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There has been no dearth of expressions of concern over the catastrophic consequences of the rising food prices for the global poor. Yet even as global organisations including the World Bank and the IMF have joined in the chorus, there is the realisation that there are no easy or quick fix solutions to the crisis. Soaring food prices have threatened food security and led to riots in quite a few countries. According to the Food and Agriculture Organisation (FAO), food prices have increased by 75 per cent in dollar terms since 2000. The rise has been particularly pronounced in 2007. While the escalation in rice prices is fairly more recent, the prices of wheat, corn and many food products have been witnessing a surge since 2006. Quite ominously, the prices of wheat and rice have been scaling new highs even as their stocks are down to unprecedented levels. Stocks of rice are at their lowest since 1976. In the case of wheat, the figure is the lowest in about 50 years — the global stocks are enough to meet just five weeks of requirements. Geopolitical tensions among countries over food prices have increased. In practically all developing countries, rising up to the challenges posed by the soaring food prices has become the single most important item on their governments' agenda.
The stakes are indeed very high. The World Bank President, Robert Zoellick has said that the rise in food prices could push 100 million people in developing countries deeper into poverty. Earlier, the IMF had warned that hundreds of thousands of people are at risk of starvation. While they emphasise the dimensions of the food crisis, the world bodies really do not offer any new plan of action. Thus the World Bank's recently adopted "new deal" to tackle the crisis is a reiteration of well recognised interventions. Basically, it calls for expanding social security programmes targeted at the poor over the short-term and improving agricultural productivity in the long-run. However, exceptional situations such as the food crisis require the world organisations to go beyond such customary advice. Two factors aggravating the food shortage can be neutralised only through global cooperation. The switch from food crops to biofuels in the United States and the European Union, often by subsidising their farmers, is one of them. The pernicious influences of climate change on food production are well documented and they can be countered only with the active participation of the developed countries. The latter should also be persuaded to rethink their biofuel policies.


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Global Health
Mapping the Future of Global Surgery
A map can tell you where you are, and it can also help lead to where you want to be.
The findings of the landmark Lancet Commission on Global Surgery report, which includes publications in seven academic journals and a series of teaching cases, are an assessment of the current state of need for surgery worldwide in resource-poor settings. The report also outlines steps that commissioners say will lead not just toward improved access to surgery for people around the world, but toward sustainable universal health care.
On May 6, the Commission held the Boston launch of the report at Harvard Medical School. The event was focused on the contributions that care providers, academic medical centers, industry and donor organizations in the developed world can make toward these goals. A series of similar events will take place around the world.
John Meara, the HMS Steven C. and Carmella R. Kletjian Professor of Global Health and Social Medicine in the Field of Global Surgery and lead author of the report, outlined the history of the commission process and pointed the way toward the future.
"We started with a clear vision," said Meara, who is also HMS associate professor of surgery at Boston Children's Hospital. "Universal access to safe, affordable, surgical care and anesthesia."
The study more than doubled previous estimates of unmet need for surgical care, finding that 5 billion people are unable to access safe, timely affordable surgery and anesthesia. This leads to 18.6 million preventable early deaths each year, surpassing the number of people who die from HIV/AIDS, malaria and tuberculosis combined. To meet these needs, researchers calculated that an additional 143 million more surgical procedures were needed annually.
As if the costs in human life and health weren't enough, the lack of surgical access also has dire economic costs: 33 million individuals face catastrophic expenditures that will plummet them into extreme poverty if they seek surgical care, and many low- and middle-income countries are fast approaching the point where losses in productivity from people hurt or killed by lack of access to proper surgical care will cost 2 percent of GDP.
"We call it a launch for a reason. It's not the end of the journey. We have a long way to go, and we're going to have to work together," Meara said.
In spite of the human and economic costs, the Commission found that surgery is not only affordable, it is actually a high return investment, saving lives and preventing economic loss that far outweighs the costs of providing necessary care.
Reaching the necessary levels of access to surgery by 2030 would require an investment of $420 billion, the commission found. That investment would save an estimated $12 trillion in lost GDP over the same period, they found. Researchers at the launch noted that these estimate make surgery a "best buy" in global health.
"We have to think in a fundamentally different way about health care and surgery's role in it in developing countries," Jim Yong Kim, president of the World Bank and former head of the HMS Department of Global Health and Social Medicine, said in a taped video address. Kim and others also noted that, since surgery is crucial to health, it is an essential part of economic development.
"Without surgery, sustainable economic development is a fairy tale, a laughable fiction," said Gavin Yamey, associate professor of epidemiology and biostatics at the University of California, San Francisco School of Medicine.
Throughout the day, speakers focused on the power of collaboration and accompaniment and emphasized that surgery is an indivisible and indispensible part of health care delivery. To accomplish these goals, surgeons will need to work with educators and students, clinicians and community health workers, hospital administrators and logistics experts. Speakers also emphasized the importance of integration, collaboration, broad-scale systems development, and building local capacity through training.
Many speakers highlighted the importance of creating pathways to unleash the passion, skills and commitment of young people throughout the world who want to make a career in global surgery.
The report features several "heat maps" that plot the availability of surgery and the supply of surgical professionals by country. In his afternoon keynote address, Paul Farmer, the Kolokotrones University Professor of Global Health and Social Medicine at Harvard and head of the HMS Department of Global Health and Social Medicine, noted that the areas in the maps that indicate the greatest unmet surgical need correspond almost exactly to the countries that are undergoing what some call a "youth tsunami."
Farmer suggested that instead of thinking of this coming wave of young people as a destructive, crashing force, we should see them as a source of enthusiasm, energy and innovation.
"We have to think of them not just as potential patients, but as future colleagues in global health and global surgery," Farmer said.
Cholera Vaccine Succeeds in Rural Haiti
A vaccination campaign that almost didn't happen was widely effective in reducing transmission of cholera in the midst of an ongoing outbreak of the disease in rural Haiti.
According to a study led by Harvard Medical School researchers at Partners In Health, there were 63 percent fewer cholera cases among the thousands of adults and children who received the cholera vaccine Shanchol than among those who were unvaccinated. The results were published in the March issue of The Lancet Global Health.
"This study demonstrates that the vaccination campaign saved lives and reduced suffering," said Louise Ivers, HMS associate professor of global health and social medicine and a senior health and policy adviser at Partners In Health. "We undertook the campaign as a public health emergency, but having data to demonstrate how effective it was helps to solidify the case for using vaccines in this kind of setting—and that helps transfer lessons from Haiti to other places where cholera occurs or may appear for the first time."
The plan to provide the vaccine was surprisingly controversial. Skeptics cited several reasons: the vaccine had been proven effective in areas with smoldering, lingering cholera, not in a full-blown outbreak; the impoverished landscape and absence of a functioning health system in much of rural Haiti would present logistical challenges; and an approach common in resource-limited settings that delivers the minimum basic health care in order to save scarce funds.
Critics of the vaccination plan suggested that efforts would be better spent on basic hygiene education and hand-washing campaigns. The vaccine costs $1.85 per dose.
"When you see people dying, you want to do everything you can," said Ivers, who is also HMS associate professor of medicine at Brigham and Women's Hospital. This includes preventive measures such as hand washing, treatments like rehydration, and using the vaccine.
Working with the approval of the Haitian Ministry of Health, Partners In Health and its sister Haitian organization Zanmi Lasante carried out the vaccination program from April to June 2012, training field workers, fighting the rainy season mud and ensuring that 45,417 patients swallowed two doses of the drug two weeks apart.
"Our study contributes to mounting evidence that oral cholera vaccines have an important role to play as a component of comprehensive, integrated cholera control efforts in Haiti," the study concludes.
The study also highlights the importance of integrating the development and testing of new vaccines and therapies, the creation of health care delivery systems and the collection of crucial research data in comprehensive, coordinated efforts.
The team also included physicians and researchers from Brigham and Women's Hospital, Massachusetts General Hospital, Zamni Lasante and the Haitian Ministry of Health and Population. Molly Franke, HMS assistant professor of global health and social medicine, was senior author on the paper.
This research was funded by the National Institutes of Health, the Delivering Oral Vaccines Effectively project and the HMS Department of Global Health and Social Medicine.
Adapted from a story originally posted at PIH.
The Ebola Era
While the current Ebola outbreak in West Africa appears to be waning after claiming more than 9,000 lives, public health and scientific concerns about the crisis remain urgent. Harvard Medical School will host a symposium on March 5, 2015, to shed light on the issue.
Register here.
"Rethinking the Response to Emerging Microbes: Vaccines and Therapeutics in the Ebola Era" will convene international experts in virology, infectious disease, vaccines and therapeutics. They will discuss strategies both to combat the current Ebola outbreak and to inform future preparedness for the unique challenges of this and other emerging infections.
HMS faculty members David Knipe, Michaela Gack, Sean Whelan, Stephen Harrison, Peter Sorger, Priscilla Yang, John Mekalanos and James Cunningham will moderate four sessions:
- Overview of the Ebola virus, its pathogenesis and the state of the current outbreak
- What are our most promising current and future therapeutics and vaccines?
- What are the scientific and regulatory issues limiting development of Ebola vaccines and therapeutics?
- How can we be more prepared for future emerging infections?
Speakers will include Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, and other leaders from government, the biomedical industry and academic research centers.
The symposium will be held from 8:30 a.m. to 5:15 p.m. March 5, 2015, in the Joseph B. Martin Conference Center Amphitheater in the New Research Building at Harvard Medical School.
This event is made possible by grants from PhRMA (the Pharmaceutical Research and Manufacturers of America) and the HMS Max Finland Lecture Fund.
Paper Test for Ebola
Imagine administering a diagnostic test for Ebola while sweltering in an airtight hooded spacesuit—with thick rubber gloves on your fingers. Then consider waiting for results while someone else operates the technology that signals whether it's a grave illness or a more ordinary infection that the person is suffering.
Thinking about devices in the hands of the people actually using them is exactly what a team of biomedical scientists and engineers from Harvard Medical School and MIT are doing as they design a diagnostic to detect Ebola virus and other dangerous microbes.
A cheap, reliable test made of paper that can rapidly determine infection is the goal of a team led by Lee Gehrke, HMS professor of microbiology and immunobiology and the Hermann von Helmholtz Professor of Health Sciences and Technology at MIT. They hope to make it as simple to use as a home pregnancy test. How cheap and how fast? Under $10 and under 20 minutes.
"That's really the mantra of the work we are doing," Gehrke said in an interview in his MIT office. "We are trying to devise devices that are easy to use in austere environments that have no power, no refrigeration, no specialized chemicals, no specialized instrumentation—and can give a quick triage notice of what disease a patient may have."
Of all the crying needs seen in such abundance in West Africa during the Ebola epidemic, diagnostic testing is high on the list. Health workers need to know who is harboring infection and who is not—quickly—without relying exclusively on sophisticated equipment whose results require off-site interpretation or troubleshooting. Proper treatment and containment of infectious pathogens hang in the balance.
"Is the person handling the test going to have to have a PhD in microbiology, or will it be somebody who just finished cleaning up after a patient and has never seen a rapid test before? Will they be wearing thick gloves to protect themselves?" asked José Gómez-Márquez, director of MIT's Little Devices Laboratory. "Making sure these things survive in an environment as hellish as what we see in West Africa can be a big challenge."
For the past five years, long before Ebola began its sweep through Guinea, Liberia and Sierra Leone, Gómez-Márquez and Gehrke have been working with other scientists and engineers in the Harvard-MIT Program in Health Sciences and Technology to bring diagnostic tools to low- and middle-income countries.
Ebola virus infection may be the most terrifying outbreak right now, but other viruses perennially spread misery among people living in countries where health care systems are less than robust. Their common symptom is fever, so distinguishing among dengue fever, Marburg fever, yellow fever and chikungunya virus infections and their subtypes is important.
The researchers hope their answer is on paper, more specifically, 3 millimeter by 15 millimeter (1/8 inch by 9/16 inch) strips of paper that separate gold nanoparticle sensors carrying antibodies and single strands of DNA or RNA called aptamers. These sensors bind to certain microbial proteins in blood or serum that then flow through paper fluidic pathways to create patterns of lines that identify the pathogen.
Gehrke calls it a simple design based on the well-established technology known as lateral flow chromatography, or paper fluidics. The goal of this project is to show that a complex mixture of proteins or sera applied to the device can deliver a clear signal about which virus or pathogen is present in such a way that is not confused by cross-over from other viruses or serotypes.
While their work had advanced the furthest on a multiplexed dengue fever test, the team accelerated its pace on an Ebola test when the crisis emerged in West Africa. Last fall they sent their Ebola test to the Texas Biomedical Research Institute in San Antonio where former HMS colleagues Jean Patterson and Anthony Griffiths are involved in verifying its accuracy in animals experimentally infected with live virus in the institute's Biosafety Level 4 Laboratory.
What they learn from dengue testing could help shape the Ebola test.
In dengue infection, discerning which serotypes are in a sample is important because immunity from one does not protect against infection with another. Changes in dengue virus samples can predict epidemics in regions where the cyclical, mosquito-borne disease is a threat.
Laboratory testing in Cambridge has shown that the team's test can pick up the four dengue serotypes. Field testing will begin in the spring in Bucaramanga, Colombia, to make sure that differences in factors such as diet, for example, between populations in Cambridge and Colombia don't interfere with the results. A sterile lab is different from a real-life clinic, where patients' leftover blood samples will be used to test the test.
Colleagues in Colombia will also be observing how people use the paper-test device and how a mobile phone app can be enlisted to record and report their findings through simple MMS or SMS messages. The mobile phone removes the subjectivity from analyzing the test results, and the team is focused on developing a culturally and clinically appropriate phone interface to use with the device.
"The challenge with detecting viral proteins or viral antibodies is that their blood levels change during infection," Gehrke explained. "The added value is that the changing levels provide information about the stage of the infection, which might be relevant to how the patient is treated."
While the scientists cannot predict when either the Ebola or the dengue test would be ready for use in the real world, Gehrke and Gómez-Márquez said they will be making changes in an iterative way based on the Colombia testers' results, speeding the process and broadening the definition of codesigners to include testers and their ideas.
To expand crowdsourcing even further, Gómez-Márquez wants to enlist patients as "citizen sensors." Ultimately the scientists hope to combine data from these tests, which can be used not just in the clinic but also in the home, to create a real-time map of disease spread in parts of the world where mobile phones may be easier to find than health care. Public health researchers now rely on information that can be weeks old, but immediate, verifiable confirmation of infection could better guide medical response.
"We don't think about this specifically as an Ebola test," Gehrke said. "Rather, we are developing a platform that could be used for a number of different kinds of tests. Fortunately this Ebola outbreak is waning, but what's coming next?"
Prescription for Ebola
When Ebola meets modern medicine, most patients survive.
But the Ebola epidemic in West Africa is raging far from the hospitals in Germany and the United States, where the few people infected with the virus have received prompt diagnosis and aggressive care.
Instead, patients in Liberia, Sierra Leone and Guinea are dying for lack of "staff, stuff, space and systems," Paul Farmer told the Harvard Medical School community members who gathered to hear him talk about Ebola and global health equity.
Farmer is the Kolokotrones University Professor of Global Health and Social Medicine at Harvard and head of the HMS Department of Global Health and Social Medicine. He is also the co-founder and chief strategist of Partners In Health, whose mission is to bring the benefits of biomedical science to those most in need.
"Modern medicine and Ebola have never collided before," he said. "What we are doing now is making them collide."
Modern medicine means IV solutions and the nurses to deliver them, plus clinics to care for patients and systems to control spread of the infectious disease while winning the trust of the people they serve.
Farmer cast his glance around the Joseph B. Martin Center auditorium, appealing for volunteers to join the cause.
"The unswerving support of the leadership at the medical school and its affiliated hospitals has been and will be critical to turning the Ebola epidemic around," he said.
On his trips to West Africa, he hears time and time again that the virus was spread by one person caring for another at home.
"Doctors and nurses are at high risk, but so is anyone providing care: children, relatives, neighbors, Good Samaritans," he said. "The transmission chain of Ebola is caring."
Hydration and electrolyte replacement are the minimum interventions required to help patients recover. During infection, Ebola patients, much like cholera patients, can lose up to 10 liters a day of fluids. There are not enough health care workers to make up the difference.
"In Liberia, a country of 4 million people, there were fewer than 50 physicians in the country working in health care delivery in the public sector before Ebola. You can imagine what it is now," Farmer said. "I see 50 physicians on every floor of the Brigham on any given morning."
Volunteers should be taken care of, too, he said, rather than met with threats of quarantine and stigma when they return.
Ebola's impact on Liberia's primary care system has been devastating and complete, he said. "If it was bad before, it's nothing short of apocalyptic now."
To help "our neighbors," we need to think about building health systems. But before then, people need to trust the Ebola treatment units where they now fear they will die.
"We need to drop the mortality rate by providing quality health care," he said.
Farmer buttressed his arguments by citing examples of work done by Partners In Health in Haiti and Rwanda.
In his introduction, Jeffrey S. Flier, HMS dean, said, "Instead of choosing between providing care and building local capacity, Paul finds a way to do both."
In closing, Farmer reminded his audience of the medical response to people injured in the 2013 Boston Marathon bombings.
Because of staff, stuff, space and systems, he said, no one who made it alive to a Boston hospital died.
"Can we do it in West Africa?" he asked. "Of course we can."
Understanding Enterovirus-D68
Over this summer and fall, enterovirus-D68 spread across the United States. This virus belongs to a virus family that is subclassified into familiar categories, including polio viruses, coxsackie A and B viruses, echoviruses and other enteroviruses.
These viruses cause a variety of illnesses, including gastrointestinal illness, rash and neurologic illnesses, such as aseptic meningitis. The respiratory tract is mildly affected.
EV-D68, however, was recognized as causing moderate to severe respiratory illness in children in the Midwest in August 2014. These affected children usually had a preexisting respiratory condition such as asthma.
Indeed, children with asthma seem to be particularly vulnerable with these children presenting symptoms such as cough, shortness of breath and difficulty breathing. Fever, which occurs in only about 30 percent of affected children, is not a major component of this illness. Thomas Bernard Kinane is an HMS associate professor of pediatrics at Massachusetts General Hospital and an international expert in pediatric respiratory conditions. Here he talks with Harvard Medicine News about EV-D68.
HMS: How concerned do people need to be about enterovirus?
KINANE: Most EV-D68 infections cause very mild symptoms, like a cough, runny nose or muscle aches. In patients with respiratory disease it can cause more serious symptoms, such as difficulty breathing or wheezing. These patients can be severely affected but almost all recover.
HMS: Who in particular might be more vulnerable or at most risk?
KINANE: Children with asthma seem to be particularly vulnerable, but asthma is not the only respiratory condition that is exacerbated by this virus. Patients with neuromuscular disease and interstitial lung disease seem to be similarly affected.
HMS: How does it differ from other more common viruses such as cold and flu?
KINANE: Enteroviruses are a different viral family from the cold (rhino) virus and the flu (influenza) virus. Enteroviruses do not usually affect the respiratory system as cold and flu viruses do. Indeed, this enterovirus is different from other enteroviruses as it seems to predominantly affect the respiratory systems.
HMS: In what sorts of ways is the biomedical research community making progress against these sorts of pathogens?
KINANE: This virus is relatively new and has only caused minor outbreaks of viral illness over the last 40 years. The medical community has focused on supportive care, which has allowed almost everyone to recover.
However, there is intense focus on another illness. Over the last two years, there was another unusual illness affecting a very small number of children. This illness causes acute muscle weakness, similar to polio. Two of these cases tested positive for EV-D68. It is difficult to know if this new condition is related to EV-D68 but is subject to intense research.
HMS: Are there more of these kinds of dangerous viruses out there in the community then there have been in the past, or are we just more aware?
KINANE: From time to time a new virus emerges; most of the viruses are variations of well-known viruses. The CDC has an excellent surveillance system. There is no reason to be concerned.
Ebola Update
On September 30, the first case of Ebola virus disease diagnosed outside of Africa during the current outbreak was reported in Dallas, Texas. With more than 3,000 already dead and estimates that as many as 1.4 million may become infected by January, the outbreak, centered in the West African nations of Liberia and Sierra Leone, has the potential to be a massive public health crisis with lasting implications across the global community.
As members of the Harvard community respond to the epidemic, Michael VanRooyen, HMS professor of medicine at Brigham and Women's Hospital, professor in the department of global health and population in the Harvard School of Public Health and director of the Harvard Humanitarian Initiative, highlights what we need to know now about the disease.
HMN: With news of this recent case in Texas, what do Americans need to know?
MVR: The U.S. has excellent resources to detect and manage an outbreak and to prevent epidemic spread of Ebola. U.S. hospitals are generally well prepared (or will be). I think there is still work to be done for routine questioning and screening of travelers from West Africa by airlines and travel security to identify high-risk travelers. This is the same in U.S. hospitals caring for recent travelers from Ebola-endemic areas.
HMN: What are the breakdowns in global public health that got us to this point?
MVR: Ebola is a disease of poverty. Liberia and Sierra Leone have very little true public health capacity and limited public health literacy, which makes epidemic detection, investigation and management very challenging. It is important to note, however, that early in the epidemic, organizations that were working on containing the epidemic, including Doctors Without Borders and Samaritan's Purse, were calling for help and indicating that this was an extraordinary event with explosive potential. One breakdown in the system was the lack of ability to listen to such advice and to mobilize international resources earlier.
It was an important moment when the President declared Ebola as a national security issue and mobilized resources. There is still little understanding, however, of the economic and security threats to West Africa. The effects of Ebola will be measured not only in those infected with the virus but in the economic slowdown and collapse of the health system.
HMN: Many entities, such as the World Health Organization, are urging the global community to step up efforts, and organizations like Partners In Health are acting. But what still needs to be done that isn't being done? What can academic institutions like ours do that isn't being done yet?
MVR: Many organizations are scaling up efforts, and there are new Ebola Treatment Centers planned; most are not familiar with the management of this type of emergency, so the time to operational readiness is slow. While treatment centers are important, it is also important to note that this war will be won not in the hospital but in educating communities, increasing public awareness and advancing new models like home-based care. This is not as high profile, but public health will be the answer to stopping the epidemic.
HMN: Are there any plans yet to send people from the Harvard Humanitarian Initiative to Africa?
MVR: We are working with several NGOs and the U.N., WHO, etc., to identify personnel needs. HHI-affiliated physicians and technical experts are being deployed on behalf of their home hospitals and will work within existing NGOs. HHI is also coordinating data collection and sharing for Doctors Without Borders and others running Ebola treatment centers and assisting African leaders to advocate for logical policy and increased resources.
HMN: What lessons must the global community draw from this outbreak?
MVR: Listen to the field. As with many major humanitarian emergencies, this epidemic could have been controlled far earlier and with far fewer resources if we would have 1) understood the need to prepare for these crises, and 2) listened to field organizations who see the crisis expanding. Now we have to play catch up.
Speeding HIV Care
A new point-of-care test to measure CD4 T cells, the prime indicator of HIV disease progression, can expedite the process leading from HIV diagnosis to antiretroviral therapy (ART) and improve clinical outcomes. Now a study by Massachusetts General Hospital investigators, working in collaboration with colleagues in Mozambique and South Africa, indicates that routine use of point-of-care CD4 testing at the time of HIV diagnosis could be cost effective in countries where health care and other resources are severely limited.
Their analysis is published in the journal PLOS Medicine.
"In severely resource-limited settings, too many people learn that they have HIV but then never initiate care," explained Emily Hyle, HMS instructor in medicine at Mass General and lead author of the paper. "Point-of-care CD4 tests can help more people reach care. But it is critical to evaluate the implementation of any technology more expensive than current care to be sure the investment is a wise one. Our mathematical model, based on the situation in Mozambique, found that point-of-care CD4 testing at the time of HIV diagnosis was very cost effective, as long as patients then have access to ART."
In most regions of sub-Saharan Africa, when people are diagnosed with HIV the standard procedure is to send blood samples to an external laboratory for CD4 testing. Patients must then return to the clinic to learn their test results, which determine whether they meet local standards to receive ART. Additional visits are often required to educate patients on the procedures necessary for successful treatment.
Patients may have limited ability to travel back and forth to clinics that are far from their home communities and require taking a day off from work, so many of them fail to return after initial diagnosis and never receive the care they need. A point-of-care test can reveal an individual's CD4 result the same day as the original diagnosis, allowing expedited initiation of ART for those who meet local standards.
Conducted in collaboration with the Clinton Health Access Initiative, the Mass General-led study used an established mathematical model of the natural history of HIV infection—including outcomes related to diagnosis and treatment initiation—to simulate adoption of point-of-care CD4 testing at an HIV testing and counseling clinic in Mozambique. Previous studies in that country, some conducted by co-authors of the current report, indicated that the availability of point-of-care CD testing improved patients' linkage to continued care but did not evaluate the costs associated with the test itself and with the initiation of ART.
The current analysis revealed that the information provided by point-of-care CD4 testing would allow more patients to receive treatment sooner than if laboratory testing were used, resulting in almost one full year of additional life expectancy. With a cost-per-year-of-life-saved of $500—less than Mozambique's per-capita GDP of $570—point-of-care testing meets standards to be considered "very cost effective."
The authors noted that because their model used the least favorable estimates for the accuracy and costs of the point-of-care test, the actual cost effectiveness could be even greater. They also examined scenarios reflecting situations in other sub-Saharan countries, some with less stringent standards for ART eligibility and others with reduced access to care. The model indicated that point-of-care testing would have the greatest clinical impact and be most cost effective in areas with fewer opportunities for patients to reach care if care had not been started at the time of their initial diagnosis.
"Many types of point-of-care testing are of value in resource-limited settings, especially those with limited capacity for convenient or frequent clinic visits. The rapid turnaround provided by point-of-care CD4 testing can substantially improve clinical outcomes and be cost effective," said Rochelle Walensky, HMS professor of medicine at Mass General and senior author of the report. "Further studies are needed to investigate point-of-care CD4 testing for monitoring of patients who have started on ART in order to determine whether treatment is effective or should be changed to other, more expensive options."
Funding for this study includes National Institute of Allergy and Infectious Disease grants T32 AI 007433, R01 AI058736, R01 MH090326 and R01 AI0932690, as well as grants from the U.K. Department for International Development and the Clinton Health Access Initiative.
Adapted from a Mass General news release.
Mobilizing Against TB
Every year, more than one million people around the world die from tuberculosis, a disease that has been treatable and preventable for decades.
"Although new tools are needed, we could achieve zero deaths from TB with treatments and technologies that we've had since the 1980s, but to reach that goal we need to fundamentally change the way we look at the disease," said Salmaan Keshavjee, director of the Harvard Medical School Program in Infectious Disease and Social Change and associate professor of medicine and of global health and social medicine at HMS.
"We need a road map to ensure that the medicines and methods that have already been proven to save lives make it the last mile down the road to the communities where they are needed most," he said.
To that end, on Sept. 12 Paul Farmer, Kolokotrones University Professor at Harvard and chair of the HMS Department of Global Health and Social Medicine, and Paul Stoffels, chief scientific officer and worldwide chairman of Janssen Pharmaceuticals of Johnson & Johnson, hosted a symposium on "Rethinking the Global Response to Tuberculosis" that brought together innovative researchers and care givers to address the challenges of treating and preventing TB in new ways.
The symposium also launched a new program funded by a pledge from Janssen Pharmaceuticals to HMS that will help plot a course for improved access to TB diagnosis and treatment in some of the world's most vulnerable communities.
While the disease has virtually vanished in the United States and Western Europe, TB is hiding in plain sight in India, China, the Russian Federation and South Africa, where nearly 60 percent of the world's multi-drug resistant-TB cases are found. Eastern European and Central Asian countries are hot spots for the disease, accounting for nearly one-third of new infections and two-thirds of previously treated TB infections. TB is the biggest killer of people co-infected with HIV in sub-Saharan Africa and elsewhere.
"Harvard Medical School is proud to forge a new partnership with Janssen to begin to address many of the gaps in the current approach to combatting TB—developing a new roadmap for TB treatment and prevention, working in alliance with researchers and advocacy groups here and around the world to shift outcomes, hopefully in a dramatic fashion," HMS Dean Jeffrey S. Flier said in his welcoming remarks.
Stoffels spoke about the importance of transforming the global response to tuberculosis through collaboration, stressing the importance of speeding the transition from the discovery of new science to the delivery of solutions for patients. "That requires massive partnerships," Stoffels said.
Janssen Pharmaceuticals, a company of Johnson & Johnson, developed bedaquiline, the first new medicine for TB in forty years.
Instead of funding pharmacological research or a pilot program for a new clinical model, the Janssen project will support a broad effort to promote and empower innovation and integration of effective existing TB treatments in local health systems, changes in global TB policy and the development of new community health systems needed to fight TB, with a particular focus on drug-resistant TB and TB in children.
"Stopping the spread of TB—whether in a single community or around the globe—requires strong partnerships and bold action," said Farmer. "Many in the global health community have begun to mobilize around the goal of zero tuberculosis deaths; achieving such a vision will require a major acceleration of efforts to link service delivery, research and the training of health workers. This project is a critical next step on that path."
Other symposium speakers outlined the importance of using a multi-disciplinary approach—understanding the disease in historical and cultural context and looking for solutions using the methodologies of microbiology, epidemiology, genetics and engineering, and about various potential methods to improve treatment and save lives.
Finding missing children
In the 1970s, global health policies were put in place that prioritized treating the most infectious cases of TB with the hope that strategic application of limited resources would stop TB in its tracks. This left many cases of TB untreated, or treated ineffectively, which helped fuel the rising pandemic of drug-resistant TB.
In addition, since TB in children rarely takes the most infectious forms of the disease, pediatric TB became an unseen epidemic.
"We have a perfect recipe for making TB in kids invisible," said Mercedes Becerra, associate professor of global health and social medicine at HMS and author of a recent study that doubled the estimate of the global burden of TB in children.
Childhood TB looks different than TB in adults—kids often have extra-pulmonary TB that affects their bones or other body parts instead of their lungs. And the most widely used test for the disease catches fewer than one in five children sick with TB.
"We found that a million kids are falling sick with TB every single year," Becerra said. "But TB can be prevented, and each one of those children represents a missed opportunity to stop the spread of the disease."
Fighting drug resistance
The selective treatment policies put in place also increased the risk of developing drug resistance in the bug. Drug-resistant forms of TB also often go undetected in resource-poor settings, because lab tests for resistance are difficult to administer with limited infrastructure.
Even when drug-resistant TB can be detected, the months-long therapy necessary to effectively treat the illness requires a careful integration between hospitals, clinics and community health workers.
To overcome these challenges, Keshavjee says, the support from Janssen Pharmaceuticals will help researchers, physicians and policy makers rethink how the disease should be approached worldwide.
"This is a great opportunity to rethink our whole global strategy for TB," said Keshavjee, who will serve as the leader of the new program.
The program will enable HMS to help set treatment targets based on sound science and accurate estimates of disease prevalence, partner with grassroots organizations in affected communities, assist low- and middle-income nations in developing their own initiatives to address this and other diseases within their borders, and monitor progress as we move toward achieving zero TB deaths, he said.
"Just as we need to translate research findings from the basic science lab bench to the hospital bedside, we also have to get better diagnostics and medicines into the communities and homes where patients live, currently beyond the reach of over-burdened health care systems," said Keshavjee.
"Getting to zero deaths from TB may be an aspirational goal, but we should also see it as a practical task," said Becerra. "We need to find the best way to get there before more people die unnecessarily."
Seven Things to Know About Ebola
The death toll from the Ebola outbreak in West Africa has passed 1,000 and is still rising, according to the World Health Organization. Fear of the virus and concerns about its spread beyond Liberia, Guinea, Sierra Leone and Nigeria are also soaring.
Hospitals in the United States, including Harvard affiliates in Boston, are reminding their staffs of standard infection-control procedures in case someone infected with Ebola comes through their emergency department doors.
Sean Whelan, HMS professor of microbiology and immunobiology and an expert in virology who studies Ebola and other pathogens, talked to Harvard Medicine News about the small chance of infection in North America, the very real humanitarian crisis in West Africa and progress being made toward therapies against the deadly disease.
Here are his answers to seven questions about Ebola.
HMN: What is Ebola?
SW: The Ebola virus was discovered in 1976. It is an RNA virus with what we call a negative-sense genome, and that virus, when it infects a cell, makes more virus particles. An infection of humans by this virus causes hemorrhagic fever and massive damage to the internal organs. Basically the body goes into shock.
HMN: What can be done to prevent or treat it?
SW: There is no current vaccine or antiviral drug that is approved to treat Ebola virus infection.
Ebola certainly has been well studied by the research community, but developing a therapeutic is not something that is a priority for most pharmaceutical companies, for example.
Until the current outbreak, the total number of deaths from Ebola virus that we knew of since 1976 was about 2,000. Whilst there's active research to study Ebola virus infection, there are a number of other infectious agents that are responsible for many more deaths per year on a global scale than Ebola.
Also, because it's a biosafety level four virus, you can work with the complete virus only in very specialized containment facilities, including the one that's about to finally open at Boston University.
The U.S. government, through the National Institutes of Health and through the Centers for Disease Control and Prevention, has funded lots of research on Ebola.
HMN: Should people in the U.S. be concerned?
SW: I don't see Ebola virus becoming a significant public health problem in the U.S. Ebola is a horrible disease but you're obviously much more likely to be exposed to Ebola virus in Africa than you are in North America. I think the challenges of being infected with a virus like Ebola are compounded because of the living conditions in West Africa versus here.
I think it's right for people in the U.S. to be concerned about Ebola virus infection, but I think we should be concerned from a humanitarian perspective, to help combat the outbreak in West Africa. I don't see that Ebola is going to become a public health problem in North America.
There was a story in the news about a patient at Mt. Sinai Hospital in New York who presented with vomiting and diarrhea and had just returned from West Africa and was being checked to see if they had Ebola virus. Well, it's much more likely that they just have food poisoning of some description.
It's an important disease and we should be vigilant and continue our efforts to try and develop therapies to combat this disease.
HMS: What might be in the pipeline?
SW: There's a candidate vaccine that has been generated by Heinz Feldmann [chief of the laboratory of virology at the National Institute of Allergy and Infectious Disease Rocky Mountain Laboratories] that's based on vesicular stomatitis virus (VSV).
He replaced the envelope protein of VSV with that of Ebola virus and has demonstrated that that virus will protect monkeys against a challenge with infectious Ebola. If given 48 hours post-infection along with a lethal dose of Ebola, it will protect those monkeys against disease so they recover.
There are also a number of interesting candidate antiviral therapeutics in various stages of development that treat the infection. Jim Cunningham [HMS associate professor of medicine (Microbiology and Molecular Genetics) at Brigham and Women's Hospital] has been working on one in cell culture that remains to be proven in the context of an infectious scenario in large animal models of disease.
There is an inhibitor against the polymerase of Ebola virus that was published earlier this year by Sina Bavari's group at USAMRIID [U.S. Army Medical Research Institute of Infectious Diseases]. That polymerase inhibitor was able to treat monkeys that were experimentally infected with Ebola. They recovered from that infection. But the toxicity of that compound isn't fully clear.
So there are things that are in stages of development, but there's nothing that is currently approved as a drug and has made it through a set of trials.
HMN: What about ZMapp, the experimental serum?
SW: It's an anti-serum that is basically an antibody against Ebola virus. We've known for years that passive immunotherapy can protect against many diseases, so long as you get it early enough in the process of infection. This experimental antibody is apparently what the people brought back to the United States had been given. But again, this antibody hasn't yet been approved as a licensed therapeutic.
This is one of the challenges with these types of diseases.
How do you get approval for doing a human clinical trial for an infectious agent like this?
Under these conditions where you have an infectious agent whose lethality varies, depending on the outbreak, from 50 percent up to 90 percent, then if your chance of surviving an infection is one in two, you're probably going to be willing to take whatever you can.
HMN: Why do Ebola outbreaks flare and subside?
SW: It's very difficult to absolutely pin down why an outbreak starts. One source of transmission to people is eating or butchering contaminated monkeys. But as to how the virus is really transmitted in nature, what's the real reservoir for the virus? Some people argue that it's bats.
And then the reason that the outbreaks subside is often because of the isolation of the people who are infected. People who are infected are very sick and it's only very close contacts of these people who usually get infected by the virus. So it sort of naturally dies out.
HMN: What's next?
SW: I'm optimistic based on the currently available data that one day there will be an effective treatment.
Then the question becomes, how do you make that available to the people most in need of this treatment? You know, the ZMapp antibody, for example, if it's going to be an effective therapy, there has to be a way to get it to people and keep it cold and then there has to be a way to inject those people with it. And antibody-based therapies are very expensive.
From a humanitarian perspective, I think there is the will to do this.
The U.S. has invested a lot of money in trying to develop therapies and vaccines to treat this disease. There are a lot of people working on this problem and a lot has been learned in the past decade or so in particular. I think the fact that there are certain experimental therapies and a candidate vaccine already in progress is a testament to that work.

subset: commoncrawl


text:
In a study titled "Benefits of SenseCam Review on Neuropsychological Test Performance," Ana R. Silva and colleagues highlight how wearable cameras can act as a cognitive stimulant in the short term. Compared to re-reading diary entries, Microsoft's SenseCam wearable camera was found to improve autobiographic memory by prompting events reflected in the images, underlining the possibilities for using SenseCam in memory rehabilitation. While future research is still needed, the researchers propose wearable cameras have the potential to reduce the resources required in treating neurodegenerative diseases, such as Alzheimer's.
Another study, "The Smartphone as a Platform for Wearable Cameras in Health Research," recognizes obstacles in the widespread adoption of Microsoft's SenseCam wearable camera, and thus presents smartphones as a viable, and in some cases, enhanced alternative.
An article by Paul Kelly and colleagues identifies and addresses the ethical implications of using wearable cameras in research. Because wearable cameras by nature can be intrusive, a framework for future ethical practice is proposed.
|Contact: Brianna Lee
Elsevier Health Sciences


text:
Armin Arlert from Attack on Titan
Armin Arlert from Attack on Titan
Round Robin: Investigation Notes:iconNaruto-Artists: NaruFest 2014 Murdery MysteryRound Robin: Investigation Notes by myomi-chan
Team Naruto: Investigation Files into the Murder of Sakura Haruno
1) OutrealmGate
2) myomi-chan
3) penguintejas
4) Carrere6
**bolded = clues to murder suspect
**underline = investigator
OutrealmGate: We are investigating the Murder of Sakura Haruno.
Some of the early details we've discovered so far include the bloody hand print found on Mei Terumī's dress. Wait! I'm getting a head of myself. Before we get to that I should mention that her body was found at the masquerade ball. It was said that the lights went off and when they were turned back on she was dead. Hinata screamed and the hand print was found. We spoke with lady Tsunade and she informed us that her jugular vein was cut by an unknown weapon and her right arm and mouth were bruised. She must have been&
Kishimoto Speaks After Naruto's FinaleQuestion: What are you feeling now?Kishimoto Speaks After Naruto's Finale by Naruto-Artists
Kishimoto: Because I just completed the last episode less than 12 hours ago, I do not have any real feeling (that "Naruto" has ended). I have had to meet a deadline every week for 15 years, so I feel that there's a deadline for next week. I thought of many things to do after ("Naruto") ends, but I do not know where to begin. I want to do something other than manga. Don't worry, I will continue creating manga.
Q: When did you decide how to end "Naruto"?
Kishimoto: Since the work was first serialized, I have been determined to end the manga series with the battle between protagonist Naruto and Sasuke, who has been his rival since the start of the story. I later decided on the details, little by little, such as whether they would fight each other as friends or enemies, their feelings and dialogues, while I was drawing the series. Around two years ago, I began to feel the story was approaching the finale.
NaruFest 2014 Murdery Mystery
Team Naruto: Investigation Files into the Murder of Sakura Haruno
1) OutrealmGate
2) myomi-chan
3) penguintejas
4) Carrere6
Carrere6: We were a bit apprehensive about asking Gaara for information, seeing as he was not present at the masquerade, but after we managed to dig up some information on Tenten for Gaara he gave us some intriguing information as well. A white kitsune mask had been found outside in a tree. The first thought that came to mind was the ANBU and their signature animal masks, but this murder was too sloppy and the evidence just did not add up enough to incriminate any of the highly skilled ANBU. With this in mind we forged ahead in our investigation as Gaara lead us to Sasuke.
We finally got to questioning Sasuke and after solving a tricky riddle for him he gave us more details about a fight he had with a masked man who Sasuke knew as Sakura's ex boyfriend. Then ex seemed determined to win back Sakura's affections which led to an all-out fight between Sasuke and the Mysterious ex. The fight was so heated that it had taken both Jiraya and Killer Bee to break up the scuffle. It was at this point the mask had fallen off and Sasuke identified the masked man as none other than Naruto. Shocked at this new found information we headed over to blood prison to question Naruto.
As we entered the holding cell we see a dejected Naruto slumped over, when he finally senses our presence he quickly jumps to defend himself. Our front is one of caution and distrust, but a lingering doubt arises as we notice the earnest look in Naruto's eyes and his past record of protecting Sakura. We tried to probe Naruto for more answers to clear his name, but his memory is fuzzy. We chat so we can try to jog his memory and after solving a riddle it all comes back to him.
Naruto recalls that he was on a mission that night with Itachi in the Hidden Mist Village. There is no way Naruto could have committed the murder. After reassuring Naruto we quickly rush out of blood prison to find Itachi so we can confirm this newfound information. After hours of searching we finally spot Itachi lazing about in a sakura tree. With a rather lax tone he confirms the information Naruto gave us.
Deciding to clear our heads we head to the local ramen shop and layout all our information. The man identified as Sakura's ex had the same face as Naruto, yet Naruto could not have been at the scene. We pause for a moment trying to decipher this information. Naruto coud have used the Shadow Clone Jutsu, but there is still no clear motive. We all sigh in resignation. Who looks like Naruto, wields a kama, goes around in a kitsune mask and black with red strapped get up, and would have strong feelings for Sakura. We stare down at our ramen as we watch the various condiments, such as naruto and menma float about. That's when it clicks.
(All investigators)
CONCLUSION: Menma Uzumaki murdered Sakura Haruno at the Ball after he failed to win back her affections. He committed the murder with a kama while wearing a black and red outfit and a kitsune mask, then fled the scene.
i am in ^_^ come check out the group!
go hinatachaaannnn~~! XD is my group!
sasusaku!!!!! (however unlikely it may b nau) XD i made this groups icon XD
and fyi, mah webcam pwns XD always XP
Current Residence: the land of narutards. XP
Favourite genre of music: j-(anything here)
Favourite style of art: anime!!!! XD
Operating System: dattebayo brain. aka naPutardness XD
Shell of choice: a seashell i guess...
Skin of choice: uhm MY skin....?
Favourite cartoon character: hinata!!!!!!!! XD i even made a fanclub 4 her XD
Personal Quote: "It's okay to give up. Go ahead, give up for today. In about five minutes, you'll realize your mistake and un-give up."


text:
Keeping your display full with a rich assortment of the most popular flavors will inspire shoppers to buy more. Regularly adding both regional and seasonal favorites to your lineup, will keep the look of your fudge display fresh and exciting. Here are some tips.
Login to see this and more exclusive content designed to help your fudge business thrive.
To tempt every customer to buy your fudge, you'll want to display it in the most appealing and attractive way.
Your customers are sure to love Calico's delicious fudge flavors. But, to drive sales further, consider creating your own unique tastes and shapes. At Opal's Confectionery, for example, employees often try out new flavors--everything from eggnog at Christmas to pina colada for the summer. "It's great for our staff to try to be creative and have fun," says Opal's Wendy George.
The entire experience has just been great and the product is excellent.
– Steve Saubert, Sea Lion Caves
© Calico Cottage, Inc.


text:
The Mount Gilead Barracudas finished up the summer dual meet schedule with a win over Bucyrus on July 9, outscoring the White Sharks 351-291.
"We got rained out of our last meet with them, so we didn't know what to expect at this match up," said Coach Dina Snow. "It turns out that their girls outscored us, but our boys outscored them by a bigger margin. As always, every swimmer counts and I try to reinforce this with the swimmers all the time."
Individual first place finishes were earned by Brice Haughn, Grace Mowery, Joel Conrad, Michael Snopik, Adriana Tinch, Isaiah Fisher, Sammie West, Tyler Knight, Eric Mowery, Shelby West, Casey Conrad, Evan Zmuda, Xander Koller, Erin Zmuda, Rachel Shipp, Daniel Freeman, Logan Conrad and Kyle Landes.
The team also scored several first place relay finishes: the 9-10 boys medley relay (Brice Haughn, Isaiah Fisher, Joel Conrad and Bradley West) the 9-10 boys free relay (Haughn, Snopik, Conrad and West), the 11-12 boys medley relay (Snopik, Knight, West and Mowery), the 11-12 boys free relay (Fisher, Knight, West and Mowery), the 13-14 girls medley relay (Kylie Irwin, Cassandra Snopik, Shelby West, Meaghan McGill), the 13-14 girls free relay (Cassidy Hack, Emily Knight, West and McGill), the 13-14 boys medley and free relays (Evan Zmuda, Colton Long, Casey Conrad, Kaleb Fisher), the 15-18 girls free relay (Shipp, Zmuda, Courtney West and Ellie Herr) and the 15-18 boys medley and free relays (Logan Conrad, Daniel Freeman, Kyle Landes and Aaron Evans).
"One of the most exciting points of the meet came with the 15-18 girls free relay race. We knew Bucyrus was tough and just hoped for a good showing with our girls lineup. Rachel Shipp and Erin Zmuda got us off to a great lead, so Courtney West and Ellie Herr had to dig in and hang on to it. That lead narrowed by the time Ellie dove in, and her opponent was a very strong swimmer. The whole place was on their feet cheering as it came down to the finish and Mt. Gilead outtouched the Bucyrus girls. It was a something to see!" according to Coach Snow. "Ellie had just made the decision partway during the season to rejoin the team for the last few meets. We are very glad she did!"
Other meet highlights included young swimmers Ryann Brinkman, Olivia Morrison, Meaghan McGill and Bradley West trying the 50 free for the first time.
The team concluded the summer season with the TCAL Championship Meet, held on Sat., July 12, at the Marion YMCA.
"This is a big meat with all of the teams represented. With the addition of Upper Sandusky to the league and the growth of both the Galion and Bucyrus teams, we didn't know what the outcome would be, especially since we were missing some swimmers. No one can top Colonel Crawford, so their win was a given. We were very pleased and excited, however, to win second place! Again, having swimmers in most of the events and relays makes a huge difference, and many swimmers did some hard things for the sake of the team. Nearly every swimmer scored points for Mount Gilead," said Snow.
Swimmers who scored in the top three in each event earned medals. Gold medalists were Michael Snopik in the 100 free, Evan Zmuda in the 100 IM and 50 breast, and Rachel Shipp in the 200 IM, 100 fly and 200 free. Rachel also set new meet records in all three events.
Silver medalists in individual events were Jaxon Tinch in the 25 free, Michael Snopik in the 50 free, Tyler Knight in the 50 breast, Evan Zmuda in the 100 free, Erin Zmuda in the 50 free and 100 fly and Dylan Knight in the 100 breast.
Relay winners were the 9-10 boys medley relay (Liam Curtis, Isaiah Fisher, Joel Conrad and Wesley Bush); the 9-10 boys free relay (Snopik, Curtis, Fisher and Brice Haughn), the 11-12 boys medley relay (Snopik, Knight, Sammie West and Eric Mowery) and the 11-12 boys free relay (Knight, West, Mowery and Joel Conrad); the 13-14 boys medley and free relays (Evan Zmuda, Colton Long, Casey Conrad and Kaleb Fisher); and the 15-18 girls medley relay (Ellie Herr, Rachel Shipp, Erin Zmuda and Courtney West).
Rounding up the top finishers were bronze medal winners Joel Conrad, 50 free, Isaiah Fisher, 25 breast, and Liam Curtis, 25 back.. Relay winners were the 13-14 girls free relay (Cassidy Hack, Emily Knight, Shelby West and Meaghan McGill), the 15-18 girls free relay (Shipp, Zmuda, West and Herr), the 15-18 boys medley relay (Logan Conrad, Daniel Freeman, Kyle Landes and Aaron Evans) and the 15-18 boys free relay (Conrad, Landes, Evans and Dylan Knight).
"The swimmers really stepped up and did their best. We had many personal bests at this meet and even a few team records. Hallie Marlow dropped 12 seconds in her 200 free, Eric Mowery dropped over nine seconds in his 100 free and Logan Conrad dropped over six seconds in his 100 fly. Michael Snopik set a team record in the 100 free and the 15-18 girls set a team record in the 200 free relay. It was fun to watch everyone achieve after a good season of work."
The team will conclude with their awards banquet this week.


text:
Teller (20 HRS) 201 W Rock Island
Job Title: Teller (20 HRS): 201 W Rock IslandJob ID Number: 5108165Schedule Type: Part-TimeWork Hours: 20Location: Boyd,TXQualifications: At Wells Fargo, our vision is to satisfy all our customers' financial needs and help them succeed financially. In this role, you will ...
May 29 -
Senior Accounts Payable Processor
Kelly Services Current Needs: Currently seeking a Senior Accounts Payable Processor in Fort Worth, TX. This is a contract opportunity. Position Descriptions: Highly analytical problem solving to ensure proper matching Review of transactions for compliance and applicable ...
May 29 -
Fort Worth
Financial Analyst
Kelly Services Current Needs: Currently seeking for a Financial Analyst in Fort Worth, TX. This is a contract opportunity. If you are interested please email your most updated resume at [email removed] or call 248.327.4141 Position Description: Entry level position to ...
Collections Analyst
Kelly Services Current Needs: Currently seeking for a Collections Analyst in Fort Worth, TX. This is a full time contract opportunity. If you are interested please email your most updated resume at [email removed] or call 248.327.4141 Position Description: This role is ...
Office Coordinator
Office Coordinator Job in Dallas, Texas
Accounting Principals is currently seeking a candidate for an Office Coordinator Job in Dallas, TX. To be considered for this position, you must have an Associates' degree and three years of related experience. You will be ...
May 29 -
Financial Analyst I
Our Healthcare client is looking for a Financial Analyst I for their Mid-Cities location. This is a 90 day project/ contract looking to start ASAP.
Under direct supervision, this position is responsible for the coordination/facilitation of multiple revenue related ...
May 29 -
Mortgage Loan Processor
If stability, good benefits and a laid back environment sounds appealing...then we would love a chance to talk!
Please note: You must have a minimum of 3 years of recent front-end mortgage processor experience to be considered for this position.
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The ...
May 29 -
Internal Audit & Bank Compliance Officer
Experienced Internal Audit / Banki Compliance Officer?
Are you looking for a growing, solid & stable bank who will appreciate your talents and reward you for it?
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May 29 -
Chief Accounting Officer
We are assisting a growing client with a search for a CAO in the DFW market. The CAO will be responsible for overseeing a variety of Accounting, Finance, SEC Reporting and Tax functions and serve in a very strategic role as the company expands into new markets. To be ...
Jr. Dealer - Chinese Fluency
** NOTE: This position is located in Dallas, TX. Must be willing to relocate at own expense. **
The FXCM, Inc. Dealing Department is seeking entry level and enthusiastic individuals for full time positions, on all shifts. If you are a driven individual with a passion for ...
May 29 -
Accounts Payable Data Entry Specialist
Accounts Payable Data Entry Specialist Job in Dallas, Texas
Accounting Principals is currently seeking a candidate for an Accounts Payable Data Entry Specialist Job in Dallas, TX. To be considered for this position, you must have an Associates or Bachelor's degree in ...
Operations Associate - Bilingual
We are seeking experienced and/or enthusiastic individuals for full-time positions in our Operations department. Prior banking/customer service experience and a college degree are preferred. We offer a competitive salary, paid medical benefits, a 401(k) plan and a fast paced ...
Fraud Prevention Monitoring Associate
The Fraud Prevention Monitoring Associate will be part of a dynamic team responsible for facilitating the transaction monitoring program covering FXCM's world-wide retail and institutional client base. The Fraud Prevention Monitoring Associate will work closely with ...
Bilingual Institutional Sales Intern - Korean Fluency
FXCM Inc. (NYSE: FXCM) is a global online provider of foreign exchange (FOREX) trading and related services to retail and institutional customers world-wide.
FXCM prides itself on maintaining a dynamic, fast-paced, and demanding working environment. The FXCM Internship ...
Accounts Receivable Specialist
Pridestaff Financial has partnered with our North Dallas client in search of a dynamic cash applications specialist to join their growing team!
Primary Duties and Responsibilities:
1.Download cash receipts and print wires from Lockbox
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PrideStaff Financial has partnered with a client in search of an Accounts Payable Specialist. This permanent role will report to their Lewisville location and interviewing is starting immediately!
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Corporate Accountant (Job #101566)
Unity Search has been retained by a large, industry leading North Dallas company in its search for a Corporate Accountant. Our client has a great corporate culture and some really good benefits including a strong 401K match. This role will be responsible for performing ...
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PVI Industries LLC, a manufacturer of commercial and industrial water heaters and boilers, is seeking an experienced Cost Accountant. This position will coordinate closely with sales, engineering, and manufacturing personnel to estimate manufacturing costs of potential ...
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Akorbi is currently seeking an Internal Auditor for our client in the Irving area. This is a direct hire opportunity with an industry leading organization headquartered here in North Texas. The Internal Auditor will report directly to the VP of Internal Audit and will be ...
May 28 -
TELLER (30 HRS) 1520 N Cockrell Hi
Job Title: TELLER (30 HRS): 1520 N Cockrell HiJob ID Number: 5112514Schedule Type: Reg-TimeWork Hours: 30Location: Dallas,TXQualifications: At Wells Fargo, our vision is to satisfy all our customers' financial needs and help them succeed financially. In this role, you will ...
May 28 -
Teller (30 HRS) 5968 W Parker Rd
Job Title: Teller (30 HRS): 5968 W Parker Rd -Job ID Number: 5109013Schedule Type: Part-TimeWork Hours: 20Location: Plano,TXQualifications: At Wells Fargo, our vision is to satisfy all our customers' financial needs and help them succeed financially. In this role, you will ...
May 28 -
Internal Audit Manager - Department Head
Avalon Synergy has been retained to locate an Internal Audit Department Head to join our large, privately held client in the Dallas-Fort Worth area. While the official title for this role is 'Manager' due to internal corporate legal reasons, this position oversees the ...
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A multi-national consumer goods client has a Senior Accounting Manager opening within its US corporate offices in the Grapevine area. This is a unique position reporting to Director level encompassing people management skills as well as broad responsibilities including ...
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Entry Level Online Trader - Work from Home
Maverick Trading, established in 1997, is an award-winning trading firm that focuses primarily on equities, equity options and index options. We are currently seeking Online Traders to be trading representatives on behalf of the firm. We have some of the ...
May 28 -
Grand Prairie


text:
SQLServerGreeks is a dynamic community founded by SQL Server MVP from India – Amit Bansal, and is supported by several community associations like UGSS, GITCA, and INETA. Sarabpreet Singh and Girija Acharya are Regional Mentors for Delhi NCR and Mumbai respectively. The community regularly conducts SQL events in several cities in India.
In November – December 2010, SQLServerGeeks.com organized eight sessions in three cities – Bangalore, Mumbai, and Gurgaon. The events saw 200+ attendees in total.
SQLServerGeeks.com Twitter | FaceBook | SQL Server Forum
If you want to join SQLServerGeeks.com, send an email to email@example.com.
thank gropert


text:
Shop gifts for mom, daughter, wife, and all the special ladies in your life. Find gifts for her with the Discovery Store gift guide. If she loves Pitbulls and Parolees, giver her Villalobos Rescue Center gear. Or if shes a fan of Finding Bigfoot, get her the Bigfoot slipper set.
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- 17 Kids and Counting: Season 1 DVD
- The 17 Kids & Counting Season 1 DVD set takes you to where it all started for Americas largest family. Michelle and Jim Bob Duggar discovered that having a bigger-than-life family was a lot of fun, and this reality TV show lets you join in. The 17 Kids & Counting DVDs chronicles how this… [ read more ]
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Kepler Helps Listen To The Music Of The Stars
Bill Chaplin from the University of Birmingham, speaking at the American Association for the Advancement of Science (AAAS) conference in Washington, said that the Kepler space telescope was an exquisite tool for what is called "astroseismology", measuring the sizes and ages of stars.
The Kepler telescope measures five times better than any other means as it "listens" to the sounds they make. The technique, used to measure some 500 far-flung stars, measures minuscule variations in a star's brightness that occur as soundwaves bounce within it.
Chaplin tells BBC News that astroseismology was, in essence, listening to the "music of the stars". Kepler's primary job however is spotting exoplanets, planets orbiting stars other than our own, by measuring the tiny dip in the amount of light that it sees when a planet passes in front of a distant star.
These precise light-level measurements also work for astroseismology, because as sound waves resonate within a star, they slightly change both the brightness and the color of light that is emitted. Researchers can measure the acoustic oscillations that gave rise to the ripples on the light that Kepler records.
The sounds are thousands of times lower than humans can hear and like a large musical instrument has lower the pitches, the bigger the star, the lower the pitch. There are overtones however – multiples of those low frequencies – just like instruments, and these give an indication of the depth at which the sound waves originate, and the amount of hydrogen or helium they are passing through.
Stars fuse more and more hydrogen into helium as they grow older giving astroseismologists a way to increase five-fold the precision of their age estimates for stars. "With conventional astronomy, when we look at stars we're seeing the radiation emitted at their surfaces; we can't actually see what's happening inside," Chaplin tells BBC News.
"Using the resonances, we can literally build up a picture of what the inside of a star looks like – there's no other way of doing that. It's not easy to do, but we're now getting there, thanks to Kepler."
Canada's Most and ESA's Corot satellites are designed specifically to collect data similar to the Kepler telescope, but just the first few months of observations by Kepler has provided scientists with data on hundreds of stars, whereas Dr. Chaplin said that only about 20 have been studied in detail Canada's efforts.
"Suddenly we have this huge database to mine," Chaplin concluded. "I could literally spend the rest of my research career working on these data – we're just starting to mine them."
Image Caption: Artist's rendition of Kepler spacecraft. Credit: NASA/Kepler mission/Wendy Stenzel
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Saint Louis Babysitters
Select from 2,231 babysitters in Saint Louis, MO. Average Saint Louis babysitting pay rate: $10.50/hr. Share this rate with friends.
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I started babysitting for families in my neighborhood and family when I was in about 6th grade and continued to babysit on a pretty regular basis throughout high school. Then I went to college and rec...
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Okay toy
posted 6 years ago
This toy seems to last because the dogs don't seem too interested in it. It I throw it they will enjoy retrieving, but that's about it.
Pros: Durable
Cons: Doesn't seem to spark much interest
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16 December 2010 12:57 [Source: ICIS news]
PRAGUE (ICIS)--Ciech has accepted a binding bid for its 89.46% stake in phosphorous fertilizer unit Fosfory Ciech from Zaklady Azotowe Pulawy (ZAP), the Polish companies announced on Thursday.
ZAP, which is Poland's largest fertilizer company, would pay around zlotych (Zl) 107.2m ($35.5m, €26.9m) for the stake and take on the obligation to repay loan sums owed by the subsidiary to Ciech amounting to Zl 120.6m, Ciech said.
"We are very pleased with the fact that we managed to negotiate a good price for these assets that are not related to the main activities of the Ciech group. I believe that our colleagues at ZAP are also very pleased, since this is an agreement that will be beneficial to both parties," said Ciech CEO Ryszard Kunicki.
"This is another transaction that shows that we are consistently implementing a programme to restructure the group and improve its financial standing," he added.
In addition to ZAP, five other expressions of interest from
Poland's treasury ministry has committed to relaunching the privatisation of Ciech - postponed indefinitely earlier this year - in 2011 if its restructuring makes good headway.
ZAP, which makes nitrogen fertilizers and is also a global melamine and caprolactam player, said it was attracted to Fosfory Ciech by both its production lines and port infrastructure.
"The decision of the board of ZAP to make a bid was in line with the strategy of achieving organic growth and an increased scale of operations through the use of mergers and acquisitions at home and abroad, and by developing the product portfolio," ZAP said.
ZAP, which is currently in the latter stages of a privatisation tender, was disappointed in June when
Fosfory Ciech has an annual fertilizer capacity of 400,000 tonnes. It also produces sulphuric and phosphoric acid.
($1 = Zl 3.02, €1 = Zl 3.99)
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Coffee Table:
- Contemporary and very smart coffee table
- Opens in the middle and provides you with extra wide storage space where you need it the most
- The side panels are on metal glides
- Adjustable leg levelers
- Assembly Required
Finish: Rich Ebony Wood with Pure White Lacquer
37.25"W x 35.75"D x 13"H
Furnished Over 1 Million Homes Since 1997...
I was very satisfied with One Way Furniture Service. I have referred them to many friends, family, and customers. Thank you. Kathy A. Eisele, Boston, MA
Product Review - Allure Coffee Table with Hidden Storage
Furniture Brand
Nexera Furniture is one of the leading ready-to-assemble furniture manufacturers. Nexera MFI features furniture made from premium quality materials and with the highest quality craftsmanship. Highly popular in both the Canadian and American markets, Nexera is well known for their cutting edge style and modern decor that harmonizes with todays trendy consumers. Each piece is fast and easy to assemble and because of the do-it-yourself nature of Nexera, they are able to offer a top quality product at an incredible price. Nexera
Weight & Size
Reference - Sku: 220733 - Allure Coffee Table with Hidden Storage by Nexera


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dreamPHOTO... Photographer
RochelleRubyModel Female Sydney, New South Wales, Australia
Mayhem # 3118809
About MeMy confidence is not majorly in the exterior but more so in who I am souly.. Outgoing, witty & energetic personality! I love being in front of the camera whether its photos or film. My past experience involves various marketing and promotional work, from in clubs for alcohol promotions to working directly for companies. Will be appearing on a reality tv show due to air around June 2013. Also modeled for an upcoming issue of Live To Ride. Whilst in Sydney working in accounting, during my spare time I voluntarily done marketing /promotions and photoshoots for a custom built choppers company. . Everyday being a different day, meeting all kinds of people from all walks of life and promoting labels the public need to know about! I may not look like the typical farm girl (grew up in far north QLD) but I guess that's what people love as I'm not who they expect. =)
dreamPHOTO... Photographer
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