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Author Affiliations: Divisions of General Medicine (Drs Rogers, Langa, Kim, Nallamothu, McMahon, and Saint and Mr Kaufman) and Infectious Diseases and Geriatrics (Dr Malani), Department of Internal Medicine, Department of Obstetrics and Gynecology (Dr Kim), Institute for Social Research, University of Michigan, Ann Arbor; SGIM (Society for General Internal Medicine)–Hartford Foundation Collaborative Centers for Research and Education in the Care of Older Adults, Pittsburgh, Pa (Dr Langa); and Institute of Gerontology (Drs Langa and Fries) and School of Public Health (Dr Fries), University of Michigan; Patient Safety Enhancement Program, University of Michigan Health System (Drs Rogers, Langa, Nallamothu, McMahon, and Saint); and Health Services Research and Development Center of Excellence (Drs Langa, Nallamothu, and Saint) and Geriatric Research, Education, and Clinical Center (Drs Malani and Fries), Veterans Affairs Medical Center; Ann Arbor.
Women have higher mortality rates after coronary artery bypass graft (CABG) surgery compared with men. Explanations for this sex difference are controversial. The objective of this study was to assess whether infection contributes to the increased risk of mortality in women.
We conducted a cohort study of 9218 Michigan Medicare beneficiaries hospitalized for CABG surgery. The prevalence of infection at any site during hospitalization was determined. Patients were followed up for 100 days after surgery to assess vital status. Analyses were conducted using proportional hazards regression and population attributable risk.
Women hospitalized for CABG surgery were more likely to have an infection than men (16.1% vs 9.8%, P<.001), regardless of age, race, type of admission, hospital volume, or presence of comorbidities. Infections of the respiratory tract, urinary tract, digestive tract, and skin and subcutaneous tissue were more common in women than in men. The risk of death in men increased 3-fold with infection, whereas the risk in women increased 1.8-fold. The interaction between infection and sex on mortality was significant after adjusting for age, type of admission, and presence of comorbidities (P = .008). The unadjusted percentage of deaths attributable to female sex was 13.9%, which decreased to 0.3% when adjusted for infection. Of the excess deaths in women, 96% could be accounted for by the differential distribution of infection between the sexes.
The increased risk of mortality after CABG surgery in women may be explained by underlying differences in the prevalence of infection among men and women.
Coronary artery bypass graft (CABG) surgery is one of the most common surgical procedures in the United States, with more than half a million procedures performed annually.1 During hospitalization, women have a greater risk of death than men.2 Several explanations have been given for the higher mortality in women, including structural differences in artery size and greater prevalence of preoperative comorbidities among women.3- 5 Given the discrepant findings across populations, however, this issue remains controversial.
Infection has not been previously considered as an explanation for this sex effect in population-based studies, to our knowledge. Yet, chronic infections are associated with atherogenesis, the severity of coronary artery disease correlates with pathogen burden, and infection increases the risk of mortality in cardiac patients.6- 11 We hypothesized that a portion of the sex effect in mortality following CABG surgery may be explained by underlying differences in the prevalence and consequences of infection among men and women.
Subjects were Michigan residents, 65 years or older, who were Part A Medicare beneficiaries and who underwent CABG surgery (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 36.10-36.19). A 100% sample of the Inpatient Standard Analytical File from the Centers for Medicare and Medicaid Services for 1997-1998 was obtained for Michigan residents, regardless of the location of the hospital where the surgery was performed. A retrospective cohort design was used, with a follow-up period of 100 days after the CABG procedure date. To accommodate the follow-up period and the 6-month period before hospitalization to assess comorbidities, patients with CABG procedures between July 1, 1997, and September 22, 1998, formed the cohort. In 16 patients who underwent 2 CABG procedures during this period, the first surgery was used for analysis. The Centers for Medicare and Medicaid Services provided written permission for use of the Medicare data files, and the study received institutional review board approval.
The prevalence of infection during the hospital stay was obtained using the ICD-9-CM codes within the Inpatient Standard Analytical File, including the primary diagnosis, up to 8 secondary diagnoses, and 1 injury code. All codes indicating infection were included, regardless of infection site. The codes listed in Table 1 are indicative only of those infection-related codes present in the subjects and are not an exhaustive list of all possible infection codes within the ICD-9-CM system. Information regarding time of onset of infection is unavailable in the Centers for Medicare and Medicaid Services files; therefore, infections that were present at the time of admission and those that occurred after admission were included. This measure is an approximation of period prevalence; it captures newly occurring and existing infections during the hospitalization period.
The outcome of interest was cumulative mortality during the 100-day period after the date of the CABG procedure, with the date of death determined from the Centers for Medicare and Medicaid Services denominator file. In-hospital mortality was also calculated, as well as 30-day cumulative mortality.
Information was obtained regarding sex, age, race, type of admission (elective, urgent, or emergency), type of hospital room (private room only, 2 persons per room maximum during stay, or ≥3 persons per room at any time during stay), hospital location (Michigan or out of state), length of stay (LOS) during hospitalization (in days), hospital volume (number of CABG procedures performed annually during the study period), surgeon Medicare volume (number of CABG procedures recorded for a given surgeon among Part A Medicare Michigan beneficiaries during the study period), and recent skilled care (hospitalization or skilled nursing facility stay ≤180 days before hospitalization).
To assess the prevalence of comorbid conditions among the patients, the method by Elixhauser et al12 was used. This method, developed for large administrative data sets, allows construction of 30 comorbidity measures using ICD-9-CM codes and has been shown to predict mortality in hospitalized patients.13 Information was obtained for diagnoses listed during the hospitalization for the CABG procedure and for any other hospitalizations during the 6-month period before this stay.
There were 4 main hypotheses tested in this study. (1) There are sex differences in the prevalence of infection among patients hospitalized for cardiac surgery. (2) Hospitalized patients with an infection are more likely to die than patients without an infection. (3) The strength of the association between infection and mortality is different in men and women. (4) The increased mortality in women after CABG surgery may be partially explained by differences in infection across sex.
The analyses proceeded in 3 phases. The first phase was an investigation of the association between sex and infection. The relative risk of infection for women compared with men was calculated, with 95% confidence intervals (CIs). Extended Mantel-Haenszel tests were used to assess differences in infection across age, LOS, and ordinal categorical variables, while χ2 tests were used to assess differences in nominal categorical data, with α = .05 (2-sided). The second phase was an examination of the relation between infection and mortality. A Cox proportional hazards regression model was used for the determination of adjusted hazard ratios, with clustering by hospital and robust calculation of the variance-covariance matrix.14 The third phase was an assessment of the mortality risk (crude and adjusted for infection) attributable to female sex. The population attributable risk of mortality due to female sex was calculated, as was the number of excess deaths in women.15 Adjustment of attributable risk was conducted using the weighted sum approach, with the proportion of individuals who died in each stratum serving as weights (case load method).15 This yielded an asymptotically unbiased estimator of attributable risk and controlled for underlying differences due to confounding, effect modification, or both. Asymptotic variance of the adjusted attributable risk for cohort studies was used to calculate 95% CIs.16 Attributable risks were stratified by LOS, by presence or absence of 1 or more of the Elixhauser comorbidities, as well as for specific comorbidities (diabetes mellitus, renal failure, chronic pulmonary disease, protein-calorie malnutrition, fluid and electrolyte disorder, deficiency anemia, paralysis, or other neurological disease) that were a priori suspected of increasing the risk of infection.
There were 9218 Michigan Medicare patients who underwent a CABG procedure during the study period, 5749 men (62.4%) and 3469 women (37.6%). Of these patients, 1122 (12.2%) had an infection during their hospitalization for cardiac surgery, including 34 (0.4%) with an admission diagnosis of infection. Most patients were not black and received care in state, with almost half admitted following recent skilled care (Table 2).
Women were significantly more likely to be infected than men (16.1% vs 9.8%, P<.001). The sex-specific prevalence of infection is shown in Figure 1, stratified by LOS. Although the prevalence of infection increased with age, urgency of admission, and LOS (P<.001 for all), the excess likelihood of infection among women persisted regardless of age, race, type of admission, LOS, hospital and surgical volume, recent skilled care, and presence of various comorbidities (Table 3). The proportion of women infected was greater than the proportion of men infected for each of the Elixhauser comorbidities, with one exception: the prevalence of infection among patients with rheumatoid arthritis or collagen vascular diseases was 10.5% for women and 18.7% for men.
Percentage of patients with infection by sex, type of admission, and length of stay.
In-hospital mortality was 11.9% in patients with an infection compared with 4.0% in patients without an infection (relative risk, 3.0; 95% CI, 2.5-3.6), while 30-day mortality was 9.2% vs 4.5% (relative risk, 2.0; 95% CI, 1.6-2.5). Mortality within the 100-day period after CABG surgery was 16.5% in those with an infection compared with 6.2% in those without an infection (relative risk, 2.7; 95% CI, 2.3-3.1). This relation, however, was stronger in men than in women (Table 4). Men with an infection had a 3-fold (95% CI, 2.2-3.9) higher mortality risk compared with men without an infection, whereas women with an infection had a 1.8-fold (95% CI, 1.5-2.2) higher mortality risk compared with women without an infection. The interaction between infection and sex remained significant after adjusting for age, type of admission, and presence of comorbidities (P = .008). This interaction was evident during stratification; mortality was 17.2% in men who were infected, 15.8% in women who were infected, 5.2% in men who were not infected, and 7.9% in women who were not infected.
Mortality risk attributable to female sex within the 100-day period after CABG surgery was 13.9% (95% CI, 8.1%-19.6%) and decreased to 0.3% (95% CI, −5.8% to 6.3%) after adjustment for infection (Table 5). The unadjusted excess number of deaths due to female sex in this population was 95, which decreased to 4 after adjustment for infection. Therefore, 96% of the sex effect on 100-day mortality could be explained by the underlying differences in infection in this population. Additional adjustment for age altered the attributable risks, but to a lesser degree than infection alone. Stratification by comorbidities yielded similar results.
Because the likelihood of infection increased with LOS, attributable risk was calculated for patients based on LOS (Figure 2). In each stratum, the attributable risk due to sex decreased after adjustment for infection. For patients who were discharged less than 5 days after admission, the attributable risk declined from 20.1% to 10.4% after adjustment for infection. For patients with longer LOS (5-8, 9-12, or >12 days), female sex was not a risk factor for mortality after adjustment for infection.
Percentage of deaths attributable to female sex by length of stay and by adjustment for infection (weighted sum adjustment of attributable risk with case load weights).
For patients who underwent elective surgery only, the unadjusted mortality risk attributable to female sex was 16.3% and declined to 0.3% after adjustment for infection. For patients with urgent admissions, the attributable risk decreased from 14.6% to 4.3% after adjustment for infection. For patients with emergency admissions, it decreased from 6.0% to −4.1% after adjustment for infection.
Respiratory tract infections were most common, occurring in 7.4% of patients, followed by urinary tract infections (4.7%) and digestive tract infections (2.2%). There were differences between men and women by type of infection (Figure 3). Respiratory tract infections, urinary tract infections, and digestive tract infections were more common in women than in men (P<.001, P<.001, and P = .006, respectively). Skin and subcutaneous tissue infections were also more common in women than in men (1.3% vs 0.6%, P<.001). One hundred twenty-six patients had postoperative infection (ICD-9-CM code 998.5), which affected 1.8% of women and 1.1% of men (P = .01). However, there were other types of infection that were similar across sex. The frequency of septicemia (ICD-9-CM code 038) was similar across sex, as was infection due to an internal prosthetic device, implant, or graft (ICD-9-CM code 996.6), which was reported in 0.5% of women and in 0.5% of men. Infections of the heart (pericarditis, endocarditis, and myocarditis) were recorded in 0.6% of men and in 0.7% of women. Mediastinitis was reported in 12 patients, 0.2% of men and 0.1% of women.
Percentage of patients with infection by sex and by infection site.
Our data suggest that the increased mortality in women after CABG surgery may be largely explained by differences in the underlying distribution of infection between men and women. Women who had CABG surgery were more likely to have an infection than men; it was this differential prevalence in infection that may have contributed to the excess deaths in women. The predominance of infection in women was evident across age, race, and other subgroups of patients, as well as across various infection sites.
Our results indicate that there were 2 competing forces that influenced the sex effect on mortality. The first was the increased prevalence of infection among women, and the second was the increased risk of mortality in men who were infected. The first put women at a disadvantage, while the second was detrimental to men. When these 2 competing forces were considered, the sex effect on mortality was substantially reduced toward zero. This highlights the importance of considering underlying factors, including effect modifiers, that may contribute to observed differences in mortality. In this population, the 95 excess deaths in women could be largely explained by infection; with adjustment, the number of excess deaths in women decreased to 4. The pathophysiology of infectious processes clearly places infection in the causal pathway and is more relevant to postsurgical death than known physiological differences between the sexes. However, small coronary artery size, more common in women than in men, also has been shown to be associated with greater postoperative mortality.3,4 Therefore, it would be prudent to investigate the relation, if any, between vessel size and infection, as well as the effect on postsurgical mortality.
Although infection in hospitalized patients has long been recognized as a risk factor for postoperative death, risk-based models for predicting mortality after CABG surgery have focused on preoperative risk factors, including sex but not infection.17 Although infection provides a possible explanation for the disparity between men and women in mortality after CABG surgery, such an explanation has not yet been recognized, despite evidence of greater infection in women after CABG surgery.18- 22 Studies18- 22 have shown that female sex is an independent risk factor for hospital-acquired infection after cardiac surgery. Other studies23- 25 of single-site infections in patients after cardiac surgery, however, have not shown an increased incidence in women. If a systemic response to sepsis affects mortality risk, investigations that solely target single-site infections may potentially misclassify exposure in individuals with infection at other sites and artificially reduce the estimate of effect toward the null.
It is possible that infection at any site may raise the baseline risk of mortality in older hospitalized patients, as our data suggest. Although a systemic inflammatory response has been shown to increase the risk of coronary events and death,26 it is unclear the extent to which an inflammatory response due to infection and the duration of such a response (acute or chronic) may precipitate death after cardiac surgery. It has been suggested that older patients with sepsis and concomitant conditions may undergo a prolonged hypoimmune state that increases mortality risk.27 Milazo et al28 found that elevated C-reactive protein levels before CABG surgery increased the risk of recurrent myocardial infarction. However, Marica et al29 did not find such a relation between preoperative C-reactive protein and cardiac events (including death), although they excluded individuals with acute infection from their analyses. Leukocyte count, an indicator of systemic inflammation, was recently found to be significantly associated with mortality after CABG surgery, with a 30-day mortality of 7.6% in patients in the highest leukocyte quartile compared with 2.6% in patients in the lower quartiles combined (P<.001).30
Although it is possible that the sex difference in the prevalence of infection found in our study could be due to differential coding of infection by sex (systematic undercoding of infections in men or systematic overcoding of infections in women), others have found a greater prevalence of infection after surgery.18- 22 Specific types of infection, such as urinary tract infections, have been widely reported to be more prevalent among women than among men, occurring at an annual incidence of 12% in women and of 3% in men.31 Moreover, the survival advantage of women, once infected, has been previously recognized,32- 34 and the percentage of patients infected after CABG surgery in our study (12.2%) was similar to that found in other studies.18,19 On the other hand, underreporting of infection when using administrative databases is a possibility. The addition of information regarding antimicrobial use to the ICD-9-CM code of postoperative infection has been shown to increase the proportion of patients identified with surgical site infection.35
With the information available, we were unable to discern whether the onset of infection was before admission or developed during the hospital stay. Data suggest that the proportion of patients with overt infection at admission is not likely to be large. The prevalence of infection increased with LOS, from 2.6% among those who spent less than 5 days in the hospital to 33.4% among those with stays of more than 12 days. Only 0.4% of the patients had an admission diagnosis indicative of infection. Furthermore, the scheduling of elective surgery would be expected to be postponed if an infection was readily apparent at the time of admission. With the database used, the extent to which unrecognized infection or low-grade infections were present at the time of admission could not be determined. Therefore, confirmatory studies using clinically robust data would be useful.
The findings of this study are not likely due to increased LOS in women. The reduction in attributable risk with adjustment for infection was evident, even after exclusion of the patients with longer LOS. However, the difference in mortality between men and women was not entirely explainable by infection status for those patients with short stays (<5 days). Short-stay patients are more likely to represent individuals at the extremes, those with favorable prognoses or those who died during the immediate postoperative period. Additional investigation would be necessary to clarify the factors that affect mortality in such patients.
Replication of these findings would be advisable in other databases with clinically relevant predictors of mortality, such as ejection fraction and extent of disease, and with time-related factors, such as antibiotic prophylaxis. Furthermore, because the Medicare data used in this study represent patients hospitalized in 1997-1998, it would be desirable to replicate these analyses using more recent hospitalizations.
The major findings are that women hospitalized for CABG surgery are more likely to have an infection than men, that infection at any site increases the baseline risk of mortality (although the degree of increase is greater in men than in women) and that the increased mortality in women after CABG surgery diminishes after adjustment for underlying sex differences in infection. Clearly, infection is an important factor when evaluating the association between sex and mortality after CABG surgery. As a direct indicator of patient safety, infection at any site, regardless of time of onset, warrants additional investigation as a potential contributor to mortality.
Correspondence: Mary A. M. Rogers, PhD, Division of General Medicine, Department of Internal Medicine, University of Michigan, 300 N Ingalls, Suite 7E07, Ann Arbor, MI 48109-0429 (email@example.com).
Accepted for Publication: August 29, 2005.
Author Contributions: Dr Rogers had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosure: None.
Funding/Support: This project was supported by the Veterans Affairs Medical Center/University of Michigan Patient Safety Enhancement Program and by grant 2002-0013 from The John A. Hartford Foundation, New York, NY. Dr Langa was supported by Career Development Award K08 AG19180 from the National Institute on Aging, Bethesda, Md, and by the Paul B. Beeson Career Development Awards in Aging Research Program, New York. Dr Saint was supported by a Career Development Award (RCD-00-006) from the Health Services Research and Development Program, Department of Veterans Affairs, Washington, DC, and by Patient Safety Developmental Center Grant P20-HS11540 from the Agency for Healthcare Research and Quality, Rockville, Md.
Role of the Sponsor: The funding agencies had no role in the design of the study, conduct of the study, analyses or interpretation of the data, or preparation, review, or approval of the manuscript.
Acknowledgment: We are indebted to Geir Egil Eide, MSc, for his statistical advice and to Steven Bernstein, MD, MPH, for his helpful comments.
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Pair head to trial in Millcreek robberies
Two Millcreek Township residents accused of robbing a township business after attempting to rob another in late October are heading to trial.
James R. Aleksandrowicz, 25, waived to trial amended charges of two counts each of robbery and conspiracy to commit robbery, and misdemeanor counts of theft, terroristic threats and simple assault during an appearance before Millcreek District Judge Paul Manzi on Tuesday.
Kayla L. Bednar, 23, waived to trial felony counts of robbery and conspiracy, along with a misdemeanor count of theft.
Both remain in the Erie County Prison on $100,000 bond in the case.
The two are accused of attempting to steal cash from H&K Donut, 3712 West Lake Road, at about 1:25 p.m. on Oct. 24. Police said they fled the business after failing to steal anything, and then robbed Stefanelli's Candies, 3732 Sterrettania Road, of $120 at about 2:25 p.m. on Oct. 24, according to the criminal complaints filed in the cases.
Aleksandrowicz told employees of both businesses that he had a gun, but he did not show one, according to police.
Aleksandrowicz was sentenced in late October to two years and six months to seven years and six months in state prison for robbing a Subway in Millcreek of $209 on Feb. 18.
TIM HAHN can be reached at 870-1731 or by e-mail. Follow him on Twitter at twitter.com/ETNhahn.

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Questcor and its controversial flagship drug Acthar have come under fire from short sellers. The drug's many grandfathered indications and high pricing have made it an easy target as bears wait for a cheap competitor or insurer pushback. But they forgot one thing -- unless or until that happens, Questcor is a moneymaking machine.
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Each Monday we publish Sunday's Coming, an email-only post on the upcoming readings, written by our current Living by the Word columnist.
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1 Samuel 16:1-13; Psalm 23; Ephesians 5:8-14; John 9:1-41
1 Samuel 16:1–13
I am intrigued by the emphasis on call in 1 Samuel 16. Because I am a theological educator, I am even more fascinated by the role each of us can play in nurturing someone's sense of call.
Saul and David are the key "called" protagonists in the story. But it is Samuel who carries, clarifies, and extends God's call.
A different way of seeing
Seeing has distracted me from learning how the light inside me works, fooled me into thinking I have a clear view of where the road leads.
Can someone be called and not know it, at least until God does something to reveal God's intentions? Apparently David is an example of this.
Little did tennis star Andre Agassi know that he was speaking prophetically when he declared in 1990s Canon camera commercials that "image is everything." The truth of his marketing statement seems everywhere today. Pope Francis was not only Time's "person of the year." He was also Esquire's "best dressed man of 2013." The new pope is what he says, does and wears.
2013 was also the year of the "selfie."
It's the second movement of Leonard Bernstein's choral work, Chichester Psalms. A boy soprano (or a countertenor), in the "role" of the shepherd boy, David, sings in Hebrew the opening verses of Psalm 23. He is accompanied–sparingly, fittingly–by the harp. The first several measures are tender but not tentative; filled with sentiment, but without sentimentality (this per Bernstein's instructions). When the women's voices take over the text at גַּם כִּי־אֵלֵךְ בְּגֵיא צַלְמָוֶת . . . (Yea, though I walk through the valley of the shadow of death . . .) there's an ethereal echo-canon effect. This part of the movement, when executed well, is something sublime.
Revised Common Lectionary © 1992 the Consultation on Common Texts. Used by permission.
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A complete list of all the functions and benefits of the B-vitamins would fill a textbook. Most B-vitamins function as enzyme cofactors, needed to manufacture or utilize vital enzymes. B-vitamins play an important role in the absorption and utilization of nutrients, and the creation of energy from food. Together, the B-complex is essential for proper cell structure and function of all cells throughout life. B-vitamins support the muscles, liver, kidneys, cardiovascular system, brain and nervous system, as well as reproductive and immune system health.
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GNOME Activity Journal Released w/ Zeitgeist Update
Back in December Zeitgeist 0.3 was released with many changes and its engine was even largely reworked. Since then there have been a few point releases as GNOME Zeitgeist is in the process of being stabilized for a Zeitgeist 0.4 release in time for GNOME 2.30. Yesterday afternoon Zeitgeist 0.3.2 was released to deliver on more stabilization work along with better support for GNOME's Activity Journal. The release announcement can be read on the mailing list.
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FCPS helps public follow Va. bills
Frederick County Public Schools is again providing its staff and the community with a means to follow bills in the 2013 General Assembly that could impact the school system.
This year's General…
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ROCKFORD — In the November issue of Forbes Magazine, managing director and investment officer Bradley Gummow of Gummow Wealth Advisory Group of Wells Fargo Advisors was featured in a special section titled "Chicago Financial Leaders."
Gummow has 30 years of experience in the financial services industry.
Gummow Wealth Advisory Group of Wells Fargo Advisors has offices in Rockford and Chicago. For information: wellsfargoadvisors.com.
Location, ST | website.com


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Gravity Research Aerial Reel – The Bay Area in 4K
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Fairfax-San Francisco murder suspects ordered to stand trialA pair of drifters accused of murders in Fairfax and San Francisco last year were ordered to stand trial.
Marin patients' medical data lost after cyber attackThe Marin Healthcare District and Prima Medical Foundation are notifying more than 5,000 patients that some of their medical data was lost due to a glitch that followed a ransomware attack in August.
West County: Congressman holding El Cerrito office hoursU.S. Rep. Mark DeSaulnier, D-Concord, will be available to talk with constituents during Mobile District Office hours from 10 a.m. to noon Oct. 5 at the El Cerrito Community Center, 7007 Moeser Lane.


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LEWISBURG-Alone with only his thoughts and a basketball, Mike Pastore spent many late nights at Loyalsock's gym last summer. Surrounded by championship banners that are spilling off the walls, Pastore worked while dreaming about one day becoming a part of the program's rich tradition.
That moment came Saturday night and he embraced it. All the hard work paid off and a sophomore who did not play any varsity minutes last year has added to Loyalsock's lore. Pastore scored 13 second-half points, including seven straight during a critical fourth-quarter stretch in which he put Loyalsock ahead to stay. Pastore made all five of his second-half shots and his fourth-quarter performance helped lift Loyalsock to a thrilling 61-55 win over Lewisburg and a second straight HAC-II championship.
"I got a chance to watch and cut down the net last year but it wasn't anything like this. It wasn't as exciting," Pastore said. "My teammates gave me opportunities and I came up with big plays, but I couldn't do it without them."
"Mike hit the shots when he had to," Loyalsock coach Ron Insinger said. "He lives in the gym. He's a gym rat. He has paid his dues and I couldn't be happier for him."
Loyalsock captured its fourth league title in five years and won it at Lewisburg for a second straight year. The Lancers (18-3, 13-0) are a game from capping the first undefeated league campaign in HAC-II history and are the only team that has beaten the Dragons (19-2, 11-2) this season. Loyalsock earned the title the hard way, fighting back after Lewisburg had erased a nine-point halftime deficit and taken a three-point fourth-quarter lead.
It was Pastore who changed everything.
After Travis Conrad put Lewisburg up 47-44 early in the fourth quarter, Pastore made a steal and a layup on the ensuing Lewisburg possession. Less than a minute later, Pastore swished a long 3-pointer to give Loyalsock a lead it did not relinquish. Seconds later, he made another steal and converted another layup. Just like that, Loyalsock had turned a 3-point deficit into a four-point lead and calmed a huge crowd that filled the gym well before tip and that roared when Lewisburg took its first lead.
It was the latest in a string of big-game performances by the smallest player on the court. Pastore scored 14 second-half points in the first Lewisburg win and also shined against Williamsport last month.
"I love these games. It's a little nervewracking, but once you get into the game it's just exciting," Pastore said. "I've been in a little slump lately but this was a big confidence booster. My teammates never gave up on me. They just kept giving me the ball and telling me to shoot and I got the spark back."
Lewisburg discovered its in the second half and turned what looked like might be a convincing Loyalsock win into a nailbiter that lived up to the hype, featuring the district's best two teams throughout the regular season. The Dragons scored 23 second-half points and tied it late in the third quarter when Erich Kline (15 points) hit a jumper.
Conrad then drained a NBA-range 3-pointer to start the fourth quarter and Lewisburg took its first lead. Following Pastore's seven-point flurry, Lewisburg cut the deficit to two twice but Loyalsock answered each time. Roger Wilson (16 points, 11 rebounds, 7 blocks) made a huge block in the final minute, preserving a four-point lead and Ben Sosa (12 points and 7 rebounds) clinched the win and championship with two free throws in the final seconds.
"I told the guys beforehand this gym has been good to us over the years. We have won a lot of big games here but not one of them has been easy," Insinger said. "It's always a dogfight here and it was no different tonight. Lewisburg is a quality team and it was appropriate to win it here."
"I'm sure I'm going to get up tomorrow and say that was fun to be a part of. Both teams played their hearts out and I couldn't be more proud of our guys for coming back from down nine at halftime," Lewisburg coach John Vaji said. "Our guys did a solid job in the second half to get back in the game. They didn't try to make a nine-point play. They executed offensively and bucked down defensively and it allowed us to get back in the game."
Loyalsock stormed out to a 14-4 first-quarter lead and Wilson was unstoppable at times early. Despite picking up his second foul midway through the first quarter, Wilson played nearly the rest of the game and continued being a force while Kyle Datres was outstanding defensively and added 12 points to go along with seven assists. Omar Little dealt five first-half assists and helped Loyalsock push its lead to 11 in the second quarter.
Roger Wilson 8 0-2 16, Kyle Datres 5 1-1 12, Omar Little 3 2-2 8, Ben Sosa 5 2-2 12, Mike Pastore 5 0-2 13, Ryan Bogaczyk 0 0-0 0, Luke Glavin 0 0-0 0, Tommy Baggett 0 0-0 0. Totals 26 5-9 61.
Travis Conrad 3 0-0 8, Erich Kline 7 0-0 15, Sam Allen 7 1-4 15, Mike Driscoll 4 0-0 9, Jesse Flannery 2 0-0 4, Nick Costigliola 2 0-0 4, Dan Cole 0 0-0 0. Totals 25 1-4 55.
Loyalsock14 14 14 19-61
Lewisburg8 11 23 13-55
3-pointers: Loyalsock 4 (Pastore 3, Datres); Lewisburg 4 (Conrad 2, Kline, Driscoll).
Records: Loyalsock 18-3, 13-0 HAC-II. Lewisburg 19-2, 11-2.


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A 9-year-old girl was hospitalized in critical condition after being attacked by a dog Friday morning in the Elmwood section of Southwest Philadelphia, police said.
An emergency call was placed at 11:36 a.m. in the 6800 block of Dicks Avenue, said Officer Tanya Little. The girl was at her babysitter's home when she opened a cage containing the dog, Little said. The dog then bit the girl in the face.
The girl was taken by a medic unit, which reported she had bites elsewhere on her body, to Children's Hospital of Philadelphia. Little said the wounds were not life-threatening. The dog, described as a pit-bull mix, was surrendered by the owner to the Animal Care and Control Team of Philadelphia. - Robert Moran


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"When misguided public opinion honors what is despicable and despises what is honorable, punishes virtue and rewards vice, encourages what is harmful and discourages what is useful, applauds falsehood and smothers truth under indifference or insult, a nation turns its back on progress and can be restored only by the terrible lessons of catastrophe." … Frederic Bastiat
Evil talks about tolerance only when it's weak. When it gains the upper hand, its vanity always requires the destruction of the good and the innocent, because the example of good and innocent lives is an ongoing witness against it. So it always has been. So it always will be. And America has no special immunity to becoming an enemy of its own founding beliefs about human freedom, human dignity, the limited power of the state, and the sovereignty of God. – Archbishop Chaput
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Thursday, September 22, 2011
Silver - Weekly Chart and annotations
There are several minor bands of support between the present level and the critical $32.50 region. Whether it holds those depends on the extent of further risk aversion related selling. As long as this market holds above the $32.50 region on a weekly closing basis, it will be okay and will continue to consolidate, although within a larger range.
If it fails there, the potential for a move towards $30 becomes likely.
Bulls need to take price back above the $40 level to shake the confidence of the bears after today's rout.
15 comments:
Thanks Dan for the posts! I don't know how you do it all when there is total CHAOS in the markets! I and many others truly appreciate what you do! Thanks again!ReplyDelete
Thanks Super Dave....ReplyDelete
the trick is to trade smaller in size and run like hell when the trade goes against you!
Sliver is awaiting for its daily/ weekly / monthly bottoming...it's another long-awaiting moment...montly one...still take one or two weeks I guess...once weekly is done..monthly will come right after....who cares it's 3X or 2X...just take another long term ride then.....28.4 or 24.6...well...19..also not a bad idea..how does that sound?ReplyDelete
4 gold...1645 and 1404 then down to 13xx or 12xx Why not?? since weekly / monthly ones look like half way wuter faling....though daily one is nearly bottoming....sign...wutever...just let it falls..since Fall is cominng...after falling..then we'll have another winner vacation!!!
On your most recent gold chart, you talk about price going under the 50 MA for only 6 sessions this year. That decline was stopped by the 90 day EMA -- which now sits at about 1681. You may want to put it on your chart as a possible downside target for this go-round.
I really appreciate all of your superb analysis. THANKS SO MUCH for all that you do!
All the best,
After a day like Thursday, I think you can appreciate this. I was laughing so hard, I was crying:ReplyDelete
All the best,
P.S. I'm not laughing at anyone's losses, it's just that -- I've been there. As you've said, it's important for people to control their position sizes in a market like this.ReplyDelete
Hi Dan and thanks a lot.ReplyDelete
Most of your analysis are short term.
Do you think that, on the long term, the trend has reversed?
Thanks in advance,
You said on gold: " former gap region near $1680 which should provide pretty solid support if this thing is going to stabilize."
Today gold went down to 1680.80 and has rebounded to $1695. Hopefully you were right and the POG will stabilize before going up again (after the gold options expire!)
As Jim Sinclair said, buy when the chart looks like a fishing line. Sell when it looks like a rhino's head. This will be another fantastic buying opp in an historic bull market.ReplyDelete
Dan, thanks for being a stat, chart, technician extrordinaire. Also, your views of this market are extremely appreciated. Best around. Help me here. I have 60% cash, and have taken a beating on the mining shares this year. Last was much different. My thoughts.ReplyDelete
1)Nothing has changed in leveraged world. In fact getting worse.
2)As far as the eye can see interest rates will probably be "negative" considering inflation, thanks to the Fed.
3)Supply Demand for Gold is favoring Bulls.
4)More money will have to be created before the European banking crisis ends.
If you could afford to lose, don't the Unhedged miners still look powerfully attractive. Their earnings will most certainly show growth if not exploding growth? Is not Homestake Mining still possible?
In latter part of depression it(Homestake)Mining exploded and price of gold had not nearly the run we are experiencing. I know about the ETF's, and manipulation, etc. I just think with the Chinese, Indians, and so much printing eventually the common investor overcomes the algos?ReplyDelete
The notion that this isn't another complete collapse is ridiculous. I like the metals but the bulls get to extremes and fail to admit when they are really really really wrong.ReplyDelete
If total collapse similar or worse than 08-09.
HUI and Gold collapsed first-10/08 HUI-168.
DJIA-5 months later 3/09 @ 6662.
Since then trillions printed. We wont see those numbers as deflated assets are already going to show higher values in Dow/HUI values. I just say that the HUI has gone up 90% since then and the Dow zero to negative. You have to be a long term bull Crusso.
So the charts changed; they do that every trading day.ReplyDelete
The fundamentals haven't changed; these are 24/7. That means the paper that banksters and government's decree as worthy is going bad every day...24/7.
Big investors drive all markets, and whatever freakiness any of us feel, they feel it more. Temporarily, the deep pockets have switched their allegiance back to the notion that cash is king, and risk is off.
This too shall pass.
Buy what others are selling, and sell what others are buying. Buy gold and silver.
This thing smells like a desperate short-cover. Look at the open-interest and the commercial net-short position during the 2008 crash. The BBs are trying to run it down in order to cover.ReplyDelete


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Napier Wind Project
Project Information
The Napier Wind Project is a 4.1 megawatt (MW) wind project located in the Township of Adelaide-Metcalfe, County of Middlesex, Ontario.
The Napier Wind Project is considered a Class 4 wind facility, and will feed an estimated 11,334,200 kWh annually into the local electricity grid, equivalent to the average annual power usage of 647 homes.
Project Timeline
Important Updates
Community Liaison Committee Meeting Notice: February 25, 2016
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Comments and concerns about construction:
Tel: (905) 813-8400 x118 (Kevin)
Email: napierproject(at)wpd-canada.ca
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Mail: wpd Canada
2233 Argentia Rd., Suite 102
Mississauga, Ontario
Tel: (905) 813-8400
Fax: (905) 813-7487


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The U.S. Senate began a heated debate Monday on its version of healthcare reform.
Democrats are deeply divided over what should and should not be in the bill.
Senate Majority Leader Harry Reid, D-Nev., eventually will need 60 votes to move forward with his nearly $1 trillion bill.
However, moderate Democrats are threatening to bail over abortion funding and the public health insurance option.
Republicans also oppose the bill saying the reforms would raise premiums and add to the deficit.
Reid warned the senators he plans to make them work every weekend until the bill is passed.
"Let's discuss the specifics of this bill, not the whispers and wild rumors," Reid said. "We will disagree at times. Let us at least agree that doing nothing is not an option."
"The majority is intent on passing this bill that the American people oppose, we know that from all of the surveys," Sen. Minority Leader Mitch McConnell, R-Ky., said.
"Mr. President there are many things we must do this month," he continued. "And yet we're going to spend an enormous amount of time on a bill the American people wish we would not pass."
The debate is expected to last at least until Christmas.
Healthcare Overhaul Could Spell Trouble for DemsDemocratic Divisions Threaten HC LegislationReform Moves Forward as Abortion Questions Remain
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Rutgers linebacker Khaseem Greene was searching for a word to describe the Ohio University offense and its breakneck pace. Bobcats coach Frank Solich, the former head coach at Nebraska, has fused several offensive schemes into one dynamic package that has befuddled opponents.
Fresh off a 44-7 victory over Marshall on Saturday, the Bobcats rank 22nd in scoring, averaging 39.3 points per game, and 23rd in total offense at 467.3 yards per game.
Ohio (3-0), a member of the Mid-American Conference, is off to its best start since 1976. Its victory over Marshall was the first for Ohio in the series since 2000.
"They're really good," Greene said today during the Scarlet Knights' press luncheon. "They have a great running system. The way they run their option, the tempo of their game. I have to think of a different word to call it because it's not like 'up-tempo' or 'high-octane' as I've heard before.
"It's like 'nitro' or something like that. The last game they got 50 plays in one half. We haven't really seen that. We saw 57 plays total against North Carolina. They have a really good quarterback who can run and throw. They have some real good skill position players."
Once considered a low-level, second-tier conference, the MAC, which boasts Eastern Michigan, Temple, Bowling Green and Western Michigan among its members, is quietly earning respect.
"The MAC conference has caught up," said Schiano, whose Scarlet Knights (1-1) face Ohio on Saturday at High Point Solutions Stadium. "The gap has closed. Last week, Temple almost upset Penn State (a 14-10 Owls loss). There's not a big separation anymore. There used to be. Every MAC team has good personnel. This team is probably the best team in that league. Their offense is certainly one of the best in the country right now the way they're performing.
"Coach Solich just called it the best team that he's had there. They're calling it maybe the best team they've ever had there. It's going to be a great challenge for our guys."
Sophomore quarterback Tyler Tettleton is the trigger man for the Bobcats offense. Making only his third career start, he threw for a career-high 285 yards and three touchdowns and rushed for another 53 yards and a score in the victory over Marshall, in which Ohio rang up 559 yards total offense. They have a bruising, four-headed running back-by-committee ground game, and five receivers each have at least five receptions. The Bobcats' other wins have come against New Mexico State (44-24) and Gardner-Webb (30-3).
"Their offense is unique in that it's a combination of the Nevada pistol offense, some gun-run offense and some of the Nebraska option offense that coach Solich used to employ with the speed option," Schiano said. "They employ a vertical passing game as well as a play-action passing game."
And the Bobcats play defense as well. They forced six turnovers against Marshall and rank 13th in the country in scoring defense, allowing 11.3 points per game.
"It starts up front," Schiano said, referring to the Bobcats' 6-3, 307-pound nose tackle Neal Huynh. "They create takeaways on defense. That's been something they've done extremely, extremely well.
"I think we'll be up to the challenge. It'll be a great football game. Looking forward to it."
Dave Hutchinson: email@example.com


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ALLEN PARK — If for no other reason than to make their NFL playoff picture easier to understand, the 10-5 Detroit Lions have to beat the 14-1 Green Bay Packers on Sunday.
If Detroit can pull off its first win at Lambeau Field since 1991, the Lions will earn the No. 5 seed in the NFC, and face the winner of Sunday night's game between the New York Giants (8-7) and Dallas Cowboys (8-7).
If Detroit loses, there are a couple of different scenarios which could take place:
- The Atlanta Falcons (9-6) lose to the Tampa Bay Buccaneers (4-11), in which case the aformentioned scenario remains in effect;
- The Falcons beat the Bucs, which gives them the No. 5 seed and the Lions will be the No. 6 seed.
If Detroit slips to the No. 6 seed, the first-round playoff opponent will be:
- The New Orleans Saints, with either a Saints loss to the Carolina Panthers (6-9) or a San Francisco 49ers win over the Rams (2-13) in St. Louis;
- The 49ers, if they lose AND the Saints win.
If you go based on records, the likely scenario is for the Lions to face the Saints in the first round, but crazier things have happened, so stay tuned.


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Adding Rubinius to multiruby Versions
January 22nd, 2009
In previous posts I've covered using
multiruby to switch between Ruby 1.8 & 1.9 and how to add JRuby to your multiruby environment. This post describes using
multiruby as a way to install and experiment with Rubinius in Mac OS X.
Read the rest of this entry
Adding JRuby to multiruby Versions
December 20th, 2008
In Switching Between Ruby 1.8 & 1.9 with multiruby I covered setting up and using Ruby 1.8 and 1.9 versions in
multiruby. This post describes adding JRuby to the list of
multiruby versions in Mac OS X.
Read the rest of this entry
Switching Between Ruby 1.8 & 1.9 with multiruby
December 19th, 2008
I just recently built and installed three different Ruby versions (see Installing Ruby 1.8.6, 1.8.7 and 1.9 on Leopard). Following that I wanted to do some benchmark testing between 1.8 and 1.9 on a separate project so I began to use ZenTest's
multiruby. It worked great for the benchmarking and I started to think about how to use
multiruby as a way to manage and switch between Ruby installations. As I started looking into it I came across Dr Nic's Future proofing your Ruby code. Ruby 1.9.1 is coming post, which turned on the rest of the lights for me. The Dr Nic post does a nice job of describing how to use
multiruby including setting up specific Ruby versions, adding gem support and using it with sake tasks. I'll cover some of the same setup and usage information so that this post stands alone but I won't repeat it all so I recommend you read Dr Nic's post. In addition I'll provide information about how to overcome a RubyGems installation issue that I encountered and how to use the
multiruby Ruby installations as a way to dynamically switch between Ruby versions. I'll also discuss how the static build and install from source approach used in Installing Ruby 1.8.6, 1.8.7 and 1.9 on Leopard could be modified to be provide a non-
multiruby dependent way to do Ruby version switching. At the end of the post I'll mention using symlinks as an alternative and how that approach could be used with
Read the rest of this entry
Installing Ruby 1.8.6, 1.8.7 and 1.9 on Leopard
December 10th, 2008
Dec. 19, 2008 Update: This post covers setting up and switching the default Ruby installation in
/usr/local. If you're looking for a more dynamic way to test and/or switch between Ruby versions see Switching Between Ruby 1.8 & 1.9 with multiruby.
I had originally installed Ruby 1.8.6 on Tiger from source using Dan Benjamin's Building Ruby, Rails, Subversion, Mongrel, and MySQL on Mac OS X instructions. I upgraded to Leopard but continued to run the
/usr/local version of Ruby. It has been working fine for me but for various reasons I decided it was time to upgrade to 1.8.7. I was happy to see Dan had created updated instructions for Leopard in his Installing Ruby, Rubygems, Rails, and Mongrel on Mac OS X 10.5 (Leopard) post. So I decided that I'd just install over my 1.8.6 version. It didn't go off without a hitch, I ran into a problem compiling readline. This post documents what worked to resolve the problem, my journey back to 1.8.6, how to add 1.9 support and how to switch between versions.
Read the rest of this entry


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In depth
Jan 28, 2004
Will Prince Charles et al diminish the opportunities of developing countries in nanotechnology?
Prince Charles1 and the ETC Group2 (formerly RAFI) have expressed opposition to nanotechnology in recent months, making this seem like a replay of the genetically-modified (GM) foods debate. That debate essentially ignored the voices of people in developing countries3. Commentators from industrialized countries are now focusing primarily on nanotechnology risks rather than its potential benefits. While there are legitimate risks that need to be managed, we argue that an exclusive focus on the risks will create another divide, the "nano-divide" – similar to the digital and genomics divides4 – between industrialized and developing countries. We have already called attention to the gap between the science and the ethics of nanotechnology5, citing global equity as a key area in which the ethics of nanotechnology must catch up to the science in order for the technology to progress in a socially responsible manner. Here, we show that there is a failure adequately to consider and understand how nanotechnology can bring benefits to the 5 bn people in developing countries. Our survey of select developing countries indicates varying levels of nanotechnology activity that can be categorized as "front runner", "middle ground" and "up and comer". We argue that the significant nanotechnology activity in developing countries may be derailed by a debate that fails to take adequate account of developing country perspectives6.
Nanotechnology for health and the environment in the developing world
Nanotechnology offers a range of potential benefits for developing countries. Nanometre-sized quantum dots can be used to tag biological molecules for the identification of proteins that indicate disease status7 without many of the drawbacks associated with conventional organic dyes used to mark cells8. Quantum dots could eventually be used in clinical diagnostic tests to quickly detect molecules associated with cancer cells and HIV/AIDS. This has great relevance to developing countries, where over 95% of new HIV infections occurred in 20029. Quantum dot optical biosensors can be used for the detection of TB10, which along with HIV and Malaria is responsible for half of infectious disease mortality in developing countries11. In India, the Central Scientific Instruments Organization has recently announced plans for the development of a prototype nanotechnology-based TB diagnostic kit which would reduce the cost and time required for TB tests and also use a smaller amount of blood for testing12. Further, quantum dots and other nanomaterials could be integrated with microtechnology to develop inexpensive miniaturized devices for medical diagnostics. The size of these devices would allow them to be easily used in remote regions. Vaccinations that have greatly reduced child mortality in developing countries13 could be administered in a more controlled and targeted manner using nanoparticle delivery systems14, 15. Two US-patented nanoparticle drug delivery systems16, 17 developed by researchers at the University of Delhi have already been transferred to Indian industry for commercialization. Nanotechnology-based bone scaffolds have the ability to repair damaged skeletal tissue caused by injury resulting from road traffic accidents, the so-called "unseen epidemic" 18 of developing countries. In China, a recently developed nanotechnology bone scaffold has been tested in 26 hospital patients19. Enzyme biosensors can be used to monitor soil and crop toxicity levels to improve agricultural quality control in developing countries20. Water purification technologies have been recognized as one of several key nanotechnology applications for developing countries21. The University of Brazil is currently conducting research on nanomagnets that would be attracted to oil to aid the clean-up of large oil spills. Many of these activities, of course, also hold promise for economic development.
Address legitimate risks
Technology is a critical tool for development22 and nanotechnology can address needs in areas of health, environment and economy. While overly apprehensive views and fear-mongering can prohibit serious progress, addressing the legitimate concerns associated with nanotechnology can foster public support and allow the technology to progress in a socially responsible manner. The Center for Biological and Environmental Nanotechnology at Rice University is exploring the unknown effects of nanomaterials on the environment. Their research addresses questions that include: How long will nanomaterials remain in the environment? How readily do nanomaterials bind to environmental contaminants? Will these particles move up through the food chain and what will be their effect on humans? Other nanotechnology concerns that have been raised by Greenpeace23 include: How will the incorporation of artificial materials into human systems affect health, security and privacy? Who will control the means of production and who will get to debate the risks and benefits? What will be the effects of military and corporate control over nanotechnology?
There are also potential risk management issues specific to developing countries: displacement of traditional markets, the imposition of foreign values, the fear that technological advances will be extraneous to development needs, and the lack of resources to establish, monitor and enforce safety regulations. Addressing these challenges will require active participation on the part of developing countries.
Perhaps the major risk for developing countries, however, is a widening "nano-divide": Will industrialized nations continue to invest in stain-resistant "nano" pants, nanotechnology-based cosmetics and other products solely for the rich, or will nanotechnology's potential to improve lives in the developing world be seized?
Will the nanotechnology debate resemble GM crops or ICT?
It is instructive for nanotechnology to reflect on the debates surrounding GM crops technology and information and communications technology (ICT) to address the needs of developing countries. Nanotechnology has the potential to shrink the gap between rich and poor nations by addressing issues specific to development. However, the emerging tendency to raise fears about nanotechnology before there is much scientific evidence has the potential to stall progress in less advanced nations if only the interests of the wealthy – and not the distinct needs of the poor – are allowed to dominate discussion and influence decision-making.
In the clash between scientists and activists in Europe and North America over GM crops, debate centred on the risks posed to developed nations, and relatively little attention was paid to the potential benefits for developing nations. Political pressure from wealthy countries, such as the threat of banning agricultural imports from countries that use GM crop technologies, effectively excluded the poor from participating in GM technology. As Paarlberg24 notes, "the most important barrier to getting GM seeds into the hands of farmers in poor countries is now the consumer policy and resistance toward GM foods that has become pervasive in wealthy countries that import food and animal feed". Zambia's initial refusal of US GM corn as humanitarian food relief in 2002 was attributed in part to economic fears of no longer being considered a GM-free nation by the European Union (EU)25. Nigeria's former Minister of Agricultural and Rural Development Hassan Adamu spoke of the pitfalls of neglecting the needs of the poor in the development of technology, particularly agricultural biotechnology: "It is wrong and dangerous for a privileged people to presume that they know what is best for everyone. And when this happens, it cannot come as a shock that those who are imposed upon often see this attitude as colonialist."26
While the acrimonious debates around GM crops continue, ICT is demonstrating how developing countries can benefit from emerging technologies. ICT has obvious potential health, economic and educational benefits for developing countries. In 2000, United Nations Secretary General Kofi Annan launched the Health Internetwork to promote access to health information via the Internet in resource-poor countries27. The Health Internetwork is now led by the World Health Organization with major pilot projects in India, Africa and Central Asia. The Chennai-based M S Swaminathan Research Foundation has created the Information Village Project28 to deliver ICT to rural communities in southern India. Partly funded by Canada's International Development Research Centre (IDRC) and the Canadian International Development Agency (CIDA), the project involves local volunteers and places particular emphasis on empowering rural women. Software technology parks have helped India's software exports to grow to an estimated US $7.8 bn29. In South East Asia, Internet-based e-Farmers30 has provided practical online education on crop production and strengthened agricultural markets through Internet trade. Telemedicine has allowed the isolated African community of Ginnack to diagnose hospital patient symptoms through inexpensive digital image analysis31. While numerous obstacles to overcoming the digital divide still exist, ICT is recognized as a tool for development and poor countries have been able to play a significant role in its advances.
Calls for a moratorium on the new production of nanomaterials32 threaten to disadvantage developing nations. Wealthy countries have the resources to continue to invest in nanotechnology despite a moratorium on public funding - as is the case with restrictions on stem cell research in the US. They also have great incentive to invest in nanotechnology, as they will reap great economic rewards when a ban is lifted and they are technologically far ahead of other countries. Frequently, activist groups call for a moratorium not because they hope to achieve a ban, but because they wish to draw attention to their cause. Even if a moratorium is not achieved with nanotechnology, the attention it receives can result in a negative public opinion towards nanotechnology. Thus, amidst mounting opposition to nanotechnology in the developed countries, a concerted effort is required not to neglect poorly represented developing countries and to consider how nanotechnology can be harnessed to benefit the majority of the world's population. Is it reasonable for five bn people to export only bananas and tee-shirts while a small group of countries continues to get richer? At a recent workshop session on innovation systems 33, one of the participants from the Eastern Mediterranean region pointed out that the focus is always on "technology transfer", not "science transfer". Those in poor countries should be allowed to emulate the science and technology development model that allowed industrialized nations to become wealthy in the first place.
Developing countries moving ahead
Given the many ways developing countries might benefit from nanotechnology, we surveyed nanotechnology research in developing countries. A number of methods were used to collect data during the period from June to September 2003. Internet searches using keywords such as "nanotechnology" and "nanoscience" were performed to identify developing countries with nanotechnology activity. Documents from government agencies outlining the planning or implementation of funding programmes were searched for occurrences of the string "nano". Patent searches in American, Korean and Indian databases were conducted for select applicants in developing countries who had many published papers on their nanotechnology research. Personal communication with approximately 30 government officials, academic researchers and industry representatives in developing countries provided further information on contacts and nanotechnology activity in the country. Academic researchers from developed countries who had attended nanotechnology conferences in developing countries were also contacted to provide information on developing world researchers. Once data were collated, categories were devised based on the degree of government support for nanotechnology, and whether or not this support included a formal government funding programme, as well as on the level of industry involvement and the amount of Internet accessible nanotechnology research from academic institutions and research groups. The information obtained provides a good overview of the general level of nanotechnology activity in select developing countries, although greater detail would be provided by individual case studies of developing countries. Nonetheless, our research revealed a surprising amount of nanotechnology activity, and we clustered the developing countries into three groups – front runners, middle ground, and up and comers (see Table 1).
There are also promising examples of North–South partnerships. For instance, the EU has allocated 285 m Euros through its 6th Framework Programme (FP6) for scientific and technological co-operation with third partner countries, including Argentina, Chile, China, India and South Africa. A priority research area under FP6 is nanotechnology and nanosciences. Another example is the US funding of nanotechnology research in Vietnam, as well as the US-Vietnam Joint Committee for Science & Technology Cooperation35. These kinds of useful and forward-looking initiatives can easily be derailed by unbalanced calls for moratoria against nanotechnology.
The way forward
The evolution of nanotechnology, particularly in relation to developing countries, can benefit from the lessons learned from previous technologies. The aim should be to encourage public discourse and consider potential benefits for the developing world. For instance, in considering the challenge of harnessing genomics and biotechnology to improve health in developing countries, we realized that a multi-faceted approach is needed36. Foresight studies can produce awareness of potential benefits, say of biotechnologies, for developing countries37. Analyses using the framework of global public goods provide justification for collective action and the mobilization of resources from the developed world to address developmental needs in poorer countries38. Regional courses and workshops which bring together scientists, politicians, journalists, lawyers and NGOs provide valuable information that informs policy-making in addition to creating valuable opinion leader networks39. Case studies of the innovation systems of successful countries can provide useful lessons and good practices for other developing countries. Harnessing the best scientific minds in the world to address global challenges, as is being done by the Bill and Melinda Gates Foundation's Grand Challenges in Global Health40, is one way for the international community to begin to make a real difference.
But most fundamentally, the challenge here is the global governance of science and technology41, 42. There is at the moment no global focal point to commission and collect research results, promote awareness of the potential applications of nanotechnology for development, create new regulatory regimes (or build upon existing ones) for managing nanotechnology's associated risks and promoting global public goods, provide a platform for constructive dialogue among all stakeholders – including representatives from government, industry, academe and citizens groups – and engage the voices of people in developing countries. For this reason, as a practical step we propose the formation of an international network on the assessment of emerging technologies for development. This network should include groups who will explore both the potential risks and benefits of nanotechnology, incorporating both developed and developing world perspectives, and explore the effects of a potential "nano–divide". The aim of the network would be to facilitate a more informed policy debate and advocate for the interests of those in developing countries.
Although nanotechnology is just in its infancy, now is the ideal time to explore its use for development. Opposition from Prince Charles, ETC Group and others in North America and Europe should not be permitted to diminish the health, environmental and economic opportunities of the poor in Africa, Latin America and Asia.
We are grateful to Warren Chan, Paul Dufour, Deepa Persad, Fabio Salamanca-Buentello and Halla Thorsteinsdóttir for comments.
Grant Support: The Program in Applied Ethics and Biotechnology (supported by Ontario Research and Development Challenge Fund, Sun Life Financial, Merck and Co, GlaxoSmithKline, University of Toronto, The Hospital for Sick Children, Mount Sinai Hospital, Sunnybrook and Womens' Health Sciences Center, the University Health Network and the McLaughlin Centre for Molecular Medicine) and The Canadian Program on Genomics and Global Health (supported by Genome Canada and International Development Research Centre). PAS is supported by a Distinguished Investigator award from the Canadian Institutes of Health Research. EC and EM were supported by an Institute of Medical Sciences Summer Student award. The University of Toronto Joint Center for Bioethics is a Pan-American Health Organization/World Health Organization Collaborating Center for Bioethics.
1 "Prince asks scientists to look into 'grey goo'" The Telegraph 5 June 2003
2 The Big Down: Atomtech – Technologies Converging at the Nanoscale. ETC Group. January 2003.
3 Singer P.A., Daar AS. Avoiding Frankendrugs. Nature Biotechnology 2000; 18: 1223.
4 Singer PA, Daar AS. Harnessing Genomics and Biotechnology to Improve Global Health Equity. Science 2001; 294: 87-9.
5 Mnyusiwalla A, Daar AS, Singer PA. "Mind the Gap": Science and Ethics in Nanotechnology. Nanotechnology 2003; 14: R9-13.
6 Don't believe the hype. 2003 Nature 424, July 17: 237.
7 X. Gao et al., Journal of Biomedical Optics 7, 532 (2002).
8 X. Wu et al., Nature Biotechnology 21, 41 (2003)
9 AIDS Epidemic Update (UNAIDS/WHO AIDS 2002)
10 http://www.doemedicalsciences.org/abt/projects/tbtest.html
11 http://www.who.int/inf-fs/en/back001.html
12 CSIO develops nanotechnology for TB diagnosis kit, The Times of India. Times News Network. January 3, 2004. Accessed at: http://timesofindia.indiatimes.com/articleshow/401636.cms
13 The World Health Report 1999: Making a Difference.
14 J. Panyam, V. Labhasetwar, Advanced Drug Delivery Reviews 55, 329 (2003).
15 S.M. Moghimi et al., Pharmacological Reviews 53, 283 (2001).
16 Maitra et al. US Patent No: 6 332 817, Nov. 27, 2001
17 Maitra et al. US Patent No: 6 579 519, June 17, 2003
18 Browner BD "The Road Traffic Injury Epidemic in the Developing World"
19 Lin-Liu Jen, "Chinese researcher ready to 'bring nano bones to the world'" Small Times July
20 Technical Opportunities and Challenges to Upgrading Food Bio-processing in Developing Countries (Food and Agricultural Organization of the United States Publication)
21 Nanotechnology: The Technology for the 21st Century (The Full Report, Vol. 2 Asia-Pacific Economic Cooperation, 2002).
22 Human Development Report 2001: Making New Technologies Work for Human Development Published for the United Nations Development Programme. 2001.
23 Arnall, H. Future Technologies, Today's Choices Greenpeace Environmental Trust. July 2003.
24 R.L. Paarlberg. Food Policy 27, 247 (2002).
25 R.L. Paarlberg Issues in Science and Technology 19, 86 (2003).
26 Adamu H. "We'll Feed Our People As We See Fit" Washington Post 11 Sept 2000.
27 http://www.healthinternetwork.org/
28 Information Village Research Project (IVRP) Union Territory of Poncicherry
29 http://idpm.man.ac.uk/rsc/is/isi/isiexpt.shtml
30 http://www.agritani.net
31 http://www.hoise.com/vmw/articles/LV-VM-07-98-5.html
32 The Big Down: Atomtech – Technologies Converging at the Nanoscale. ETC Group. January 2003.
33 Executive Course on Genomics and Public Health Policy, Canadian Program in Genomics and Global Health and WHO/EMRO
34 Pak, Eugene. A bid to take the lead. Eye on the Future: Nanotechnology. Mechanical Engineering.
35 Waga, Miwako. 2002. "Emerging nanotechnology research in Vietnam." Glocom Platform: Japanese Institute of Global Communication. Emerging Technology Report #29
36 Singer PA, Daar AS. Harnessing Genomics and Biotechnology to Improve Global Health Equity. Science 2001; 294: 87-9.
37 A.S. Daar et al. Top 10 Biotechnologies for Improving Health in Developing Countries. Nature Genetics 2002; 32: 229-32..,
38 Thorsteinsdóttir H et al. Genomics – A Global Public Good? Lancet 2003; 361: 891-2.
39 The Genomic Policy Executive Course, India Course, Canadian Program on Genomics and Global Health
40 http://www.grandchallengesgh.org
41 E. Dowdeswell et al., Global Governance Journal 9: 1-6 (2003).
42 Daar AS et al. Genome Diplomacy: Canada's Crucial Role. Policy Options 2003; 24(8): 56-61.
About the author
Erin Court1, Abdallah S. Daar1,2, Elizabeth Martin1, Tara Acharya1, Peter A. Singer 1,3 1University of Toronto Joint Center for Bioethics, Canada; 2McLaughlin Centre for Molecular Medicine and Departments of Public Health Sciences and Surgery, University of Toronto; and 3Department of Medicine, University of Toronto, Canada


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Houdan offers one of the best locations in the entire Ile-de-France region and more specifically Yvelines - a district known for its stately chateaus such as Versailles, Rambouillet and St-Germain-en-Laye. Houdan is excellent for camping, hotels and its particularly high class restaurants. Car hire in Houdan is recommended as Paris is just 63km to the east; on the way you'll go through Versailles which is also in close proximity. Monet's Giverny is in easy driving distance to the north. Hiring a car in Houdan is available from the town itself, Charles de Gaulle Airport, Orly Airport and many other destinations in Ile-de-France.
Special Offer
France - Save 2% on your car rental: 2% off all bookings from 14th August to the 31st August. This offer applies to bookings made up until 31st August 214 only. To qualify please enter the offer code 79124 in the promotional code box (CDP) when making your booking online. Read More


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gm wrote:
> In my wife's machine FF opens new windows every time when she types
> anything into the address line. Even only one letter is enough to open a
> new empty window. I have already reinstalled windows and FF. The problem
> came back soon after reinstall.
> Another strange thing - Ctrl-Alt-Del does not work. I check the computer
> with AVG and Ad-Aware. Everything is kosher. What gives?
> Thanks in advance for the help.
> gm
Never mind. Faulty keyboard.
Thank you for reading anyway.


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On Air: 6:00 AM - 9:00 AM
Tags: Kim Kardashian, Kimye, Kim K, Kardashian Klan, North West, Kimye Baby, Kimye wedding, Kim Kardashian Elopement, North West Wedding, North West Walking Down the Aisle
Your average baby walks when they're about one. And that's something Kanye West and Kim Kardashian are banking on, because they're planning to have their baby play a big part in their wedding this year!
Rumour has it that Kim and Kanye will be getting hitched in the American summer, when baby Nori has her first birthday. But the pair are playing with fire, because while a baby can start walking as early as 8 months some don't get up and running until they're 18 months.
And if she DOES get onto her own two feet in time? Apparently Kimye are getting a pairof DIAMOND shoes with REAL DIAMONDS from iconic jewellery designer Lorraine Schwartz.
Talk about homework incentives!
Southern Cross Austereo


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Media Releases
Media contact: Cameron MacRae, Director of Marketing & Communications
780-984-3634; email@example.com
For the first time in Alberta, audiences will be treated to a royal Tudor love triangle in Donizetti's bel canto opera, Mary Stuart. Love, betrayal, lies, and anguish come together in the ultimate struggle for power between two famous British monarchs—Elizabeth I and Mary, Queen of Scots.
Director Maria Lamont brings an innovative concept to the production of Mary Stuart, one that she and designer Camellia Koo created for Pacific Opera Victoria in 2012. Now, Edmonton audiences will be transported to a present-day Tudor mansion in England, where museum staff are preparing an exhibit of famous British monarchs. As the staff mount grand portraits of Mary and Elizabeth, the two women step out of their frames and come to life, ready to stir up their passionate rivalry from centuries ago. Art imitates life and life imitates art in this visionary production.
Donizetti's trademark bel canto (literally, 'beautiful singing') style of opera takes on an intensely dramatic tone in Mary Stuart. Breaking convention, he creates two lead female characters and ensures both have distinct personalities that clash with one another. This is especially apparent in the famous showdown between Mary and Elizabeth at the end of Act II, where the two sopranos try to one-up each other vocally, resulting in a colourful display of vocal pyrotechnics.
Edmonton Opera brings two internationally acclaimed sopranos to the stage for this electrifying face-off. Renowned as one of the most promising coloratura sopranos of this generation, Kathryn Lewek plays Mary, Queen of Scots. Lewek has performed her signature role, Queen of the Night, at prestigious venues such as the Metropolitan Opera. She is described as "a vocal gymnast" who "fluidly slips from one impossibly high note to another" (Broadway World).
Keri Alkema sings Elizabeth, a role she also recently performed at her Seattle Opera debut, garnering praise for her "incisive, powerful singing" (Seattle Times). Alkema interprets Elizabeth's complex motivations with poise, and is known to offer a "rich, full vocal presence that caresses the score to perfection" (Toronto Star).
Edmonton Opera's production of Mary Stuart is part of a growing worldwide interest in this Donizetti piece, showcasing his versatility as a composer. After the success of Lucia di Lammermoor last season, Mary Stuart serves as the perfect way to continue the trend of staging Donizetti's prolific and thought-provoking operas.
The media dress rehearsal for Mary Stuart will be on Thursday, April 14, 2016, at the Northern Alberta Jubilee Auditorium, at 7 p.m. Please RSVP your outlet's attendance to Cameron MacRae, Director of Marketing & Communications, at 780-984-3634 or email@example.com.
Mary Stuart will be performed in Italian with projected English translation on Saturday, Apr. 16
(8 p.m.), Tuesday, Apr. 19 (7:30 p.m.) and Thursday, Apr. 21 (7:30 p.m.). Tickets start at $40.
Enjoy a night out at the opera with this special event! "Opera's a Drag: Meet the Queens at Mary Stuart", hosted at Earls Campus Towers, gives you a chance to enjoy a drink and appetizers with drag queens from the Imperial Sovereign Court of the Wild Rose. Then, head to the Jubilee to watch the dueling queens of Mary Stuart. Tickets include a drink, bites from Earls menu, and admission to the performance of Mary Stuart. Tickets are $49+Eventbrite fees.
More media releases
For the first time in Alberta, audiences will be treated to a royal Tudor love triangle in Donizetti's bel canto opera, Mary Stuart. Love, betrayal, lies, and anguish come together in the ultimate struggle for power between two famous British monarchs—Elizabeth I and Mary, Queen of Scots.
Donizetti's Duelling Queens Face-off in Alberta Premiere
This April, audiences will witness the dramatic showdown between two famous Tudor queens in Edmonton Opera's season clincher, the Alberta premiere of Donizetti's Mary Stuart.
Queen Elizabeth I and her cousin Mary Stuart, Queen of Scots, never got along. Elizabeth was always afraid her Catholic cousin would usurp her throne, and kept Mary prisoner for 20 years before having her beheaded. Their rivalry, however, was only ever carried out by letter—the two queens never met.
New concept for familiar piece at Edmonton Opera
There may only be three performances of Carmen in Edmonton this winter, but Edmonton Opera staff have been living with the production for months.
The scenery and costumes for the production, set on the verge of the Spanish Civil War in the 1930s, were built locally, in Edmonton Opera's northside production facility.
This new concept for Carmen was envisioned by director Maria Lamont, scenery designer Camellia Koo, costume designer Deanna Finnman and lighting designer David Fraser, and it will be unveiled Jan. 30 at the Jubilee.
Opera's ultimate femme fatale opens in Edmonton
Bizet's story of passionate, destructive love heats up the Jubilee stage this winter, in a new production of Carmen.
The new concept, envisioned by director Maria Lamont, scenery designer Camellia Koo, costume designer Deanna Finnman and lighting designer David Fraser, sets the action within the tumultuous years leading up to the Spanish Civil War in the 1930s.
"The intense passion and doomed love of Don José and Carmen touches us because we all understand the attraction and ultimate impossibility of a certain kind of love," Lamont wrote in her director's notes.
Edmonton Opera opens season with high-kicking musical comedy
A dash of romance, a scoop of comedy and a pinch of schemes is the recipe for The Merry Widow, the musical confection that opens Edmonton Opera's 2015/16 season.
All of Paris' eligible bachelors are vying for a place on the rich widow Hanna's dance card, but it spells financial ruin for the small nation of Pontevedro if she falls in love with a foreigner. In their own way, each of the characters strives for a happy ending, but it's Hanna (sung by Canadian soprano Sally Dibblee) who skilfully guides and nutures the huge emotion known as love throughout the story.


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EAST LIVERPOOL-Michael C. Renner of East Liverpool passed away very unexpectedly on Sunday, June 8, 2014 in the emergency room of East Liverpool City Hospital. He was 59 years old.
Born in East Liverpool on June 17, 1954, Mike was a son of the late John L. and Joyce E. Martin Renner.
Mike's life revolved around his family, his wife of 22 years and who married on Nov. 13, 1992, Carolyn LaNeve Renner, and his children, Jenna and Krista Renner, at home and his son, Michael Caleb Renner and wife Jamie of Weirton have been devastated by his sudden loss.
Article Photos
Michael C. Renner
Mike was a hard worker and never turned down shifts at the First Energy Samis Plant in Stratton, where he was a yard operator.
He proudly served his country with the US Air Force, and he loved spending time at the Elks lodge 258 in East Liverpool.
To say that he was huge sports fan would be an understatement. He was glued to the television if any of the Pittsburgh sports teams or any Ohio state Buckeyes teams were on.
In addition to his wife and children, Mike will be sadly missed by his family including, his sisters, Christy Ward and husband Steve of East Liverpool, and Julie Prande and husband John of Kearney, Neb.; his brothers, Steve and Jeff Renner of East Liverpool and Rick Renner and wife Haiyen of Rockwell, Texas; and his step mother, Donna Renner of East Liverpool. Krista's boyfriend, Aaron Long, and Mike's dog Princess Rose, as well as several nieces, nephews, extended family and friends, especially Kim and Fred Langer and Janet and Pete Dudgeon, who he loved spending time with, are extremely saddened by his loss.
Besides his mom and dad, he was preceded in death by his father and mother-in law, Dr. George L. and Genevieve T. LaNeve.
In fulfilling Mike's wishes a private grave side service will be held at Riverview Cemetery, at the convenience of the family, and a celebration of his life is being planned for a later date.
These services have been entrusted to the Arner Funeral Chapel in Chester where you may view this memorial and send condolences at www.arnerfuneralchapel.com.


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LOS ANGELES (AP) — Rampant fraud within California's recycling redemption program is costing the state millions, as scammers drive trucks full of cans across the border from Nevada and Arizona to collect nickels on deposits that were never paid.
The Los Angeles Times reports (http://lat.ms/QW1sg8) in addition California recyclers are claiming redemptions for the same containers several times over, or for containers that never existed.
Government officials recently estimated the fraud at $40 million a year, and an industry expert told the newspaper it could exceed $200 million. The Times says the state's $1.1 billion recycling fund paid out $100 million more in expenses last year than it took in from deposits and other sources.
Gov. Jerry Brown signed a law last month that will help identify people bringing cans into California.


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What it is: The Camden-based group will perform at 7 p.m. Friday at Buckingham Friends School in the first event of the Children's Cultural Center's Special Events Series for Families, which resumes after a six-year hiatus.
The first performance in the four-event series, which is aimed at families with young children, recognizes Black History Month. The Universal African Dance & Drum Ensemble is known for its electrifying shows, featuring stilt walkers, dancers, drummers, grand masquerades, and an acrobatic display.
The ensemble, founded by Robert and Wanda Dickerson in 1984, bills itself as one of the largest professional African dance and drum ensembles in the United States.