rebetron). Intron-A is delivered by a multi-dose pen dosed at 3MU three times a week. Ribavirin is in 200mg tablets and is dosed at 1000mg/day (divided into two doses of 400mg and 600mg) for patients <75kg (165 pounds) and 1200mg/day (divided into two doses of 600mg) for patients >75kg (165 pounds).
Approximately 28% of patients that have genotype 1 hepatitis C can expect to achieve a sustained virological response (SVR) with Rebetron. Dr. Morgan reiterated the recommendation to treat genotype 1 patients for 48 weeks. Approximately 60% of patients that have genotype 2 or 3 can expect to achieve an SVR with Rebetron and for patients with genotype 2 or 3 the recommended duration of treatment is 24 weeks. The overall SVR that can be achieved with Rebetron is approximately 40% and Dr. Morgan recommends stopping treatment if PCR is HCV positive at 12 weeks.
Next, Dr. Morgan discussed "What is a PEG?" The word PEG comes from Polyethylene Glycol. PEG is a long molecule composed of repeating units of HO-(CH2CH20) n-CH2CH2-OH. PEG is inert, non-toxic and non-immunogenic. PEG is water soluble, mainly renally excreted and FDA approved for internal use.
Dr. Morgan then differentiated the two pegylated interferons that are or will shortly be used to treat hepatitis C; peginterferon alpha 2b (PEG-Intron™) and peginterferon alpha 2a (Pegasys™). Dr. Morgan stated "We hold this truth to be self evident – that all PEG's are not created equal…." The characteristics of a PEG vary depending on whether the chain is branched or linear, the length of the PEG chain, whether the PEG is attached to the interferon at a single site or at multiple sites and lastly the type of bond that attaches the PEG to the interferon.
Dr. Morgan characterized peginterferon alpha 2b (PEG-Intron™ - Schering) as:
A 12kD, linear PEG
Absorption T1/2 = 7 hours
Elimination T1/2 = 4 days
Renally (kidney) cleared
Needs to be weight based dosed due to large volume of distribution
Dr. Morgan characterized peginterferon alpha 2a (Pegasys™ - Roche) as:
A 40kD, branched PEG
Absorption T1/2 = 50 hours
Elimination T1/2 = 11 days
Hepatically (liver) cleared
Fixed dosing due to small volume of distribution (targeted distribution in the serum, organs and plasma)
Dr. Morgan then showed a graph comparing the Mean Serum Concentrations of Pegasys versus PEG-Intron after multiple doses. Pegasys maintains consistently high concentrations and the curve shape is flat with no peaks or troughs. The graph showed consistent concentrations for Pegasys in the 1000-1400pg/ml range throughout the entire week after multiple doses. PEG-Intron on the other hand even after multiple doses has a concentration curve over the week that looks very similar to standard interferon with a pronounced peak and trough. The peak reaches concentration levels of about 1200pg/ml and then drop gradually until the end of the dosing period when there is no PEG-Intron concentration in the serum. By pegylating the interferon, which is the active antiviral agent weekly dosing is made possible by decreasing the rate of clearance as well as sustaining plasma levels for a greater period of time. The reasons that each peg yields different pharmacokinetic parameters as well as different results are due to the different PEG characteristics between PEG-Intron and Pegasys.
Dr. Morgan in his presentation then discussed the clinical trials of both pegylated interferons with and without ribavirin. The trials discussed were the pivotal trials on treatment naïve patients with chronic hepatitis C.
Peginterferon alpha 2b, 12kD, Peg-Intron™ (Schering) compared to Intron-A
Dose of PEG-Intron = 1.0µg/kg
Dose of Intron-A = 3MU tiw
This trial is published in Hepatology 2001, 34:395-403
Genotype 2 and 3, low viral load(<2 million copies/ml)
PEG-Intron SVR = 62%
Intron-A SVR = 36%
Genotype 2 and 3, high viral load(>2 million copies/ml) PEG-Intron SVR = 42%
Intron-A SVR = 25%
Genotype 1, low viral load(<2 million copies/ml)
PEG-Intron SVR = 38%
Intron-A SVR = 21%
Genotype 1, high viral load(>2 million copies/ml)
PEG-Intron SVR = 8%
Intron-A SVR = 2%
Peginterferon alpha 2a, 40kD, Pegasys™ (Roche) compared to Roferon-A
Dose of Pegasys = 180µg
Dose of Roferon-A = 6MU followed by 3MU tiw
This trial is published in the New England Journal of Medicine (NEJM) 2000, 343:1666-72
Genotype 2 and 3, low viral load(<2 million copies/ml)
Pegasys SVR = 67%
Roferon-A SVR = 50%
Genotype 2 and 3, high viral load(>2 million copies/ml)
Pegasys SVR = 48%
Roferon-A SVR = 30%
Genotype 1, low viral load(<2 million copies/ml)
Pegasys SVR = 44%
Roferon-A SVR = 15%
Genotype 1, high viral load(>2 million copies/ml)
PEG-Intron SVR = 14%
Roferon-A SVR = 1%
Peginterferon alpha 2a, 40kD, Pegasys™ (Roche) Phase 111 Pivotal Cirrhotic Trial
Dose of Pegasys = 90µg or 180µg
Dose of Roferon-A = 3MU tiw
This trial is published in the New England Journal of Medicine (NEJM) 2000, 343:1673-80
Genotype 1
Pegasys 180µg SVR = 13%
Pegasys 90µg SVR = 5%
Roferon-A SVR = 2%
Genotype 2 and 3
Pegasys 180µg SVR = 51%
Pegasys 90µg SVR = 29%
Roferon-A SVR = 15%
Combination Therapy
Peginterferon alpha 2b, 12kD, Peg-Intron™ (Schering) and ribavirin compared to Intron-A and ribavirin
Dose of PEG-Intron/RBV = 1.5µg/kg plus 800mg ribavirin
Dose of Intron-A/RBV = 3MU tiw plus 1000mg ribavirin
PEG-Intron/RBV SVR = 54%
Intron-A/RBV SVR = 47%
Genotype 2 and 3
PEG-Intron/RBV SVR = 82% (121/147)
Intron-A/RBV SVR = 79% (115/146)
Genotype 1 Overall
Intron-A/RBV SVR = 33% (112/343)
Genotype 1, low viral load(<2 million copies/ml)
PEG-Intron/RBV SVR = 68% (63/92)
Intron-A SVR = 43% (41/96)
Genotype 1, high viral load(>2 million copies/ml)
PEG-Intron SVR = 30% (78/256)
Intron-A SVR = 29% (71/247)
SVR by Fibrosis
No/minimal fibrosis
PEG-Intron/RBV SVR = 57% (189/333)
Intron-A/RBV SVR = 49% (164/336)
Bridging fibrosis or cirrhosis
PEG-Intron/RBV SVR = 44% (60/136
Intron-A/RBV SVR = 41% (54/132)
Change in Inflammation and Fibrosis Score (Biopsy)
Inflammation (All patients)
PEG-Intron/RBV = 68% (-3.4)
Intron-A/RBV = 69% (-3.4)
Inflammation (Patients with SVR)
PEG-Intron/RBV = 90% (-5.2)
Intron-A/RBV = 91% (-5.3)
Fibrosis (All patients)
PEG-Intron/RBV = 21% (-0.1)
Intron-A/RBV = 20% (-0.2)
Fibrosis (Patients with SVR)
PEG-Intron/RBV = 26% (-0.3)
Intron-A/RBV = 69% (-0.2)
Dr. Morgan then moved his presentation to the clinical data that is available for Pegasys™, pegylated interferon 2a (Roche). He commented that most of his experience with pegylated interferons has been with Pegasys as he has been an investigator in the pivotal trials.
Peginterferon alpha 2a, 40kD, Pegasys™ (Roche) and ribavirin compared to Roferon-A and ribavirin
Dose of Pegasys/RBV = 180µg plus 1000mg-1200mg ribavirin
Dose of Intron-A/RBV = 3MU tiw plus 1000mg-1200mg ribavirin
Pegasys/RBV SVR = 56%
Roferon-A/RBV SVR = 45%
Genotype 2 and 3
Pegasys/RBV SVR = 76%
Roferon-A/RBV SVR = 61%
Genotype 1
Pegasys/RBV SVR = 46%
Roferon-A/RBV SVR = 27%
Dr. Morgan completed his review of the pegylated clinical trial results by referring to the Veterans Health Administration revised treatment recommendations as outlined below for reference:
Treatment Recommendations for Patients with Chronic Hepatitis C 1.0
A. Treatment Naive Patients
Interferon alfa 2b plus ribavirin
Interferon 3 MU tiw and ribavirin (1,000 mg for <75 kg, 1,200 mg for >75 kg in two divided doses daily) with a decision to continue or withdraw therapy based on virological response at 24 weeks and assessment of the clinical needs of the veteran. or
Peginterferon alfa 2b (12 kD) plus ribavirin
Peginterferon alfa 2b 1.5 mg/kg q week plus ribavirin 800mg qd with a decision to continue or withdraw therapy based on virological response at 24 weeks.
Decision to Treat with Standard Interferon versus Peg interferon
Peginterferon plus ribavirin offers the convenience of dosing once a week, yet peginterferon and ribavirin treatment offers only a slight increase in efficacy and more adverse events (injection site reactions and neutropenia) compared with standard interferon plus ribavirin. This is true for patients with a genotype 1 infection and a high viral load and for genotype non-1 infection. For patients with non-1 infection, there are more data guiding decisions regarding the duration of treatment with standard interferon plus ribavirin than with peginterferon plus ribavirin. Until additional data are available, both peginterferon and regular interferon in combination with ribavirin are appropriate for many patients and that treatment choice should be based on both efficacy data and an individualized assessment of the risks and benefits of each form of therapy in each patient.
Treatment Duration
Genotype 1 Infection
Patients receiving interferon plus ribavirin (whether standard interferon or peginterferon) should be treated for 24 weeks. In those who are HCV RNA negative after 24 weeks, treatment should be continued for a total of 48 weeks. In those with detectable HCV RNA after 24 weeks, treatment should be discontinued because a sustained viral clearance with an additional 24 weeks of therapy is rare. Exceptions to this algorithm include patients with advanced disease who could in theory benefit from viral suppressive therapy and patients with either a biochemical or a virological response after 24 weeks but not both. Continued treatment for up to 48 weeks may be beneficial in these latter two groups. Benefits of treatment beyond one year in preventing long-term complications of liver disease are under investigation. Long-term suppressive therapy cannot be recommended until such data are available.
Genotype Non-1 Infection
Patients receiving standard interferon plus ribavirin should be treated for 24 weeks. In those who are HCV RNA negative after 24 weeks and have favorable characteristics of response, treatment should be discontinued. In those with unfavorable characteristics, treatment should be continued for a total of 48 weeks. In those with detectable HCV RNA after 24 weeks, treatment should be discontinued for the same reasons and with the same provisos as described above for genotype 1 infection. The treatment duration is less clear for peginterferon plus ribavirin because no 24 week studies have been performed. Until such data are available, one must assume that 48 weeks of treatment is necessary in maintaining the virological response observed after 24 weeks.
Ribavirin Dose
In combination with standard interferon alfa 2b, the dose of ribavirin is either1,000mg (<75kg) or 1,200mg(>75 kg). In combination with peginterferon alfa 2b (12 kD), the dose of ribavirin is 800mg. The use of higher doses of ribavirin is under evaluation with peginterferon alfa 2b. Ribavirin is not effective as a single agent.
Ribavirin Toxicity
For patients who develop hemolytic anemia, the ribavirin dose should either be reduced or discontinued. Erythropoietin therapy to counter the anemia is only necessary if the veteran develops moderate symptoms from the anemia, or if symptomatic anemia persists despite ribavirin dose reduction.
Peginterferon alfa 2b Monotherapy as Potential First Line Therapy
While there are no prospective comparisons of peginterferon alfa 2b (12kD) monotherapy with interferon alfa 2b and ribavirin, sustained virological responses appear to be lower in the former than in the latter group. Thus, peginterferon alfa 2b monotherapy should not be administered as first line therapy in treatment naïve individuals unless the patient has contraindications to ribavirin.
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B. Treatment Naïve Patients with Contraindications to Ribavirin
Peginterferon alfa 2b Monotherapy as First Line Therapy
Pegylated interferon (1.0 mg/kg) should be given every week for one year. A decision to continue or withdraw therapy after 24 weeks is based on the virological response, regardless of the infecting genotype.
Other Interferons as Monotherapy
Given the superiority of peginterferon alfa 2b (12 kD) over standard interferon, treatment with interferon alfa 2a, alfa 2b, or alfa con-1 is no longer indicated as first line therapy in any population.
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C. Non-Responders to Interferon plus Ribavirin Combination Therapy
No Approved Treatments for Patients who have Failed Interferon and Ribavirin
There are no approved treatments for this population. However, pegylated alfa 2b (12 kD) interferon plus ribavirin can be considered, preferably as part of an experimental protocol.
The next area that Dr. Morgan covered regarding the combination clinical trials with the two pegylated interferons and ribavirin was the side effects that were seen with both products as compared to the comparator which in both cases was standard interferon and ribavirin (marketed in the United States as Rebetron). The adverse events that Dr. Morgan felt were worthy of discussion were the following:
Dr. Morgan then discussed the difference in the side effect profiles between PEG-Intron/RBV and Pegasys RBV (both were compared to Rebetron in the clinical trials) and determined that the main differences in side effect profiles can be seen in the 'flu-like symptoms' as well as depression with Pegasys/RBV having significantly less side effects than PEG-Intron/RBV as shown below
In the combination PEG-Intron/RBV trial the discontinuation of PEG-Intron/RBV due to adverse events was 14% versus 13% for Rebetron (the range for 48 week studies with Rebetron has been 19-21%). In the combination PEG-Intron/RBV trial the dose modification due to adverse events was 42% versus 34% for Rebetron (the range for 48 week studies with Rebetron has been 10-26%)
Regarding monitoring treatment Dr. Morgan recommends the following guidelines including stopping treatment if PCR is positive at 24 weeks.
Monitoring During Treatment
Dr. Morgan next discussed Schering's 80-80-80 adherence theory (a patient must take 80% of the interferon, 80% of the ribavirin dose, 80% of the time). He shared some of the Schering data that shows that a patient could produce superior SVR rates if they complied with the 80/80/80 theory. Dr. Morgan stated that no conclusions can be made as to the validity of this theory until it has been shown in a clinical trial that is designed to study this adherence therapy prospectively.
Editor's note: This theory does not carry much weight when you consider that this is retrospective data and more importantly that 42% of patients in the Peg-Intron plus Rebetol clinical trail required dose reductions, which would make it very difficult to adhere as suggested by this theory.
Dr. Morgan finished his presentation by discussing the cost of the HCV medications that are included in the VA guidelines to the VA. He shared the following table showing the cost to the VA of hepatitis C medications based upon length of therapy:
Editor's note: The VA automatically receives an approximate 30% cost reduction on the price of these medications
180 pound (82kg) man treated for 24 weeks with:
IFN 3MU tiw + 1200 RBV = $5,520
PEG-Intron +800 RBV = $7,896 (43% increase in cost of Rebetron)
Dr. Morgan made some concluding statements by reiterating the VA hepatitis C treatment recommendations which are as follows:
Genotype 1
IFN a-2b 3MU sc tiw plus RBV 1000-1200mg po qd
Peg IFN a2b 1.5µg/kg sc every week plus RBV 800mg GD
RBV > 800mg/day is NOT recommended
Assess response at 24 weeks, treat for 48 weeks
No difference in SVR for genotype 1/high viral load patients
Genotype Non-1
IFN a 2b 3MU sc tiw plus RBV 1000-1200mg po qd
Treat for 24 weeks
Treat for 48 weeks if patient has < 4 tolerable factors
During the question and answer period, Stephen Rossi, PharmD from the San Francisco Center of Excellence was asked how his institution is implementing the VA treatment guidelines and he commented that they are only recommending that PEG-Intron/RBV be used for genotype 1 low viral load (<2 million copies/ml) and due to the fact that in their extensive experience through clinical trials with PEG-Intron the side effect profile is significantly greater than Rebetron, in many cases where appropriate they are recommending that these patients wait for a better therapy. In addition Dr. Rossi made some comments regarding the 80/80/80 theory and he stated that the 80% is a number that has not been studied to be the threshold in hepatitis C and that the 80% comes from HIV and hypertension. He stated that the percentage that would significantly impact outcomes in HCV treatment has not been determined and needs to be studied. It was commented though that the theory could be used as a good motivational tool to keep patients adherent to therapy
Part II will feature continued coverage
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