text:
Appendix A
Summary of Recommendations for Partner Services
Programs for HIV Infection, Syphilis, Gonorrhea, and Chlamydial Infection
Legal and Ethical Concerns
- Public health agencies responsible for partner services should conduct a thorough review of all laws relevant to
their provision of these services. This review should serve as a basis for developing policies and procedures for partner
services programs. Program managers should also ensure that program staff members understand the implications these laws
have for conducting partner services. Laws relevant to provision of these services include the following:
--- the legal authority for the public health agencies for partner services;
--- provisions related to privacy and confidentiality (e.g., requirements of the Health Insurance Portability and Accountability Act [HIPAA]);
--- provisions related to duty or privilege to warn and criminal transmission and exposure;
--- the ability of the public health agencies to coordinate with other agencies (e.g., law enforcement).
- Program managers should ensure that their staff members understand the legal basis for their work, legal restrictions on their practice (e.g., duty or privilege to warn), the extent to which they are protected from civil litigation, and how to coordinate with law enforcement officials in ways that protect the civil and procedural rights of the persons involved.
- To ensure that program staff members invoke their duty or privilege to warn appropriately, partner services programs should have written policies and procedures to guide staff members in handling complex cases. Guidelines and protocols should be based on the jurisdiction's statutory and case law and developed in consultation with legal counsel. Legal counsel should also be consulted regarding specific cases in which duty to warn or privilege to warn might apply.
- Program managers should be aware of the applicable laws regarding criminal transmission and exposure in their jurisdictions and should coordinate with legal counsel regarding specific cases in which allegations of criminal transmission or exposure are made.
Identifying Index Patients
- All persons with newly diagnosed or reported early syphilis infection should be offered partner services. All persons with newly diagnosed or reported HIV infection should be offered HIV partner services at least once, typically at diagnosis or as soon as possible after diagnosis. Partner services program managers should develop strategies with written policies, procedures, and protocols for identifying as many persons as possible with newly diagnosed or reported infection and ensuring that they are offered services.
- Resources permitting, all persons with newly diagnosed or reported gonorrhea should be offered partner services. Programs should consider which resources and services they can devote to partner services for chlamydial infection. Persons with newly diagnosed or reported chlamydial infection should either be offered partner services (e.g., as are those with gonorrhea), or programs should plan alternative strategies to enable partners to be notified.
- Partner services programs should use surveillance and disease reporting systems to assist with identifying persons with newly diagnosed or reported HIV infection, syphilis, gonorrhea, or chlamydial infection who are potential candidates for partner services. To maximize the number of persons offered partner services, health departments should strongly consider using individual-level data, but only if appropriate security and confidentiality procedures are in place (Appendix D). At a minimum, health departments should use provider- and aggregate-level data from their surveillance systems to help guide partner services.
- Strategies for identifying potential index patients for partner services should be carefully monitored and evaluated for completeness, timeliness, effectiveness, and cost-effectiveness.
- Partner services programs should establish and adhere to strict, jurisdiction-specific guidelines, policies, and procedures for information security and confidentiality. These should incorporate the guiding principles and program standards (Appendix D) and should adhere to all applicable laws. They should be applied to all individual-level information used by partner services programs, including hard-copy case records and electronic-record systems or data-collection systems.
- All partner services and surveillance programs that share information should meet the minimum security and confidentiality standards (Appendix D).
- Penalties for unauthorized disclosure of information should exist for both surveillance and program staff members. All staff members should be informed of these penalties to ensure that data remain secure and confidential.
- For successful sharing of individual-level information, open communication channels between surveillance and partner services programs, adequate resources, clear quality-assurance standards, community inclusion and awareness of the processes, recognition of the rights of infected persons, and sensitivity to health-care providers' relationships with their patients are all needed.
- Jurisdictions that plan to initiate use of disease reporting data to prompt partner services should consider information flow, develop written protocols, and pilot test the proposed system. Protocols should cover practical considerations, such as which types of information will be shared and who will have access, staffing, security measures, and methods for evaluating the system.
- To ensure that appropriate policies and procedures are developed and followed, partner services programs should designate an overall responsible party (ORP) who has responsibility for the security of the program's information collection and management systems, including processes, data, information, software, and hardware. Preferably, a single person should serve as the ORP of both the surveillance and partner services programs.
- Partner services programs that involve community-based organizations (CBOs) in partner services (e.g., for interviewing index patients receiving diagnoses in their counseling and testing programs) should assess the CBOs' ability to meet the minimum standards for data security. CBOs that cannot meet these minimum standards should have limited access to data, although they can still participate in partner services.
HIV Infection
- HIV partner services programs should collaborate with health-care providers who provide HIV screening or testing, other HIV counseling and testing providers, HIV care providers, and HIV case managers to ensure that their clients and patients are offered HIV partner services as soon as possible after diagnosis and on an ongoing basis, as needed.
- HIV partner services programs should work with providers of anonymous HIV testing services to develop strategies for providing partner services to persons who test positive, even if the person decides not to enter a confidential system. These providers should be trained on how to offer partner services and elicit partner information from persons with newly diagnosed HIV infection.
Prioritizing Index Patients
- Program managers should establish criteria for prioritizing index patients to determine which patients will be interviewed first. In general, these criteria should include behavioral and clinical factors that affect the likelihood of additional transmission. Pregnant women should always be considered a high priority, regardless of behavioral or other clinical factors.
- Persons with evidence of ongoing risk behaviors for transmission (e.g., recurrent sexually transmitted diseases [STDs] or being repeatedly named as a partner of other infected persons) might be playing an important role in transmission in the overall community and should be prioritized for partner services.
- Many program areas use a reactor grid to assist with determining investigative priorities for syphilis reactors. The reactor grid is based on age and syphilis serology laboratory results (titers). Programs that use a reactor grid are strongly encouraged to validate its performance annually and during suspected outbreaks.
Interviewing Index Patients
- In general, partner names should be elicited (partner elicitation) during the original interview. If this is not possible, a reinterview should be scheduled.
- Programs should establish clear policies and procedures for the timing of interviews relative to date of diagnosis or report.
- Index patients should be provided information about the following:
--- the purpose of partner services;
--- what partner services entail;
--- benefits and potential risks of partner services for index patients and their partners, and steps taken to minimize any risks;
--- how and to what extent privacy and confidentiality can be protected;
--- the right to decline participation in partner services without being denied other services; and
--- options available for notifying partners.
- Program managers should ensure that policies and protocols are in place to safeguard the confidentiality of information shared with health department staff members during the partner notification process. Specifically, staff members must be trained to maintain confidentiality in both their professional and private lives. Confidentiality is particularly salient in rural areas, where a disease intervention specialist (DIS) might have substantial contact with clients outside of the professional environment (e.g., because they are neighbors, parents of children's classmates, or members of the same church) (101).
- To ensure confidentiality, interviews should not be conducted with other persons present, except for quality assurance or for interpreting.
- In general, partner-elicitation interviews should be conducted by trained health department specialists. However, to expand partner services coverage, health departments should consider enlisting other types of providers to conduct interviews on their behalf. Successfully eliciting information about partners requires skilled counseling and interviewing; therefore, all providers conducting interviews on behalf of the health department should receive appropriate training. The yield of interviews conducted by other providers should be carefully monitored.
- In general, interviews should be conducted in person. Telephone interviews might be conducted if no reasonable alternative exists, with strict safeguards in place to verify the identity of the person being spoken with and ensure that privacy and confidentiality are protected.
- Programs should use interview techniques that maximize the amount of information gathered in the original interview about the index patient's partners. Policies, procedures, and protocols should establish criteria for instances in which reinterviews should be done, how soon they should be done, and when they are unnecessary. The yield of original interviews and reinterviews should be monitored closely and policies, procedures, and protocols adjusted accordingly.
- In addition to information about partners, interviewers also can elicit information about the index patient's social network, including venues frequented, for use in planning additional prevention activities.
- Policies, procedures, and protocols should address circumstances that might require specific consideration in interviews with index patients (e.g., age and developmental level, literacy, language barriers, hearing or visual impairment, alcoholism or abuse of other substances, mental health concerns, or potential violence).
Syphilis, Gonorrhea, and Chlamydial Infection
- For early stages of syphilis, policies, procedures, and protocols should specify that all index patients receive an original interview as close to the time of diagnosis and treatment as possible. Every reasonable effort should be made to ensure the partner notification process begins on the date of the original interview.
- For cases of gonorrhea and chlamydial infections that partner services staff members will follow up, policies, procedures, and protocols should specify that all index patients receive an original interview as close as possible to the time of diagnosis and treatment. Unless the index patient has evidence of recent infection, notification primarily serves case-finding goals and might be briefly delayed, if necessary.
- For cases of gonorrhea and chlamydial infection that partner services staff members will not follow up, patient referral instructions should be provided as close as possible to the time of diagnosis and treatment.
- For STDs other than HIV, partner services programs should follow established recommendations for interview periods (Table 1).
HIV Infection
- Policies, procedures, and protocols should specify that all index patients receive an original interview as soon as possible after diagnosis, ideally within a few days. For index patients who are not willing or able to provide partner information during the original interview, a reinterview should be scheduled, preferably no later than 2 weeks after contact was first made (and sooner, if possible, for index patients with acute infections).
- Programs should develop criteria for establishing the interview period for index patients with HIV infection (Table 1). Criteria for prioritizing partners should be developed in consultation with persons who have expertise in clinical and laboratory aspects of HIV (e.g., viral and serologic markers of HIV infection).
- Program managers should ensure that policies and procedures regarding notification of spouses adhere to requirements of the Ryan White CARE Act Amendments of 1996 and any other applicable laws.
- Policies, procedures, and protocols should address interviews for persons with reactive rapid HIV tests, including when partner names should be elicited, when partners should be notified, and policies about notifying partners when a confirmatory test is not available.
Risk-Reduction Interventions for Index Patients
- Program managers should develop protocols that establish the minimum amount of information and prevention messages that should be provided to all index patients. For patients with HIV infection, the information should include the index patients' responsibility for disclosing their HIV serostatus to current and future partners.
- Program managers should develop protocols for screening HIV index patients for current or recent behavioral risks and other factors that facilitate transmission. Screening should include asking all HIV index patients about possible signs or symptoms of other STDs, which enhance risk for HIV transmission and indicate current or recent risky sex behaviors.
- Protocols should address management of HIV index patients with risky sex or drug-injection behaviors or who have signs or symptoms of any type of STD. All index patients with ongoing risk behaviors or recurrent STDs of any type should be provided prevention counseling or referred for counseling or other prevention interventions.
- Program managers should assess the program's' capacity for providing prevention counseling to all index patients without interfering with partner elicitation. For partner services programs that do not have the internal capacity to regularly provide prevention counseling to all index patients or are limited by resource or logistical factors, program managers should establish formal relationships with other agencies that can provide prevention counseling and more intensive behavioral intervention services and develop clear policies and procedures for making and following up on referrals.
- Program managers should develop protocols to ensure that DISs conducting prevention counseling receive adequate training and supervision and should ensure that quality assurance plans are in place.
Treatment for Index Patients
Syphilis, Gonorrhea, and Chlamydial Infection
- Program managers should ensure that patients are treated according to CDC treatment guidelines for timely and efficacious treatment with appropriate instructions and attention to recommendations regarding the importance of follow-up testing.
HIV Infection
- Program managers should create strong referral linkages with HIV care providers and case managers to help ensure that the medical needs of index patients are addressed.
- HIV-infected index patients who are not receiving medical care should be referred or directly linked to medical care or to case managers who can then link them to care services.
Referring Index Patients to Other Services
- Because of the diverse needs of many index patients with HIV infection and other STDs, program managers should identify resources for psychosocial and other support services. DISs routinely should be provided updated information about referral resources.
- Many referral needs can be addressed through linkage to medical care and HIV case management; however, DISs should screen for immediate needs and make appropriate referrals.
Notifying Partners of Exposure
- All identified partners should be notified of their possible exposure as soon as possible, typically within 2--3 working days of identification, unless a potential for partner violence exists.
- Program managers should ensure that protocols include screening for potential violence with each partner named before notification. If the provider considers a violent situation possible, the provider should seek expert advice before proceeding with notification. DISs should follow up on referrals for partner violence services to verify that referred persons are safe and have accessed these services.
- Programs should establish criteria for prioritizing the order in which partners are notified. Criteria should be based on behavioral and clinical factors that confer a higher likelihood of the partner having been infected as a result of exposure or, if already infected, of transmitting infection to others. In addition, the Ryan White CARE Act Amendments of 1996 require that states receiving funds under part B of title XXVI of the Public Health Service Act should ensure that a good-faith effort is made to identify spouses of HIV-infected patients. Criteria should be reviewed at regular intervals (at least annually).
- Programs should accommodate various notification strategies that allow the DIS and index patient to collaborate on the best approach for notifying each partner of exposure and ensure that the partner receives appropriate counseling and testing. Regardless of which strategy is used, the DIS and index patient should plan for potential unanticipated outcomes.
- For partners for whom the index patient has provided a name (or other identifying information, such as an alias) and locating information, programs should strongly encourage provider referral but be supportive of index patients who choose contract referral for selected partners.
- When contract referral is chosen, the DIS should establish an agreement with the index patient specifying when partners should be notified (typically within 24--48 hours), how the provider will confirm that partners were notified, and which follow-up services will be required for situations in which the index patient does not notify the partner within the allotted time frame.
- Programs should allow for self-referral as permitted by state and local laws and regulations. Index patients who choose self-referral for certain or all partners should be informed of its disadvantages and informed about methods for accomplishing the notification safely and successfully. Self-referral should be discouraged if screening indicates a potentially violent situation.
- Protocols for self-referral should, when possible, incorporate interventions that enhance its effectiveness and
include instructing the index patient about the following:
--- when to notify the partner (e.g., within 24--48 hours);
--- where to notify the partner (e.g., private and safe setting);
--- how to tell the partner;
--- how to anticipate potential problems and respond to the partner's reactions;
--- how and where the partner can access counseling and testing for HIV and other types of STDs;
--- for persons with HIV infection, how to address the psychological and social impact of disclosing infection status to others; and
--- how to contact the DIS with any questions or concerns that might arise.
- To the extent possible, programs should develop methods of monitoring whether partners who are to be notified by the index patient (i.e., via contract or self-referral) are actually notified and receive appropriate counseling and testing.
- Dual referral should be an option for index patients who prefer to be directly involved in the notification but express a need for assistance and support from the DIS. When dual referral is chosen, the DIS and index patient should plan in advance how the session will be conducted.
- Program managers should ensure that policies and procedures, consistent with applicable laws, are in place to protect the identities of index patients when informing partners of their exposure and to ensure that information about partners is not reported back to index patients.
- Local reporting laws relating to domestic violence, including child abuse and abuse of older adults, must be followed when clients report risk or history of abuse.
- Program managers should ensure that DISs are the following:
--- knowledgeable about HIV and STD infections, transmission, and prevention;
--- well informed about relevant laws and regulations;
--- familiar with HIV and STD program standards, objectives, and performance guidelines;
--- culturally competent in providing partner services;
--- skilled at problem solving and dealing with situations that might be encountered in the field (e.g., personal safety, intimate partner violence, violence to others); and
--- trained how to screen for and address partner violence concerns.
Social Contacts
- In general, notification of partners should have a higher priority than notification of individual social contacts identified through clustering. Routine follow-up of social contacts should be carried out only after the program is successfully interviewing most new patients with cases and locating and notifying most partners and only after carefully considering the potential case-finding yield and resource implications. If this strategy is used, the number of cases identified should be carefully monitored, and the approach should be continued only if its effectiveness and cost-effectiveness equal or exceed those of other case-finding strategies. Notification of social contacts might be given higher priority during an outbreak.
HIV Infection
- For persons with HIV infection, information about social contacts should be used as an aid to understanding transmission dynamics in the community and to help guide additional prevention interventions at the community level (e.g., screening and social marketing). In general, if individual social contacts are to be recruited for HIV testing, a self-referral approach rather than provider referral should be used. A provider referral approach should be used only after careful consideration of potential individual and community concerns about privacy and confidentiality. Provider referral might be appropriate during an outbreak.
Risk-Reduction Interventions for Partners
- Program managers should develop protocols that describe the minimum amount of general information and prevention messages that should be provided to all partners at the time of notification.
- All partners of STD/HIV-infected index patients should receive prevention counseling.
- Because a substantial proportion of partners decline to or do not keep appointments for counseling and testing, prevention counseling should be provided by the DIS at the time of notification.
- Prevention counseling should be based on counseling models that have demonstrated efficacy (e.g., the Project RESPECT model).
- Program managers should develop protocols for screening partners to determine whether they need additional risk-reduction interventions and refer them for such interventions.
- Program managers should develop protocols to ensure that DISs conducting prevention counseling receive adequate training and supervision and ensure that quality improvement plans are in place.
Cluster Interviewing Partners
- When notifying partners of their possible exposure, DISs might also elicit information about the partners' social networks, including venues frequented, for use in planning additional prevention activities.
- In general, notification of partners should be prioritized over follow-up of individual associates identified through cluster interviews. Routine follow-up of associates should be done only after the program is successfully interviewing most new patients with cases and locating and notifying most partners, and only after carefully considering the potential case-finding yield and resource implications. If this strategy is used, its case-finding yield should be carefully monitored, and the strategy should be continued only if its effectiveness and cost-effectiveness equal or exceed those of other case-finding strategies. Follow-up of associates might be given higher priority during an outbreak.
HIV Infection
- For persons with HIV infection, information about associates should be used as an aid to understanding transmission dynamics in the community and to help guide additional prevention interventions at the community level (e.g., screening and social marketing). In general, if individual associates are to be recruited for HIV testing, a self-referral approach rather than provider referral should be used. A provider referral approach should be used only after careful consideration of potential individual and community concerns about privacy and confidentiality. A provider referral approach might be appropriate during an outbreak.
Testing Partners
- To the extent possible, testing for HIV and other types of STDs should be done at the time of notification. Partners who are not tested at the time of notification should be escorted or referred to the health department for testing or linked to other health-care providers who can provide these services.
- DISs should follow up on partners not tested at the time of notification to verify that testing has occurred, test results were received and understood, and other referral services were accessed. If another health jurisdiction has been asked to contact a partner, follow up should be conducted by the initiating health department to determine whether services have been received.
- Program managers should explore ways in which screening for HIV, screening and treatment for other types of STDs, screening for hepatitis B and hepatitis C viruses, and vaccination for hepatitis A and hepatitis B viruses might be integrated in partner services programs.
- Blood should be drawn in the field when DISs are trained to do so and when specimen maintenance conditions can be met. Partners should be referred for evaluation regardless of whether a specimen has been collected.
Gonorrhea and Chlamydial Infection
- If provider referral is used, programs should consider protocols for collecting specimens in the field.
HIV Infection
- Partner services programs should consider using rapid HIV tests to maximize the number of partners who are tested and receive test results.
- When notification is done in the field, rapid tests should be used or a blood or an oral fluid specimen should be collected for conventional testing. If neither of these is possible, the partner should be escorted or referred to the clinic for testing.
- Partners who test negative for HIV antibody should be advised to be retested in 3 months.
Treatment for Partners
Syphilis, Gonorrhea, and Chlamydial Infection
- Program managers should ensure that partners are treated according to CDC treatment guidelines as soon as possible after notification.
- Programs should consider field-delivered therapy for gonorrhea and chlamydial infection when partners are notified via provider referral.
- For STDs for which single-dose oral therapy is feasible (i.e., gonorrhea and chlamydial infection), programs should consider patient-delivered partner therapy for partners who will not be notified via provider referral.
- Programs should be sure that all appropriate parties are consulted to ensure that any EPT strategy in the jurisdiction is medically and legally sound. Appropriate parties vary by jurisdiction but might include state health commissioners or legislative bodies.
HIV Infection
- Program managers should create strong referral linkages with HIV care providers and case managers to help ensure that the medical needs of HIV-infected partners are addressed.
- Partners who test positive for HIV should be linked as soon as possible to early intervention services, medical care, and HIV case management, through which they can receive complete medical evaluations and treatment, assessment, referral for psychosocial needs, and additional prevention counseling.
- Follow-up should be conducted to verify that HIV-infected partners have accessed medical care or HIV case management at least once.
- Partner services programs implementing postexposure prophylaxis (PEP) should develop protocols to ensure that persons exposed to HIV within the previous 72 hours are informed of the option of PEP, including risks and benefits as they relate to the exposure risk. Staff members conducting partner services should be aware of the options for persons to access PEP, whether through existing programs, urgent care facilities, emergency departments, or private physicians.
Referring Partners to Other Services
- Because of the diverse needs of partners, program managers should identify referral resources for psychosocial and other support services. DISs routinely should be provided updated information about referral resources.
- Many referral needs of partners testing positive for HIV will be addressed through linkage to early intervention, medical care, and HIV case management; however, DISs should screen for immediate needs and make appropriate referrals.
- Partners testing negative for HIV should be screened and referred for other medical and psychosocial needs and prevention services.
Specific Populations
- Programs should have specific protocols in place to guide partner services for youths. Protocols should address assessment of maturity and extent of social support, use of age-appropriate counseling and communication models, provision of services in youth-friendly environments, and assessment for physical and sexual abuse. These protocols should be developed in collaboration with legal counsel to ensure that they are consistent with all applicable laws and regulations.
- Program managers should ensure that all staff members are aware of state and local requirements related to reporting of suspected sexual activity involving an adult and a minor child, child abuse, and sexual crimes. DISs providing services to youths should be sure to discuss the possibility of sexual abuse with their clients and, if sexual abuse is suspected, should notify the appropriate authorities (e.g., child protective services agency) in accordance with applicable laws and regulations.
- Program managers should ensure that partner services staff members remain knowledgeable and updated on state and local laws and regulations related to parental consent, diagnosis and treatment of STDs, and HIV counseling and testing. If doubt or confusion arises regarding a specific case, legal counsel should be sought.
- Program managers should ensure that any staff person who conducts elicitation of partner names and notification of partners for youths has received training on conducting services in a way that is appropriate for each child's age and developmental level. Training should include ways to recognize and address child abuse or sexual abuse situations.
Immigrants and Migrants
- Program managers should review epidemiologic and other data to identify potential immigrant and migrant populations at high risk for infection in their jurisdictions and be prepared to provide partner services that are linguistically and culturally appropriate.
- Based on the immigrant and migrant needs identified in the community, program managers should develop partnerships with community-based organizations and health-care providers that can deliver linguistically and culturally appropriate care, treatment, prevention, and support services.
- Program managers should consider the diversity training needs of DISs who are working with the immigrant and migrant populations. In particular, staff members conducting interviews should be sensitive to cultural norms governing the discussion of sex and sexual behaviors. To the extent possible, clients who have limited ability to speak English should be interviewed in their native language.
- Programs should consider the literacy level of their clients as well as the primary (or only) language of the clients. Programs should ensure that HIV and STD prevention educational materials are available in appropriate languages that reflect the cultural norms of the population.
- Because of the geographic mobility of immigrants and migrants, program managers should consider use of rapid HIV tests and active outreach strategies for migrant and seasonal workers in nontraditional settings.
- Health jurisdictions should consider developing collaborative agreements with bordering countries (i.e., Canada and Mexico) to assist with notification and follow-up of partners.
- Program managers should be aware of federal, state, and local laws and regulations that might affect partner services for undocumented immigrants.
Incarcerated Populations
- Program managers should become familiar with the federal, state, or county jail and correctional facilities in their jurisdictions. They should meet with key personnel in correctional facilities to discuss the services offered and goals of partner services as a public health intervention, the need for public health staff members to have access to facilities and adequate private space to meet with clients, and ways that partner services activities can be integrated into the facility response plans that are required by PREA. Follow-up meetings to facilitate communications and coordination should be held periodically.
- Program managers and key correctional facility personnel should establish a formal written agreement to clearly outline roles and responsibilities for both public health and correctional facility staff members.
- Program managers should collaborate with correctional facility staff members to develop protocols for partner services staff members to follow while in the facility, especially during emergencies. Ensuring that partner services staff members know and adhere to facility rules and regulations also is essential. Not adhering to the rules and regulations of a correctional facility will jeopardize implementation and continuation of the partner services program.
- Program managers should collaborate with correctional facility staff members to develop protocols regarding administration of partner services for named partners within a correctional facility.
Strategies to Enhance Case Finding and Partner Notification
Core Areas
- Health departments should assess the geographic concentration of gonorrhea and consider focusing provider-referral partner notification in core areas.
Social Networks
- Programs should assess the social networks that influence disease transmission in the area as a strategy for finding persons who are at risk for disease but have not been identified by an index patient or partner.
- This strategy should be used to enhance case finding, considering relevant epidemiological and behavioral information.
The Internet
- When an index patient indicates having Internet partners, the DIS should attempt to obtain identifying and locating information about the partners (e.g., e-mail addresses, chat room handles, and names of chat rooms or websites where the partner might be located).
- Internet partner notification is recommended for partners who cannot be contacted by other means or can be more efficiently contacted and notified through the Internet. This type of notification includes ensuring policies and protocols are in place to 1) ensure that confidentiality or anonymity of the index patient and partners are maintained on the Internet and 2) eliminate structural and bureaucratic barriers to staff member use of the Internet for partner notification.
- Partner services programs should collaborate with community partners to develop strategies for addressing structural challenges to health department--mediated Internet partner notification.
Program Collaboration and Service Integration
- To the extent possible, partner services program managers should ensure that persons receive coordinated HIV and STD prevention and related social services, particularly when the persons are affected by more than one disease.
- Partner services program managers should assess and eliminate barriers to programmatic collaboration and service integration within the jurisdiction so that, at a minimum, services are well integrated at the client (i.e., service delivery) level.
- Partner services program managers should ensure that shared protocols and policies are developed to help coordinate partner services for persons identified through HIV or STD clinics or other health department clinics.
- Partner services program managers should encourage private medical care providers to support partner services through active communication mechanisms (e.g., by visiting key medical providers, making presentations about partner services at local and state meetings of providers of HIV care, mailing educational brochures, or providing a summary of these recommendations).
- Partner services program managers should establish systems of communication and information to ensure widespread distribution of these recommendations to health department partners, medical providers, and CBOs.
- HIV program managers should ensure that communication and information about the partner services recommendations are shared with HIV prevention community planning groups.
- Partner services programs should ensure that clearly defined, written protocols and procedures that address confidentiality and data security are in place to address incoming and outgoing requests for intrastate and interstate transmission of information.
Program Monitoring, Evaluation, and Quality Improvement
- Partner services programs should be monitored closely to assess program performance and identify areas that need improvement.
- Monitoring should be designed to answer specific questions about program performance; all data collected should be clearly related to answering these questions.
- Data should be analyzed and reviewed regularly and used to improve program effectiveness and efficiency.
- At a minimum, the following questions should be addressed through monitoring:
--- How completely is the program identifying newly reported cases and intervewing patients for partner services?
--- How effectively is the program identifying partners, notifying them of their risk, and examining or testing them for infection?
--- How effectively is the program identifying new cases of syphilis, gonorrhea, and chlamydial infection through partner services? How effectively is the program treating patients through partner services? How effectively is the program identifying new cases of HIV infection and linking patients to care services through partner services?
--- Do any measures indicate variations by index patient age, race/ethnicity, sex, or risk behavior?
- Programs should establish specific objectives for essential steps in the partner services process and continuously track progress toward achieving these objectives.
- All partner services programs should develop and implement quality improvement procedures and ensure that program staff members receive orientation and training on quality improvement.
- Responsibility for conducting quality improvement procedures should be clearly assigned to a specific person or persons.
- Quality improvement activities should be conducted at regular, scheduled intervals (e.g., quarterly or more often if needed).
- Program staffing infrastructure should include enough staff members who have specific training and expertise in technical supervision of partner services activities to supervise DISs. Quality improvement and review of performance of staff members should be made clear priorities for supervisors.
Support of Staff Members
- Programs should develop and implement comprehensive training plans for partner services staff members at all levels, including program managers and supervisors. All staff members should receive initial training at the time of employment and updates at least annually. Initial training for DISs should include the CDC training course Introduction to STD Intervention or equivalent, and training for managers should include the CDC training course Fundamentals of STD Intervention or equivalent (course information available at http://www.cdc.gov/std/training/courses.htm). Staff members also should receive training in public health laws and regulations relevant to partner services.
- Programs should use a balance of quantitative and qualitative methods for assessing the performance of individual staff members at all levels (including program managers and supervisors) and developing strategies for improvement.
- Programs should develop and maintain written policies and procedures for maximizing safety of staff members, including policies and procedures that help staff members avoid occupational exposure to infections and procedures for addressing any exposure that occurs. Policies and procedures should be reviewed and updated at least annually.
- DISs should receive initial and periodic (at least annually) training and orientation on policies and procedures related to workplace safety and should be required to follow them.
- At a minimum, local policies and procedures should encompass applicable policies of the Occupational Safety and Health Administration (available at http://www.osha.gov).
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For most people, tax season means making a quick buck.
For others, it means forking over some serious cash to settle up with the IRS.
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The group of those that owe is small, just 20 percent of taxpayers, but if you find yourself among them, you could be staring down a debt you can't begin to afford.
"The tax system is a pay-as-you-go system, so you can't just end up with a huge tax bill at the end of the year without being penalized," said Dan Boone with the IRS.
And the longer you wait, the bigger bill.
"The IRS levies interest and failure to file penalties. That's where the majority of the big tax debt comes from," said Freeman.
For some, the knee-jerk reaction is to run, but experts say it is best to get to the bottom of things right away.
There are five - and only five - strategies for getting out of debt with the IRS.
You can set up a monthly payment plan through an installment agreement or a long term payment plan through a partial installment agreement. An offer in compromise is also an option, where you settle your tax debt for less than you owe, and if you have absolutely no way to pay, filing not currently collectible or bankruptcy may be your answers. But not all of these deals are easy to come by.
"The offer in compromise is something the IRS allows, but not many people qualify for that," Boone said.
"The easiest one is to create a payment plan with the IRS," said Freeman.
Experts say one thing you don't want to do is turn to a tax relief company.
"To go from $50,000 to $600 is extremely unlikely and extremely rare," Freeman said.
No matter which option you choose, the bottom line is you have to pay your taxes in some way or the other.
"The big thing is if you owe taxes, don't ignore the bills that come from the IRS. Stay in touch with the IRS, work with us, and we will work with you," said Boone.
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Call them secret agent man and wife. Former�Chuck�star�Zachary Levi�secretly married�Rookie Blue's�Missy Peregrym, the actress revealed on�her Twitter account�Monday.�US Weekly�was first to report the news.
The most memorable TV weddings
Peregrym posted a picture of the two of them in matching Mr. and Mrs. robes, with the caption "That coffee date was UNREAL," and the hashtag #marriedinmaui.
The nuptials were confirmed by their friend and�Bones�actor Joel David Moore, who�tweeted his congratulations�to the couple. "Congrats to @ZacharyLevi and @mperegrym on their stunning wedding and beautiful future. Couldn't be happier for my brother & new sis pal."
Watch This Tonight! Find out why�The Fosters�is today's editors' pick:
View original Chuck's Zachary Levi Secretly Marries Rookie Blue Star Missy Peregrym at TVGuide.com
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Here is the Member Directory
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text: In this introductory hands-on session, you will learn how to create media-based conversations with your students using the online program VoiceThread. Learn how to upload pictures, digital video clips, PowerPoints and other documents into your VoiceThread digital slideshow, record comments and then share the conversation with your students. We will also discuss advanced sharing features, including how to easily add VoiceThread to your Desire2Learn course.


text:
Expired Property Listing
This property is disabled.
Balboa Beach Cottage in Newport Beach
- bedrooms 3
- baths 1½
- sleeps 6
- pool no
- hot tub no
- pets allowed yes
- type House
- community
- rates (USD) $ 2,200 - $ 3,500 / month
vacation rental description
This is a classic Balboa cottage that has been in our family for 40 years. Very cozy, convenient for a family, couple, or friends! Half a block from the harbor and safe bay beaches and one block to wide sandy beaches along the Pacific. Lindo Avenue is a quiet street that is walking distance to a small market, coffee bar/cafe, Italian Restaurant, barber shop and library. Additionally, you can walk to Balboa and enjoy it's attractions or catch the ferry to Balboa Island. You literally don't have to get in your car once you arrive!
Two bedrooms are in the main house, one queen, and two singles (trundle and bed). "The back room" as we call it, has a queen bed and bathroom. The laundry facilities are also out in the back. Additionally, the living room has a window bench that is a lovely place for napping, but is equally comfortable for an overnight sleep - we've all fought over it for years!
All furnishings and linens included. High speed internet, full kitchen with everything but a dishwasher. Cable TV, local phone, BBQ. Lovely deck to sit on and enjoy the beautiful weather. Parking available - up to three cars in the driveway.
house rental amenities
All furnishings and linens included. Washer/dryer, High speed internet, full kitchen with everything but a dishwasher. Cable TV, local phone, BBQ. Lovely deck to sit on and enjoy the beautiful weather. Parking available - up to three cards in the driveway.
activities and attractions in Newport Beach Los Angeles Area
Park your car & walk or ride bikes everywhere! The ocean beach is wide - great for walks, running (also along the boardwalk), swimming or body surfing - there's a lifeguard tower straight out from our street. Rent boats, take harbor cruises. The original Ruby's Diner is at the end of the Balboa Pier and the Newport Pier offers many restaurants like Charlie's Chili and the Crab Cooker. The Catalina Flyer leaves daily out of Balboa - you can walk down, catch flyer and spend the day in Catalina. Great shopping and dining are a ferry ride to Balboa Island, or drive up to Fashion Island, ten minutes away.Nearby is fabulous golfing, theater, museums, sports arena, Disneyland, Knotts Berry Farm and the Aquarium in Long Beach. Huntington Beach (Surf City USA), is five minutes up the road, and Laguna Beach is ten minutes south - great art festivals in the summer. Los Angelels and Hollywood are an hour north, and San Diego is an hour south.
vacation rental rates
We are currently only renting on a yearly or monthly basis
Cleaning Fee: $95. $300 fully refundable deposit
Pets welcome on an individual basis, with an additional deposit.
$500 refundable security deposit


text:
Provides reviews and summaries for books currently on the New York Times bestseller charts. Link to specialty stores and other related resources.
Book Sense Bestsellers
Presents fiction, nonfiction and mass-market lists based on info from independent booksellers in the United States. Peruse the archives.
Read excerpts from current bestsellers, and other quality fiction and nonfiction. Includes reviews, summaries and book news.
Read author interviews and reviews each month, post your own reviews, and find news of forthcoming titles.
Offers reader recommendations categorized by author, genre or subject. Includes reviews of popular titles and an email newsletter.
Insider's scoop on authors, agents, publishers and bookstores, with articles on the latest book industry moves and links to conferences.
View US bestseller lists, or use a well-ordered index to locate publishers, booksellers or libraries.
Publishers Weekly - Bestsellers
Check out lists of the top 15 sellers in fiction, nonfiction, religion, computer, paperback, audio and children's books categories.
Romance Reader, The
Has reviews of historical, suspense and fantasy romance novels. With news, discussion topics and interviews.


text:
AP: 'Some' Obama Health Care Bill Promises Not Kept; More Like 'Almost All'
Werner's work was conveniently accompanied by a heavily downplaying headline -- "Final health bill omits some of Obama's promises" -- while her rundown of the specifics in reality ended up being "all but two":
It was a bold response to skyrocketing health insurance premiums. President Barack Obama would give federal authorities the power to block unreasonable rate hikes.
Yet when Democrats unveiled the final, incarnation of their health care bill this week, the proposal was nowhere to be found.
Ditto with several Republican ideas that Obama had said he wanted to include after a televised bipartisan summit last month, including a plan by Sen. Tom Coburn of Oklahoma to send investigators disguised as patients to hospitals in search of waste, fraud and abuse.
And those "special deals" that Obama railed against and said he wanted to eliminate? With the exception of two of the most notorious - extra Medicaid money for Nebraska and a carve-out for Florida seniors faced with losing certain extra Medicare benefits - they are all still there.
For the White House, these were the latest unfulfilled commitments related to Obama's health care proposal, starting with his campaign promise to let C-SPAN cameras film negotiations over the bill. Obama also backed down with little apparent regret on his support for a new government-run insurance plan as part of the legislation, a liberal priority.
But was it all the president's doing?
In the cases of the insurance rate authority, the Republican ideas and the special deals, it came down to Obama making promises that Congress didn't keep. He can propose whatever he wants, but it's up to Congress to enshrine it into law.
Arguably, the president could have foreseen that outcome, and was making a low-risk p.r. move by floating proposals - dismissed by critics as insubstantial anyway - whose demise he couldn't be blamed for.
While the White House worked hard to trumpet Obama's plans for the rate authority, his embrace of bipartisanship and his opposition to special deals, the administration hardly advertised the lack of follow-through. Understandable, certainly, but perhaps not the new way of doing business that Obama promised to bring to Washington.
Werner also continued the wire service's annoying habit of saving some of the more important news for the very end when she quotes a health policy consultant who says that "Democrats will have three years to tinker with health reform before universal coverage goes live."
Geez, after 2,000-plus pages in heaven knows how many Senate and House iterations, with who knows how many new bureaucracies, taxes, mandates, fines, and penalties, we will have to endure another three years of "tinkering" until we know what we're really going to face in 2014 if the current madness disguised as legislation "passes" this weekend ("passes" is in quotes because the constitutionality of attempt is extremely dubious)?
If so, this will mean that the length of the Wall Street Journal has called "the uncertainty economy" will bear quite a resemblance to how certain not-free countries used to run things -- i.e., five-year plans -- while endless establishment press protection prose continues to proliferate.
Cross-posted at BizzyBlog.com.
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Spam Alert
Submitted by 26CX on Sat, 10/16/2010 - 7:48am.
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Yeah, these things pop up
Submitted by motherbelt on Sat, 10/16/2010 - 7:54am.
Yeah, these things pop up every now and then. I think it's funny when they pop up in really OLD threads like this one.
Spam filter must need recalibration.
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health-health informetion and tips
Submitted by ddruiam on Sat, 07/09/2011 - 6:26am.
Gevolgen stoppen met roken
Een gezonder leven, een betere conditie en veel geld besparen. Mensen die roken hebben veel meer kans om kanker en andere ziektes te krijgen dan niet-rokers. Ook krijgt u weer een mooie huid als u stopt met roken. Er zijn dus veel positieve gevolgen van stoppen met roken, waarvan het gezondheidsvoordeel de belangrijkste is.
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text:
More From Ford F-350 videos
VIDEO: Ford F-350 uses tracks, not tires, to spin a big...
Posted by Wayne Grayson on Jan 03, 2014
Just in case you ever wondered whether or not a truck outfitted with tracks can still do a burnout, this ...
Do you want some tips to stay safe on the job site?
Equipment World has created an entire section devoted to safety.
Here are the most recent tips we've posted:
Hauling headaches: Know your load limits when trailering equipment
One-man machines: The operator should be the only person on a wheel loader


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Authors: Patterns from AQS Authors
Crossed Laurel Spray by Marsha D. Radtke
Download attached PDF of Pattern
Free Pattern from A Baltimore Album: 25 Appliqué Patterns by Marsha D. Radtke
Other Patterns
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Tennessee Star Block - Bonnie K. Browning
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Stamping up some fabric
The Giving Quilt Pattern by Bonnie K. Browning
AQS Anniversary Dogwood Pattern by Linda J. Hahn
Friendship Daisy block from The Jane Austen Quilt Club
Oak Leaf Swirl by Lynda Smith
Carolina Lily Block from The Potting Shed Quilt


text:
Richmond wins the first battles in its war against big banks on behalf of underwater homeowners
It will be a long war, but for now, Richmond is winning.
Two battles in the start of the city of Richmond's war on foreclosures were fought and won in the past week. A US District Court of Appeals judge dismissed Wells Fargo's lawsuit against Richmond's controversial plan to use eminent domain to save residents with underwater mortgages (see "Not for sale," Sept. 3). And Mayor Gayle McLaughlin successfully fought off legislation at the Richmond City Council to torpedo the plan before it started.
"I'm willing to go as high as the Supreme Court to settle this on behalf of our community," McLaughlin told us. These are the first fledgling steps in that long fight, a fight McLaughlin calls a just cause.
Half of all mortgages in Richmond are underwater, and as homes get foreclosed upon, the problems stack up: blighted neighborhoods, declining property tax revenues, public employee layoffs, rising crime, and homeless families. To stem the tide of foreclosures, Richmond teamed with Mortgage Resolution Partners (MRP) to attempt to buy the loans of 624 underwater mortgages and allow the owners to keep their homes.
Richmond's government sent out offers, and it is still waiting to hear back from the owners of the loans.
The controversy comes when the banks that hold the loans refuse to sell. In that case, Richmond would invoke the power of eminent domain to seize the mortgage loans.
Wells Fargo said in its lawsuit that this is a plan to line the pockets of MRP and the city of Richmond, a greedy and unconstitutional land grab. Eminent domain has never been used for this purpose, but as the judge noted in the lawsuit's first hearing Sept. 12 in San Francisco, the plan has yet to be acted on.
"Okay, let's end the suspense, I don't believe (the case) is ripe for determination," Judge Charles Breyer told the attorneys from Wells Fargo. "There are a series of steps that can or cannot take place.... If they do take place, that's the time for the court to take a look at it."
Breyer noted that if and when Richmond wanted to use eminent domain to seize mortgage loans, the council would need to file a resolution of necessity through state court. At that point, he could act.
On Sept. 16, the case was dismissed. Too little has happened, and it is entirely too early to make any decisions, Breyer said.
Stacey Leyton, a lawyer representing Richmond in the lawsuit, explained the judge's decision plainly: "Courts are not supposed to review legislative actions before the (legislative body) has decided which action to take."
The Guardian reached out to Wells Fargo but we were told that it had nothing to say beyond its court filings, and referred us to the investors in the loans, of which Wells Fargo is a trustee.
But why is Wells Fargo pushing so fast for the courts to intervene? The eminent domain plan could mean a possible loss of revenue for Wells Fargo and the investors it represents, sending chills down the spine of Wall Street, a representative of MRP said.
MRP founder John Vlahoplus told us the eminent domain tactic is powerful because for Wells Fargo, legally challenging every municipality in the United States is much tougher than paying off a few fat cats in Congress.
So the stakes are high: if Richmond wins the eminent domain battle, cities across the country could use the tactic to rescue underwater mortgages, and the families that would otherwise lose their homes, swinging the balance of power from Wall Street toward cities.
Score one for Richmond, and zip for Wells Fargo, so far.
But the real drama happened closer to home. Before Richmond could fight the enemies from without, it fought the enemies within.
The judge only rendered an opinion that the lawsuit was too early and not that it was without merit. You should be honest enough to say that.
And the Richmond council meeting was addressing only procedural issues and ventured no opinion on whether this plan was constitutional which, it seems fairly evident, it is not.
This is a truly horrible idea, which is why Fannie and Freddie have already been instructed by the FHA to red-lline Richmond if they do this. Plus Richmond can no longer get muni bonds floated.
Richmond will be in bankruptcy if it attempts this and homeowners there should sue the city for devaluing their properties by making the city a no-go area.
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text:
Martin Paul Wilkinson, 64, pleaded guilty to voluntary manslaughter as a habitual offender and possession of a firearm as a felon in connection with a 2012 homicide.
Wilkinson was originally charged with first degree murder and possession of a firearm as a felon in the August 2012 murder of 47-year-old Gregory O'Hare.
The Linn County Sheriff's Office says O'Hare was found face down near 2558 Janette Nehl Lane in rural Central City, an area known as "Muckersville".
Deputies say an investigation led them to Wilkinson. They then spent nearly six hours negotiating with Wilkinson before resorting to tear gas and a taser gun to get him out of a home at 2567 Windy Hill Circle.
Wilkinson faces up to 30 years in prison. A sentencing date has not been set.
Strange formation at bottom of Utah irrigation pond baffles farmers and scientists. John Hollenhorst reports.


text:
This week, four developers (Eric Lemoine and Tom Payne for Camptocamp, Tim Schaub and Andreas Hocevar for OpenGeo) are getting together in Vienna to focus on OpenLayers 3 again, in a code sprint together with developers from GeoServer.
During a 1-week sprint with seven developers in June and in follow-up discussions, an agreement has been found on the flavor of the external API and the general architecture of OpenLayers 3. This week, we can build on the core that we already have. The main goal in addition to implementing features is to create a project infrastructure with a simple build process and good documentation, so other developers can more easily look at and work with the new code, and start to contribute.
You can follow our progress on http://github.com/openlayers/ol3.
A big THANK YOU goes out to the Research Group Cartography at the Vienna University of Technology, for hosting the sprint. And another one to Camptocamp and OpenGeo for sending developers and covering travel and accommodation costs.


text:
Kraft Food Groups is recalling more than 7,000 cases of cheese.
Lt. Gov. Timothy Murray on Thursday visited Genevieve Swiss, a precision manufacturing company in Westfield, to highlight jobs and workforce training.
"We want to make sure we are growing manufacturing and we know it is particularly important in Western Mass," said Murray.
Murray stopped by the company to check in on the progress that has been made since it received a training grant back in 2010.
"It's helped us actually to move into the manufacturing sector. Prior to that we were a distributor," said the company's controller Scott Barbanel.
The Patrick-Murray administration has distributed $5 million in labor and workforce grants in Hampden County since they have been in office. And for companies like GenSwiss the money has helped them to transition and grow despite the tough economic times.
"We're growing through this period but we could be growing a lot better if the economy were more stable," said Barbanel.
One of the challenges facing the manufacturing industry is the lack of people interested in pursuing a career in the field.
"We know in manufacturing we are going to have 100,000 vacancies in the next 10 years - that's even if we don't create another new job - just because people are aging out. So we need to get more young people, more workers retrained in manufacturing," said Murray.
"We've lost a lot of manufacturing in the state and in the country and we believe very strongly here that manufacturing is the key to economic success and strength," said Barbanel.
Workers at the plant say part of the way to attract young people is to explain how much it has changed through the years.
"We're trying to get away from promoting manufacturing as a dirty, rough industry and like what we do it's very clean and it's very technical and it's very entrenched in the sciences," said the company's marketing manager, Scott Laprade.
And officials say they are currently looking into whether or not applying for another grant could benefit their company.
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text: Saturday Scholars® Accelerated Degrees Finish your college degree in as little as two years. Our Saturday Scholars® accelerated degree completion program can help you start a new career or advance in your current one by providing challenging and practical coursework in a supportive environment. Designed for working professionals who have already earned an associate's degree or equivalent college credit, the Saturday Scholars® program is a quick and convenient way to earn one of the following bachelor's degrees or certificates. Program Catalog Description Degree Behavioral Health Counseling (Fall or winter term entry only) BS Communications and Applied Technology BS Computing and Security Technology BS Computing Security Post-Bachelor's Certificate Creativity and Innovation Certificate Elementary Education – Pre-Kindergarten to Grade 4 – Pre-Kindergarten to Grade 4 and Special Education BS Emergency Management Certificate Fundamentals of Property Management (Fall, winter, or spring term entry only) Certificate General Studies BS Health Services Administration (Fall or spring term entry only) BS Non-degree/Non-matriculated N/A Professional Studies BS Property Management BS


text:
Three die in slurry tank accident (From Banbury Cake)
When It Happens Panel Get involved: send your photos, videos, news & views by texting 'OXFORD NEWS' to 80360 or email
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Three die in slurry tank accident
10:44pm Saturday 15th September 2012 in National News © Press Association 2014
A family has been devastated by the death of two brothers and their father in a farming tragedy in Northern Ireland, which left their sister injured.
The men died after falling into a slurry tank at a farm outside Hillsborough in Co Down.
Emergency crews went to the scene on Drumlough Road outside the village after the alert was raised. But following a lengthy rescue operation it was confirmed the three men had died and the woman was taken to hospital for treatment for the inhalation of fumes.
Lives have been lost in the past in accidents at other farm slurry pits, but the scale of the latest tragedy had shocked Northern Ireland.
The Northern Ireland Ambulance Service (NIAS) said it responded to a 999 call at about 6.15pm following reports that at least three people had fallen into a slurry tank. It said it immediately despatched three Rapid Response Paramedics, four accident and emergency vehicles and an ambulance service doctor to the scene.
The Northern Ireland Fire and Rescue Service also attended and rescued four people from the pit.
A spokesman said: "Three were unconscious and NIAS paramedics commenced resuscitation efforts immediately assisted by other ambulance personnel. One of the four showed initial signs of responding to the efforts of the crews and was transported immediately to the nearby Lagan Valley Hospital, where unfortunately he died a short time later. Despite the best efforts of all involved the other two men died at the scene.
"A female was treated at the scene and taken to the Royal Victoria Hospital where she is recovering from the effects of fume inhalation."
The ambulance service said it extended its sympathies to those involved.
A police officer said: "The Health and Safety Executive have been notified and will carry out an investigation in due course."


text:
By JAMES E. CASTO
For The State Journal
HUNTINGTON – In the 1970s, the nation's railroad industry
was on the ropes, says Michael Ward, the president, chairman and CEO of rail
transportation giant CSX.
The industry, he explains, was being strangled by excessive
federal regulation while struggling with the interstate highway system that was
enabling trucking companies to snare a larger and larger share of the nation's
freight business.
What saved the railroad industry, bringing it back from the
brink of extinction, Ward says, was the Staggers Act of 1980, a piece of
landmark legislation that deregulated the railroads, enabling them to compete.
The bill, he notes, was named for its key sponsor, the late West Virginia
Congressman Harley O. Staggers Sr.
Ward's description of what he calls the "railroad
renaissance" was part of his wide-ranging remarks as the keynote speaker April
30 at the annual dinner of the Huntington Regional Chamber of Commerce at the
Pullman Plaza Hotel.
Today's CSX, he noted, operates in 23 states and two
Canadian provinces. It has 32,000 employees, including 1,600 in West Virginia.
Both Ward and Chamber President Mark Bugher emphasized the
historic ties between the city of Huntington and CSX, stretching back to the
city's 1871 founding by rail tycoon Collis P. Huntington, who created it as the
western terminus of his Chesapeake & Ohio Railway, a key corporate
predecessor of CSX.
Ward is familiar with Huntington, having lived in the
community in 1995-96 while working his way up the railroad's corporate ladder.
During his 34-year career with CSX, he has served in key executive positions in
nearly all aspects of the company's business, including sales and marketing,
operations and finance. He's been CSX president, chairman and CEO since 2003.
Huntington, he noted, is an important CSX division
headquarters and the home of the railroad's mammoth locomotive repair shop. The
city has 550 CSX employees.
CSX long has been a generous supporter of worthy causes and
institutions in the Huntington community, including the United Way of the River
Cities, Marshall University and the new children's hospital project at Cabell
Huntington Hospital.
Margaret Mary Layne, executive director of the Huntington
Museum of Art, a member of the sold-out crowd at the dinner, noted that a CSX
contribution some years back enabled the museum to establish a children's
program that's still in operation and "last year served 26,000 youngsters."
While Ward was in Huntington, he used his visit to reveal
CSX's latest gifts.
Ward and Randy Cheetham, the railroad's regional vice president,
announced CSX is donating an old rail bridge that spans the Guyandotte River in
Guyandotte to the Paul Ambrose Trail for Health (PATH) along with $25,000 to
help pay for the bridge's renovation so it can accommodate pedestrians and
CSX also announced that it is making a separate $25,000 cash
donation to the Rahall Transportation Institute (RTI) at Marshall University.
State government's Bucks for Brains program will match the railroad's donation
Ward said.
RTI is named for Congressman Nick Rahall, D-W.Va., who
introduced Ward at the Chamber dinner. State Sen. Bob Plymale, D-Cabell/Wayne,
the director at RTI, was the master of ceremonies for the evening.
"We love the work that RTI does here because they take a
very practical approach to things, not just for research's sake or to create a
paper," Ward said. "They try to create things that improve safety and improve
efficiency. It's one of the leading transportation institutes in the nation,
and we're glad to support it."
The Chamber's annual dinner was its 122nd since 1891, when
the organization was founded as the Huntington Board of Trade. The dinner was
the last for Chamber President Bugher, who has announced he is retiring later
this year. A search committee is working to find a successor.


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> View this now
Published on: November 16, 2012
Type of content: WHITE PAPER
Length: 9 pages
Price: FREE
Commercial banks must meet the challenge of retaining customers in the short term while investing in technology that will drive the innovation required to keep these customers for the long term. This is complicated by issues like regulatory compliance, especially the Dodd-Frank Wall Street Reform and Consumer Protection Act which requires banks to respond more quickly to more complex and numerous requests for information.
This white paper outlines the major areas that pose serious challenges for commercial banks today, including:
• Cost and margin pressures• Risk and compliance uncertainties• Demand for new products and services• And more.


text:
A plea for less sleepers
As could have been expected, Silas Redd's departure to USC has opened up the floodgates at Penn State. Khairi Fortt has left for Cal, Kevin Haplea is now a Seminole, Robert Bolden is going to LSU, and some safety you've never heard of went to NC State. This is on the heels of Ryan Nowicki leaving, and rumors about freshman OL Brian Gaia, RB Akeel Lynch, K Anthony Fera, and LB Mike Hull. The cracks are starting to show, and frankly, this may only be the beginning. For now, Rutgers will have to be satisfied with DT Jamil Pollard. This is interesting in the sense that he reportedly had qualifying issues as a recruit, which is why I initially didn't see him as a realistic possibility. He made it through the clearing house into Penn State though, and once the sanctions hit, high-tailed it out of there at the first opportunity. This is a fun little bit of payback for years of Penn State bullying. Let it be the first of many. So, how will this affect the roster moving forward? You'd think Jamil ends up on defense, given that Rutgers just signed a ton of offensive linemen and all. Last year's class did have two DE/DT tweeners in Pinnix and Hammer. Traditionally those guys would have grown into DTs at Rutgers, but who knows, maybe this is part of the new trend with big tackles like Al Page and Marquise Wright. DTs bust pretty often, so that has to curb any premature celebration somewhat, but that is precisely why these recruits are worth their weight in gold. If we are actually going to run a defense that uses big tackles now, well then, that's even more for the better.
Recruiting critics have been abuzz since one of Kemoko Turay's assistant coaches recently tweeted that he had received an offer from the Rutgers staff. He was a star at a recent on-campus camp, but hasn't played organized football the past few years. Yep, it's another super-athletic sleeper lottery ticket that not many recruiting gurus are familiar with - a label that could apply to a good percentage of this year's recruiting class. Note: any comment comparisons of Turay to Jason Pierre-Paul or Jevon Kearse are bannable.
Not many fans are thrilled about the amount of sleepers Rutgers is signing in this year's football class, but for Josh Klecko, they might make an exception. His father, of course, starred for the Jets in the early 80s, but Rutgers has signed other players in the past with NFL bloodlines. More relevant is his brother Dan's experience at Temple. Terry Shea infamously spurned Dan Klecko by not offering him a scholarship, and Klecko proceeded to develop into an All American-caliber player for the Owls. He was undersized, but holy crap was Dan good, and it seemed like he took extra relish in torturing Rutgers each year to make up for Shea's unforgivable sin. Rutgers could not afford to make that mistake again.
Wait, so Rutgers actually signed a player from Timber Creek? Yeah, I know, Quanzilla last year, but Greg Webb was always looking factory, and Dajuan Drennon''s interest quickly faded. In terms of offers, Nash is probably the best get of the class up to this point. Looks like one of those classic LB who grows into an undersized R end types.
In the first of the day's three commitments as recruiting camp winds down, Rutgers received a verbal from Florida tight end Taylor Marini. Tight end was a big need for this class with Rutgers losing a player at the last minute last year. They needed two, and now they have them in Nick Arch and Marini. Marini has a solid offer list, and is exactly the kind of heralded mid-level recruit that Rutgers has made their name with as of late. You can be a little disappointed in some of the sleepers in this class, but not with Marini (or Myles Nash for that matter.) The problem is more that they should be the rule this year, not the exception. Congrats to Jim Panagos for his recruiting prowess today. Rutgers will probably need to land a few prospects out of Florida this year like Marini and LB Skai Moore to make up for missing out on a few local prospects. That's how Greg Schiano did it at the start of his tenure too.
Another week, another mid-level, semi-sleeper commits to the Rutgers football program. This time, it's Pennsylvania DL Sebastian Joseph, who reportedly had interest from some Big East and ACC programs - which fits the mold of a lot of the team's commits this year. Some recruiting gurus are high on Joseph, citing strong camp performances. My thoughts on him are pretty much the same as they are for the rest of the class: each of the commits is overall, fine in a vacuum - I do wish on the whole Rutgers was doing better with some of the more high-profile prospects this season though.
The current state of Rutgers football recruiting
Brandon Arcidiacono is coming to Rutgers this fall as a center, and as of today, his younger brother Nick will be joining him in a year as a tight end. As Rutgers did not sign a tight end in last year's class, they could well be looking to sign two this year, so stay tuned on that front. Also worth watching is the possibility that there could be more Arcidiaconos coming down the pike in the future. Look out DePaolas, they're going to make a run for being the first family of Rutgers football.
Timing can be interesting at times. Rutgers saw a top-ranked local player go off the board today with Immaculata (why does RU never seem to get their players when the school is so close by) DT Tashawn Bower committed to Auburn. That may have been behind the decision to offer Eric Wiafe, but other reports cite his standout performance at a local big man camp. That's fine. What's a little unnerving though are Wiafe's comments about being a "medium" verbal commit and still wanting to take visits. Dude. This is your first decent offer. If you want to wait, then wait. Committing in name only just to hold a spot might as well be no commitment at all. Come on, get serious man. This is why I can't really get on any player who seems to be dragging the decision process out. Some people just need to be sure, and while it's frustrating, that's certainly their right. Something like this is definitely higher on the irksome scale. Still, Rutgers saw fit to jump on Wiafe almost immediately, so I hope things work out and he can grow into his potential. Besides the odd comments, some fans certainly will be upset about missing out on another big local target. Rutgers is definitely doing well with the mid-level guys who are the bread and butter of the program every year, but RU has struggled with most top local prospects (there are still a few good ones left who are possibilities if not likely to Rutgers), which is understandable given the results of the past few months. Rutgers needs to win under Kyle Flood, and that will work itself out in time, but it's definitely an issue until the program can demonstrate some stability again. Getting to the point of the past few years where Rutgers turned into a destination for elite prospects did not happen over night.
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Founded in 1971, the Annenberg Center for the Performing Arts of the University of Pennsylvania is a major cultural destination and crossroads in the performing arts, connecting Philadelphia regional audiences and the University of Pennsylvania through exposure to innovative human expression in theatre, music, and dance.
The Annenberg Center highlights the value of the performing arts by presenting world renowned and emerging artists and companies who express adventuresome perspectives on contemporary issues, timeless ideas, and diverse cultures. By offering contextualization programs, featuring Penn faculty as well as experts from the artistic and business communities, the Annenberg Center promotes critical thinking among its audiences, creating uniquely rewarding arts experiences.Learn more about the Annenberg Center for the Performing Arts:


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customizing buddypress profile page default tab and item-nav order
With the assistance of @boonebgorges, I was able change both the default tab that loads when you visit a BuddyPress profile page and the order of the tabs on profile pages.
Both of these functions are called before theme files are, which was giving me trouble. Here's how to do it:
Default Tab:
In your wp-config file, add the following line:
define( 'BP_DEFAULT_COMPONENT', 'preferred_default_tab' );
but make sure it's above the require_once(ABSPATH . 'wp-settings.php'); line, or else the change won't take place.
Item-Nav Order
In plugins/bp-custom.php, I added
function bbg_change_profile_tab_order() {
global $bp;
$bp->bp_nav = 10;
$bp->bp_nav = 20;
$bp->bp_nav = 30;
$bp->bp_nav = 40;
$bp->bp_nav = 50;
$bp->bp_nav = 60;
$bp->bp_nav = 70;
add_action( 'bp_setup_nav', 'bbg_change_profile_tab_order', 999 );
and was able to order the tabs as I wanted. Thanks, Boone!
You must be logged in to reply to this topic.


text:
Weight: 0.07
In stock
List Price:$2.29
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International customers, please view our shipping page for information on additional shipping fees. CLICK HERE
COATS YARN-Red Heart Sizzle Crochet Nylon. This nylon can be knit; crocheted; knotted; braided or macramed. Make friendship bracelets; jewelry; belts; bags and other accessory items. Content: 100% nylon. Putup: 100yd/91.4m. Suggested crochet hook size B1/2.25mm. We try but are not always able to match dyelots. Care: Machine wash; dry flat; do not bleach; dry clean using P solvents. Comes in a variety of colors. Each sold separately. Imported.


text:
Metairie welcomed its first parade of the Carnival season on Sunday.
The kid Krewe of Little Rascals rolled down the Veterans route in the afternoon. More than 200 children rode on 16 floats for the 30th annual Little Rascals Parade.
This year's theme was, "They said it couldn't be done."


text:
Client Login
Please enter your Client Log-in user name and password for access to the Special Client Booking Facility.
If you wish to cancel your booking, please enter the Booking Reference Number and your last name.
If you have a friend that you would like to recommend this page to, or if you just want to send yourself a reminder, here is the easy way to do it!
Simply fill in the e-mail address of the person(s) you wish to inform, your name and e-mail address (so they do not think it is spam or reply to us with gracious thanks), and click the SEND button. If you want to, you can also enter a message that will be included on the e-mail.URL to send:


text:
Auto Scanner
Larry Rubenstein
---- — Q: I have a 2001 Subaru Forrester. For a couple of years now, I have had this terrible gas odor only in the cold weather and usually when I put the heat on. Several people have looked at it and no one seems to know the cause. It can be pretty bad at times. Sometimes it smells like it's burning, too. I would have it looked at again, but don't want to spend money for someone to tell me they don't know what it is. Any suggestions?
A: My first suggestion is to continue pursuing this problem. A few common places for leaks that are hard to find would be the top of the gas tank, a porous diaphragm at the fuel pressure regulator, a leaking vent hose at the filler neck and also the fuel tank filler neck itself. It's interesting that you did not mention a Check Engine light. Your vehicle is equipped with the OBD II computer diagnostic system. One of the major functions of this system is to check for fuel vapor leaks.
I would be more inclined to look under the hood for this leak if the back underside looks OK. The reason is that you say it's worse in cold weather. In cold weather, you are using the vehicle heater at a higher fan speed. The air intake for the HVAC system is located near the engine compartment, so you could have been pulling in fumes from the engine. However, you need to be sure it's really gasoline you are smelling and not antifreeze from a leaking heater core.
And finally, you didn't mention any loss of antifreeze, but your car has a reputation for blowing head gaskets, which will make a horrendous smell when leaking externally from the gasket and hitting the exhaust pipe. Don't let this go. This could be very dangerous.
Q: I recently brought my 2009 Honda Accord in for a standard 15,000 mile service. I got that inevitable follow-up call suggesting additional items, one of which was a four-wheel alignment. The technician said they recommend this once a year. The steering wheel is centered and I do not feel any pulling when driving on a straight road. I inquired if there was any evidence of uneven tire wear. There was none. I drive this car only about 5,000 miles a year. What is your recommendation? Oh, another thing, I would be reluctant to incur the expense of an alignment with pothole season quickly approaching.
A: You're very astute to decline the alignment. All the reasons you stated convince me that the car does not need an alignment. Front suspensions on today's cars are much tougher than those of 10 or more years ago. It really takes a lot to knock a front-end or rear-wheel assembly out of alignment. Any signs of tire wear, wheel pull, or off-center steering, however, should prompt you to have an alignment performed.
Car Care Tip: Know what oil your car uses. In your owners' manual there will be a section that lists all the proper fluids that your car requires. A repair shop will not be offended when you go in for service and you state what grade and weight of oil you want in your car.
Larry Rubenstein is a master technician who owns a North Shore service station. His column appears every Saturday. Write to Larry at The Salem News, c/o Auto Scanner, 32 Dunham Road, Beverly, MA 01915, or send an email to firstname.lastname@example.com.


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August 22, 2014
By Playbill Staff
21 Oct 2013
"Back to Before" from Ragtime.
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