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Last January, I had the opportunity to share some thoughts on PIDS' role in combating vaccine-preventable diseases, focusing on vaccine advocacy, innovative studies of pathogenesis, high-quality epidemiologic studies, and rigorous clinical trials. Now, one year later, we are experiencing a measles outbreak in the US that has affected over 100 people in 14 states, most of which are linked to an exposure at a California amusement park. As the outbreak unfolds, we are reminded of the cardinal symptoms of measles, a disease that many practicing physicians have never seen; the efficient transmission of the virus to unvaccinated individuals; and the importance of PIDS' ongoing education and vaccine advocacy efforts.
As recently as the 1950s, measles was one of the most common childhood infections in the US. On average, about half a million cases, 50,000 hospitalizations, 1,000 cases of chronic disability, and 500 deaths were reported each year; however, due to underreporting, it is estimated that as many as 4 million cases occurred annually. In many ways, measles is a typical respiratory illness, leading to fever, cough, coryza, conjunctivitis, and malaise. Because of this, and because of the fleeting nature of pathognomonic Koplik spots, we must maintain a reasonably high index of suspicion, particularly in our unvaccinated patients, in order to identify measles cases promptly. When measles is suspected, providers should evaluate measles-specific serum IgM antibody and measles RNA by PCR from both the oropharynx and the urine.
The timely diagnosis of a case of measles is of critical importance, since a single measles patient will infect approximately 15 others in the absence of pre-existing immunity (R0~15), making measles the most easily transmitted virus on the planet (for comparison, smallpox R0~5, Influenza R0~3). Moreover, 90% of non-immune individuals will develop measles infection following close contact with an infected individual. Fortunately, the MMR vaccine is remarkably effective (~95% after one dose and 98-99% after 2 doses) in generating life-long, protective immunity. The MMR vaccine is also effective if administered within 72 hours of measles exposure and is recommended for infants as young as 6 months of age if exposure is likely (e.g., travel to an endemic area).
This effectiveness of the MMR vaccine in preventing measles infection is the foundation of measles eradication efforts, which have been highly successful in many parts of the globe. PIDS members continue to play key roles in this effort, leading clinical trials, conducting global epidemiology studies, and informing public policy decisions. It is now time, through our vaccine advocacy committee, training programs, and local media markets to redouble our efforts in reassuring parents and providers about the safety of MMR vaccine and the importance of vaccine coverage (>93% coverage is required in a community to disrupt transmission). For more information about the current outbreak and for general talking points about measles, please visit the PIDS website (www.pids.org).
The eradication of measles has been a daunting task; unfortunately, the eradication of misinformation and mistrust may be even more so. Allowing measles to resurface essentially turns back the pediatric clock by several decades, reintroducing morbidity and mortality that are a distant memory. Our job, as a society and as individual members, is to provide clear, trustworthy information to our trainees, our patients, and the general public in order to ensure these preventable outbreaks do not become the new epidemiologic norm. - by Buddy Creech, MD, MPH, FPIDS
As physicians, scientists, and other medical professionals dedicated to treating and preventing infections in children, the Pediatric Infectious Diseases Society (PIDS) remains extremely concerned about the current measles outbreak as it continues to unfold.
It has become clear that we are in the midst of a larger, very disturbing trend. Despite the fact that measles was eradicated from the United States 15 years ago, this country had 644 measles cases in 2014, more than in any year since 1994. 2015 is now on pace to well exceed that number.
The measles vaccine is a victim of its own success. Vaccination was so effective at eliminating this disease, and many other diseases, that younger generations do not appreciate or understand the severity of vaccine-preventable diseases. Instead, the focus now often lies on unfounded, disproven and discredited concerns regarding the safety of the vaccine. We know that parents want the very best for their children, and this includes keeping them safe from serious infections. It is a tragedy that some parents, often because of misinformation they may have received from friends, colleagues, or the Internet, are putting their children and others in harm's way by refusing to vaccinate.
The current measles outbreak, which has now affected more than 100 people and will likely continue to spread, was entirely preventable. As long as approximately 95 percent of a population is vaccinated, a potential outbreak from measles will be halted in its tracks. Most states exceed this level of coverage, in part due to school vaccination requirements, but an increasing number of states have regions where vaccination coverage falls well below this level. This is in large part due to personal belief exemptions or religious exemptions that allow parents, misled by false information, to avoid vaccinating their children.
States with areas where vaccination rates are lower can look to Mississippi, where strong immunization requirements have maintained high vaccine coverage levels among children. As PIDS President David W. Kimberlin, MD, FPIDS, told The New York Times this week, "That kind of strong approach is helpful for the health of children in America. I believe that that should be something we all work toward, that we all hold in the highest of value in terms of our prioritization."
Simply put: vaccines are safe, vaccines are effective, vaccines save lives. Children are being harmed by the growing trend of vaccine refusal. We strongly urge any parent who has a concern about the safety of a vaccine, including the MMR vaccine, to discuss these concerns with their child's medical provider as soon as possible. Similarly, we encourage all primary care providers to actively engage all parents in the discussion about vaccines, provide clear messaging about their safety and efficacy, and be transparent about the minimal risks. This outbreak can be stopped, and future outbreaks prevented, with adequate vaccine coverage.
Pediatric Infectious Disease Experts Urge Vaccination as Measles Outbreak Continues (PDF)
Written by: Pui-Ying Iroh Tam, MD
Last month, I was asked to consult on antimicrobial management for a premature baby who had presumed necrotizing enterocolitis. The baby was transferred from an outside hospital after a suspected aspiration event, and on arrival was started empirically on clindamycin. Due to suspected sepsis in a premature infant, she was also started on ampicillin, gentamicin and fluconazole. When she developed respiratory distress and deteriorated, neonatologists broadened her ampicillin and gentamicin to vancomycin and cefotaxime. Despite this, she continued to be unstable and blood cultures became positive for MSSA. Gentamicin was added for synergy and after there was no clinical response or sterilization of blood cultures after 3 days, was then changed to rifampin.
Hence, when we first met this patient, she was on vancomycin, clindamycin, rifampin, cefotaxime and fluconazole.
Kim and Gallis first coined the phrase 'spiraling empiricism' back in 1989 with an article in the American Journal of Medicine titled 'Observations in spiraling empiricism: its causes, allures and perils, with special reference to antibiotic therapy [1].' Their term refers to the 'inappropriate treatment, or the unjustifiable escalation of treatment, of suspected but undocumented infectious diseases.'
Sound familiar? I faintly ridicule other specialties for committing this transgression, but whom of us in pediatric infectious diseases have not been seduced by the fallacies of antibiotic therapy? However, the implications of this practice – where over half of hospitalized patients receive antimicrobials [2], and where an estimated 50% of outpatient antimicrobial prescriptions are considered unnecessary [3] – is that we have also contributed to the growing problem of antimicrobial resistance. When the CDC published their first ever report in 2013 quantifying the extent of antimicrobial resistance, they estimated that at least 2 million people a year in the US become infected with antimicrobial resistant bacteria, and a minimum of 23,000 people die annually as a direct result of these infections [4].
These fallacies (I have bolded this word lest a reader skimming this should think I am detailing pearls of wisdom) are, as Kim and Gallis lists:
Most illustrative is a recent case published in the New England Journal of Medicine [5]. A 14 year-old male with severe combined immunodeficiency status post two bone marrow transplants presented to a medical facility three times over a four month period with fever and headache. With an extensive negative infectious workup and low suspicion for bacterial meningitis, he was not given any empiric antimicrobials until his third presentation when he had interval development of status epilepticus and basilar leptomeningitis on MRI. Then he was given a series of empiric antimicrobials that physicians continued to add to and broaden when he did not respond. When next-generation sequencing analysis suggested neuroleptospirosis, his therapy was narrowed to penicillin, and the patient gradually recovered over the next seven days.
Of all the antimicrobials this patient needed, with all the technology that we could provide in the 21st century, the answer was the first antibiotic ever discovered. There is a beautiful simplicity to that which reminds one how much of clinical practice remains more of an art than a science.
And my premature baby on a veritable cocktail of antimicrobials? We optimized and simplified her therapy, cognizant of the perils of excessive and redundant antimicrobial use. After that I don't know, since I signed her out to the next attending. But I suspect all must have turned out well, since isn't ignorance bliss?
Written by: Matthew Kronman, MD, MSCE
Fisher BT, Sammons JS, Li Y, de Blank P, Seif AE, Huang Y, Kavcic M, Klieger S, Harris T, Torp K, Rheam D, Shah A, Aplenc R. Variation in Risk of Hospital-Onset Clostridium difficile Infection Across β-Lactam Antibiotics in Children With New-Onset Acute Lymphoblastic Leukemia. J Pediatric Infect Dis Soc. 2014;3(4):329-35.
In the December 2014 issue of the Journal of the Pediatric Infectious Diseases Society, Fisher, Sammons and colleagues report the findings of a large, multi-center retrospective cohort study of children with new-onset acute lymphoblastic leukemia (ALL) that aimed to determine the relative contributions of different β-lactam antibiotics to the risk of developing Clostridium difficile infection (CDI).
The authors employed the Pediatric Health Information System (PHIS) database, which includes pharmaceutical billing data and diagnoses for all children admitted to 43 freestanding children's hospitals. To decrease misclassification, the authors used previously well-validated definitions for both new-onset ALL cases (based on an ALL diagnosis and receipt of appropriate chemotherapy) and CDI outcomes (based on a CDI diagnosis and billing for C. difficile testing.)[1, 2] The PHIS data provided the authors with the ability to track antibiotic exposures to the day; the analyses were adjusted for age, race, gender, illness severity, days in the hospital, antibiotic receipt other than β-lactams, and admission hospital itself. The authors furthermore had the ability to adjust for other factors that could have been associated with CDI, such as use of proton pump inhibitors or use of an enteric feeding tube.
In their adjusted analyses, the authors found that the hazard for developing CDI increased by 5% (adjusted Hazard Ratio 1.05, 95% Confidence Interval 1.01-1.09) for each additional day subjects were exposed to anti-pseudomonal β-lactam antibiotics. This relationship held true for ceftazidime (5% increased hazard) and cefepime (7% increased hazard), but not for anti-pseudomonal penicillins such as piperacillin/tazobactam or carbapenems.
There are three main reasons why we should take note of this study. First, this study backs up the antibiotic stewardship mantra "every dose counts" with hard data. Accounting for other confounding variables, every additional day of certain anti-pseudomonal β-lactam antibiotics added a 5% risk of developing CDI. This daily additional risk compounds rapidly: just 5 days of exposure to these antibiotics contributes an almost 30% increased risk of CDI. Remembering that these authors have previously demonstrated that hospital-onset CDI is associated with an almost 7-fold increase in mortality,[3] we can all use the present study to remind us not to put off until tomorrow stopping those antibiotics we could otherwise stop today.
Second, the present study should serve to remind us that what may appear to be routine practice changes in the Divisions we support may come with unintended consequences. The authors demonstrated that two cephalosporins – cefepime and ceftazidime – were associated with CDI in adjusted analyses while anti-pseudomonal penicillins were not. In the initial univariate analyses, the incidence rate ratio of CDI among those exposed to cefepime was more than twice that of those exposed to ceftazidime. We might consider ceftazidime, cefepime, and piperacillin/tazobactam as approximately equivalent selections for the empiric treatment of the febrile neutropenia so often seen in the ALL patients who were the subjects of this study. These data should remind us that even apparently small decisions such as deciding among these three agents should be weighed carefully, especially when institutional guidelines that might affect hundreds of patients are being developed and updated.
Lastly, we continue to learn slowly about our relationship with our gut microbiota. Large-scale epidemiologic studies such as this one can provide hints and clues as to the underlying biology of the diseases we examine. A meta-analysis demonstrated increased risks for community-onset CDI among those exposed to cephalosporins, monobactams, and carbapenems relative to those exposed to penicillins.[4] One might have supposed that agents with the largest breadth of anaerobic activity (such as piperacillin/tazobactam and carbapenems) were universally more likely to be associated with CDI, by substantially reducing the vast numbers of anaerobic commensal gut bacteria, allowing C. difficile the ecological space to grow logarithmically. Here, the authors demonstrate that piperacillin/tazobactam, despite its breadth of anaerobic activity, was not associated with CDI. Perhaps this finding can suggest testable hypotheses to further our understanding of how and why CDI develops in the first place.
In summary, Fisher, Sammons, and colleagues nicely demonstrated in this study the importance every additional day of antibiotics can hold. We have more to learn about CDI and how to prevent it, but in the meanwhile, we are better equipped to encourage our colleagues to stop unnecessary antibiotics as soon as possible.
Written by Chris Nyquist, MD, MSPH
"The lung is so irritated that every attempt to expel that which is causing the trouble...it neither admits the air or easily expels the air. For they are without this troublesome coughing for the space of 4 or 5 hours at a time, then this paroxysm of coughing returns, now so severe that blood is expelled with force through the nose and through the mouth."
1578 Pertussis Epidemic in Paris, Guillamaume de Baillou
The"100 day cough" described in the 1500's in England ultimately became known in 1679 as pertussis, "violent cough", courtesy of Sydenham (of Sydenham's chorea fame). In the 21st century we now have better diagnostic tools to identify pertussis, vaccines for pertussis and effective antimicrobials that should decrease the contagiousness of patients yet we continue to and increasingly have pertussis epidemics.
The CDC MMWR recently reported another pertussis epidemic in California. The number of reported cases in 2014 is surpassing the recent 2010 epidemic and represents the most cases reported in California in the last 70 years. The overall rate of pertussis in the population is 26 per 100,000 population with the highest incidence in infants younger than 1 year (174.6 cases per 100,000). This "new normal" makes the case for continued pertussis research rethinking what we know about pertussis epidemiology, testing and antibiotic use.
Stone et al describe a prospective cohort study conducted from July 2004 to August 2006 at Primary Children's Medical Center in Salt Lake City, Utah. The objective of the study was to better understand the length of time pertussis PCR (polymerase chain reaction) is positive in a patient with clinical pertussis. Children less than 18 years of age who were hospitalized with a positive B. pertussis PCR and met CDC laboratory confirmed definition of B. pertussis infection were defined as index cases. Associated cases were defined as close contacts with at least 7 days of unexplained cough illness. Subjects enrolled in the study had nasopharyngeal samples tested with pertussis PCR at baseline and then weekly for 3 weeks, then monthly or every other month, for 1 year from symptom onset until the samples yielded a negative result.
True B. pertussis cases were cases that had the first pertussis PCR positive or who met CDC clinical criteria for pertussis but had the initial sampling after 21 days of illness. Over half of the associated cases (close contacts) were PCR positive for pertussis. The final analysis included 31 PCR positive and 3 PCR negative subjects who were sampled after 21 days but met CDC clinical case criteria. Despite completing an appropriate course of antibiotics (14 days erythromycin or 5 days azithromycin) B. pertussis PCR results remained positive for a median of 58 days after symptom onset (range: 4 to 172 days). Half of the patients continued to have a positive pertussis PCR for greater than 50 days after the onset of symptoms, despite antibiotic treatment and clinical improvement.
What does this study mean for Pediatric Infectious Disease clinicians and Hospital Epidemiologists? How should we clinically use pertussis PCR? Does the prolonged presence of B. pertussis DNA beyond 21 days of illness or after completing recommended antibiotic treatment correlate with continued contagiousness of the patient and further transmission to susceptible hosts? How do we clinically use this information to improve patient care and public health?
Pertussis culture is the only 100% specific method for identification and is still the gold standard. PCR is now the preferred method of diagnosis in the clinical setting. Commercial serologic tests, although not yet standardized by the FDA, can be helpful for diagnosis later in illness or for epidemiologic studies although the interpretation of serology may be influenced by recent vaccination. A 2007 Cochrane review of antibiotic treatment for pertussis evaluated 10 trials published between 1969 and 2004 that described microbiologic eradication determined by pertussis culture. Meta-analysis of microbiologic eradication as an outcome in these trials was not possible because of the difference in type of antibiotics used.
For patients hospitalized with pertussis, the AAP Committee on Infectious Diseases Red Book ®, recommends standard and droplet precautions for 5 days after the initiation of effective therapy, or if appropriate antimicrobial therapy is not given, until 3 weeks after cough onset. In the early 1990s at Children's Hospital Colorado, we experienced healthcare associated transmission of pertussis from a hospitalized coughing patient who completed an appropriate course of antibiotics and was thus removed from droplet isolation. We subsequently tightened our restrictions and kept patients with pertussis in droplet isolation until the time of hospital discharge. Recently we relaxed our isolation policy and now allow hospitalized patients with pertussis who are hospitalized greater than 14 days and with two documented negative pertussis PCRs one week apart to be removed from droplet isolation. Further studies evaluating pertussis PCR may help provide an evidence basis for changes to recommendations regarding appropriate isolation practices.
Pertussis continues to be a 21st century problem. We need to clearly develop research to answer the old and new questions. Replication and expansion of this pilot study in the ambulatory setting may bring us closer to answering questions in the time of the pertussis "new normal."
By: Rebecca Wallihan, MD
Between abundant vaccine myths and increasingly vocal anti-vaccine celebrities, it seems like an uphill battle each year to increase rates of influenza vaccination. This year we are faced with an additional challenge.
Read more: Let's Set the Record Straight on the Influenza Vaccine
Written by Chris Nyquist, MD, MSPH
What is the value of Pediatric Infectious Disease fellowship training? Is the equation "Value equals Quality divided by Cost" valid? Is the Pediatrics journal article, "Does Fellowship Pay?" (Pediatrics 2011;127:254) describing a negative financial impact of over $800,000 associated with pursuing a career in Pediatric Infectious Diseases compared to a career in general pediatrics accurate?
As we look to creating our future and understanding where it may be progress, PIDS is sponsoring a qualitative research study to explore the value of Pediatric Infectious Disease Specialists. This important global look at perception of value, work force, and our role in healthcare of children will provide us with actionable measures but will also raise more questions for the future. Before the study is complete we must start the journey and individually recognize our own value as a Pediatric Infectious Disease Specialist. This is the first step to more effectively recruit and retain the best pediatricians to an infectious diseases fellowship and to assert the overall value of Pediatric Infectious Diseases.
Written by: Buddy Creech, MD, MPH
On my shelf are two staphylococcal books from the 1960s - Proceedings from Staphylococcal Symposia held at the the NY Academy of Sciences and in Warsaw, Poland.
ARLINGTON, Va. (October 31) – The Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the Pediatric Infectious Disease Society (PIDS), the HIV Medicine Association (HIVMA) and the Center for Global Health Policy remain opposed to mandatory quarantines being imposed on asymptomatic healthcare workers returning from Ebola-stricken countries in West Africa.
Read more: Joint Statement: Opposing Quarantine for Asymptomatic Healthcare Personnel Traveling from West...
Written by: David Kimberlin, MD
At the PIDS Business Meeting held on October 10 at the 2014 IDWeek meeting, I shared good news about the state of the society and its numerous activities. Let me start by prefacing that PIDS continues to be financially stable. Our investment accounts are weaker than last year, but investments are not tapped for operating expenses and therefore are not impacting our current budget. PIDS leaders continue to press forward using the roadmap from the 2013 strategic planning session. The roadmap consists of four focus areas: 1) the value of pediatric infectious diseases as a subspecialty; 2) education and training for pediatric infectious specialists the future job markets; 3) communication to members and among members; and 4) the visibility of PIDS in the crowded marketplace of expertise that exists in this decade. Below is a list of activities that PIDS currently is doing or will soon undertake in the coming months as we focus on each of these areas.
A critical aspect of increasing PIDS' visibility is the continued enhancement of the visibility of the society's journal, the Journal of the Pediatric Infectious Diseases Society (JPIDS). I strongly encourage you, the esteemed experts in our field, to submit your research to our journal via http://mc.manuscriptcentral.com/jpids. I also ask that you encourage your colleagues to do the same. I promise that you will find the peer review and online publication of manuscripts to be very rapid, the feedback from reviewers to be thoughtful, and the editorial staff of the journal to be extremely responsive. In addition, the Society will feature key articles to our membership via the enhanced Communications efforts detailed above.
In addition to the International Affairs Committee, PIDS has 12 other committees that are actively working toward advancing the Society's goals and bringing value to its members. This year, 61% of members offering to serve on committees were assigned to their 1st or 2nd committee preferences. There is still much to do, so please contact me if you are passionate about a particular issue that you think PIDS can help with (or that it can help with PIDS).
I encourage you to read this entire issue of PIDSNews. Meeting information such as the Call for Cases for the St. Jude/PIDS Transplant ID Symposium, Call for Abstracts for the St. Jude/PIDS Pediatric Infectious Diseases Research Conference, and other important information are provided. In addition, the Antibacterial Resistance (AR) Leadership Group is seeking pediatric proposals in their efforts to reduce the public health threat of AR. Please follow the link provided in this newsletter to learn more.
Finally, I want to update you on Ebola and PIDS' response to the recent Centers for Disease Control and Prevention (CDC) guidance and the implications for pediatricians. On October 28, PIDS publicly joined with IDSA to implore our political leaders to follow the science in the development of public policy relating to this unfolding human catastrophe. We must think strategically when faced with challenges of this magnitude, and PIDS members are uniquely suited to address those areas that affect children's health. To be certain, this is a dynamic and fluid situation. Our approach to it, therefore, must be flexible as well. We believe that by joining our voices with those of the CDC, American Academy of Pediatrics (AAP), and others, we can most favorably impact the care provided to children with documented or suspected Ebola virus infection. Many of these efforts will be behind the scenes – we all have seen the detrimental effects of too many voices adding to the confusion perceived by the public. But rest assured that we are doing the work, both as individuals and as a group. We – the Pediatric Infectious Diseases community – are making a difference.
In the coming months and years, I am excited about our Society's continuing growth as an organization, maintaining a focus on important issues related to pediatric infectious diseases and providing value to our members. On behalf of the PIDS leaders, thank you for all of your support, hard work, and commitment to the Society!
Written by: David K. Hong, MD
The continuing Ebola crisis in West Africa has been unprecedented. As of October 22, 2014, there have been 9936 confirmed cases of Ebola, many more cases than any previous Ebola outbreak (1).
A Children's Task Force has been activated by the Centers for Disease Control and Prevention (CDC) Emergency Operations Center (EOC) as part of the 2014 Ebola outbreak response.
Read more: CDC Activates Children's Task Force in Response to Ebola Outbreak
The Pediatric Infectious Diseases Society (PIDS) endorses Statement from the Infectious Diseases Society of America (IDSA) regarding involuntary quarantine of healthcare workers returning from Ebola-affected countries. PIDS is the world's largest organization of professionals dedicated to the treatment, control and eradication of infectious diseases affecting children. PIDS agrees that strategies to limit Ebola Virus disease transmission should be based on the best available medical, scientific, and epidemiological evidence, as stated by IDSA. Furthermore, PIDS supports the policies promoted by the Centers for Disease Control and Prevention and the National Institutes of Health to end the Ebola outbreak without further losses.
Drs. Georgina Peacock, Timothy Uyeki and Sonja Rasmussen published "Ebola Virus Disease and Children: What Pediatric Health Care Professionals Need to Know" in JAMA Pediatrics.
In AAP News, Dr. Carrie Byington authored the article, " Ebola and Children: Identifying and Meeting Their Needs."
The United States has been experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. The most recent version of key points on EV-D68 is now available.
On October 14, 2014 the Centers for Disease Control and Prevention (CDC) issued a press release sharing news about a new lab test developed by CDC for EV-D68 which will allow more rapid testing of specimens. Because of this new test, confirmed cases of EV-D68 will appear to rise rapidly over the next 7-10 days as specimen testing accelerates, however, changes in case counts won't represent a real-time influx of new cases.
Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing. Many parents continue to be worried about the outbreak and want information about what they can do to prevent illness and protect themselves and their families. CDC has developed information and resources for parents about EV-D68. Please help us to address parents' questions and concerns and make them aware that these resources are available.
Below are CDC resources about EV-D68 developed for parents:
A Prospective, International Cohort Study of Invasive Mold Infections in Children
Written by: Pia S. Pannaraj, MD, MPH
Invasive mold infections (IMI) are life-threatening infections in immunocompromised children. Most of our current knowledge of the epidemiology, diagnosis, treatment, and outcomes of pediatric mold infections is extrapolated from studies in adults. Whereas amphotericin B formulations (polyenes) were once the mainstay of therapy of IMIs, new generation azoles and novel echinocandins have expanded the arsenal of antifungal agents and are being used in children despite limited pediatric pharmacokinetic and efficacy data. In addition, treatment with a combination of different classes of antifungal agents appears attractive despite a paucity of studies. In the Journal of the Pediatric Infectious Diseases Society Advance Access online on July 19, 2014, Wattier et al. and the International Pediatric Fungal Network (PFN) addressed these issues by characterizing the current epidemiology of IMIs in children with varied underlying conditions, describing the patterns of antifungal therapy, and reporting contemporary outcomes from their large, international, multicenter network.
Between 2007 and 2011, PFN enrolled 131 children diagnosed with proven or probable IMIs from 22 study sites (12 US, 10 international) of 42 sites in the network. Most children (75%) had invasive Aspergillosis (IA); 25% had other mold infections. Malignancy and hematopoietic stem cell transplantation were the most common underlying conditions, but the study also characterized IMIs in children with inherited immunodeficiencies, autoimmune diseases, and non-malignant hematologic conditions.
Three main points are emphasized from this study of IMI in children:
This large study of IMI in children had some limitations. The majority of patients were enrolled from 6 sites, with 25% of the patients from one site alone. Twenty PHN sites did not enroll any patients. The study did not document if this was due to lack of cases or lack of time/resources for the investigators to enroll patients. The study did attempt to control for potential confounding by adjusting for clustering by site in the outcomes analysis. Study sites also may differ in their interpretation of underlying risk factors, approach to diagnostic evaluation, and reporting of adverse events. Furthermore, they may differ in aggressive treatment with surgical excision of localized infection known to improve outcome; this study did not collect data on surgical interventions. Despite these limitations, PHN's study provides us with additional understanding of the epidemiology, contemporary treatment, and outcomes of IMIs in children. More pediatric studies are needed.


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I sure hope you do not think Apple will rebound because you will be needing some very strong medicine. Matter of fact BJ's Warehouse sells Peptol Bismol by the gallon for a discount. You will be needing to save money. Trust me on this one.
if true .. it will affect every electronics manufacturer not just apple! Apple is not operating in another universe.. they do what they do by being smart ..
AAPL is in a MUCH better position because they have pre-bought HUGE chunks of components locking in low prices.....and making supply scarce. They will kill the tablet competition on Functionality AND Price.
it does not matter to AAPL.... AAPL pre-paid;but other are not ... OUNCH!
Dead right....all these tablet cloners losers are going to go the same way as the Windoze Zune....I remember when all the Dozers were saying the Zune was going to KILL the iPod....LOL
You better stock up on vaseline at BJ's Warehouse dude to help with the chafing of your butt cheeks as AAPL moves back up after this blatant options pinning at 350.00. I mean, come on, any fool can see what's going on.... No, wait, I'm sure it's just a coincidence....AAPL pulls back to 350 and POT pulls back to a perfect 180, etc....

subset: commoncrawl


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Daniel Hill Mews, Sheffield S6Flat to rent - 3 bedrooms
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Jews and Hip Hop
Former Bad Boy superstar Shyne surprised many when he converted to Judaism during his eight-year prison bid. Since his release, he's been seen sporting Jewish garb in Israel, letting his beard and sideburns grow, and at times renouncing his gangster-rap roots in favor of his new religious path. On August 1, he unveiled a new song, "King Crown of Judah," featuring Hasidic rap-reggae singer Matisyahu, which addresses his faith and conversion head on. We're not sure why people have been that surprised though — hip hop and Judaism have been crossing paths for years now. Click on for a look at some of the most prominent Jews in rap.
(Photo: UPI/Debbie Hill /Landov)
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PURCHASE, N.Y. — Misericordia's baseball team opened Freedom Conference action with a 28-2 win at Manhattanville on Friday.
After taking a 6-0 lead in the first inning, the Cougars opened up a 14-2 lead before scoring 14 runs in the eighth inning.
Kyle Lindsay had four hits and Jeremy DeCotiis drove in five runs to lead the Cougars.
Ryan Dorosh struck out 12 over seven innings to earn the win.
DeSales 17, King's 6
King's Tim Zaccone collected two hits for the Monarchs and scored a run, while Stephen Brynock also chipped in two hits to go with an RBI and a run in the King's loss.
King's sweeps doubleheader
King's posted a doubleheader sweep of Baptist Bible College, winning 16-2 and 9-0.
Amanda Cardone was 3-for-3 with a double, triple, home run and three RBI in game one, while Jenn Harnischfeger also finished 3-for-3 with a double, triple, three RBI and four runs.
Amy Kowalczyk finished 2-for-3 with a two-run double in game two, while Maggie Gola was also 2-for-3 with a double. Kelsie Senchak added an RBI-triple for the Monarchs.
Eastern sweep Wilkes
Wilkes opened its home schedule and Freedom Conference play with a pair of losses as Eastern won 12-0 in five innings and 7-1.
Alysha Bixler suffered the loss for Wilkes in game one. Haylie Phillips took the loss in game two, allowing six runs and eight hits.
Misericordia 9, Immaculata 0
Misericordia earned the victory in a sweep of Immaculata.
Tony Goodall, Corey Dulsky, Christian Pugliese, Robert Knipper, Eric Correll and Samarth Shah were all double winners for MU.
Wilkes 9, Elizabethtown 0
The Colonels remain unbeaten after cruising to a 9-0 victory.
Wilkes swept all three doubles before posting wins in all six singles.


text:
Playstation 2
Restore Tricky meter for SSX TrickyHome / Playstation 2 /
This page contains SSX Tricky Hints for Playstation 2 called "Restore Tricky meter" and has been posted or updated on May 23, 2009 by peterpota. Let us know what you think of this Hint by thumbs voting.
Boxshot / Details
- Developer: EA Canada
- Publisher: EA Sports Big
- Genre: Sports
- Release Date: Nov 5, 2001
- ESRB: Everyone
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Restore Tricky meter
If you are running out of Tricky boost (for Uber Tricks), do a 180 while riding to get it full.
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text: Books These Books Have Gone to the Dogs November 6, 2006 A book about a dog has been at or near the top of nonfiction best-seller lists for about a year now. Librarian Nancy Pearl suggests some other notable books featuring, but not necessarily written by, canines. Listen Loading… Download Playlist


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Established in 1993, The Watch Company has grown to four retail stores and one central ecommerce facility. Whether you shop online or at one of our Watch Co. stores, you can rest assured knowing you'll experience the same passion for all things watches and unmatched dedication to customers who share our appreciation for a high-quality, well-designed timepiece.
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The number of people drowning in the Maritimes is falling, but the rates are not the same in all three provinces.
The latest Maritimes Drowning Report from the Lifesaving Society Canada says 153 people drowned in the Maritimes from 2007-11, which represents an 11 per cent drop in the drowning rate when compared to 2002-2006.
The best news in the report came from Prince Edward Island, where the number of people who drowned was cut almost in half, from 13 to 7. The rates in New Brunswick were the same as the Maritime averages, and the rate in Nova Scotia did not change.
Halbert Pratt, president of the Lifesaving Society of P.E.I., would like to see those rates stay down. He said the coming four weeks are peak drowning season.
"Play it safe, enjoy the summer, swim with a buddy and if you're getting into some place where you should be wearing a lifejacket by all means do," said Pratt.
That advice is especially important for young men. While parents are understandably careful with their children, it is men between the ages of 25 and 29 who are most likely to drown, with rates more than double those for children. Young men in the Maritimes are also more likely to drown than young men in other parts of Canada.
The report identified some of the some of the greatest risk factors for drowning.
- Not being able to swim
- Swimming alone
- Alcohol consumption
- Not wearing a life jacket when appropriate
The Lifesaving Society does not have data beyond 2011, but an official with the P.E.I government said there was just one drowning in the province last year.
For mobile device users: Which of the risk factors for drowning would you consider the biggest concern for you or your friends and family?
Comments on this story are moderated according to our Submission Guidelines. Comments are welcome while open. We reserve the right to close comments at any time.
Note: The CBC does not necessarily endorse any of the views posted. By submitting your comments, you acknowledge that CBC has the right to reproduce, broadcast and publicize those comments or any part thereof in any manner whatsoever. Please note that comments are moderated and published according to our submission guidelines.


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The mass atrocities being committed daily in Syria will not cease without outside intervention, says Radwan Ziadeh, spokesperson of the Syrian National CouncilMore
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In his essay, Radwan Ziadeh, founder and director of the Damascus Center for Human Rights Studies and an activist during the "Damascus Spring", discusses several possible scenarios for the outcome of the conflict between the Syrian regime and the protest movementMore
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Beautiful actress Arielle Kebbel is one of the stars of "The After" Amazon video television series and she is attracting the attention of entertainment insiders for her recent appearance in the pilot episode of the show. The creator of the show, the renowned X-Files creator Chris Carter, made the decision to leave huge room for growth in Arielle Kebbel's character which suggests that he has big plans to showcase her dramatic acting talents in this role.
Arielle Kebbel in "The After" plays the role of Tammy, an escort who has become a favourite of fans of this show in large part because of her decision to take a swim absent her bikini and the fact that she has fans wondering what will be her next move. Arielle Kebbel is known to fans for her role in "Vampire Diaries" and as a very attractive actress but she is much more than just a beautiful actress and this is something that is known to the producer of "The After" and also to entertainment insiders.
Television critics can envision Arielle Kebbel's character expanding and thus enabling her to show her impressive dramatic range over the course of the next several episodes of "The After" that have been ordered by Amazon due to the immediate popularity of the show which they were able to determine due to the fact that the show is made available on video.
There are some actresses who have the potential to take a role and make it one that viewers consider a must-see character and it looks as if the creator of "The After", Chris Carter, believes that Arielle Kebbel possesses this ability and considering her performance in the pilot episode of the show, the fans and entertainment critics seem to agree.


text:
Tech Helproom
It's free to register, to post a question or to start / join a discussion
PC for £500 or less
Likes # 0
Posted November 18, 2012 at 12:29AM
Hello I am having trouble with trying to find a PC that is powerful enough to use 3D modeling software and also good enough for gaming and is £500 or less. If you find a desktop PC it also needs to have a monitor, keyboard and mouse with it and where are the best places to get big sales on PCs on boxing day.
Likes # 0
Posted November 18, 2012 at 9:17AM
You are going to struggle with that sort of budget particularly when you need to include all the peripherals with the PC.
Likes # 0
Posted November 18, 2012 at 9:45AM
You can try putting one together here http://www.cougar-extreme.co.uk/ but as Chronos the 2nd states, you will struggle with your budget.
Likes # 0
Posted November 18, 2012 at 1:02PM
I have to agrre with Chronos and Kestrel , your budget is way short of the mark . A more realistic budget would be in the £800 - £1000 range
Likes # 0
Posted November 18, 2012 at 5:37PM
Found a Dell Ultrasharp U2312HM 23 inch IPS LED Monitor for a £153.94 and a Vostro Desktop 470 MT for £379 which adds up to £532.94 which I can afford. The desktop has 3rd generation Intel® Core™ i5-3450 processor (3.10GHz with Turbo Boost 2.0 up to 3.50GHz), Windows 8 Pro 64bit English, 4GB2 DDR3 SDRAM at 1600MHz, 500GB Serial ATA III (7.200 Rpm) Hard Drive and 1GB ATI® Radeon™ HD 7570 graphics card. Is this good enough for what I want to use it for.
Likes # 0
Posted November 18, 2012 at 5:55PM
Check the Vostro price again. It doesn't include VAT or shipping.
Likes # 0
Posted November 18, 2012 at 6:28PM
Might have to increase my budget even further but is this PC good for what I want to use it for or would I be wasting money that could be used on something better.
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4:08 pm
Thu March 31, 2005
Terrorism Bill Concerns Humane Society
By Pat Bradley
Plattsburgh, NY – A growing number of states are seeking harsher penalties for attacks by animal rights activists and environmentalists. Arson, vandalism, assault, break-ins and other tactics used by extremists already are illegal, but a national group of conservative state lawmakers has been promoting laws creating a separate offense of eco-terrorism.
The Humane Society of the United States opposes violence in the name of protecting animals, but considers many of the recent proposals too broad, especially one that has been introduced in New York.
More From WAMC's North Country Bureau Chief Pat Bradley.


text:
Federal Employees Health Benefits Program:
Enrollee Cost Sharing for Selected Specialty Prescription Drugs
GAO-09-517R: Published: Apr 30, 2009. Publicly Released: Jun 1, 2009.
Additional Materials:
- Full Report:
- Accessible Text:
(202) 512-7043
Office of Public Affairs
(202) 512-4800
Recent increases in prescription drug costs have been fueled in part by the high and rising cost of specialty prescription drugs. Specialty prescription drugs are typically used to treat chronic or life-threatening conditions, such as multiple sclerosis and cancer, for which few other treatment options exist. The drugs typically have few competitors or generic alternatives and may require frequent dosage adjustment, special storage, patient education, or special methods of administration, such as by injection. Costs for specialty prescription drugs are usually high, typically ranging from $1,200 to $40,000 for a 30-day supply. Health plans--including those participating in the Federal Employees Health Benefits Program (FEHBP), which covers nearly 8 million federal employees, dependents, and retirees-- provide coverage for many specialty drugs. Enrollees may be required to pay a portion of specialty drug costs through a copayment--a flat dollar amount--or coinsurance--a percentage share of the drug's actual costs. To manage the high and rising costs of these drugs, some health plans have begun to require enrollees to contribute a greater share of their costs, such as by increasing the use of coinsurance. Congress asked us to examine the costs that FEHBP enrollees may incur for specialty prescription drugs. In this report we describe cost-sharing requirements and limits for specialty drugs covered by FEHBP plans.
Enrollees in FEHBP plans are subject to varying cost-sharing requirements for the 18 specialty drugs. More than 6.6 million of the nearly 7.8 million enrollees in the plans we reviewed (86 percent) are generally subject to copayments that limit enrollee costs to about $55 on average for a 30-day supply of the drugs. Nearly 900,000 enrollees (11 percent) are subject to coinsurance for more than 1 of the 18 specialty drugs, which requires the enrollees to pay on average nearly 31 percent of the cost of the drugs. About 700,000 of the enrollees subject to coinsurance are in plans requiring it for all 18 of the drugs. Enrollees' coinsurance costs for specialty drugs are typically limited by per prescription dollar maximums or annual out-of-pocket limits. Depending on the plan, these varying requirements can result in a wide range of costs for enrollees for the same drug. For example, we estimate that an enrollee taking the multiple sclerosis drug Betaseron for a year could pay $420 if subject to a copayment, $2,400 if subject to a coinsurance with a per prescription dollar maximum, or $6,000 if subject to a coinsurance with an annual out-of-pocket maximum.
Mar 27, 2015
Children's Health Insurance:Coverage of Services and Costs to Consumers in Selected CHIP and Private Health Plans in Five StatesGAO-15-323: Published: Feb 25, 2015. Publicly Released: Mar 27, 2015.
Mar 25, 2015
Health Care Funding:Federal Obligations to and Expenditures by Selected Entities Involved in Health-Related Activities, 2010-2012GAO-15-270R: Published: Mar 20, 2015. Publicly Released: Mar 25, 2015.
Mar 24, 2015
Drug Discount Program:Status of GAO Recommendations to Improve 340B Drug Pricing Program OversightGAO-15-455T: Published: Mar 24, 2015. Publicly Released: Mar 24, 2015.
Mar 23, 2015
Private Health Insurance:Early Evidence Finds Premium Tax Credit Likely Contributed to Expanded Coverage, but Some Lack Access to Affordable PlansGAO-15-312: Published: Mar 23, 2015. Publicly Released: Mar 23, 2015.
Medicare:Payment Methods for Certain Cancer Hospitals Should Be Revised to Promote EfficiencyGAO-15-199: Published: Feb 20, 2015. Publicly Released: Mar 23, 2015.
Mar 13, 2015
Medicaid Financing:Questionnaire Data on States' Methods for Financing Medicaid Payments from 2008 through 2012 (GAO-15-227SP, March 2015), an E-supplement to GAO-14-627GAO-15-227SP: Published: Mar 13, 2015. Publicly Released: Mar 13, 2015.
Medicaid Financing:States' Increased Reliance on Funds from Health Care Providers and Local Governments Warrants Improved CMS Data Collection [Reissued on March 13, 2015]GAO-14-627: Published: Jul 29, 2014. Publicly Released: Jul 29, 2014.
Mar 9, 2015
Comparative Effectiveness:Initial Assessment of the Patient-Centered Outcomes Research InstituteGAO-15-301: Published: Mar 9, 2015. Publicly Released: Mar 9, 2015.
Mar 4, 2015
Healthcare.gov:CMS Has Taken Steps to Address Problems, but Needs to Further Implement Systems Development Best PracticesGAO-15-238: Published: Mar 4, 2015. Publicly Released: Mar 4, 2015.
Drug Shortages:Better Management of the Quota Process for Controlled Substances Needed; Coordination between DEA and FDA Should Be ImprovedGAO-15-202: Published: Feb 2, 2015. Publicly Released: Mar 4, 2015.
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text: A couple weeks back we attended a very invigorating panel about startup culture. It was the third installment of Orrick's Founder's Guide series where they ask successful startup folks to talk shop. Orrick is a law firm that specializes in the tech world and startups. But as far as law firms go their content engine, Orrick Total Access, is actually very good. That was the inspiration for the panel, which included the likes of Amanda Hesser, Co-Founder and CEO of Food52, Shauna Mei, Founder and CEO of AHAlife, and Chantel Waterbury, Founder and CEO of Chloe + Isabel.


text:
FAO Schwarz, New York City
26 Reviews
26 Reviews
Unbelievable.....this is the LARGEST toy store in the world.
It was made famous in the movie with Tom Hanks called "Big".
What to buy: They have the Simpsons as shown in this picture, barbie dolls, stuffed animals larger than life. Just anything any rich person can desire is here.
This is the one place that seems to consistently have a long line waiting to get in. One of those sneaky lines too. Where you think you're getting close, only to discover that it snakes around yet again.
What to buy: People come here more to gawk at the displays than to buy anything. You could pick up a little something I guess, so you can walk up and down fifth ave. with a FAO Schwaz shopping bag. Of course if you have kids, NOT buying anything is not an option.
Opened in 1870, this place is an institution. I have very fond memories of visiting this store as a child. FAO Schwarz is the most wonderful toy store in the world. It is a giant department store filled with toys. Nothing even comes close. The Tom Hanks "Big" keyboard dance scene was filmed here. Multi level and full of every thing imaginable. At Christmas time there is actually a long line of parents and their desperate kids that are waiting to get inside for their ultimate childhood fantasy. Truly Fantastic!
What to buy: From baby rattles to $30,000 lifesize toy cars. Large log houses, slides and giant teddy bears. It's a wonderful feast for your eyes.
What to pay: I think it can be expensive, but it's the experience your'e buying.
I hadnt been in FAO in about 15 years when I found myself walking by it on a VT tour. We ducked in and to my surprise at the top of the stairs they had set up a Kwicky Mart.
Proving once again. NYC has it all.
FAO Schwarz, is a playground for parents as well as children. It stands as one of the world's largest toy stores and matches that grandeur with life-size stuffed animals, immense displays, and even a separate Barbie doll annex.-
What to buy: Toys, toys and more toys. You can shop by categories, brands, boutiques, characters or from their FAO catalog.-
What to pay: It´s so expensive, but , there are lots of bargains in FAO bargain bazaar.-
My son just loved it. Before we left to New York, he saw the movie 'Big' with Tom Hanks.
He couldn't believe his eyes as he recognised the store with the piano on the floor.
What to buy: Toys of course ...
Across the road from the Plaza Hotel (as in Home Alone) and beside Central Park. The big teddy is great for a photo opportunity
What to buy: Anything! There's every sort of toy or game you could want.
What to pay: Expensive-ish
YES, I kid you not...$10,000 for this giraffe. It is standing between the escalators..WOW!!! can you imagine.
This is the outside of FAO Schwarz but they are remodeling it.
we walked all around it for three days until realized this was what we were looking for.
So, keep eyes peeled.
This is a huge toy store filled with every toy or game imagineable.
Even if you don't want to buy anything, it is worth going in for a look around.
I've been to Hamley's in London and FAO's in NYC, and it's a close one but FAO Schwarz's is the better toy shop. You could spend an entire week here
Get an instant answer from local experts and frequent travelers
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text:
In just minutes, you can create fresh, homemade meals the entire family will love. These kid-tested recipes make healthy eating fun, even for young chefs in training.
The Vitamix 5200 Deluxe offers three containers and two cookbooks.
Discover just how easy it is to make fresh, homemade baby food.
read more
Children love to help, especially in the kitchen, and a child who helps you prepare a dish is much more likely to try it.


text:
I heard the word spinal stenosis(narrowing of the open spaces within your spinal column).
If people say something rude or off-color, you have to take it with a grain of salt, because they don't know you.
Chris Daughtry
titiwio-he can still do that as a Mike. He just moves the best in space imo of all the possible mlb rd 1 names associated with our potential pick. he has a burst/quickness that isnt matched as well. he also can be used as a DL on occassion...you could use him all over the place and he just seems with his athleticism AND ability to take on blockers that he'd be my choice at least over ogeltree, who in reality is actually a similar prospect.
Last edited by giantsfan420; 03-21-2013 at 03:28 PM.
or if we could trade back and grab him and an additinal 2nd. dude was a consensus top 10 pick before the medical questions...and prob still goes top 10
If we are lucky enough to get Ogletree I'll be pretty happy.
Fast, good in pass coverage, solid tacking technique, good off the edge, and loved the stuff at the goal line:
Last edited by moosedrool; 03-21-2013 at 03:39 PM.
"Behold, the tailgate party. The pinnacle of human achievement. Since the dawn of parking lots, man has sought to fill his gut with food and alcohol in anticipation of watching others exercise."
- Homer J. Simpson


text:
Latest Science education Stories
10 Events Focus on Science, Technology, Engineering and Math (STEM) Philadelphia, PA (PRWEB) April 03, 2014 On Saturday, April 5th, approximately 50
12 Teachers and STEMConnector® Honored at Annual Science Education Conference WILMINGTON, Del.
Conference goal is to enhance science teacher development and improve learning in STEM FALLS CHURCH, Va., April 2, 2014 /PRNewswire/ -- The Northrop Grumman Foundation is joining with
techJOYnT Academy will be in DC, with an interactive booth showcasing Robotics and Game Design on the last week of April.
Nation's Science Teachers to Be Introduced to a New Array of Resources for Educators and Students San Diego, CA (PRWEB) March 27, 2014 On April 3-6,
Yahoo's Marissa Mayer, IBM's Florence Hudson, Microsoft's Julie Larson-Green, and UCF's Pamela McCauley Bush are among the 42 members of this year's Connected World magazine Women
Dr. Charles A.
Global contest promises to rewrite the future of play. Boulder, Colorado (PRWEB) March 14, 2014 DevelopHer Toy & Game Challenge (DevelopHer), the
Eighth-grade students from West Philadelphia will be experimenting with making and recycling bio-plastics. Philadelphia, PA (PRWEB) March 10, 2014 Middle
Learning List, a K-12 instructional materials review service, releases reviews of Scientific Minds' Biology Starters and Chemistry Starters. Austin, TX (PRWEB)
- One who brings meat to the table; hence, in some countries, the official title of the grand master or steward of the king's or a nobleman's household.


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The first domestic trailer for Tinker, Tailor, Soldier, Spy, that movie you only care about because it has a couple of actors from The Dark Knight Rises in it, has arrived. To get a look at Ralph Fiennes, Colin Firth, Gary Oldman, Tom Hardy, and Ciarán Hinds in Tomas Alfredson's espionage thriller, check out the exciting video below.
Tinker, Tailor, Soldier, Spy was released December 9th, 2011 and stars Mark Strong, John Hurt, Zoltán Mucsi, Péter Kálloy Molnár, Ilona Kassai, Imre Csuja, Gary Oldman, Toby Jones. The film is directed by Tomas Alfredson.


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Ralph LeVanSenior Research ScientistOCLC
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This information is deemed reliable but not guaranteed. You should rely on this information only to decide whether or not to further investigate a particular property. BEFORE MAKING ANY OTHER DECISION, YOU SHOULD PERSONALLY INVESTIGATE THE FACTS (e.g. square footage and lot size) with the assistance of an appropriate professional. You may use this information only to identify properties you may be interested in investigating further. All uses except for personal, non-commercial use in accordance with the foregoing purpose are prohibited. Redistribution or copying of this information, any photographs or video tours is strictly prohibited. This information is derived from the Internet Data Exchange (IDX) service provided by Sandicor®. Displayed property listings may be held by a brokerage firm other than the broker and/or agent responsible for this display. The information and any photographs and video tours and the compilation from which they are derived is protected by copyright. Compilation © 2015 Sandicor®, Inc.
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Friday, March 27, 2015
Friday Games
Deep Sleep
Double Wires
Lego racer
Splitter 2
Flood Fill
Dig to China
Gimme Friction Baby. Olden but golden.
Spin the Black Circle
Football quiz: guess the player or team from these Premier League stats 3/10.
Football quiz: name the career. 11/15.
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Labels: Games and Quizzes
Thursday, March 26, 2015
How Obesity Became a Disease
Genetically speaking, mammals are more like their fathers
A paralyzed woman flew an F-35 fighter jet in a simulator — using only her mind
To digitize a brain, first slice 2,000 times with a very sharp blade
As They Lay Dying
Short-sightedness is reaching epidemic proportions. Some scientists think they have found a reason why.
Playing ill or feigning madness has been a con for hundreds of years. But can a fake sickness become a real sickness?
Sexing up the human pheromone story: How a corporation started a scientific myth
How Obesity Became a Disease
This is why you shouldn't believe that exciting new medical study
Angelina Jolie Pitt: Diary of a Surgery
My First Life as a Nurse
The Two Leukemia Patients Whose Survival Revolutionized Cancer Treatment
Poison As Medicine: How A Bee Sting Saved My Life
Is Medicine's Gender Bias Killing Young Women?
Posted by ILuvNUFC 0 comments
Labels: Health
Wednesday, March 25, 2015
Beauty Tips for Girls, From Lego
For Master Thieves, Legos Are the New Uncut Diamonds
A Dad Posted His Son's Lego Design On Imgur And Days Later It Was Bought By A Toy Company
Mapped: The beaches where Lego washes up
How Lego Became The Apple Of Toys
How scientists are using Lego to handle insects
Lego Jurassic Park Is Everything We Wanted It To Be, And More
Beauty Tips for Girls, From Lego
WorldBricks - Lego Catalogues
Lego Spider
Disneyland Made Out Of Lego
The Brick Testament
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Labels: lego
Tuesday, March 24, 2015
Lithofayne Pridgon: Jimi Hendrix's original 'foxy lady'
An Oral History of Laurel Canyon, the Sixties and Seventies Music Mecca
The Music Industry's Biggest Problem Is You
How I Taught My Computer to Write Its Own Music
The six golden rules of moshpit etiquette
Court Sides with Bob Marley's Family in Suit Over the Use of His Portraits on T-Shirts
Exclusive: Listen to a Brand New Jimi Hendrix Tune, 'Station Break,' Unearthed After 50 Years
Music to die for: how genre affects popular musicians' life expectancy
Lithofayne Pridgon: Jimi Hendrix's original 'foxy lady'
33 Musicians Discuss Their Favorite Radiohead Songs
Posted by ILuvNUFC 0 comments
Monday, March 23, 2015
When the Town Stops Burning
How Ikea took over the world
India's Dying Well of Death
When the Town Stops Burning
Why are van Gogh's paintings slowly turning white?
Tales of Whoa
Doing astronomy with neutrinos
Goodbye, math and history: Finland wants to abandon teaching subjects at school
It's Not a Junk Drawer. It's An Archive Of An Interesting Life
The Economics of California's Drought
'The Anarchist Cookbook' and the rise of DIY terrorism
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Labels: Mixed Bag
Friday, March 20, 2015
Thursday, March 19, 2015
Newcastle Graffiti
Hiding messages in hotels since 2006
Graffiti Art of the City, From the Bronx to Brooklyn
Graffiti Mecca 5Pointz Whitewashed Overnight
Humorous Street Art and Urban Interventions by SpY
"City as Canvas: Graffiti Art from the Martin Wong Collection": See Some of the Greatest Graffiti Relics from 1980s New York
Can Graffiti Be Copyrighted?
Newcastle graffiti 2014, 2013, 2012, 2011 and 2010. From Flickr user apwbATTACK
10 Pieces of Nasty Ancient Graffitti - Now Translated!
The Brilliantly Colored Graffiti Murals of El Salvador
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Labels: Graffiti
Wednesday, March 18, 2015
The World War II Multimedia Database
The World War II Multimedia Database
Thousands evacuated after WWII bomb found in French city
Miss Atomic Bomb: the A-Bomb in Popular Culture--Comics, Cakes and the Will of God
Digging Up Ads From WWII—When They Pushed Products No One Could Buy
D-Day's Legacy: Remnants of invasion linger in beach sands
The Bombing of Dresden, 13/14 February 1945
The Cold War's Missing Atom Bombs
Erno Egri Erbstein: Tragic tale of Jewish soccer hero who defied Nazis
World War II: Daring Raids and Brutal Reprisals
WWII battleship Musashi found, says Microsoft's Allen
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Tuesday, March 17, 2015
Kangaroo has a sneezing fit
Top Predators May Be the Most Important Animals on Earth
In Animal Kingdom, Blood Comes in a Rainbow of Colors
8 Amazing Animals at Risk From Wildlife Crimes
Chameleons Use Built-In Crystals to Change Color
Undercover Photos: Plight of Zimbabwe's Captured Baby Elephants
'Extinct' Bird Rediscovered in Myanmar, Surprising Scientists
8 things you didn't know about ferrets
Back from the brink of extinction: hunting for the world's rarest frog
Pedro the pony gets periscope to see over his door
The surprising way bighorn sheep use their horns
Camera trap captures rare tiger family portrait
The bobcat is an unexpected urban resident
Even Squirrels Are Eating Almond Butter
This Baby Elephant Is Excellent At Birthdays
Secret hideout helped penguins survive the ice age
Coyote finds old dog toy, acts like a puppy
Animals making some seriously silly faces
Birds build some staggering structures, from nests the size of walnuts to makeshift rafts and even apartment complexes
Horses can read human signals and use their own experiences when responding to tasks
Weird and wonderful animal encounters
The tails of peacocks aren't just pretty to look at. They also make infrasound that humans can't hear
From the impossibly large and showy to sharp and deadly, each of these bird beaks is superbly designed for purpose
Penguins Rapidly Conquered New Zealand After Humans Ate Rivals
Alligator hazard is par for the course at Florida golf club
Beavers on verge of living wild in England after being confirmed free of disease
Urban wildlife: when animals go wild in the city
The Daily Wild: Nature's Most Incredible Creatures
Piggyback riders: 17 funny photos of lazy hitchhiking animals
Kangaroo has a sneezing fit
Man wakes up to find python in his box of cornflakes
Our humble hedgehog is disappearing fast
International Polar Bear Day celebrated with wildlife photographer Paul Goldstein
Animal photos of the week
Lynx to be reintroduced into wild in Britain after a 1,300-year absence
Pangolins: What are they, why are they so endangered and what can we do to help?
Indian tiger triumph may be based on shoddy science, study says
Photo: Eastern screech owl is a perfect ball of cuteness
The most contaminated birds on the planet: Michigan's bald eagles are full of illegal flame retardants
Photo: Snowy owl stare down
Watch This Adorable Baby Elephant Take The Clumsiest Bath Ever
17 Lion Vines That Will Kill You With Cuteness
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Labels: Animals - Other
Monday, March 16, 2015
The Labradoodle Racket
The Labradoodle Racket
Dogs Can Sniff Out Thyroid Cancer in Your Urine
Man's Best Friend: Photos From Around the World
Dog with cancer gets helping hand from Home Depot
Shelter cat makes perfect rock-climbing partner
Meet the Poop-Sniffing Dogs That Are Saving Endangered Wildlife
Dog Days of Winter? Alaska's Lack of Snow Forces Change in Iditarod
17 Extremely Helpful Cats
22 Dogs Who Are Just Really Happy To Be Here
What Makes a Great Sled Dog? Breed, Ambition, Tough Feet
Dog walks 20 blocks to find owner in hospital
Pusses in boots
Don't judge a dog by its fur (or lack thereof)
New film reveals special relationship between inmates and shelter dogs
8 special dogs saved by social media
7 things your senior dog would like to tell you
How to safely bike with your dog
Why are male calico cats so rare?
Beanie cat
What do you get when you cross a pit bull with a Dachshund?
Popular pet names offer cultural snapshot
Meet the cats that rule Facebook
Have cape, will travel Meet Britain's most heroic dogs
Cat crawls from grave 5 days after burial ... and lives!
Snoozing hound dreams big in magical nap scenes
17 Puppies Who Are So Cute They Will Make You Mad
Snacking In America Hits "Tipping Point," Cats And Dogs Included
The 20 Cutest Underdogs At The Westminster Show Ranked
27 Dogs Who Just Know How To Have A Really Fun Time
Dog allegedly poisoned at Crufts show dies
This Cat Can't Stop Hugging His Dog Friend Who Just Returned Home After 10 Days
A complete guide to taking road trips with your dog
Can You Spot The Cat?
19 Confused Puppies Learning About Water
The Definitive Ranking Of Dog Breeds
NYPD Rescues Adorable Pack Of Sweater-Wearing Puppies From Abandoned House
Meet The Newest Cat Who Also Happens To Be A Real Grump
21 Super Cute Dogs Who Are Embracing This Never-Ending Winter
Share and share alike
27 Cats Who Will Make You Question Evolution
21 Puppies Who Haven't Grown Into Their Ears
Man Receives Instant Karma After Laughing At Dog Slipping On Ice
How to make your cat happy
21 Dogs Who Made Poor Life Choices
12 Cats That Are Definitely Libertarians
24 Cats Who Are Actual Nightmares
Obese Dachshund Lost 44 Pounds After Giving Up Burgers And Pizza
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Labels: Animals - Cats and Dogs
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Giuseppa Tiralongo (1913 - 1978)
Biography & Family History Add details
Giuseppa Tiralongo (1913 - 1978) was born in 1913. Giuseppa was born into the Tiralongo family.
Giuseppa was born to Latina Sebasti Tiralongo and Pazzano Rosa Tiralongo, and was an only child. Giuseppa died in 1978 in Fitzroy, Australia at age 65.
Giuseppa Tiralongo's last known residence is at Fitzroy, Australia.
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Quagga Mussel Containment Strategy
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Date: May 23, 2014
The National Park Service (NPS) has developed a response strategy in accordance with the NPS Quagga/Zebra Mussel Infestation Prevention and Response Planning Guide (2007) to help reduce the spread of quagga mussels from Lake Powell to other lakes and rivers. The Glen Canyon National Recreation Area quagga mussel program has shifted from prevention (trying to keep the mussels out) to containment (trying to keep the mussels from spreading to other bodies of water).
As a result, ramp hours will no longer be restricted and green mussel free certificates no longer required. NPS staff will focus on checking for evidence of attached mussels on boats entering and leaving the lake. Rangers on the ramps, at the marinas, and along beaches will educate visitors on how to stop the spread of mussels with Clean, Drain, and Dry techniques.
Utah and Arizona state laws require that boat owners decontaminate their vessels and conveyances to avoid the transport of quagga mussels to uninfested waters.Specific information on state laws for Utah can be found at www.wildlife.utah.gov/mussels or for Arizona at www.azgfd.gov/ais.
"Now that the quagga mussels are in Lake Powell, we need to focus our efforts on containing them," said Superintendent Todd Brindle. "We all put up a good fight for 14 years to keep Lake Powell mussel free, but now we need to work just as hard to protect other lakes and rivers."
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The ride-hailing service will help the India-based safety-tracking app collect more information about various areas in New Delhi.
The countries' intelligence agencies will work together and conduct cyberwar games later this year to test the security of financial institutions.
The online retail giant launches Zocalo, a storage and sharing service designed for companies.
With Crowd Companies, Jeremiah Owyang is hoping to help companies develop business models and best practices around the shared economy, the maker movement, and more.
The cloud storage company wants to power the editing and collaboration behind all software, starting with integration within Microsoft Office applications.
Google Keep is receiving an update that will add two useful features to the note-taking app. Here's how to use them.
Windows apps are arriving on new devices from Dell and other hardware makers. Microsoft is also expanding its partnership with Samsung.
After a series of allegations of Uber drivers committing rape and other crimes against passengers, the ride-hailing company expands on its safety measures.
Single and in a hurry? The ride-hiring app service has teamed up with a luxury car-rental service to give rides around the island nation in supercars.
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He was her first lover and the first to break her heart, but Jack has never forgotten Cassie. He's determined to prove he's changed and win...
How to Talk Dirty
It's a simple question that opens the door to talk about family. Those are the relationships he's been grooming his whole life, so they're a pretty good indicator of how he'll be with you. It's why we love us a mama's boy.
See if his answer is something you could get behind, and get a feel for the kind of thing he's interested in. If he'd love to live on a mountain and your idea of roughing it is going a week without a manicure... well, you see where this is going.


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Video: Stylista's Cologne
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Johnny Weir Has to Sell His Clothes on eBay to Escape Fashion Judgment
"I have so many beautiful clothes that I can really only wear once without being judged."
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"Our styles kind of mix together now...we kind of coordinate in a way."
On the Liberating, Isolating Choice Not to Have a Baby
For years it was just Courtney Hodell and her brother—gay, fun, fantastic. Then he decided to have a child.
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