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When a charge against the man accused of sexually assaulting her was dropped, a College of Charleston student started thinking that everything she had been through was wasted.
FERPA exception
A federal law that the College of Charleston says requires it to withhold certain student information in connection with a recent allegation of sexual assault includes an exception for violent crimes, an expert said.The school denied The Post and Couriers request for the names of the suspects in an April allegation against four baseball players and for the results of their disciplinary hearings.Such documents could help explain why the school police force chose not to pursue charges in the case and how the school approaches internal reprimands against students. The school has said that the four suspects were found in violation of student conduct codes, but it has not discussed the students sanctions.Attorneys for the college argued that the Family Educational Rights and Privacy Act, or FERPA, guards certain student data from release.But Daniel Carter, director of the 32 National Campus Safety Index, said an exception to the federal law allows schools to release the information when its connected with investigations of violent crimes, including all sex assaults.The law does not require schools to disclose the data, but they should provide specific reasons if they decide not to, Carter said. They cant say its protected information, Carter said. I dont believe its appropriate for them to hide behind the federal law when theres a finding of responsibility.The Post and Courier has filed several FOIA requests since the criminal investigation into the case closed Nov. 9. Those remain pending.The exception to FERPA follows:An educational agency or institution may disclose personally identifiable information from an education record of a student without the consent required ... if the disclosure ... is in connection with a disciplinary proceeding at an institution of postsecondary education.The institution must not disclose the final results of the disciplinary proceeding unless it determines that ...The student is an alleged perpetrator of a crime of violence or non-forcible sex offense; andWith respect to the allegation made against him or her, the student has committed a violation of the institutions rules or policies.Definitions of information to be disclosed:Final results: decision by entity authorized to resolve disciplinary matters within the institution. The disclosure of final results must include only the name of the student, the violation committed and any sanction imposed by the institution against the student.Sanction imposed: description of the disciplinary action taken by the institution, the date of its imposition and its duration.Violation committed: institutional rules or code sections that were violated and any essential findings supporting the institutions conclusion that the violation was committed.
She had answered questions from investigators that, she said, turned everything around on me.
She had coped with insomnia and depression.
She had failed a math class.
But prosecutors said her case wasnt provable in court. After the incident on the campus in fall 2011, she sent text messages to the suspect that dismissed their encounter as a drunken romp that we wouldnt have done if we were sober, according to prosecutors.
While the 19-year-old student and her mother cling to hope that a criminal charge will be revived, they aim to encourage improvement of the schools handling of on-campus sex assaults. Both filed written complaints to the governor, alleging shortcomings by the school and by prosecutors.
The duo also has reached out to the family of a College of Charleston softball player who accused four baseball players of sex assault earlier this year.
Last week, The Post and Courier first reported the case that ended with internal disciplinary action but no arrests.
A criticism from the families in both cases centers on whether a law allowing campus police to control sex assault investigations is in the alleged victims best interests. Such a commanding role creates at least a suspicion of bias, they argue.
We cant change what happened to her, but we certainly can do something if we all come together, said the mother of the student from the fall 2011 incident.
The Post and Courier does not name alleged victims of sex crimes or their family members.
We have to make a stand, she said. They need to make changes.
The school and prosecutors have pointed to weak evidence and credibility issues that prevented success in the courtroom.
College officials said they are mindful of concerns from the accusers families and insist that they offered many levels of assistance after the incidents, said Mike Robertson, the schools senior director of media relations. They said no changes in procedure need to be made.
In any case involving sexual assault, we strive to treat students and parents with dignity, compassion and respect, Robertson said, and answer all questions as completely as we are able.
Contrary evidence
On Oct. 22, 2011, a College of Charleston student drank alcohol at a Halloween party on King Street.
A young man the student knew from her hometown had invited her and a friend to the party. She later said the man previously expressed a desire to date her, but that she had brushed off his advances.
About 1 a.m., she returned to Berry Residence Hall, which houses 636 female students. She reported that the man begged her to let him stay because he had nowhere else to go.
The womans mother said a police officer manning the entrance should have noticed that her daughter was too drunk to have visitors. The officer, she said, should have made the man leave instead of checking him in.
Throughout the evening, the woman said she was assaulted in her bed despite her attempts to deflect the mans advances.
The woman tried to forget about the ordeal, but she couldnt shake the memory. She reported it to campus authorities after Thanksgiving.
Two weeks later, the schools Department of Public Safety arrested then-20-year-old Diego Landa-Bonilla of West Ashley on a charge of third-degree criminal sexual conduct.
But the case was weak, prosecutors said, and the charge was dropped in June. The Post and Courier identified Landa-Bonilla because he has expressed a wish to clear his name publicly.
In his written explanation of the dismissal, which was obtained through an S.C. Freedom of Information Act request, Assistant Solicitor Timothy Finch noted statements from the student that would fill jurors mind with reasonable doubt.
A month before the incident, a Facebook conversation between her and Landa-Bonilla set the stage for a consensual encounter, Finch wrote. The student said in the messages that she was sometimes attracted to Landa-Bonilla and that maybe one day they would take their relationship to the next level.
On the morning after the incident, Finch added, the student allowed her alleged assailant to remain in bed for three hours. That laissez-faire attitude isnt what you would expect from a sex assault victim, Finch said.
We were both drunk, and we wouldnt have done that if we were sober, she later wrote in a text message, according to Finchs letter.
Whatevs. Lets just not talk about it again.
In letters to Gov. Nikki Haley and President Barack Obama, she also wrote that her accused assailant said: That was wrong of me. But Im not going to lie. I enjoyed it.
But she hadnt told prosecutors about those comments, which Finch said presents an inconsistency that the defense would easily highlight.
Whats right
The prosecutors explanation didnt sit well with the students mother.
She and her daughter wrote to the Crime Victims Ombudsman, which is part of the governors office, and called for an investigation into why prosecutors refused to send the case to a grand jury.
Their written complaints describe a litany of concerns about how prosecutors, police and the school handled the case.
They list no specific accusations of wrongdoing, but they point out what they considered a lack of diligence and compassion by authorities.
The ombudsmans office declined to discuss the case, citing a law preventing public comment.
It felt as though the detectives turned everything around on me as if I were the one who had raped someone, the student wrote. This was a very difficult thing to go through, as it was already hard enough finding the courage to press charges.
Her mother asked the school to make policy changes requiring dorm visitors of the opposite sex to stay in the buildings common areas.
She also called for better freshman orientation dealing with sex assault awareness.
I dont feel theyre looking out for the students, the mother said in an interview. I dont feel theyre going to do whats right by the students.
Not the intent
In two reports of sex assault at the College of Charleston during the last year, the accusers families have questioned whether campus police was equipped to investigate.
They also have faulted the school for not having a female investigator handle the accusations.
School officials argued that its their protocol to send a policewoman, but one is not always available. The school has one female investigator who was promoted to that position in July, after both the allegations surfaced, school spokesman Robertson said.
If a female investigator is not available to conduct the investigation, he said in a statement, a male investigator is assigned.
Central to the families complaints is a 5-year-old law that the school said had charged its own police force with controlling all investigations into sexual assaults reported on campus.
Legislators and experts with knowledge of the Jessica Horton Act have said it was not the laws intent to require the schools police rather than a local city agency to serve as the primary investigator. Some college police agencies are not qualified, they said, and some other schools do not have their own departments.
Instead, schools should work with outside agencies that have more expertise in sex assaults, they said.
Daniel Carter, director of the 32 National Campus Safety Index formed after the Virginia Tech mass shooting, helped draft legislation in Tennessee that he said served as a model for South Carolinas law.
The Tennessee version, he said, arose after a student died on a college campus under suspicious circumstances. Campus police officers initially assumed that the case was a suicide, and they destroyed evidence that might have proved otherwise, he said.
Ensuing legislation was designed to ensure that the best resources from multiple agencies are used in future cases, Carter said.
In sex assaults, the law suggests, campus police should lead investigations because, he said, they often deal with such crimes and are more sensitive to victims. Many times, investigating sex assaults is not a question of forensics, but of sensitivity to the issue, he said.
But the aim was not to remove the responsibility from agencies that handled investigations before the law was passed, Carter said.
The intent never was to cut out any agency from the process, he said. Thats not a true joint investigation. Thats not what was envisioned.
Reach Andrew Knapp at 937-5414 or twitter.com/offlede.


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"I'm just speechless and so proud," her teary-eyed father, Jerry Nugent, told the Tampa Bay Times". "She took it over the top. ... She's not ever going to hold back. That's my superhero. That's my angel."
The milestone seemed barely imaginable shortly after the freak accident almost took the Florida toddler's life nine weeks ago. Since then she has had seven surgeries on her legs and feet, which needed to be amputated, and she faces more possible surgeries as she continues to grow, her mom, Nicole Nugent, tells the Times.
For now, doctors expect she will need new prosthetics every three months as she gets bigger, even though doctors inserted cartilage into her leg stumps to slow bone growth.
Will Vragovic / Tampa Bay Times / ZUMA
"I really thought she would be nervous and not wanting to do it, but she really was not afraid," Nicole told reporters gathered to watch her walk on the parallel bars Monday on a pair of test legs before her more permanent ones are crafted.
Like most 2-year-old girls, Ireland wasn't totally focused on the magnitude of her accomplishment. Instead, her mom said she was struggling with a much bigger decision: Does she like Dora or Minnie Mouse better? The little girl apparently has a say in the design of her new gams.
"She first picked princess legs and went with that, but as a normal 2½-year-old she picked Dora, then Minnie, then Dora, then Minnie, so finally I said we'll buy both," Nicole told the Times. "Whatever maker her happy – these are her legs."
Will Vragovic / Tampa Bay Times / ZUMA
"I'm so happy for her knowing everything she's gone through. She's really is going to be okay," said Nicole. "She really is going to have a great life."

subset: commoncrawl


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Matthew Scheidt cried in court Wednesday as testimony continued in the case against him.
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Hamilton College's Admission Committee seeks candidates with intellectual curiosity, academic promise and a diverse range of interests and backgrounds. Each application is carefully reviewed and evaluated on the basis of its merits and in the context of the strengths of the applicant pool. Our ultimate goal is to admit the most able and promising mix of students who will contribute to the Hamilton Community in meaningful ways.
Although the primary criteria for admission are academic achievement and intellectual potential, Hamilton also values leadership and commitment to extracurricular and community activities. In forming the class, the admission staff seeks students representing diverse geographic, economic, and ethnic backgrounds whose perspectives will enrich the learning community. Lastly, Hamilton seeks to admit candidates who are a good fit with the programs and experience the College offers.
To apply for admission, Hamilton's candidates must submit an application through the Common Application or The Coalition for Access, Affordability and Success. For information regarding our deadlines, requirements and process please choose the appropriates links below.


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Topics - June 01, 2012
World Weather
USA: Start of 2012 hurricane season
MIAMI, June 1, 2012 (AFP) - The 2012 Atlantic hurricane season officially begins Friday, with US forecasters predicting a "less active" season of one to three major hurricanes but warning coastal communities to remain vigilant.
"NOAA's outlook predicts a less active season compared to recent years," said Jane Lubchenco, administrator of the National Oceanic and Atmospheric Administration (NOAA), which tracks tropical storms and hurricanes. "But regardless of the outlook, it's vital for anyone living or vacationing in hurricane-prone locations to be prepared," she said. "We have a stark reminder this year with the 20th anniversary of Hurricane Andrew," a Category 5 hurricane that devastated South Florida in August 1992, during a late-starting season that produced only six named storms. The NOAA predicted nine to 15 named storms, with winds of 39 miles (62 kilometers) per hour, saying four to eight would likely grow into hurricanes, with wind speeds of 74 miles (120 kilometers) or higher.
It predicted one to three storms would develop into major hurricanes ranking Category Three, Four or Five on the five-point Saffir-Simpson wind scale. Over the last 30 years, the average hurricane season has produced 12 named storms with six hurricanes, including three major ones, NOAA said. NOAA's chief hurricane forecaster Gerry Bell said the 2012 season could prove less active if the El Nino climate phenomenon develops by late summer or early fall.
US Secretary of Homeland Security Janet Napolitano was to speak to reporters on Friday to discuss efforts to prepare for the coming storm season, which officially runs until November 30.


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Top Definition
a very very horny person who cannot stop thinking about sex or having sex the feeling of sex.
sandra is always thinking about sex and tells tim (her friend) about her kitty getting all wet all the time ... Tim says you hornball!
от Sandra Arambula 27 декември 2003
Trending Now
Can you define these popular missing words?
hornball: a great big ball of horniness. Literally someone who will bang/thrust anything they touch.
Mom: Oh dear, Tommy, you are such a hornball. Quit jerking your meat and come to dinner.
от Thrust It 13 януари 2007
A person who is constantly thinking about sex.
Omg dude, stop being such a hornball.
от MollyD 02 януари 2009
A person who ask people questions that are sexual because they are little perverts
Matt from tccs is a little horn ball for asking for naked pictures of someone else.
от Peenor master 06 ноември 2006
a man who is always wanting sex, thinking about sex, or who can't get enough sex; man who only things of sex.
от Anonymous 21 юли 2003
A very sexually frustrated person who decides to take their sexual needs out on other people.
Sad, isn't it?
Sad, isn't it?
"NigNog, you is such a hornball."
от Nikkkkay, Gurlfrann 26 ноември 2009
A male that talks about sex or how hott a woman is more than anything else.
Person 1: Did you see the South Park?
Person 2: Did you see the tits on that girl?
Person 1: Dude, really? you're a horn-ball
Person 2: Did you see the tits on that girl?
Person 1: Dude, really? you're a horn-ball
от CaptinGonads 27 април 2009


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Heavy-equipment giant Caterpillar Inc. is closing its Summerville plant, citing a decline in orders for the 280-worker factory, a sizable blow to the Charleston region's manufacturing industry.
The company said Monday it has decided to shut its transmission remanufacturing factory off Jedburg Road next year based on "an extensive strategic review" of the business.
"Over the last few years, the company has worked to position the facility to be more competitive," the Peoria, Ill.-based company said in a written statement. "However, it has concluded that the Summerville facility is not viable as a long-term operation."
The Dorchester County factory tears down, recycles and rebuilds heavy-duty transmissions and related components for original equipment makers, which then resell the parts to aftermarket buyers.
Caterpillar spokeswoman Barbara Cox said the company began to look at the business after some of the plant's main customers went with other suppliers.
A smaller division that works on hydraulic components in Summerville also will be closed because "that portion the business alone is not enough to sustain that facility, which is a rather large facility," Cox said.
The 200,000-square-foot plant is on McQueen Boulevard off Jedburg Road, near U.S. Highway 78.
Caterpillar said it will conduct an "orderly ramp down of production," ahead of the scheduled mid-2014 closing.
The factory has 255 full-time employees and 25 temporary workers. They were notified of the closing Monday. Full-time staffers will receive severance packages, and the company said it plans to work with agencies that provide employment outplacement services.
"We're going to do everything we can to support them," Cox said of the affected workers. "This is our family, and we'll do everything we can to make this transition as smooth as possible, even though it's a tough one."
Several people expressed sympathy Monday on The Post and Courier's Facebook page for the workers who will lose their jobs.
"What a shame!" Ramona Lynn Grimsley said.
Mac Finch called it a "sign of the times."
Caterpillar joined the lineup of blue-chip name manufacturers in the Charleston region in 2005, when it bought Summerville-based automotive parts maker Williams Technologies Inc. At that time, the company had about 400 workers in the region
Greg Folley, vice president of Caterpillar's remanufacturing and components division, said "in no way" does Monday's "decision reflect upon our employees' hard work and dedication."
"They have demonstrated tremendous efforts to produce quality products for our customers," Folley said in a statement.
The company told local officials about the closing and job cuts Monday.
"The good thing is that the workforce is highly skilled, so I think they'll have an opportunity for re-employment within the region," said Jon Baggett, Dorchester County's economic development director.
Also, Baggett noted that the building will be desirable for businesses that are looking to expand. Demand is growing for the type of "Class A" industrial space that Caterpillar leases in Summerville, he said.
Reach John McDermott at 937-5572.


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|Welcome to the MANGA Forum.
|You will have to register before you can post: log in or sign up at the top of the page to proceed. To start viewing messages, select the forum that you want to visit from the selection below.
man i'm really starten to get down.i mean i wish more and more each day that my life was like a manga or animeyou know the sexy girl that kid growing and saving the world the adventcher and i really hate the fact that all in my high school think im justa nerd because i read manga i mean i even play starter on the football team but its like they cant see past that iu read manga it just pisses me off
i know what your sayig but dude just dont warry about what other people think. screw them! what do your friends think?
i spend all my days working hard to not fall into the hell hole that school is for me but it seem to me that the more i fight the worse i geti just wanna go off its like how naruto wants every one to acnolage him thats a lot like what i want .i just want to not be looked down on for being me most the time i don't give a damn about what anyone thinks of me(sorry for the swear) but if just keeps up most in my school mistake my kindness for weakness you know?i just cann't take it no moreon some real stuff yall help me more then yall know ziggy a wicca warrier the last great ninja
We're all here for you buddy, we try to do what we can. Just remember we're here, i'm here all the time as a mater of fact fourth time today. Don't let stupid people get you down."You will See, in Time you shall walk the same path as I"
I'm not on here as much as I used to, but I've been through it all. School was hell for me as well. It helps to remember that you only have a limited amount of time in the box, and after that it's done. I've also noticed that the "cool" kids have a terrible life after high school.( the ones with the terrible attitudes, not the decent ones.you know the ones I mean,)Mr. Star Football Player from my class flunked out of college ( in his first year) and works as a mall security guard. His wife, who used to be the prettiest girl in school,(I had a HUGE thing for her)looks like your stereotypical trailer trash. One girl that was in my class was the daughter of a state senator. She's been in rehab 4 times. Four of her other friends are raging alcoholics. Just keep your head straight, and be yourself. There is nothing wrong with the way you are. And remember, Karma comes full circle, so resist the temptation to lash out. 92% of the teenage population would be dead if Ambercrombie and Fitch or Hollister said it was uncool to breathe.
high school was rough, anything that sets you apart is pounced on. Try no to let it bother you too much and remember all of us are here if you need to vent a little. We're all buddy's here right. "You will See, in Time you shall walk the same path as I"
I wouldnt let it bother you, i read plenty of manga, play WoW, go to manga events, and yet i have a GF and am not really popular but have plenty of friends, whether its different at my high school or not i dunno but most of the dicks that started anyhting were either put int here place by others or by myself personally before they got too far. Everyone has there niche of things they love and want to do, try and find a few others that like this or introduce others to it, plenty of my friends have becoem addicted to anime as i have jsut because of my influence ^.^
I feel exactly the same way you do. i mean, secondary school was hard for me but college is an arse 'cause i'm in my final few weeks now and some of the teachers revision sessions for my exams that i'm doin' soon really suck. i'm gettin' stressed out as it is. i wish the same as you do, to just be an anime charcater and everyone accepts you for what you are. "I am Darkness, BWA HA HA HA HA!"


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Systemwide Events Calendar
Manoa Maniacs Student TailgateNovember 16, 3:30pm - 5:30pm
Manoa Campus, Aloha Stadium
The Manoa Maniacs will be hosting a student tailgate area for all of the home games, so come out and support the UH Rainbow Warrior Football team against the Mountain West opponents at Aloha Stadium. Your student ID allows you and 5 friends to enter into the tailgate area where food and beverages will be available for purchase. Follow the Manoa Maniacs on Facebook at facebook.com/manoamaniacs and on Instagram @manoamanaics
Event Sponsor
Student Life and Development - Manoa Maniacs, Manoa Campus
More Information
|Saturday, November 16
|The Wellness Center - Fitness Class Schedule
Maui Campus, Pilina Bldg., Wellness Center
|Japanese Flower Arranging - Ikebana Sogetsu
Windward Campus, Hale Kuhina 115
|MPLA Social Event
Manoa Campus, Manoa Falls
|Manoa Maniacs Student Tailgate
Manoa Campus, Aloha Stadium
|Bike-In Theater at Old Stadium Park!
2237 S King St
|Dance Anniversary: Look Back Move Forward
Manoa Campus, Kennedy Theatre Mainstage
|Queens of the Night
Manoa Campus, Earle Ernst Lab Theatre
- Highlighted dates have scheduled events.
- Select the date to view all events for that day.
Ongoing Events
- The Wonder of Learning: the Hundred Languages of Children Exhibit
- Red Hat System Administration I
- EWC Arts Exhibition: Bollywood & Beyond: Costume in Indian Film
- Kalaupapa -- A Source of Light, Constant and Never-Fading
- Convergence: Glitch_Click_Thunk, Featuring Mark Amerika
- Trip Around the Island
- Trip Around the Island exhibit
- Waikiki Parc Features Ashley Huang
- Holding On, Letting Go


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Why Penn State Shenango?
Penn State Shenango is rich in tradition of being a Big Ten school with a big time reputation that is close to home. We offer innovative classes that incorporate the latest technologies, taught by award winning faculty who challenge you in the classroom and lead the way in their fields of research.
At Penn State Shenango, you'll have access to one of the largest academic libraries in the nation and endless opportunities for growth beyond the classroom in the form of student organizations, cultural events and undergraduate research.


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Technological advances in the life sciences hold out the promise of controlling or eliminating stubborn diseases. They also increase the risk that malevolent actors will learn to produce new and highly dangerous pathogens, a prospect that deeply concerns security professionals in developed countries. In the developing world, meanwhile, where many nations struggle mightily with diseases such as AIDS and malaria, public health concerns tend to focus more on the here and now—or, when it comes to emerging threats, on how to contend with natural rather than manmade pathogens. Below, authors from Nigeria, South Africa, and Argentina address the following question: How can governments, institutions, and professionals in both the developed and developing worlds make the world safer from emerging pathogens, whether natural or manmade?
Experts from emerging and developing countries debate crucial, timely topics related to nuclear energy, nuclear proliferation, and economic development. Each author contributes an essay per round, for a total of nine essays for the entire Roundtable. This feature was made possible by a three-year grant from the Norwegian Foreign Ministry.
How to confront emerging pathogens
Round 1
National responsibilities, cooperative possibilities
Combatting pathogens through ethics education
Making bad data good
Round 2
Health in Africa: Corruption and misplaced priorities
Why don't problems get fixed?
Planning for the entire disease cycle
Round 3
Wake up. Ease off.
The journey, not just the destination
Spotlight on South America
Round 1
National responsibilities, cooperative possibilities
Governments and scientific communities in the developed world devote considerable attention and study to the emergence and re-emergence of pathogens. But in resource-constrained countries, this is often not the case. Africa is a region especially prone to outbreaks of the diseases naturally transmitted between vertebrate animals and humans (zoonotic diseases); these include Ebola, Rift Valley Fever, and plague. All countries in the region are at risk from these diseases, and cross-border outbreaks are frequent. But African nations are often characterized by a failure or inability to effectively address the emergence of new diseases or the re-emergence of endemic ones.
Several reasons for this stand out. Africa's systems for disease surveillance are weak and laboratory support is poor, making it difficult to produce data needed for assessing disease burdens and responding with appropriate priorities. When good information is unavailable, the emergence of new pathogens is often met with denial—until a disease outbreak reaches epidemic proportions. Once an epidemic is under way, an affected country is invaded by international health agencies, but they operate in panic and crisis-response mode, and their efforts amount to too little, too late. Pathogen outbreaks ultimately become opportunities for foreign researchers and health agencies to fine-tune their skills, leaving scientists in resource-poor countries permanently dependent on outsiders—reduced to mere sample collectors, unable to control the next pathogen outbreak on their own.
How can these challenges be overcome? The first step involves focusing on local processes of pathogen emergence. Pathogens emerge under widely varying environmental, demographic, and socioeconomic circumstances. A pathogen's ability to emerge or re-emerge depends on factors including genetic changes or adaptation in the pathogen itself; environmental conditions associated with climate, economic development, and land use patterns; and issues related to pathogens' human hosts, including demographics, international trade patterns, misuse of antibiotics, people's occupational exposure, the neglect of public health services, and bioterrorism. These factors and conditions interact differently in different parts of the world—therefore, the first step toward preventing and controlling outbreaks of emerging and re-emerging diseases is to gain a thorough understanding of local processes of pathogen emergence. Once such an understanding is gained, governments, institutions, and professionals—especially in the developing world—must commit themselves to clearly defined, proactive roles in the fight against emerging and re-emerging diseases.
At the national level, in particular, it is essential that each country take "ownership" of systems for disease surveillance, prevention, and control; this allows country-specific response measures to be formulated. Taking ownership of these systems entails making a genuine political commitment to them, and requires that adequate resources, financial and human, be provided for disease surveillance and for laboratory support systems. It is crucial that nations maintain systems capable of detecting, identifying, and containing pathogens that have epidemic potential before they spread too widely.
For governments, taking a proactive role in combating disease also entails implementing appropriate emergency response plans; coordinating collaborative interactions between human and veterinary health surveillance systems; building and sustaining the disease-fighting capacity of local health personnel by providing them training, opportunities to update their skills, and an empowering work environment; and establishing a multidisciplinary approach to disease control, one that allows individuals from diverse fields to bring their expertise to bear on the control of emerging or re-emerging diseases. (Engagement from the private sector, for example, ought to be forthcoming because disease outbreaks threaten everyone's economic security.)
Making the world safer from emerging and re-emerging pathogens also requires a great deal of global collaboration. Nations should collaboratively implement policies, for example, that control pathogens' ability to spread via modern transportation systems. They should participate in regional surveillance and response activities. They should share real-time surveillance information in order to detect zoonotic diseases in animal populations before they appear in human populations. Meanwhile, researchers all over the world should collaborate to strengthen surveillance of human populations that are at high risk of contracting zoonotic diseases. Science-based nongovernmental organizations, because of their wide geographic reach and their field expertise, should be engaged as partners to help provide comprehensive surveillance and response capabilities. Meanwhile, innovative mechanisms could be established that would ensure adequate funding for sustainable global disease surveillance systems. The struggle against emerging and re-emerging disease is a complex and difficult challenge that requires full-scale effort at both the national and international levels.
Combatting pathogens through ethics education
Pathogens do not respect borders. Efforts to control outbreaks of disease—including those caused by emerging pathogens, whether natural or manmade—require that local and national responses be synchronized and that mechanisms for international cooperation be established. At both the national and international levels, scientists play an important role.
Scientists, because of their engagement with pathogens in daily research and their immersion in the literature that surrounds them, are well positioned to act as an early warning system for disease outbreaks. Their involvement in, and endorsement of, measures for biosafety, biosecurity, and dual-use control are vital to confronting the threats posed by emerging pathogens. ("Biosafety," in simple terms, refers to preventing unintentional exposure to pathogens, or their unintentional release. "Biosecurity" means protecting pathogens from theft, loss, or diversion. "Dual-use" research is legitimate research that could be misused to threaten public health or national security.)
In their role as a first line of defense, scientists often find themselves enthusiastically embraced by those who care about pathogen control. But serious questions surround the education that scientists receive in the ethics of biosafety, biosecurity, and dual-use research, and in associated standards for responsibility, professionalism, and good conduct. Ethics education often fails to prepare scientists to meet the expectations that are placed on them, and indeed numerous studies indicate that ethics education, on a global level, remains patchy and unstandardized. Until international ethics education becomes more comprehensive, it is difficult to see how scientists can be cast with real confidence as first-line defenders.
Ethics education for scientists must be focused so that scientists can see value in the topics under discussion—that is, ethics education requires buy-in from the scientists. Without buy-in, ethics education can aspire to little more than providing scientists with information about the risks associated with biosafety, biosecurity, and dual-use issues. It cannot encourage scientists to engage in critical reflection about the misuse of research and to practice ethical decision making.
Getting buy-in from scientists is not so difficult when it comes to biosafety. The biosafety risks associated with research, and scientists' responsibility to address these risks, are a fairly straightforward and generally manageable element of the ethics curriculum. But making scientists properly aware of security risks—whether these risks fall into the biosecurity or the dual-use category—is a far more complicated process. Scientists often perceive these risks as quite removed from their daily research practices (and in most cases there is little that scientists can actually do to reduce the risk that their work will be misused). If scientists are presented with responsibility for reducing risks that they perceive as unfounded, the efficacy of ethics education can be severely undermined. Thus ethics education must walk a fine line—encouraging ethical decision making and critical reflection without exaggerating the security risks inherent in research.
Low- and middle-income countries often suffer from a persistent lack of formalized ethics education. The majority of the ethics education that scientists receive in these nations is made available because funding requirements or collaboration agreements require that it be provided (or else it comes in the form of online courses). Scientists therefore receive ethics education that is highly generalized—or, if specific, is specific to the research context of a high-income country. These decontextualized ethics initiatives often discuss types of research that are outside the national research remit of low- or middle-income countries—and scientists often struggle to see the point in discussing risks that fall outside their frames of reference. Moreover, highly visible problems such as poor health care provision may overshadow security concerns in low- or middle-income countries, further complicating ethics education.
Another problem facing education initiatives in low- and middle-income countries is that these nations do not have, nor are they likely to develop soon, comprehensive structures allowing scientists to report concerns about biosafety, biosecurity, and dual-use issues. Such structures in wealthier nations may not be perfect, and they remain the subject of considerable discussion, but they do exist. So those involved in ethics education must be very careful not to present developing-world scientists with responsibilities that they have no way of fulfilling. Initiatives in ethics education must strike the right balance between responsibility and risk; otherwise, scientists will see biosecurity and dual-use issues as simply not pertinent to their research.
An important step toward confronting the threat of emerging pathogens is to develop improved educational approaches for life science ethics. As such approaches are developed, it must be continually reiterated that one size cannot fit all—any successful model for ethics education must contend with issues such as the cultural environment in which the model is to be applied and the practicalities of specific research environments. (Then again, the international harmonization of ethics education is an important issue in its own right.) Until ethics education can overcome such challenges, it will be very difficult to establish an international community of scientists—scientists appropriately aware of biosafety, biosecurity, and dual-use issues—who truly can act as a united first line of defense against emerging pathogens.
Making bad data good
Outbreaks of emerging pathogens, whether natural or manmade, are not just health issues. They present challenges along several other dimensions—legal, political, economic, and military. Improved disease surveillance is at the heart of meeting many of these challenges.
Disease surveillance entails gathering information about the current and past prevalence of diseases in specific countries and regions and provides context necessary for understanding new disease outbreaks and determining, among other things, if they are natural or manmade. Such information is gathered, for the most part, by national health organizations, which forward it to entities such as the World Health Organization, the Pan American Health Organization, and the Centers for Disease Control and Prevention. There, information is compiled into databases and published. But it's not always good information.
I have worked closely with disease statistics for more than a decade. Sadly, I have found that information about disease prevalence, whether in the developed or developing worlds, often contains discrepancies. For example, Argentina, Brazil, and Bolivia were reporting cases of dengue fever some years ago at a time when Paraguay was not. From a geographical and disease-transmission perspective, this was impossible. The discrepancy was not resolved until Paraguay provided updated numbers.
Faulty disease statistics are quite troubling in a world where international travel is easy and controls on passenger health are loose. They are troubling because urbanization has created very poor areas where crowding, inadequate hygiene, and low-nutrition diets allow diseases to flourish. Inaccurate statistics also represent a major impediment to national initiatives in both public health and defense. If you cannot say with confidence which diseases exist in your country, how can you develop a strategic plan to fight disease? How can you gauge the impact of diseases on your population? How can you prevent malevolent individuals from doing harm with deadly pathogens? Better data about the prevalence of disease are also essential for helping researchers perform their jobs more effectively and fulfilling commitments to instruments such as the Biological and Toxin Weapons Convention. If more effective systems for disease surveillance are to be established, improvements are necessary in two main areas: the legal and institutional realm, and the educational realm.
An international legal and institutional framework already exists for emerging diseases, comprising a health component and a weapons component. On the health side, the World Health Organization oversees efforts to combat many diseases. On the weapons side, the Biological and Toxin Weapons Convention, the Geneva Protocol, and the Australia Group (an informal export-control entity) are intended to inhibit the development of biological weapons. But there is considerable overlap between the two realms—for example, yellow fever and dengue fever are relevant both to the health side and the weapons side. This leads to much duplicated effort, as individuals and institutions responsible for disease reporting often must report data to multiple entities. Thus the odds increase that data discrepancies will appear. These problems could be remedied if international health and weapons institutions came to regard disease surveillance as a natural point of contact between their respective endeavors.
But no matter how close the coordination might be between health-oriented and weapons-oriented organizations, data on disease outbreaks will remain flawed if—as is often the case—local health professionals lack the education and training they need to fulfill their duties in disease surveillance. Nations and individual health professionals sometimes lack the ability to identify diseases. Sometimes they don't clearly understand which diseases to report, or whether to report individual cases or only major outbreaks. They may be unsure whether to report all cases or only fatalities. And there may be confusion about whether reports should be filed yearly, monthly, or whenever a worrisome event occurs.
The good news is that these problems can be resolved through improved education for health professionals and officials. The bad news is that little is being done at the international or national levels to improve education. Entities such as the World Health Organization should develop educational programs to address these problems, monitor their performance, and coordinate their efforts with related national initiatives. But bottom-up efforts can also be useful. For example, the University of Bradford has developed excellent tools that can be used to train health care professionals on issues such as reporting data to the Biological and Toxin Weapons Convention. Creating a world safer from emerging pathogens requires that players at all levels—from municipal to national governments, and from regional organizations to global ones—do their part to improve systems for disease surveillance and reporting.
Round 2
Health in Africa: Corruption and misplaced priorities
In April 2001, member states of the African Union met in the Nigerian capital of Abuja and pledged that, by 2015, each nation would devote at least 15 percent of its governmental expenditures to public health. Prospects for meeting that goal seem poor. As of 2009, the proportion of government expenditures devoted to health had actually declined in 11 African nations. As of 2011, though the proportion of government expenditures devoted to health had increased across the continent (to 11 percent from 9 percent), only six countries had reached the 15-percent goal.
Many African governments blame inadequate public health funding on poverty. But the real culprits are corruption and misplaced priorities—which guarantee that delivery of health care is poor, surveillance systems to detect emerging and re-emerging pathogens are ineffective, and efforts to control disease often end in failure. The AIDS and Rights Alliance for Southern Africa, a regional network of nongovernmental organizations, runs a campaign that draws attention to the spending choices that African governments make. The alliance reports that some governments, instead of providing adequate funds for health, education, and other services that would better the lives of their people, devote exorbitant sums to frivolous expenditures. The government of Swaziland has spent $500,000 on a luxury car for the king. Uganda has spent $48 million on a private presidential jet. Zimbabwe spent $250,000 on a lavish celebration of the president's 85th birthday. Senegal has spent $27 million on a bronze statue taller than the Statue of Liberty—and a proposed new city gate to Abuja would cost $395 million. None of these nations has met its 2001 commitment regarding health care spending.
In most African countries, implementation of the disease surveillance activities that are required for early detection of emerging pathogens remains defective at both the local and national levels. For example, a recent assessment of disease surveillance and response implementation in Nigeria's Kaduna State revealed that 38 percent of the state's health facilities had no standard case definition for priority diseases, 71 percent lacked a computer and printer, and 81 percent carried out no analysis of data they collected. In Africa, poor surveillance and data management mean that months can often pass between the beginning of an outbreak and the time it is first reported to health authorities. Even then, underreporting is likely to be rampant—epidemiological investigations often reveal many more cases than were reported through surveillance systems. The African Union has estimated that corruption costs African economies about $150 billion each year. A fraction of that money could provide every nation in Africa with an efficient disease surveillance system and a high-quality laboratory network to support it.
In Round One, Louise Bezuidenhout and Chandre Gould discussed ethics education as a critical element in allowing scientists to act as a first line of defense against emerging pathogens—but where corruption flourishes to such an extent, there is little chance for ethics to survive or thrive. Developing countries must get their priorities in order and be held accountable for their health expenditures. If each country did what it is really capable of—in enhancing disease surveillance, improving laboratory support, and efficiently managing data—the world would be much safer from emerging and re-emerging pathogens.
Why don't problems get fixed?
In Round One, the authors participating in this roundtable identified several problems that must be addressed if developing countries are more effectively to detect and respond to emerging and re-emerging diseases—or prevent and detect malevolent or accidental releases of pathogens. The ideas presented in the three essays are important. But they are not new to discussions on disease control.
Oyewale Tomori correctly identified several weaknesses in nations' health capacities, including inadequate systems of disease surveillance and poor laboratory support. He proposed that nations "take 'ownership' of systems for disease surveillance, prevention, and control," and also urged governments to share information and resources. Maria José Espona focused on the integrity of the data that surveillance systems provide and argued that health professionals, particularly in developing countries, often exhibit low capacity to produce accurate data. She believes that education represents a big part of the solution to emerging pathogens. We, the authors, believe likewise, and we argued in Round One that improved ethics education for scientists is crucial.
But for years, the problems identified in Round One have received attention in international health discussions, particularly in the context of the Biological and Toxin Weapons Convention (BTWC) and the World Health Organization (WHO). The concerns raised by Oyewale and Espona are addressed to a large extent in the 2005 International Health Regulations, a legally binding international agreement negotiated under the auspices of the WHO, which specifically requires states to "develop minimum core public health capacities." In support of this requirement, the WHO's Department of Global Capacities Alert and Response works to enhance national and international capacities in disease surveillance and response. As for ethics education and awareness-raising for scientists, these issues have been identified in the context of the BTWC, over at least the last eight years, as critical in preventing malevolent uses of the life sciences.
Shortcomings in national capacity, disease surveillance, and ethics education are well understood. So what stops them from being addressed successfully? The likely answer is that these shortcomings are symptoms of larger problems in the global health system. One such problem is weak or corrupt governance, as addressed by Tomori in Round Two. Another is the relatively low priority given to public health at the regional, national, and international levels.
But in addition, while the BTWC has the potential to provide a framework for international cooperation and exchanges in health, its effectiveness is undermined by its current inertia—which can be traced to the 2001 collapse of negotiations to establish a verification mechanism for the treaty. The BTWC, like other disarmament treaties, is also vulnerable to larger international political tensions. Today, decision-making processes in the treaty context are all but nonexistent.
In 2011, ahead of the Seventh Review Conference for the treaty, co-author Gould, along with Jeremy Littlewood and Gigi Kwik Gronvall, argued that one way to cure the BTWC's malaise might be to more vigorously implement the treaty's Article X, which encourages states to share knowledge and technologies. Such sharing could, among other things, improve disease detection and response. Gould, Littlewood, and Gronvall recommended—and this remains as relevant today as it was in 2011—that knowledge and technology exchanges between developed and developing nations no longer be cast as interactions between donors and hapless recipients.
Indeed, when it comes to disease surveillance and response, developing countries can give as much as they gain in exchanges with wealthier nations. But as things stand now, developing countries don't view the BTWC as a useful forum through which to raise concerns and share knowledge. This produces something of a chicken-or-egg problem, because if the treaty is to become truly relevant to scientists and publics in emerging countries—and more effective on a global level—developing nations need to put their own stamp on proceedings. Discussions at the BTWC that do not take into account the concerns of developing countries produce linguistic and conceptual gaps that ultimately induce apathy. This problem must be overcome if all parties to the treaty are to participate in it effectively.
Unfortunately, there are only a tiny handful of civil society groupings around the world that follow the proceedings of the BTWC. A similarly insignificant number of national activist organizations campaigns for improved public health services. So while the treaty could offer a powerful tool for fostering international discourse on disease control, something is lacking—the political pressure and sense of purpose needed to effect changes that could counter the spread of disease.
Planning for the entire disease cycle
So far in this roundtable, the authors have presented a number of valid and largely correct arguments. But the conversation has been atomized, with each author focusing on issues that fall within his or her own experience or area of expertise. This atomization is symptomatic of problems within the global health system, where inadequacies in communication and coordination can plague efforts to control emerging pathogens. Often, stakeholders in health systems don't know who the other key players are, what those individuals' responsibilities are, and how to go about working together.
To remedy this, nations must establish systemic approaches to battling pathogens. One way to make efforts systemic is to organize them around the stages of a disease's evolution—that is, to make plans corresponding to the times before, during, and after an outbreak.
Before an outbreak, the most important issues are to evaluate readiness and to predict the needs that will emerge once an outbreak occurs. Accordingly, officials must gather good statistics regarding past and present epidemiological conditions. Needs for equipment and personnel must be identified, and those responsible for resource allocation must make appropriate decisions. Scientists, medical doctors, nurses, and even politicians must receive the education and training that they will need in the event of an outbreak; all stakeholders must be included. Response plans must be formulated in line with plausible outbreak scenarios. Finally, those responsible for treating disease (doctors, nurses, and administrative personnel) and those who study disease (scientists in research laboratories) must prepare to work collaboratively, and they must be provided incentives as necessary. Changing health care's need-to-know culture into a need-to-share culture is fundamental.
Outbreaks put to the test the steps taken during the preparatory stage. During an outbreak, officials once again must gather good statistics. They must decide where to allocate emergency resources including money, equipment, instruments, professionals, and so on. Political decision makers must provide support for disease-fighting efforts. The mass media must do its part to provide necessary information to the public.
The aftermath of an outbreak amounts to a learning opportunity, a chance to judge the adequacy of plans made before the outbreak and of implementation during it. Evaluations made at this time—not only of health care itself, but also of communications efforts and the political aspects of disease response—should be fed back into planning for the next outbreak. Thus a new cycle begins.
All this sounds fairly straightforward, but pathogens' refusal to stay within one country complicates everything. Regional and international cooperation is imperative—but if it's difficult to build a successful response program within a single nation, doing so across several nations presents enormous difficulties. This is where the World Health Organization, with its ability to coordinate national efforts, plays a very important role.
In any event, it is critical that the goals of disease-fighting efforts be defined in objective terms; that an appropriate level of commitment be given to meeting those goals; and that individuals responsible for following through on plans be held accountable if they fail to fulfill their duties. In the struggle against emerging pathogens, there is a lot to lose and a lot to gain. Winning the battle depends on making good plans, implementing them well, assessing successes and failures, and incorporating what is learned into plans for the future.
Round 3
Wake up. Ease off.
Global efforts to contain emerging pathogens will continue to fail, and pathogens will continue to have a field day, as long as some countries shirk their responsibilities and others annex responsibilities that aren't rightfully theirs. Clear and distinct roles must be defined for both developed and developing countries and, crucially, each country must be held accountable for lapses in performing its defined role.
In Round Two, Louise Bezuidenhout and Chandre Gould discussed the concerns about national capacities in disease surveillance and response that Maria José Espona and I, separately, had earlier raised. Bezuidenhout and Gould noted that concerns about capacity are "addressed to a large extent in the 2005 International Health Regulations." These regulations, as Bezuidenhout and Gould wrote, require states to "develop minimum core public health capacities." But in 2011, six years after the regulations were agreed upon, the World Health Organization reported that only 32 percent of African countries had established legislation in support of the regulations. Only 33 percent had established the capacities in human resources necessary for implementing the regulations.
Meanwhile, Africa's perennial weakness in surveillance and reporting is demonstrated by an ongoing Ebola outbreak in Guinea. The first case in the outbreak appeared no later than December 2013 but Guinea did not notify the World Health Organization until March 2014. This represents no improvement over the Ebola outbreak that 19 years ago struck Kikwit, in the Democratic Republic of Congo (then Zaire). At that time, the interval between the outbreak and the notification of health authorities was about three months. When it comes to improvements in rapid response to pathogens, Africa has remained in the slow lane.
What's responsible for this inability to rapidly contain emerging pathogens? In addition to corruption, and the failure to prioritize health issues—themes I addressed in Round Two—many developing countries seem to have settled into a condition of dependency regarding health and emerging pathogens. Developed countries, meanwhile, have a tendency to cling to sovereign control of disease surveillance processes. One example should illuminate my point.
During the 1995 outbreak of Ebola in Kikwit, an international study team led by the World Health Organization was on hand to help contain the epidemic. At the closing ceremony, a discussion took place about how to disburse the funds that countries around the world (a few of them African) had donated to control the epidemic. I suggested that some of the money be used to upgrade a laboratory in Kinshasa that the French government had begun to construct but subsequently abandoned. Upgrading the laboratory would have enhanced African scientists' capacity to provide support for disease surveillance and would have enabled them to handle dangerous pathogens on their own. Without improved laboratory support, as I explained, any African country undergoing a future Ebola epidemic would have to call for external help, which would work to the detriment of local scientists. No one present, whether from a developing or developed country, took my suggestion or my prediction seriously. Since then, Africa has experienced over a dozen outbreaks of Ebola; the affected countries have included Gabon, Sudan, Uganda, and now Guinea. Africa has been unable to contain any of these outbreaks without resort to international aid. In 1995, African countries missed an opportunity to "own" the processes of disease surveillance. Developed countries missed a chance to surrender their control.
It isn't that Africa has made no progress. Rather, progress has been too slow and too fragile. When the continent has registered successes, they've usually been built on a foundation of assistance from international agencies—assistance that comes with time limits.
African and other developing countries must wake up from their dependency stupor regarding health, including disease surveillance and prevention. African countries must make more vigorous efforts to develop the core capacities required under the International Health Regulations—and countries that don't meet their agreed targets should face sanctions. Unfortunately, the International Health Regulations don't allow for sanctions or other accountability measures. But, for example, travel restrictions could be imposed on individuals from countries where certain diseases are endemic. But above all, each African country must commit its resources to ensuring appropriate surveillance for emerging and re-emerging pathogens. Meanwhile, developed countries should ease off on the dominance, on their control of the processes of global disease surveillance. Only then can developing countries truly "own" these processes.
The journey, not just the destination
In Round Two, Maria José Espona identified an "atomization" in this roundtable. The various authors, she wrote, were mostly emphasizing issues relevant to their own expertise. And she argued that the roundtable's "atomization" was symptomatic of the global health system's inadequacies in communication and coordination. In Round Three, Oyewale Tomori expressed deep frustration over African states' failure, as he sees it, to take responsibility for effective disease surveillance and response. He characterized African nations' reliance on international support as evidence of a "dependency stupor."
Espona and Tomori, in their different ways, highlighted the global health system's critical need to become more integrated, more responsible, and more responsive. But the vision that they effectively share represents a destination. Before the destination can be reached, it is necessary to recognize and gain a better understanding of a multiplicity of factors that impede progress (in addition to those already identified by Tomori and Espona). Several of these factors involve either inadequate information—regarding what works, what doesn't, and why—or a failure by health care and science practitioners to advocate forcefully for change.
In many cases, important issues surrounding the establishment and administration of health systems in developing countries are poorly understood. The broad forces that underlie these systems—historical, social, economic, and ethical—are rarely documented or investigated in an extensive fashion by in-country researchers. As a result, though it is easy to identify problems in a given country's health system, it can be hard to know where to lay the blame for problems, or how to remedy them. Also, poor understanding of local circumstances (and the factors that underlie them) often causes "donor" countries to offer or impose solutions that do not suit local contexts, or don't correspond precisely to local problems.
Conversely, a lack of in-depth data about a particular country's health system can also cause what does work—and why—to be overlooked. Not all developing countries share the same risks and capacity constraints or exhibit the same systemic failures. For example, the health systems in South Africa and Kenya differ considerably from those in the Democratic Republic of Congo and Guinea. Disease surveillance systems in the former nations have their shortcomings, but these countries' capacities to detect and respond to disease outbreaks are far more robust than in countries that, for example, have experienced prolonged conflict. Thus, a lack of discussion about why some initiatives work makes it difficult to adapt successful strategies from one context to another and diminishes the potential to learn from successes.
An important dimension to these information gaps is that developing countries' health practitioners are often relatively silent and invisible in international policy forums. Because these practitioners are responsible for providing health services on a daily basis, they are ideally positioned to offer insights and propose remedies. When they don't contribute insights and remedies, or their contributions are not heard, outsiders often impose solutions that fail to address underlying problems, or that don't receive buy-in from policy makers and health care providers. Thus it is imperative that developing-country scientists, at conferences and in the context of collaborations, assert their needs and explain their realities—that they advocate for change more actively. A related stumbling block to progress is that many in the scientific community are reluctant to be vocal about—and active in—addressing weak governance and other systemic problems that hinder disease control efforts. It is crucial to determine why this reluctance to force positive change exists.
Similarly, national and international professional associations that are in a position to advocate for change could use their positions to greater effect if they pressured governments and donor organizations to heed the recommendations of scientists and health professionals. If they exerted such pressure, key issues might find their way onto national or international agendas. Such issues might include the difficulty of implementing improvements in biorisk management when, for example, core funding for laboratories isn't available (as is the case in many countries). Discussion of these issues is necessary if a clearer understanding of mismatches between health policy and health practice is to be achieved.
Ultimately, making the world safer from emerging pathogens requires a multi-faceted approach that includes improved bioethics educations (as we, the authors, discussed in Round One) and greater collaboration among developing countries (as we discussed in Round Two). It also requires health practitioners at the national, regional, and international levels to take more vigorous action to effect systemic change.
Spotlight on South America
The fight against emerging pathogens can appear in very different lights depending on who you are and where you live. In this roundtable, Africa's efforts to control emerging pathogens have received a lot of attention, while my own region of South America has received less. So I'd like to devote my last essay to illuminating the South American picture.
From the perspective of emerging pathogens, a major difference between South America and Africa is that, when Spain and Portugal began conquering South America in the sixteenth century, they merged with local populations to a very large extent. They traveled not just to the coasts but to most areas of the continent. They imposed their religion and their legal systems. They established new population centers. This meant that they also introduced new diseases—which devastated indigenous populations. But because the Europeans intermarried with local people, immunity to many pathogens was also introduced.
In South America today, because of migration that is motivated by the desire to work or study, or by family considerations, populations continue to mix with one another at a high rate. As South Americans travel from place to place, they often carry no records of their disease history—but they do bring pathogens with them, or interact with new disease vectors along the way. Once they are established in their new locations, they tend to exhibit behaviors—regarding their own health care, for example, or food preparation—that they brought from their previous homes. Pathogens can thrive under such conditions, and diseases such as dengue fever and yellow fever are endemic in a range of South American countries. Meanwhile, the mobility of South American populations makes it very complicated to carry out disease surveillance, determine a disease's epidemiological status, or harmonize policy among nations.
Nonetheless, South America's health system has a lot going for it. Advantages include well-organized ministries of health. They include a cadre of well-trained doctors and scientists, as well as good basic infrastructure such as high-quality laboratories and hospitals devoted to infectious diseases. (Unfortunately, these resources tend to be concentrated in big cities; small towns and rural areas are underserved in comparison.) South America's advantages include regional organizations such as Unasur, which provide forums for discussing health challenges and formulating responses. Advantages also include a shared regional history and a set of shared values, factors that make cooperation across borders relatively easy.
Nonetheless, South America could do a much better job of containing emerging pathogens. With the region continuing to struggle against urgent problems such as poverty and social inequality, inadequate governmental attention and resources are available for public health. In the long run, what South America needs is a common, systemic approach to the fight against emerging pathogens. Some elements of the continent's health system work well, but the various pieces of the puzzle don't fit together optimally.
Each of the world's regions is unique, and each of its health systems is unique as well. Today, with forces such as urbanization and increased international travel presenting new challenges in the fight against emerging pathogens, it is crucial to understand the past and the present of every region. The future of health care depends on it.


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The pop star, 21, narrates this promo for the two-hour Miley Cyrus Bangerz Tour special, which airs Sunday at 9/8c, and it's all about the anticipation and drama – as Cyrus is seen getting pumped up backstage before a show, and talking about her intense connection to her fans.
"They feel safe in there. And there's not that many places that you're around 20,000 people and you feel safe," she says of the adoring throngs at her arena concerts. "I feel like they think that I'm some sort of leader, and I'm giving them kind of the push to go forward."
There is no actual concert footage in the promo, as it fades to black and the crowd's roar just as Cyrus is about to take the stage. But NBC has also released a minute-long clip of Cyrus's "We Can't Stop" performance from the special, which you can also see below.
The special features concert footage from recent shows in Barcelona, Spain and Lisbon, Portugal, as well as behind-the-scenes footage.
"Her performance in this special is flawless and passionate," the tour's creative director, Diane Martel, tells Billboard. "Miley's performance is intense and wild … To see her eyes close up, to see her lithe body and huge voice making this collection of people respond in tandem, that's the important thing to translate from stage to the small screen."


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on December 21, 2012 - 6:28 AM
, updated December 21, 2012 at 6:56 AM
Stanford Lipsey, the longtime Buffalo News publisher widely credited with keeping the newspaper an influential and viable voice throughout a challenging era for daily newspapers, will step down effective Jan. 1, News Chairman Warren E. Buffett announced.
Lipsey, who moved to Buffalo in 1980, will become publisher emeritus and will be succeeded as publisher by News President Warren T. Colville, who came to The News as advertising director in December 1987 and has been president of the company since 2001.
In his 32 years at The News, Lipsey led the newspaper's fight with the rival Buffalo Courier-Express, turned The Evening News into an all-day and then a morning newspaper, and oversaw The News' transformation into a multimedia company with a growing commercial printing business.
Lipsey, 85, also was a fierce advocate for Buffalo, encouraging business leaders to be more active, leading architectural preservation efforts, starting popular community events such as the Jazz at the Albright-Knox Series and promoting the News Neediest Fund, which has raised an estimated $20 million for needy families in the community.
"I say it's no exaggeration that The News might now be extinct, save for Stan," said Buffett, the billionaire investor whose companies have owned The News since 1977.
"We were getting clobbered," Buffett said, referring to The News' competition with the Courier-Express. "If Stan hadn't come there, I don't think we would have made it."
Others say Lipsey's influence in the newspaper business extended beyond Western New York. Donald Graham, chairman and chief executive of the Washington Post Co., said Lipsey's success in Buffalo was a factor in Buffett's decision this year to buy 63 newspapers.
"It was Stan's brilliant management of The Buffalo News that persuaded Warren that newspapers that focus on community and on the news that is most important to their readers could still be a good business," Graham said.
Added Graham: "Stan is an amazing story. The best news in the newspaper industry is Berkshire's acquisition of all those newspapers, and that wouldn't have happened without Stan. I have no doubt about that."
When Lipsey came to Buffalo, first part time in the late 1970s and then full time starting in 1980, the-then Buffalo Evening News was locked in a death match with the Courier-Express. The Courier was a morning newspaper with a strong Sunday edition, a big advertising edge and a favorable court ruling (later reversed) that made it difficult for The News to compete on Sundays.
Lipsey came to Buffalo because of his connection with Buffett, whose Berkshire Hathaway owns everything from GEICO auto insurance to Benjamin Moore Paints. Both Buffett and Lipsey are from Omaha, Neb., and in 1969, Lipsey sold a chain of weekly newspapers he owned to Buffett's company. The two became friends, even collaborating with the weeklies' news staffs on a 1972 series that won a Pulitzer Prize for an expose of Boys Town, the first Pulitzer won by a weekly newspaper.
Started in Omaha
"I came from a weekly group in Omaha that was competing against the daily, so I always was the underdog," Lipsey said. "I always had to scrap to get the newspaper ahead."
In Buffalo, Lipsey focused on winning over advertisers and readers. He imported one of his and Buffett's favorite features from the Omaha Sun, a real estate section called Homefinder, complete with TV commercials to boost its popularity. That helped The News gradually become that marketplace for real estate advertisers.
"The key in winning a newspaper battle is, 'Can you be the marketplace for advertising, including autos and real estate?' " Lipsey said. "That's how you win."
The Courier-Express closed in September 1982. Ten months later, Lipsey was named publisher of The Buffalo News.
In the three decades since, Lipsey earned a reputation as a hands-on publisher, a familiar figure on the editorial, circulation and advertising floors. He quipped that he could handle any supervisory job in the newspaper, other than on the production side.
"He's a perfectionist. He wants to know every detail about everything," Colville said of Lipsey. "He's intense, extremely committed to succeed for Warren Buffett – that relationship should not be underestimated – and he's a very smart guy. When he sets out to do something, I can't remember him ever failing."
Says Margaret M. Sullivan, who left The News last summer after 13 years as editor to become public editor of the New York Times: "Stan is very smart. We sometimes disagreed, but I often came around to seeing his point.
"He has a passion for the community, he expresses his beliefs very well, and he is persuasive."
Buffett, a longtime close friend and confidant, was asked about the secret to Lipsey's success.
"He's passionate about the newspaper," he replied. "He's 85, and he's always in motion – in a positive way. And he loves newspapers. You put that motion and passion together, and you have incredible results."
Key business figure
As publisher, Lipsey has been a leader in the business community. One of the great things about Buffalo, said Sen. Charles E. Schumer, is the small handful of people who care about the region, who look out for Buffalo and who accomplish important things for the community.
Lipsey "was our guardian angel," Schumer said. "You could see him hovering above Western New York and looking out for it every moment of the day."
Said Howard Zemsky, managing partner of Larkin Development Group and a friend of Lipsey's: "He's been in a hurry to change the trajectory of Buffalo. That's always been his highest priority. I don't think there's anything any person could give him that could make him happier than if Buffalo's economy were firing on all cylinders."
Lipsey has been a key figure in the restorations of both the Darwin Martin House and the Richardson complex near Buffalo State College. It's part of Lipsey's belief that a community builds on its strengths, and one of Buffalo's strengths is its richness of 20th century architecture, Zemsky said. Lipsey was given the Spirit of Wright Award by the Frank Lloyd Wright Conservancy in 1997 and the New York State Governor's Preservation Award by Gov. George E. Pataki in 1998.
Last year, Lipsey and his wife, Judi, were one of 10 philanthropic families, dubbed the "Circle of 10," that pledged $1 million apiece to Roswell Park Cancer Institute. In 2004, the Lipseys donated $1.1 million to Roswell Park.
And in his three decades as News publisher, several large-scale community events have become almost synonymous with The Buffalo News, including the Junior League of Buffalo Decorators' Show House, Kids Day, the Buffalo News Jazz at the Albright-Knox Series and the News Neediest Fund.
"We've fed every single hungry family in Western New York at Christmas," Lipsey said.
As Lipsey turns over the publisher's job to Colville, neither harbors any illusions about the challenges facing The Buffalo News.
"The technology has just turned everything upside down," Lipsey said. "That's number one. Number two, what can't be ignored, is that 60 years ago, the paper came to the house, and the kids started reading the comics and then the sports, and then they read the whole paper.
"Now the attention and interests of young people just aren't what they were back then."
Colville, 68, has been at The News for 25 years. He cited The News' ongoing transition toward a successful multimedia company.
"The Buffalo News is still in the process of redefining our business, and it is our goal to be nimble enough to respond to the needs of our readers and customers and to make certain that we remain relevant in these changing times," he said.
Lipsey had nothing but praise for Colville.
"Warren is very capable," he said. "He came up through advertising, and there's no better advertising man in America than Warren Colville. I think he will do a splendid job as publisher."
Future plans
As he looks ahead, Lipsey and his wife plan to travel more and spend more time in their Palm Springs, Calif., home. But Lipsey said he still plans to spend the bulk of his time in Buffalo. He will continue to have an office at The News and will continue to serve on The News editorial board.
"I won't be on the payroll," he said. "I won't be in a position of authority, but I love writing editorials and sitting in on the editorial board.
"I love newspapers."
As he prepares to step down, Lipsey traded tributes with his longtime close friend, Buffett.
"He's the perfect boss," Lipsey said. "He lets me run the paper. He's a source when I have to bounce things off someone. There's no one better or smarter than Warren Buffett. He has an infallible memory; he doesn't forget anything. And he's a darn good newsman."
Buffett got the last word.
"He's been a sensational friend – and a sensational newspaperman."
email: firstname.lastname@example.com


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Isla Taboga/ Taboga Island
This beautiful island is under an hour away; just a boat ride across the Panama Canal entrance. It is sometimes referred to as the "Island of Flowers" because of the abundance of orchids, roses, and other variety of flowers that adorn its beautiful walkways.
Taboga is a perfect day-getaway from the traffic and business of the city. While on the island you can shop, birdwatch, scuba dive or simply spend the day on the beach. There are a couple of public beaches, and one private beach accessible by a nice hike through the jungle. One of the more historically interesting sites is a simple church that lies on the island. It was found in 1550 making it the second oldest church in the western hemisphere.
If you do choose stay overnight at Isla Taboga there are a few small B&Bs and hotels. Some of these hotels, like the Cerrito Tropical, even offer day pass where you can use a room for the day. They can also help set you up with hiking fishing, boating and snorkeling trips by advance reservation. The Hotel Taboga is closed as undergoes renovation into a probable resort however here are some other places to stay .
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Getting to the Island:
To get to the island you must take one of two ferries. The Calypso ferry departs from the Playita de Amador on the Amador Causeway. The ferry departure times are in the chart below. Times can change without notice so to confirm departure/arrival times call (507) 314-1730 or check with your hotel. You need to be there an hour before departure, this can be important because there are two afternoon boats and its better to get the latest on so you can don't have to rush your day. Ticket prices are $11 adults, $7 kids & seniors (roundtrip) and the trip lasts 45min-1 hour. Last piece of advice is bring cash because there are not ATMs or banks on the island.
The other ferry option leaves from the Balboa Yacht Club at 8AM and 3PM M-Sunday. The tickets cost $10 Round trip and the ride is 30-45min. Again you want to be there an hour early. To confirm the time you can call 314-0571
|Departs Amador Causeway
|Departs Taboga Island
|8:30 a.m.
|9:30 a.m.
|3:30 p.m.
|4:30 p.m.
|Departs Amador Causeway
|Departs Taboga Island
|8:00 a.m.
|9:00 a.m.
|10:00 a.m.
|3:00 p.m.
|4:00 p.m.
|5:00 p.m.


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Top Definition
Street name for LSD. Mainly used in the Hicks side of society when they have nothing better to do other than trip on their own feet.
"You have to have taken 4 hits of Blotter Acid to mistake the moon for a cloud."
af Namegiven 18. juni 2014
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John Carucci/Associated Press
John Carucci/Associated Press
NEW YORK � To get his latest gig, Phish founder Trey Anastasio successfully wooed Pulitzer Prize-winning playwright Doug Wright over a plate of enchiladas.
The two men � joined by their mutual friend, the lyricist Amanda Green � met for the first time over Mexican food at a Chelsea restaurant. They were there to discuss the possibility of taking a huge step together � turning the 1997 documentary �Hands on a Hardbody� into a stage musical.
Wright, who wrote �I Am My Own Wife� and the musical �Grey Gardens,� obviously knew about Phish, but confessed, �I immediately associated them with their Ben & Jerry�s flavor.� Would Anastasio be able to win him over to be their composer?
�When I sat down, he gave one of the most thrilling, impromptu dissertations on why the overture to �Gypsy� is one of the most seminal pieces of American theater music,� Wright recalls. �I almost chocked on my refried beans. I was like, �This guy knows his stuff.� In that one moment, I was won over 100 percent.�
Asked about it, Anastasio admits he may have hoped to impress his dinner companions: �I probably wanted them to know that I had a reverence for musical theater and that I�ve loved the theater my whole life.�
Three years later, the trio�s collaboration finally reaches Broadway after a stop at the La Jolla Playhouse in California last summer and lots of tinkering from a fairly obsessive trio.
�It�s been a whirlwind,� says Anastasio.
�It�s been insane but really rather exhilarating,� says Wright.
It was Wright who first rented S.R. Binder�s documentary about an endurance contest at a Texas car dealership that offered a free Nissan pickup to whoever could keep their hands on it the longest. The winner lasted 77 hours.
Wright instantly thought it had potential for the stage: It had swelling drama, quirky characters and explored the meaning of the American dream. Wright gave it to his friend Green, the daughter of lyricist Adolph Green whose most recent Broadway show was �Bring It On.�
She and Wright began to work on the musical but she still wanted to find the perfect collaborator to write the music. Her husband suggested the Phish frontman, whom Green had been writing songs with on the side.
�The answer was right in front of my face,� she says. �Doug and I were both like, �We want it to sound great. We don�t want it to sound like Broadway-does-country or Broadway-does-rock. Trey just can�t do a false move musically. It just sounds like we dreamed it would.�
Anastasio threw himself into the work with the enthusiasm of a novice. Though he grew up in a home that revered show tunes and was regularly taken to Broadway, the jam band leader had to learn the hard way that what he did in Phish didn�t translate to the musical stage.
�In the theater, everything has to propel the journey of the character � every lyric, every note, everything. In a concert venue, it�s different,� he says. �I expected it to be tough. I didn�t expect it to be as tough as it has been.�
Wright and Green credit Anastasio with the flexibility and bravery to know when a song isn�t working, as he did just a week into previews at the Brooks Atkinson Theatre.
The collaborators cut the offending tune and then he and Green rushed into a dressing room and wrote a new song � �If She Don�t Sleep� � for the first act in a �mad spasm of inspiration,� as Wright puts it.
Anastasio, who was obsessed with �West Side Story� as a kid, joked that he used to love poring over old photos of Stephen Sondheim and Leonard Bernstein lounging on couches as they collaborated on last-minute songs.
Now he was doing it himself, minus all that cigarette smoke. �I always thought, �That�s it. That�s the dream: Being locked in a room with a week left before opening night and to have to come up with a new song,�� he says.
His eclectic soundtrack built on work that Wright and Green had begun as they traveled to Texas to meet more than a half dozen of the original contest participants. So determined were the writers to ground their musical in real lives that they hired a private investigator to find as many as possible.
From those meetings came heartbreaking and moving portraits of desperate people needing the truck � a man who lost his job after falling off an oil rig, an Iraq war veteran, and a Texas-born Latino who needs the truck so he can sell it and pay for veterinary school.
�It�s a musical I think about striving and about identifying dreams and going after them in a tangible and unapologetic way,� Wright says. �We hope that it�s funny and compassionate and surprising and that people see themselves in it no matter who they are and where they come from.�
All these years after that first meeting over enchiladas, the collaborators � who have worked six days a week on the show and begin texting each other at 7 a.m. � say it�s been worth it.
After a morning interview earlier this week, they were due back at the theater for more tinkering. There was a patch of underscoring that wasn�t landing and they wanted to fix it.
�I�m looking forward to playing live music again,� Anastasio says with mock fatigue, anticipating his band�s summer tour that starts in Maine in July. �It�s so much easier.�


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"She said she did a photo session with New York magazine," Hackford told PEOPLE at Tuesday's New York premiere of Love Ranch, which he directed. "I had no idea what they were until I saw them in the magazine."
The photos, which Hackford says he "loved," correspond with Mirren's role in Love Ranch as the madame of a legalized brothel.
Mirren's take on it is slightly different. "He loved them because he recognized me in them. That's the Helen that he knows," she tells PEOPLE of the shot which is "as naked from the neck up as it is from the neck down."
They do agree on the context, however. Hackford explains the shoot was more about art than nudity as Mirren, 64, is very interested in art photography. She says, "The intention was not to make a sexy photograph, the intention was to do a bare photograph."
Love Ranch, which is in theaters now, is the first time the couple has worked together since they met on the set of White Nights 26 years ago. And it is no accident. After years of hoping to work with his wife again, this time Hackford, 65, says he "consciously went out and looked."
"She played two different queens of England, two different Elizabeths, in the same year," says Hackford. "And I know as a director that's how you seduce actors – you give them something [different]."
Her role this time, Mirren says, is "not a sexy role, it's not. It's about love. A brothel, believe it or not, is not a very sexy place."
With reporting by ULRICA WIHLBORG
For more on Mirren embracing her sexy side and starring in Hackford's films, pick up the new issue of PEOPLE on newsstands now
See what other readers have to say about this story – or leave a comment of your own


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August 2012 Dairy Checkoff Update
August 2012 Dairy Checkoff Update
New Website Helps Tell Dairy's Story
The dairy checkoff has launched a new website – www.DairyGood.org – to help tell dairy's story among consumers and thought leaders.
The site reinforces the U.S. dairy industry's important role in a safe, affordable and abundant food supply by focusing on:
· Healthy People – America's dairy producers believe in ensuring a better future for the next generation through the consumption of healthy, nutritious and great-tasting dairy products.
· Healthy Communities – The U.S. dairy industry is a vital part of the nation's food system and contributes thousands of jobs, income and vitality to communities across the country.
· Healthy Planet – Dairy farm families, along with others in the industry, are committed to environmental stewardship and reducing the industry's environmental impact.
DairyGood.org also features personal accounts of dairy producers and their challenges and solutions in dealing with the worst U.S. drought in the last 50 years.
The site represents the interests of more than 51,000 U.S. producers, along with dairy food companies that represent more than 130,000 employees nationwide and hundreds of thousands of dairy industry professionals who support a $100 billion U.S. industry that provides jobs to local communities.
For more information, visit www.dairygood.org.
Checkoff Joins National Dairy Shrine in Awarding Scholarships
Theresa Twohey of Stewartville, Minn., has been awarded the 2012 National Dairy Shrine (NDS)/Dairy Management Inc. (DMI) Milk Marketing $1,500 Scholarship. Seven undergraduate students have earned $1,000 scholarships that are made possible by DMI and NDS to encourage students to pursue careers in dairy product marketing.
Twohey is majoring in Agriculture Education Leadership and Communications at the University of Minnesota. Other award recipients include:
· Jacob Achen – University of Minnesota
· Hannah Bachman – Pennsylvania State University
· Erin Daninger – University of Minnesota
· April Johnson – South Dakota State University
· Stephanie Kasper – University of Minnesota, Twin Cities
· Ashley Swenson – University of Minnesota
· Abby Wethal – University of Wisconsin-Madison
Scholarships will be presented Oct. 4 during the World Dairy Expo.
For more information about the checkoff, visit www.dairycheckoff.com.


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A villain from the Dragonball Z OVA Plan to Destroy the Saiyans which was only realesed in Japan. He was the most brillant scientest of the Tsufuru-jin race who was bent on destroying all of the saiyans for destroying his race. He is also the creator of the monster machine Hachihyakku.
Dr Raichi hates the Saiyans
von AkatoshsServent 18. August 2007
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Anatomy of the Pancreas
The pancreas is a gland behind the stomach and in front of the spine. It is about 6 inches long. One end is wide and tapers to a narrow tail at the other end. The wide end is called the head. The middle is called the body. The narrow end is called the tail.
The pancreas makes digestive juices and hormones. These two substances help your body break down the food you eat and turn it into the energy your body needs.
Pancreatic juices contain chemicals called enzymes that help you digest food. These enzymes are made in exocrine cells. (Most pancreatic cancers start in the exocrine cells.) The pancreas releases these juices when they are needed during meals. These juices enter your intestine through tubes called ducts.
The main pancreatic duct is at the head of the pancreas. It joins the common bile duct which comes from the liver and gallbladder. The juices from the pancreas, and other substances from the liver and gallbladder mix together. The merged ducts open into the first part of the small intestine, called the duodenum. In the duodenum, the juices help break down fats, sugars, and proteins from the food you eat.
Hormones are chemicals that help your body control how it works. The pancreatic endocrine cells are arranged in small clumps called islets of Langerhans. They make many hormones, including insulin and glucagon. These hormones help your body use and store the energy created from the food you eat. A small number of all pancreatic cancers are found in endocrine cells. Because they are less common and treatment varies widely, endocrine cancers are not discussed here.


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How scientists can determine age and other features of a rock or material it contains.
Students take an informational tour to gain a basic understanding of geologic time, the evidence for events in Earth's history, relative and absolute dating techniques, and the significance of the Geologic Time Scale.
Quiz on Tree Rings, Ice Cores, and Varves
A list of student-submitted discussion questions for Tree Rings, Ice Cores, and Varves.
Using the Antarctic science research being completed by ANDRILL, students will learn through personal scientist accounts how they determine the age of rocks and connect it to Earth's climate history. Students will then manipulate a simulation to see the impact climate change will have on the Antarctic ice sheet.
This study guide summarizes the key points of Tree Rings, Ice Cores, and Varves. You can download and customize it to suit your needs and study habits.
These flashcards help you study important terms and vocabulary from Tree Rings, Ice Cores, and Varves.


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on November 15, 2012 - 7:35 PM
BATAVIA – The Genesee County Legislature wants appointments of directors who serve on the Genesee County Economic Development Center to "continue to be at the pleasure of the Legislature."
At a meeting Wednesday, the legislators approved a resolution that sets six-year terms of office for the six board members. The plan is to stagger terms so only one expires each year. Since its inception as in industrial development agency, board members have been appointed by the Legislature, but there has been no defined time. The only term ending next year is longtime board member John F. Andrews, who serves as chairman. The term of the newest member, former County Attorney John L. Rizzo, ends in 2018.
The legislation also enables the Legislature to make appointments should a director leave in midterm. A legislator – currently Rochelle M. Stein of Le Roy – acts as liaison and would not be affected by a term.
County funding for the economic development center came under fire in current discussions on the 2013 budget. The county pays $215,000 a year, but some legislators say the profitable agency does not need funds that could be diverted to other county needs.
Since its inception in 1970, board members were appointed by the Legislature and served indefinite terms.
In other business, the Legislature:
• Appointed Felipe Oltamari director of the Planning Department at a salary of $56,742 per year. He will succeed James Duval, who retired.
• Approved the distribution of $313,815 in mortgage tax proceeds among the city, 13 towns, six villages and Attica, which is partly in the county. The city and town will get $110,000 from the 0.25-point levy on mortgage transactions.
• Allocated $348,565 to the Department of Mental Health Services for 2013 social rehabilitation services.
• Approved a Mental Health contract, also for 2013, with Regional Action Phone for rehabilitation services at a cost of $108,891 for its hotline response.
• Transferred $140,000 to the Sheriff's Office for unexpected costs of housing female inmates. The census has jumped to about three times what it was. Genesee has no lockup provisions for women who are housed in jails in neighboring counties.