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Vol. VIII, No. 8 ~ EINet News Briefs ~ Apr 15, 2005
*****A free service of the APEC Emerging Infections Network*****
APEC EINet News Briefs offers the latest news, journal articles, and notifications for emerging infections affecting the APEC member economies. It was created to foster transparency, communication, and collaboration in emerging infectious diseases among health professionals, international business and commerce leaders, and policy makers in the Asia-Pacific region.
In this edition:
- International response to the distribution of a H2N2 influenza virus for laboratory testing: Risk considered low for laboratory workers and the public
- East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
- East Asia: FAO Latest information on Avian Influenza, summary report
- Indonesia, Thailand and Viet Nam: FAO "Focus on the issues"
- Viet Nam: 71 percent of ducks in southern Viet Nam infected with bird flu
- Viet Nam: Avian influenza WHO situation update
- Viet Nam: HIV Carrier Infected with Avian Influenza Virus
- North Korea: UN expert says N. Korean bird flu different from version in Southeast Asian
- North Korea: Requests help for Avian influenza from FAO/OIE
- North Korea: Requests Seoul's Help to Fight Bird Flu
- China: Explanation on Using Vaccines for the Prevention of Avian Influenza in China
- Cambodia: Avian influenza WHO situation update
- Indonesia: Avian Influenza Virus Identified in Pigs
- New Zealand: Disease strikes research scientist (Wellington)
- Russia: 5 humans develop trichinellosis in Buryatiya after consuming dog meat
- USA: Bush Authorizes Use of Quarantine Powers in Cases of Bird Flu
- Mexico: Report of low-pathogenic avian influenza
- USA/Canada: Strain of Clostridium difficile produces high levels of toxins A and B
- USA (Michigan): Drug-resistant staph infection spreading
- USA: Florida outbreak of E. coli is traced to 6 petting-zoo animals
- USA: Public Health officials report on tularemia outbreak at Boston University
- Canada: Ontario issues warning against unpasteurized milk
1. Updates
- Influenza
- Dengue/DHF
2. Articles
- Risk of oral infection with bovine spongiform encephalopathy agent in primates
- Outbreaks of Salmonella Infections Associated with Eating Roma Tomatoes—US and Canada, 2004
- Health Concerns Associated with Disaster Victim Identification After a Tsunami--Thailand, December 26, 2004--March 31, 2005
- Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food--10 Sites, US, 2004
3. Notifications
- National Plan for Reliable Tuberculosis Laboratory Services Using a Systems Approach
- CDC International Course in Applied Epidemiology
- 50th Anniversary of the First Effective Polio Vaccine--April 12, 2005
- National Infant Immunization Week--April 24--30, 2005
- Web Portal to "One World, One Health: Building Interdisciplinary Bridges to Health in a Globalized World" Symposium
- Sixth International Symposium on the Epidemiology and Control of Foodborne Pathogens in Pork
- The Second Annual Biosafety and Biosecurity Training Course
4. APEC EINet activities
- New subscription system through APEC EINet website
5. To Receive EINet Newsbriefs
- APEC EINet email list
International response to the distribution of a H2N2 influenza virus for laboratory testing: Risk considered low for laboratory workers and the public
The Public Health Agency of Canada (PHAC) informed WHO 26 Mar 2005 that an influenza A/H2N2 virus was identified by the National Microbiology Laboratory in Winnipeg, Manitoba in Canada. The H2N2 virus identified was found to be similar to H2N2 viruses that circulated in humans in 1957-58 at the beginning of the so-called Asian influenza pandemic (the H2N2 strain killed 1 million to 4 million people worldwide in 1957 and 1958). The H2N2 virus which circulated at this time was fully transmissible among humans. It continued to circulate in humans and cause annual epidemics until 1968, when it vanished after the emergence of influenza A/H3N2 viruses that caused the next pandemic. Therefore, persons born after 1968 are expected to have no or only limited immunity to H2N2. H2N2 virus is not contained in current trivalent influenza vaccines.
Appropriate biosafety measures were immediately taken at the involved laboratory in Canada and respiratory surveillance measures initiated. Subsequent investigation by the Public Health Agency of Canada traced the source of the H2N2 virus to a panel of proficiency testing samples containing influenza A and influenza B viruses which the Canadian laboratory received from the College of American Pathologists (CAP) Feb 2005. CAP routinely sends various panels of proficiency testing samples to participating laboratories every year. Normally, currently circulating influenza A viruses (H3N2; H1N1) are used for proficiency testing. The H2N2 virus was distributed by CAP for the first time Oct 2004.
WHO, the US Department of Health and Human Services (HHS) and CDC were informed of the situation by PHAC 8 Apr 2005. The problem arose when Meridian Bioscience Inc. sent a panel of virus samples to about 3700 laboratories, some in doctors' offices, to be tested as part of routine quality-control certification conducted by the CAP. The 3700 samples were sent out beginning last fall. Neither the CAP nor Meridian was aware that the virus being shipped was the 1957 strain, said a spokesman for the college. The college asked the company to ship a type A strain of virus, and Meridian's paperwork indicated that this strain was benign. Subsequent investigation revealed that similar proficiency testing samples with H2N2 virus were sent to 3747 laboratories in 18 countries. 61 of these laboratories are located in 16 countries outside the USA and Canada. HHS has recently learnt that other proficiency testing providers have sent additional H2N2 containing samples to further laboratories in the USA.
On 8 Apr 2005, CAP asked all laboratories which participated in the proficiency testing to immediately destroy samples containing the H2N2 virus. On 12 Apr 2005, a second correspondence from CAP to these labs further requested that destruction of the H2N2 virus be confirmed and that any case of respiratory disease among laboratory workers be investigated and notified to national authorities. WHO has received the list of addresses of the involved laboratories and has provided detailed contact information to the relevant Ministries of Health and requested their collaboration.
As of 12 Apr 2005, there have been no reports of H2N2 infections in laboratory workers associated with the distribution of the H2N2 samples. The proper use of biological safety cabinets, along with the use of recommended personal protective equipment, greatly reduces the risk of laboratory-acquired influenza infections. While a few H2N2 laboratory acquired infections have been documented in the past, the likelihood of laboratory-acquired influenza infection is considered low when proper biosafety precautions are followed. The risk for the general population is also considered low. WHO recommends that biosafety procedures be reviewed for use on influenza viruses that have not circulated recently in humans and against which the majority of the population would have no protective immunity.
List of countries and areas that have received H2N2 influenza virus: Bermuda, Belgium, Brazil, Chile, France, Germany, Hong Kong, Israel, Italy, Japan, Lebanon, Mexico, The Republic of Korea, Saudi Arabia, Singapore, Taiwan, and China.
CDC also offers the latest information (http://www.cdc.gov/flu/h2n2situation.htm), with updated links to:
East Asia: Cumulative Number of Human Cases of Avian Influenza A/(H5N1)
The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota compiles up-to-date figures of avian influenza cases and deaths in East Asia. As of 14 Apr 2005 the number of unofficial cases in East Asia from Jan 2004 to the present is 89 with 52 deaths; whereas the official WHO figures are 80 cases and 50 deaths. Numbers of cases reported mid-Dec 2004 to present are:
Economy / Unofficial (Official) Cases / Unofficial (Official) Deaths
East Asia: FAO Latest information on Avian Influenza, summary report
Viet Nam: Last known outbreak: 29 Mar - 4 Apr 2005. Total of 1300 ducks have either died or been culled in Tra Vinh Province. The confirmed human cases in Viet Nam reported by WHO have been 33 since 30 Dec 2004, of which 15 were fatal.
Thailand: Last known outbreak: 10-17 Mar 2005. Total of 50 birds have died or been culled in Ban Dan Lan Hoi district, Sukhothai Province.
Cambodia: Last known outbreak: 22-28 Mar 2005. Total of 139 chickens and ducks have been culled in Keatha Vong Leu village near Vietnamese border. A 28-year-old man who died 22 Mar 2005 and an 8-year-old girl who died 07 Apr 2005 both from Bantey Meas district, Kampot Province were confirmed to have been infected with H5N1.
Indonesia: During Jan - Mar 2005, HPAI had killed a total of 281 730 birds in Central Java, South Sulawesi and West Java Provinces. In Central Java Province, quail farms have been affected and over 77 000 poultry have either died or been culled. Inter-island chicken trade from South Sulawesi has been banned since mid Mar 2005. In West Java Province, 21 000 dead chickens were reported Jan - early Mar. HPAI had mostly affected quails in West Java. In Cirebon (declared as an epidemic area), destroyed quails were said to have been brought from Sleman (Yogyakarta). Some 200 000 doses of vaccine against H5N1 infection had been distributed to infected areas, and the government has set aside Rp 750 million (USD 79 000) and Rp 250 million [USD 26 000] backup fund to assist poultry breeders who destroyed their bird flu-infected flocks. Since 31 Mar 2005, West Java authorities have stopped all poultry traffic into the area. The poultry-check operation targeting chickens, quails and ducks was held in Losari.
Democratic People's Republic of Korea (DPRK): Outbreak of avian influenza was reported in 3 chicken farms including the Hadang Chicken Farm in Pyonyang province. The State Emergency Veterinary and Anti-Epizootic Committee has been organized and movement control, and increased surveillance in poultry farms has been implemented. A total of 219 000 poultry have been slaughtered. Increased mortalities were observed in Hadang Farm, and in 2 neighboring farms belonging to the same company. Veterinary authorities have vaccinated birds in these farms and the vicinity. A FAO expert is working with DPRK authorities in the diagnosis. Indirect evidence suggests that the strain is H7. (Promed 4/14/05; FAO http://www.fao.org/ag/againfo/home/en/home.html)
Indonesia, Thailand and Viet Nam: FAO "Focus on the issues"
Viet Nam: 71 percent of ducks in southern Viet Nam infected with bird flu
On 1 Apr 2005, Viet Nam started a month-long campaign to clean up poultry farms nationwide in a move to stamp out bird flu, which has hit 35 cities and provinces nationwide since Jan 2005. 33 localities have so far detected no new affected spots in their territory for 3 weeks, meeting the country's criteria to announce an end to the disease. To minimize the risk of infection, it has intensified publicity, urging local people not to eat dishes made from raw duck blood or to slaughter sick poultry for food and to avoid coming into contact with fowl without wearing protective gear. The role of ducks as reservoir of infection in Eastern Asia has been addressed during the recent FAO/OIE consultation, which concluded that the possibility of vaccinating ducks should be explored. Experimentally, vaccines have been shown to significantly reduce AI virus replication and shedding in domestic ducks and geese and thus decrease environmental contamination and prevent contact transmission. (Promed 4/13/05)
Viet Nam: Avian influenza WHO situation update
Viet Nam: HIV Carrier Infected with Avian Influenza Virus
North Korea: UN expert says N. Korean bird flu different from version in Southeast Asian
Poultry production is one of the few growing sectors in North Korea, which has relied on foreign aid to feed its people since it disclosed in the mid-1990s that its state farm system had collapsed. The number of the country's poultry was estimated at 25.5 million in 2004, about 2 times the level of 1997. According to a new definition of avian influenza in OIE's Terrestrial Animal Health Code, "Notifiable avian influenza" is an infection of poultry caused by any influenza A virus of the H5 or H7 subtypes or by any AI virus with an intravenous pathogenicity index (IVPI) greater than 1.2. (Promed 4/5/05)
North Korea: Requests help for Avian influenza from FAO/OIE
North Korea has asked FAO and OIE to provide diagnostic tools and technical assistance for disease control strategies, including vaccination. OIE and FAO welcomed North Korea's request as a sign of improved transparency and international cooperation. Both organisations said that they are ready to extend their technical support to ensure an effective control of the disease in the country. FAO experts have already been fielded to Pyonyang and are currently supporting the government in obtaining information on the extent of the outbreaks and designing control strategies. OIE has been asked to assist in the training of veterinary experts.
The FAO/OIE conference appealed to donor countries to provide more funds for the fight against avian influenza for which around USD 100 million would be urgently required. So far, only Germany, Japan and The Netherlands have expressed their willingness to financially support affected Asian countries. Many of the countries affected or threatened by AI are under-resourced and lack the capacity of veterinary services for an effective and early detection and response to the epidemic in poultry.
Improving the efficiency of veterinary services in affected countries is essential for controlling the disease at its source in poultry and free-farmed ducks. Strategies are needed for financing sustainable, concrete actions at local level. This is likely to include support for restocking or compensation for losses and should also encompass education on safe poultry keeping and development of appropriate infrastructures. Further scientific research is required to obtain more information on the potential virus transmission from animals to humans. The conference also urged laboratory networks coordinated by WHO, OIE/FAO to conduct research on H5N1 bird flu virus and other avian influenza viruses that could pose a potential threat to humans. Veterinary and Public Health Services should better work together to improve national, regional and global health security. Public Health Services should support the agriculture sector and veterinary services in order to control and eliminate the disease at its origin.
OIE and FAO announced the launch of the New Worldwide Avian Influenza Network (OFFLU) which will improve the collaboration between reference laboratories specialised on AI in animals, coordinated by OIE and FAO and laboratory networks focusing on human influenza coordinated by WHO. The network will speed up the immediate exchange of scientific data on bird flu and animal virus strains to produce efficacious vaccines for humans that respond to specific virus characteristics. (For more information on the OIE/FAO/WHO conference, see the FAO article at: http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html) (Promed 4/8/05)
North Korea: Requests Seoul's Help to Fight Bird Flu
China: Explanation on Using Vaccines for the Prevention of Avian Influenza in China
Based on the "National Emergency Plan Against High Pathogenic Avian Influenza" (HPAI), China has inoculated poultry flocks in areas susceptible to avian influenza infection. China has also inoculated poultry flocks on breeding farms, large-sized egg layer farms and in areas with a high concentration of water bodies. Poultry in certain areas designated "no enforced inoculation areas" or "no disease infected areas" have not been inoculated. Other areas apply voluntary inoculation. From Feb 2004 to Jan 2005, China has inoculated a total of 2.68 billion birds. The objective of China's poultry vaccine is to inactivate H5N1. During 2004, this vaccine played an important role in HPAI elimination and prevention in China. The vaccine is only manufactured at the plants designated by the Chinese Government.
The National Reference Laboratory has also developed 2 new vaccines. One is a recombinant AI H5N1 virus inactivated vaccine, and the other is a H5N1 fowl pox live virus vaccine. They are highly efficient, safe and can be produced cost-effectively. The recombinant H5N1 virus inactivated vaccine even works better against the HPAI because its protective period for chickens is longer, and it is especially effective for waterfowl immunity. The vaccine can efficiently stop the spread of the HPAI virus. Now, it is widely used for waterfowl inoculation in water concentrated areas in South China.
In order to strengthen disease control and guarantee inoculation quality, the MOA has carried out regular inoculation supervision and evaluation through sampling serum and pathogen tests among inoculated poultry flocks. Up to now, we have not isolated any H5N1 virus from our inoculated poultry flocks. At the same time, some provinces in South China have adopted a measure of placing inoculated poultry in highly exposed areas to watch the result of infection.
A. AI inactivated vaccine (H5 sub-type, N-28 strain)
2) Result: The antibody level reached the highest rate, 8 log2, during the 5th week after vaccination. This rate was maintained for 4 weeks. The antibody protective level can be sustained into the 23rd week after vaccination.
3) Feature: MOA approved this vaccine as a new bio-product for animal inoculation in Dec 2003. This vaccine was widely used in China during the outbreaks of HPAI at the beginning of 2004.
B. Recombinant AI virus inactivated vaccine (H5N1 sub-type, Re-1 strain)
2) Result: The antibody reached highest level of 9 log2 during the 3rd week after vaccination. This rate was maintained for 4 weeks. The antibody protective level can be sustained into the 25th week after vaccination.
3) Feature: MOA approved this vaccine as a new bio-product for animal inoculation in Jan 2005. It works efficiently for avian influenza, it helps poultry organs generate high levels of antibodies and the protective period lasts longer. The laboratory experiments proved that waterfowl inoculated with this vaccine are free of AI infection or infectivity. Many countries in the world now use this method to try to develop vaccines, but only China has succeeded and put the vaccine into commercial production.
C. Recombinant fowl pox virus live vaccine for AI (H5 sub-type)
2) Result: The antibody reached the highest level of 7 log2 during the 2nd week after vaccination. The antibody protective level can be sustained into the 26th week after vaccination.
3) Feature: MOA approved this vaccine as a new bio-product for animal inoculation in Jan 2005. It helps create antibodies against the antigen of specific proteins. It is good to differentiate immunity and field infection. Mexico also has this kind of vaccine and widely uses it.
During 2005, the Chinese Government will invest over RMB 5 billion (approximately USD 600 million) in animal disease control. (Promed 4/2/05)
Cambodia: Avian influenza WHO situation update
Human-to-human transmission as a source of the girl's infection appears unlikely, as none of her known contacts were sick with similar symptoms before she became ill. Investigations as to the source of the girl's infection are continuing. Samples were collected from 4 close contacts who cared for her at the village and 9 medical contacts from Kampot and Phnom Penh. All have tested negative for the H5N1 virus. The public education campaign in Banteay Meas and neighbouring districts is continuing. The recent funding from international donors will be crucial in helping Cambodia control this disease.
"We know she was in contact with chickens when they were dying in Feb 2005, but the exposure period is too long," WHO official Megge Miller said. "We're looking at the potential role of ducks as asymptomatic carriers," she said, noting that it was common for ducks not to show signs of the disease but still carry and spread the virus. Cambodia's first 2 victims, a woman aged 25 who died in January 2005 after traveling to Viet Nam for treatment in January 2005, and a 28-year-old man who died Mar 2005, were also from Kampot province, which borders Viet Nam. (Promed 4/12/05, 4/11/05)
Indonesia: Avian Influenza Virus Identified in Pigs
New Zealand: Disease strikes research scientist (Wellington)
ESR chief executive John Hay said the source of infection was unknown. Overseas expert Andrew Lawrence reviewed the lab's practices and reported that there were no recorded accidents. He had no reason to assume the disease was acquired in the lab. Mr Hay said the woman had worked with many strains of meningococcal disease before coming to work at the Kenepuru Science Centre. ESR has been researching a New Zealand strain of meningococcal bacterium for about 15 years. Medical officer of Health Annette Nesdale said that, the latest cases showed the meningococcal disease epidemic was far from over and demonstrated the importance of immunization. All 5 patients had been admitted to hospital; 3 had already been discharged and only the scientist remained in intensive care. Wellington Hospital infectious diseases specialist Tim Blackmore said the number of patients admitted with meningococcal disease in the past few weeks was unusual, but the disease was generally more common in winter. Health boards in the Wellington region are preparing to immunize more than 100 000 babies, children and teenagers starting May 2005. It is not stated what serotypes were involved; nor is it stated whether the researcher had previously received meningococcal vaccination. (Promed 4/7/05)
Russia: 5 humans develop trichinellosis in Buryatiya after consuming dog meat
USA: Bush Authorizes Use of Quarantine Powers in Cases of Bird Flu
President Bush signed an executive order authorizing the government to impose a quarantine to deal with any outbreak of the particularly lethal bird flu. The fatality rate among those reported to have contracted the disease is about 70 percent. Health officials around the world are trying to monitor the virus because some flu pandemics are thought to have begun with birds. Mr. Bush's order added pandemic influenza to the government's list of communicable diseases for which a quarantine is authorized. It gives the government authority to detain or isolate a passenger arriving in the United States to prevent an infection from spreading. The authority would be used only if the passenger posed a threat to public health and refused to cooperate with a voluntary request, the Department of Health and Human Services said. The quarantine list was amended in 2003 to include SARS, or severe acute respiratory syndrome, which killed nearly 800 people in 2003. Other diseases on the list are cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever and viral hemorrhagic fevers.
Quarantine and isolation were last used during the SARS outbreak in 2003. The last large-scale quarantine was during the Spanish flu pandemic of 1918-19, though there have been lesser quarantines -- for instance, travelers coming off airliners or cruise ships who have been exposed to curable diseases. Jennifer Morcone, a spokeswoman for the health centers, said Mr. Bush's executive order was intended to prepare for all options. The Public Health Service, Ms. Morcone said, would typically recommend voluntary home quarantine when possible. In general, the government defers to state and local authorities in their use of quarantine powers and would work with them in case of an outbreak, she said. (Promed 4/2/05)
Mexico: Report of low-pathogenic avian influenza
USA/Canada: Strain of Clostridium difficile produces high levels of toxins A and B
According to an SHEA news release, the toxic strain is identical to that which caused outbreaks in 7 hospitals across 6 US states, 2001 to 2004. Data presented in 2004 at the Infectious Diseases Society of America meeting suggest that the bacterium is resistant to fluoroquinolone therapy. The study was initiated to identify the emergent strain related to the quadrupled incidence of C. difficile-associated diarrhea and almost doubled case-fatality ratio observed at CHUS during 1991 to 2003, as reported in an earlier study by Jacques Pepin, MD. "The perception of a number of physicians is that the strain they are dealing with is more virulent than usual," Michel Warny, MD, PhD, lead investigator and director of bacterial process development for Acambis Inc, told Medscape. "This is illustrated by the substantial increase in mortality per case of C. difficile infection since the year 2000."
In the study, a single identical strain (toxinotype III) was identified in 82 percent of isolates collected from patients involved in the CHUS outbreak. Dr. Warny noted, "This finding was significant because in general the toxinotype III strain is found in only 2 percent of isolates." Further, the toxinotype III strain was found to produce 16 times more toxin A and 20 times more toxin B in vitro compared with 13 variations of the toxinotype 0 strain commonly found in 80 percent of isolates. "The main pathogenic factor of C. difficile is the production of these 2 toxins," said Dr. Warny, suggesting that the ability of the emerging strain to produce up to 20 times more toxin than more common strains may explain reports of its virulence. (Promed 4/12/05)
USA (Michigan): Drug-resistant staph infection spreading
MRSA is a skin and soft tissue infection. It is also found in some pneumonias, said Dr. Lilly Immergluck, an infectious disease specialist at DeVos Children's Hospital. It has also turned up on athletic teams, among Marine recruits, and in hospitals and nursing homes. The MRSA infection has 2 epidemiological strains: 1 picked up in hospitals and the other in the community. In hospitals, it is most likely to strike those already in a weakened state. It is suspected of causing 2 million infections and 88 000 deaths worldwide each year. The community-acquired infection is appearing in healthy people as well as those with weakened immune systems, Immergluck said. Doctors and hospitals aren't required to report single cases of MRSA, so it's impossible to get accurate figures about prevalence, said T.J. Bucholz, a spokesman for the Michigan Department of Community Health. However, health officials do report outbreaks or clusters of cases. "We know anecdotally, though, that we are hearing of more cases now," Bucholz said. Community-associated (CA) MRSA has become a common and serious problem.
***In the 7 Apr 2005 issue of the New England Journal of Medicine, there are 2 full-length publications, 2 letters, and an editorial regarding CA MRSA. (Promed 4/12/05)
USA: Florida outbreak of E. coli is traced to 6 petting-zoo animals
Agventure was the only zoo to provide animals to the 3 fairs that have been identified as sources of human contact with E. coli. Dr. John O. Agwunobi, Florida's secretary of health, said 8 Apr 2005 that the 6 animals at issue were the only ones identified -- through DNA testing on them and patients -- as carrying the bacteria. State officials said the infected animals -- 2 sheep, 2 calves and 2 goats -- would be permanently barred from contact with the public and from slaughter for human consumption. The problem is that even healthy, well-kept animals can harbor intestinal diseases and parasites harmful to humans. Transmission can occur when animals step or sit in their own feces and then are petted or fed by children, who then put their hands in their mouths. Simple hand-washing is key to preventing transmission of these bacteria and parasites. (Promed 4/8/05, 4/4/05)
USA: Public Health officials report on tularemia outbreak at Boston University
1. At this time, the source of Type A F. tularensis in the BU laboratory remains unknown. The federal investigation into the incident is pending.
2. The extensive investigation to date has found no evidence to indicate that either the contamination of the LVS stock or the infections of the BU researchers were intentional.
3. The tularemia outbreak at BU was limited to 3 BU employees and never posed a risk to the public at large.
4. The failure to identify work-related illness in laboratory staff is a major concern for health officials.
5. The failure to immediately report suspicious work-related illness to local and state health departments is a major concern.
6. Appropriate infection control practices in laboratories must be clearly documented for all workers and enforced.
7. The BU Institutional Biosafety Committee was not able to ensure compliance with appropriate laboratory protocols and procedures.
The full report can be found at: http://www.bphc.org/reports/pdfs/report_202.pdf (Promed 4/13/05)
Canada: Ontario issues warning against unpasteurized milk
E. coli O157:H7 is just one of a number of infections that can be transmitted to humans from unpasteurized milk or dairy products. These include Salmonella sp and Campylobacter sp, both of which may be multi-drug resistant, as well as staphylococcal food poisoning, Q fever, listeriosis, brucellosis as well as bovine tuberculosis. Additionally, Brainerd diarrhea, a chronic diarrheal process of unknown etiology is also associated with raw milk ingestion. Symptoms of E. coli O157 include severe stomach cramps and diarrhea (sometimes bloody). Young children and seniors are also at higher risk of developing serious complications, which can be fatal. Dr. Basrur is also asking the public to report sales of unpasteurized milk to the Ministry of Agriculture and Food's complaint line: 1-888-466-2372 ext. 64391. The Ministry of Health and Long-Term Care continues to monitor the situation. (Promed 4/11/05)
1. Updates
Seasonal influenza activity for the Asia Pacific and APEC Economies 2005, 7 Apr 2005
Overall influenza activity declined in week 12, 2005. Influenza activity declined in most parts of the world in week 12 except in Hong Kong. Overall levels of influenza activity were medium–low. While the total number of influenza viruses detected decreased significantly, the proportion of B viruses increased.
Canada. Overall influenza activity continued to decline, with widespread activity reported in 2 provinces. Of the influenza viruses detected during week 12, 42% were influenza A and 58% were B viruses.
Hong Kong. The number of influenza viruses isolated increased significantly in weeks 11–12, although overall influenza activity remained medium–low. Influenza A(H3N2) and B viruses co-circulated.
Japan. Influenza activity continued to decline and was reported as sporadic in week 12.
Russia. A decrease in influenza activity was observed in week 12, although widespread activity remained.
USA. Influenza activity continued to decline in weeks 11–12. The overall ILI consultation rate was still above the national baseline, although it has declined during the past 5 weeks. The proportion of deaths attributable to pneumonia and influenza remained above the epidemic threshold. During weeks 10–11, 6 additional influenza-associated pediatric deaths were reported. Of the influenza viruses detected in week 12, 37% were influenza A viruses and 63% were B viruses.
Other reports. During weeks 11–12, Brazil, Chile, Malaysia and Mexico reported no influenza activity. (WHO 4/7/05 http://www.who.int/csr/disease/influenza/update/en/print.html)
USA, from CDC Weekly Report: Influenza Summary Update, Week ending April 9, 2005-Week 14
An MMWR summary of influenza activity in the US during Oct 3, 2004--Mar 26, 2005 is available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5413a2.htm.
Addendum to the recommended composition of influenza virus vaccines for 2005-2006 season
Hong Kong
East Timor
2. Articles
Risk of oral infection with bovine spongiform encephalopathy agent in primates
Lasmezas CI et al.
"The uncertain extent of human exposure to bovine spongiform encephalopathy (BSE)--which can lead to variant Creutzfeldt-Jakob disease (vCJD)--is compounded by incomplete knowledge about the efficiency of oral infection and the magnitude of any bovine-to-human biological barrier to transmission. We therefore investigated oral transmission of BSE to non-human primates. We gave two macaques a 5 g oral dose of brain homogenate from a BSE-infected cow. One macaque developed vCJD-like neurological disease 60 months after exposure, whereas the other remained free of disease at 76 months. On the basis of these findings and data from other studies, we made a preliminary estimate of the food exposure risk for man, which provides additional assurance that existing public health measures can prevent transmission of BSE to man…" (Promed 4/5/05, Lancet. 2005 Feb 26;365(9461):730-1.)
Outbreaks of Salmonella Infections Associated with Eating Roma Tomatoes—US and Canada, 2004
Health Concerns Associated with Disaster Victim Identification After a Tsunami--Thailand, December 26, 2004--March 31, 2005
Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food--10 Sites, US, 2004
3. Notifications
National Plan for Reliable Tuberculosis Laboratory Services Using a Systems Approach
Recommendations from CDC and the Association of Public Health Laboratories Task Force on Tuberculosis Laboratory Services
To eliminate TB in the United States, improvements are needed in laboratory services to support treatment, prevention, and control. Developing an integrated system that ensures prompt and reliable laboratory testing and flow of information among laboratorians, clinicians, and TB-control officials is critical. For the full article, visit: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5406a1.htm (CDC MMWR Recommendations and Reports, April 15, 2005 / Vol. 54 / No. RR–6)
CDC International Course in Applied Epidemiology
Computer training using Epi Info, a software program developed at CDC and the WHO for epidemiologists, is included. Prerequisites include familiarity with the vocabulary and principles of basic epidemiology or completion of CDC's "Principles of Epidemiology" home-study course or equivalent. Early registration deadline is Jun 1; late registration deadline is Sep 1. Additional information is available from Emory University's Rollins School of Public Health, International Health Dept. (Attn: Pia), 1518 Clifton Road, N.E., Room 746, Atlanta, GA 30322; fax, 404-727-4590; at http://www.sph.emory.edu/epicourses; or by email, pvaleri@ sph.emory.edu. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5413a6.htm (MMWR April 8, 2005 / 54(13);336)
50th Anniversary of the First Effective Polio Vaccine--April 12, 2005
Through support by the National Foundation for Infantile Paralysis (the March of Dimes), Thomas Francis Jr. of the University of Michigan led the pioneering field studies of inactivated polio vaccine that led to the April 12, 1955, announcement. Approximately 1.8 million children from 217 areas of the United States, Canada, and Finland participated in the vaccine field studies. Thousands of health-care workers and lay persons volunteered to assist with the field studies, the largest ever in U.S. history. The National Foundation for Infantile Paralysis also supported the development work of Albert Sabin, whose oral polio vaccine (OPV) was licensed in 1961. The Global Polio Eradication Initiative, spearheaded by the WHO, Rotary International, UNICEF, and CDC, was begun in 1988. That year, an estimated 350,000 children were stricken with polio worldwide; in 2004, polio cases had decreased to approximately 1,200 cases globally. Although the Americas are polio-free, the disease still exists in some countries in Asia and Africa. Using the Sabin OPV, the Initiative continues to conduct immunization campaigns in those countries that have not been declared polio-free.
Information about polio disease, vaccine, and eradication efforts is available at http://www.cdc.gov/nip.
National Infant Immunization Week--April 24--30, 2005
During NIIW, states and hundreds of communities throughout the US will sponsor activities highlighting the need to achieve and maintain high childhood vaccination coverage rates. Special kick-off events, including provider education activities, media events, and immunization clinics are planned along the US--Mexico border in collaboration with state and local health departments, the US--Mexico Border Health Commission, and PAHO. In addition, CDC and its partners will introduce a new public education campaign. NIIW is being held in conjunction with Vaccination Week in the Americas, scheduled for April 23--30. That event, sponsored by PAHO, promotes childhood immunization and access to health services concurrently in all countries in the Western Hemisphere. Additional information about NIIW and childhood vaccination is available from CDC's National Immunization Program at http://www.cdc.gov/nip. Information on Vaccination Week in the Americas is available at http://www.paho.org/english/dd/pin/pr050211.htm.
Web Portal to "One World, One Health: Building Interdisciplinary Bridges to Health in a Globalized World" Symposium
Sixth International Symposium on the Epidemiology and Control of Foodborne Pathogens in Pork
The Second Annual Biosafety and Biosecurity Training Course
- 8-10 Jul 2005: animal oriented (one day on large animal ABSL-2 and -3 facilities, containment, etc; one day on small animal ABSL-2 and -3 facilities and containment; 1/2 day on veterinary hospital, clinic, and farm and ranch Biosecurity (infection control)).
- 11-12 Jul 2005: general Biosafety and Biosecurity (BMBL, rDNA Guidelines, Biosafety committees, other administration aspects, risk assessment, Select Agent regulations and administration, HEPA filters and biosafety cabinet certification).
- 12-14 Jul 2005: plant oriented (containment of recombinant plants, infectious disease research with plants, biopharm, regulations, permits, plant disease diagnostic lab network, diseases of crops, and greenhouse design and management).
For more information: <http://www.cvmbs.colostate.edu/microbiology/crwad/relatedmeetings.htm> Contact: Robert Ellis, 970-491-6729, email@example.com (Promed 4/13/05)
4. APEC EINet activities
New subscription system through APEC EINet website
The APEC EINet website now allows for automatic subscription at: http://depts.washington.edu/einet/?a=subscribe. Additional recent features include: 1) A Search and Browse function which allows you to look for specific information from the EINet Newsbriefs and Alerts (currently only available for data from 2005 and Dec 2004 Tsunami Alerts) 2) Print option which allows you to print the specific article you are interested 3) Email option which allows you to email an article.
5. To Receive EINet Newsbriefs
APEC EINet email list
The APEC EINet email list was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia-Pacific Rim. To subscribe (or unsubscribe), go to: http://depts.washington.edu/einet/?a=subscribe or contact email@example.com. Further information about the APEC Emerging Infections Network is available at http://depts.washington.edu/einet/.


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Top Definition
A bisexual person who has slept with both genders.
John is a goldstar bisexual.
Cookiearrowによって 2015年05月22日(金)
Trending Now
Can you define these popular missing words?
A bisexual who has never had sex with the opposite gender (i.e bisexual man never had sex with a woman and vice-versa).
I'm a bisexual male, but I've never slept with a woman, so right now I'm a gold star bisexual.
Attracted to both gendersによって 2013年12月02日(月)

subset: commoncrawl


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Carlisle Area School District officials said attendance at Carlisle High School is only about 50 percent Thursday after the school received a report that a shooting was rumored.
Three straight days of threats, accident have taken their toll on students.
Police have patrolled campus and extra security measures have been taken at the school but the threat, discussed on social media sites, turned out to be nothing more than a rumor.
Superintendent John Friend said students who stayed home because of the threat will not be cited for missing classes as long as their parents send a note when they return Friday.
At nearby Wilson Middle School, where seven students were sent to the hospital for treatment after a science experiment caught fire on Wednesday, attendance was close to normal. About 90 percent of Wilson students, including one of the injured kids, was in school today, Friend said.


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Texans Will Most Likely Go After Franchise QB (Manziel)
Whatever happens in the NFL draft, this much is certain: the Texans, who hold the first overall pick, are in the market for a franchise quarterback.
Whether they'll take one No. 1 remains to be seen, but Sports on Earth's Russ Lande writes that, "According to trusted sources, the Texans are initially leaning towards taking either Blake Bortles or Johnny Manziel with the top pick. Although Manziel would obviously be the choice of owner Bob McNair, [new coach Bill] O'Brien is not sold that Manziel possesses the work ethic and intangibles necessary to be the face of a franchise."
For more on this story visit: Ryan Wilson, CBS Sports


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Aircast A60 Ankle Support
FREE DELIVERY on orders above £50
Aircast A60 Ankle Support
FREE DELIVERY on orders above £50
- This is the model Andy Murray uses for ongoing everyday semi-rigid support.
- Created with the athlete in mind, the A60 provides a winning combination of effective support and protection, comfort, and simplified application. The patent pending design incorporates a pair of sleek stabilizers located on either side of the ankle. These stabilizers are moulded at a 60 degree angle to help guard against ankle sprains and prevent rollover. Manufactured from Breath-O-Prene® material, the A60 ensures that the wearer stays comfortably cool and dry, while the light-weight anatomic design easily fits in athletic footwear without creating additional bulk. The A60 is applied and adjusted with a single strap that securely holds it in place; replacing time-consuming lacing.
- The A60 model is perfect for everyday support for sports strains and injuries as it allows training and playing support.
- The A60 model is available in three sizes: small, medium, and large, with left and right models.
- SMALL would suit up to shoe size UK 6.5
- MEDIUM would suit up to shoe size UK 7 TO 10.5
- LARGE would suit up to shoe size UK 11.5 +plus
Andy Murray has started wearing one of these on his right ankle as well (May 2011) to go with the one he has been wearing on and off for years...unfortunately the white model he wears is not available in the UK. It certainly does the job though !
If it's good enough for Murray.....
We ship worldwide and offer a range of delivery options. Delivery charges depend on your delivery country. For full details of our delivery policy, click here.
Tennisnuts.com makes every effort to ensure each customer experiences a flawless shopping experience. Sometimes you may wish to return your order. Tennisnuts.com has a simple returns policy which can be read here.


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I was recently contacted by No Starch Press and they gently offered to send me a copy of "Perl One-Liners", a book by Peteris Krumins.
Before looking at the book itself, it's interesting to see that the author is a serial-oneliner-author, if I can say: Perl One-Liners is his third book on the topic, after Awk One-Liners Explained and Sed One-Liners Explained. I think Peteris bash history must look a bit scary to unprepared eyes!
So, as you can guess the book is about oneliners, those magic-and-cryptic commands some bearded sysadmins use everyday to tell their servers what to do (Wait? This last sentence is a cliché? No way!).
The book's cover looks nice and fresh, I must say the first impression is good, it's nice to see new Perl books published with nice and eye-candy artworks. Speaking of the artwork, it's funny to see that a one-liner is here associated to a telegram machine, as if this was the antic way of communicating with a computer. Or maybe that's more about the compact size of the instruction sent. Anyway, let's look more at the content!
A quick glance at the table of contents tells everything: this book is a cookbook for the sysadmin. The title tells no lies, it's not a guide to enlightened modern Perl programming, but more something like: How to use Perl as a swiss-army knife, on the command line. Which is indeed another interesting angle to look at Perl.
The table of contents gives the full overview of what you can find: one-liners grouped by topics (Spacing, Numbering, Calculations, Array and Strings, Text Conversions, Printing and Deleting Lines, Regular Expressions).
I won't comment on all the one-liners (130 of them in the book!) but I can say that this book can be a good companion to learn how to use Perl on the command line.
By reading this book and trying the recipes, you'll master shortly all the command-line options that can turn the Perl interpreter into a sed-awk-grep-toolboox-on-steroids. Indeed, here is the real lesson you'll find in that book: beyond the 130 examples, you'll get to understand how and when to use flags like -p, -l, -i or -n, which will let you write your own one-liners in no time when needed.


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debt management
Here are some keywords which we've determined lie within the same circle of relevance as debt management.
management, debt, debts, credit, solutions, help, financial, debt solutions, money, credit counseling, services, management plan, credit cards, counseling, free, advice, management plans, debt free, cards, debt relief
Enter a domain name or a keyword.
# a b c d e f g h i j k l m n o p q r s t u v w x y z


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In the 1930s, there were several species of wildlife in North America that were at or near extinction due to excess hunting pressure or human environmental destruction.
To solve this problem, organized groups of hunters asked for the federal government to create an excise tax on firearms and ammunition that would provide funds to each state to manage wild animals and their habitat. The Pittman-Robertson Act was signed into law by Franklin Roosevelt on Sept. 2, 1937, and became effective on July 1 of the following year. As a result, several species of wildlife have made an extraordinary comeback from the brink since the implementation include black bear, waterfowl, white-tailed deer and wild turkey. Instead of this money going into the United States Treasury, it is kept separate and given to the Secretary of the Interior to distribute among the states.
According to the Department of Internal Revenue Service, the federal government collected more than $760 million in firearm and ammunition taxes for the Fiscal Year 2013. The Secretary of the Interior determines how much to give to each state based on a formula that takes into account the area of the state and its number of licensed hunters.
According to a spokesman for the West Virginia Division of Natural Resources, West Virginia's share of this revenue should be between 7.5 and 8 million dollars. This may seem like a tiny portion of $760 million. It is true that a large percentage of the state's population does purchase a hunting and/or fishing license; and we must keep in mind that West Virginia is one of the smallest states in the entire nation (in area and population).
Another factor to keep in mind is that apportionment of the revenue has risen at a steady pace since 2008 because of the rise in firearm and ammunition sales since then. The 7.5 to 8 million dollars is almost a 50 percent increase from the 2012 apportionment. Every dollar of the revenue has to be put into a state's wildlife-enhancement efforts. This is what the federal law mandates.
It was just a few years ago when a past presidential administration wanted to use this money to cover the medical treatment for the victims of gun violence who did not have any health care coverage. This idea came to a fast halt from the individuals who closely monitor how this revenue is spent.
Firearms and ammunition are not the only things that bring in revenue to this program. Today, archery equipment also generates additional tax revenue for wildlife-enhancement.
Many outdoor enthusiasts would like for the DNR to use this money to purchase more acreage. Remember, West Virginia has its own program for buying land for public hunting with the conservation stamp ($5 resident, $13 nonresident). Purchasing land with the Pittman-Robertson funds would only mean that the bureaucrats in Washington would be able to dictate how the state could use or could not use the acreage. When it comes to buying more land for public hunting, West Virginia can do it with their own resources and we can do it better.
n n n
I attended the fishing expo on March 29 and 30 at Elkins High School, working with the Izaak Walton booth and assisting Dr. Farukh Khan in handing out blood glucose monitors. There were several law enforcement groups handing out information to the kids. The Mountaineer Chapter Izaak Walton League was selling raffle tickets for a boat to support their youth programs, and several other organizations were present with information regarding products that would interest outdoor enthusiasts.
It was the local Izaak Walton League who started the annual event 20 years ago. The idea was to be dedicated to the youth to generate interest in outdoor activities. I hope it will continue to stay this way.


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FIFA 14 Download for Xbox 360On: Xbox 360, PS4, Xbox One, PS3, PC, 3DS, PS Vita, iPhone
FIFA is back with a raft of new additions.
Review Verdict Read Review
9Out of 10Back to game info
Download courtesy of:
Download: FIFA 14: All New Celebrations Tutorial
Category: HD Video
Find out how to do all of the new FIFA 14 celebrations in our tutorial.
Download File
File Size: 22.15 MB


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Dallas man faces intoxication manslaughter charge in death of 52-year-old woman
A Dallas man is in jail today, facing a charge of intoxication manslaughter after the death of a 52-year-old woman in a crash early yesterday along Scyene Road in Pleasant Grove.
Dallas police say Wesley Wayne Savannah, 30, was speeding as he tried to pass an SUV driven by 52-year-old Maria Perez. His car slammed into the SUV, causing it to careen off the road, through several chain link fences and into a large tree.
Perez was pronounced dead later at a hospital.
Police say Savannah walked away from the scene after the crash, but officers soon found him nearby, intoxicated. He faces charges of intoxication manslaughter and failure to give aid and is being held on $200,000 bail.
In March, Savannah was sentenced to seven months in jail after pleading guilty to evading arrest in a motor vehicle. He had already been on probation for a 2005 charge of assault on a public servant.


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If you need immediate assistance, call 877-SSRNHelp (877 777 6435) in the United States, or +1 585 442 8170 outside of the United States, 8:30AM to 6:00PM U.S. Eastern, Monday - Friday.
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Bomb-sniffing dogs patrol Albuquerque fun run
Albuquerque police ramped up its presence at the past weekend's Color Me Rad 5K fun run with bomb-sniffing dogs.
Runners followed a three-mile course at Balloon Fiesta Park where they were colored with powder along the way.
The event supports the local charity NMX Sports, but race organizers also donated funds to help victims of the Boston Marathon bombings.
"Everyone who registered from Monday to (Sunday,) we donated $5 to the victims of the Boston marathon. We raised over $4,000," race manager Jasmine Routh said.
Photos: Marathon bombing timeline | Photos: Boston manhunt ends
One Fund Boston is accepting donations for the victims of last week's bombings.
Copyright 2013 by KOAT.com. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


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West Virginia Association of Nurse Anesthetists
WVANA Practice
In addition to an active WV RN license, an Advanced Practice Registered Nurse (APRN) license is required for CRNA practice in WV. The first APRN licenses were issued in 2013. The application for initial licensure as an APRN is available by clicking this link: APRN License Application. Completing the online application requires a credit card and a printer. Upon completion of the application you will print it and send it in with the required documents.
Continuing Education Requirements
CE Information for WV RN Licensure All registered nurses (RN) in West Virginia (WV) are required to complete Continuing Education (CE) in order to maintain state licensure. All WV RN licenses expire October 31st each year. Twelve (12) hours of CE are required to renew annually. A new CE requirement for WV RNs is CE for mental health conditions common to veterans and family members of veterans.


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"Agedashidofu" or (Tofu first deep-fried, then served with dashi soup" is a very popular Japanese dish that can easily be adapted to fit vegetarian and vegan priorities!
Moreover, whatever dashi/soup is left can be poured onto a bowl of freshly staemed rice for a fillingand healthy suppelementary dish!
Vegan Agedashidofu!
Prep time:
Servings: 2
Cost per serving $0.40 view details
- Tofu (momen tofu) 1/2 a large piece (can of course be increased!)
- flour: 1 tablespoon (whatever flour as this could add an interesting variation!)
- Cornstarch: 1 tablespoon
- Oil for deep-frying
- Freshly grated daikon (to taste)
- Thinly chopped leek (to taste)
- Dashi (konbu/seawed dashi): 100 ml
- Soy sauce: 2 tablespoons
- Mirin/sweet sake:2 tablepoons
- You may add spices of your choice, especially grated ginger and hot chili powder!
- 1. Press as much water out the tofu as possible. Cut the tofu into large pieces. Take as much as humidity off their surface by wrapping inside a clean cloth for a while. Mix the flour and cornstarch.
- Roll the tofu pieces into the flour and cornstarch so as to cover all sides. If you don't have enough flour/cornstarch, prepare more.
- Drop in deep-frying oil at 170 degrees.
- 2. Prepare the dashi soup by heating the konbu dashi with the soy sauce and mirin (and extra spices if wanted).
- 3. Pour the dashi in individaul dishes. Place fried tofu in the middle. Top tofu with freshly grated daikon and chopped leek.
- SUGGESTION:
- Boil some cut mushrooms in the dashi before serving them together with the tofu!
- Easy and healthy, isn't it?
Add the recipe to which day?
Adding to Planner
Nutrition Facts
|Amount Per Serving
|Serving Size 63g
|Recipe makes 2 servings
|Calories 51
|Calories from Fat 10
|Total Fat 1.15g
|Saturated Fat 0.18g
|Trans Fat 0.0g
|Cholesterol 0mg
|Sodium 918mg
|Potassium 119mg
|Total Carbs 6.06g
|Dietary Fiber 0.2g
|Sugars 0.86g
|Protein 3.93g


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Firearms and domestic violenceMarch 22,2013The New York Times said the following in an editorial:
A man abuses and threatens his ex-wife. She tells a judge that she is frightened and that he is armed. The court orders him to stay away from her. Should it also order him to give up his guns?
Of course it should. If a protective order is to mean anything, the court must do all that it reasonably can do to keep a vulnerable person from becoming a homicide statistic.
An article by Michael Luo in The Times on Monday examined the threadbare web of protection for victims of domestic violence in a country overrun with guns. While there is a federal law that forbids most people subject to permanent protective orders to buy or own firearms, it was invoked fewer than 50 times by prosecutors last year. That leaves to the states the job of imposing meaningful laws to separate domestic abusers from their guns.
Most states are failing at that job. While a handful have laws requiring judges to order the surrender of guns when issuing any protection order, even temporary orders, most states do not go nearly that far. When legislators try to tighten the laws, they face the wrath of the National Rifle Association, whose relentless lobbying usually manages to kill or cripple such bills. Even modest cooling off laws allowing sheriffs to confiscate weapons temporarily for the first, most volatile days of a divorce action or separation have failed.
The NRAs blind defense of individuals gun rights has left a catastrophic toll. Stricter laws could help stem killings in domestic-violence cases. But legislatures would have to place prudent safety measures over Second Amendment absolutism. There is evidence that it would work: a study in the journal Injury Prevention in 2010 examined so-called intimate-partner homicides in 46 of the countrys largest cities from 1979 to 2003 and found that where state laws restricted gun access to people under domestic-violence restraining orders, the risk of such killings was reduced by 19 percent.
Rep. Lois Capps, D-Calif., recently introduced a bill to toughen the federal law to cover temporary protective orders and current or former dating partners, not just spouses. Congress should pass it, and states should reinforce it with their own laws, requiring judges to act when a persons safety is at obvious risk from an ex-partner with a gun.MORE IN CommentaryAbout midway through their first debate, Hillary Clinton said of Donald Trump: I think Donald... Full StoryHeres what happens every election cycle: Pundits demand that politicians offer the country new... Full StoryPunditry, like most human occupations, depends on pattern recognition. Full Story
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On board the boat, you can admire the splendid lakeside villas and lush gardens; the mild Mediterranean climate ensures that an abundance of exotic and rare plants thrive year-round. Sit back and relax as you cruise around the Borromean Islands. Pass by Isola Madre before heading to Isola dei Pescatori, where you will dock and enjoy free time to explore, hit the shops or enjoy a light lunch.
Next, it's back on board the boat for a stop on the third island, Isola Bella, where you can visit the Borromean Palace and gardens or discover the many shops, boutiques and cafés housed in historic buildings. Finally, you will rejoin the boat and cruise back to Stresa for your return Milan.
Recent Photos of this Tour
Schedule details
Select a month to view a calendar of availability and departure details.
Pricing information
Click the link below to check pricing & availability on your preferred travel date. Our pricing is constantly updated to ensure you always receive the lowest price possible.
Pricing information
Lake Maggiore Day Trip from Milan
- Transport by air-conditioned coach
- Local guide
- Boat tickets
- Entrance to Palazzo Borromeo and Isola Bella Gardens
- Professional guide
- Gratuities (optional)
- Food and drinks, unless specified
- Confirmation will be received at time of booking
Cancellation Policy
If you cancel between 3 and 6 day(s) in advance of the scheduled departure, there is a 50 percent cancellation fee.
If you cancel within 2 day(s) of the scheduled departure, there is a 100 percent cancellation fee.
Traveler Reviews
Reviewed by: muru s, September 2016
Amazing! I highly recommend!
Reviewed by: Fiona B, August 2016
Amazing tour, great guide who was very knowledgeable. Bus was clearly marked and easy to find and very modern. The boat tour was great as was the Palazzo Borromeo tour. There was just enough time to explore each island with the free time given. I would recommend the tour supplying some bottled water in the morning or on the boats as it gets very hot! Overall great tour and would definitely recommend this over any walking tours as well!


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Schedule a Ride
To schedule a ride, you must be certified. Call 320.252.1010. Trips may be scheduled between one and seven days in advance.
When scheduling a ride provide:
1. Name 2. Origin address 3. Destination address
4. Desired arrival time 5. Companion or child information
• Every effort will be made to schedule trip requests at the specific time desired. Earlier or later pick-up times may be suggested due to system capacity limitations.
• All trips are scheduled to carry as many passengers as possible.
• Wait at the outer door of your designated pick-up location at the time provided.
• Return trips for medical appointments can be scheduled when the initial ride is requested or can be called in when your medical appointment is completed.
• Allow at least 15 minutes beyond the pick-up time before calling about the ride.
• Drivers do not take appointments or make changes. Specialized Service does not provide emergency medical transportation.
Subscription Trips
Subscription Service may be available for those who travel to the same place, at the same times, several days a week. To be considered for Dial-a-Ride Subscription service, all of the following criteria must be met:
• Certified to use Metro Bus Dial-a-Ride, except those with Temporary or Visitor certifications
To be considered for a Subscription Service, please complete the following form: Subscription Request Form
Subscription Service requests are reviewed the first Monday of each month and the five working days following. Approval is based on meeting the set criteria, as well as the availability of service.
Subscription trips may be put on hold for up to 30 days. If a rider does not resume subscription trip within 30 days, it will be removed and rescheduled through the subscription trip request process. Subscriptions have no expiration. If there are any changes made to the subscription (day, time or destination) it may be canceled and will be reinstated, if there is availability. If a rider cancels 50% or more of their trips in the month, subscription service may be removed.
A companion is a family member or friend who rides along. More than one companion may ride if there is capacity on the vehicle. Each companion must pay a fare each time they ride and must board and deboard at the same location as the rider.
A family member or friend serving as your personal care attendant (PCA) isn't consider a companion. A suspended certified individual cannot travel as your companion.
Personal Care Attendant (PCA)
A Personal Care Attendant is someone who provides care for the certified individual and is necessary to the individual's mobility. One PCA can accompany a certified Dial-a-Ride rider at no charge. An individual's certification should indicate he or she may, at times, require a PCA. A PCA ride must be scheduled in advance. The PCA must board and deboard at the same locations as the rider.
Canceling a Scheduled Trip
Trips must be cancelled as far in advance as possible. If a scheduled trip will not be used, it must be cancelled at least two hours in advance to avoid a no-show.


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Police are trying to find the person who shot a 26-year-old man in the head. Click here to watch Ed Weinstock's report.
The views expressed are not those of this site, this station or its affiliated companies. By posting your comments you agree to accept our terms of use.blog comments powered by Disqus


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Article Title:
It's about Time: How 3-D Visualization Software Helps Law Enforcement Analyze Data
By Karen McDonough, Former Public Information Officer, Oceanside, California, Police Department; and Freelance Writer
Month of Issue:
October 2012
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I am a graduate student conducting research on how people assess thecredibility of nutrition websites. The brief survey, linked below, contains questions that should help me better understand how people assess the credibility of websites.
Procedure: Participation is voluntary. Participation is completing a web survey (linked below) that will take less than 10 minutes of your time.
Privacy and risks: Your responses will remain anonymous. Your participationposes no risks to you outside of your normal daily life.
Participation and Consent: If participate in the survey, you can withdraw from the study at anytime without penalty by simply exiting the survey. Additionally, you are welcome to ask questions regarding the research project at any time by messaging me on this board.
Your completion of this survey indicates that you have read the provided information, agree to participate in this research project, and understand that you can exit the survey at any time.
If you are a woman between the ages of 20 and 55, click the link to take my survey!
Thank you!
My answers are probably more in line with what I'd expect from any scientific/ journalistic site as an engineer, but then again, if the site can't provide backup for it's claims, it's not a good site.
Life is not a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, steak in one hand, chocolate in the other, yelling "Holy F***, What a Ride!"
My Latest Journal


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A retired Army officer was shot in the stomach with a sawn-off shotgun when he answered the door of his cottage, a court heard yesterday.
Lieutenant Colonel Robert "Riley" Workman, 83, was killed on his doorstep in Furneux Pelham, Hertfordshire, on January 7, 2004. The identity of his killer was a mystery. Subsequently, Christopher Docherty-Puncheon, a pest controller, was charged with his murder, Richard Latham, QC, for the prosecution, told a jury at St Albans Crown Court.
The court was told that Docherty-Puncheon, 33, from nearby Stocking Pelham, was serving a life sentence for the murder of another man, Fred


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Travel Photos
Legoland Hotel proves kid-centricity
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miRNA Profiling
MicroRNAs (miRNAs) are an abundant class of small single-stranded non-coding RNAs (19-30 nucleotides long) that serve widespread functions in post-transcriptional gene silencing. Recently, research has demonstrated that miRNAs are crucial regulators of gene expression, affecting a wide variety of cellular functions including development, proliferation, differentiation, and apoptosis.
In this course we will go through all steps of a microarray-based miRNA profiling experiment, starting from RNA QC using the Agilent Bioanalyzer through the labelling, hybridisation and scanning up to data analysis using GeneSpring GX. Each participant will be able to run two microarrays.


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Single Article Purchase:
Midlife vs Late-Life Depressive Symptoms and Risk of Dementia: Differential Effects for Alzheimer Disease and Vascular Dementia
Barnes DE, Yaffe K, Byers AL, McCormick M, Schaefer C, Whitmer RA.
Arch Gen Psychiatry. 2012;69(5):493-498.
Published online May 1, 2012
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Girls Strip Poker Videos
Watch more Girls Strip Poker Videos, share videos and find the latest funny videos at Viduu.
- Here is another video of the Perfect Ass Keyra from Supertangas.com !
- We all know professional wrestling isn't real. But, no one really cares when you've got hot women stripping.
- A Sexy cam chick strips off to show us her fine boobs on her webcam.
- This amateur teen babe strips down to show us her hot body. Enjoy.
- Two fine young ladies strip each other off at a car show. Check the young boy who can't seem to stay still.
- A contender for Keyras ass? Again from Supertangas, Ele has a hot body and an ass to die for!By: nearlygood l Tags: ele, supertangas, hot ass, nude, strip
- This cute blonde girl strips all the way down, showing off her sexy, naked body.
- Sexy, slim bodied Carli Banks strips off her pink lingerie.By: nearlygood l Tags: carli banks, strip, striptease
- A girl attempts to do a striptease for a guy when a very large amount of hot girls break in on the action.By: nearlygood
- Hot, sexy, and beautiful. This Natalie K does a strip tease you soon won't forget.By: nearlygood
- Freakin' hilarious. This girl starts a strip show for her boyfriend on webcam when her mom walks in behind her!By: nearlygood l Tags: web girls busted
- This hotty gets her more than ample chest out on her cam. (Nudity Warning)
- This sexy cam girl is not only recording herself on cam, but striping for a load of guys in her room too!By: nearlygood l Tags: strip, stripping, webcam, web cam
- Carmen from CamWithHer doing a sexy dance and stripping in a cute little teddy shirt.
- Ah, springbreak, when young college girls go... well you've heard it all before and you know what happens. This video is no different, college chicks get drunk then more..By: nearlygood l Tags: spring break, springbreak, drunk, girls


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|Boxing Champions | Boxing Schedule | Boxing Video | Boxing History | Pound For Pound | Lounge | The Wire | Arcade
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Floyd has always been the best pfp. Goodbye Pacquiao, hello Donaire...lmmfao!
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Floyd is the best technical boxer of his generation. Whether that is boring or non-crowd pleasing is irrelevant, people still buy his fights. Yesterday proved nothing, Manny was the one who changed his approach and got nailed for it. He wanted a decisive knockout and unfortunately was too aggresive. Andre Ward for me at present is P4P no1 but only becuase he has fought the best in his division and won convincingly. I think Floyd is #2 and Marquez is #3 with manny being #4. I think yesterday proved that boxing isnt all about Floyd and Manny. This whole Floyd vs Manny thing has left fighters like ward,marquez and martinez out of the spotlight, whereas Marquez proved last night he is up there with the best. Still think that if Marquez hadnt landed that shot then Pac would have stopped him in the next 2 rounds. Marquez was blowing in round 5 let alone in the later rounds.
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Mayweather will go down as the guy who fights lacked drama. Not one fight on Mayweather's resume is legendary.
But to Mayweather's credit his skill level is so great...... he takes the drama out of the fight by making it look easy.
Pacquiao has been in some legendary battles with morales,marquez,
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Floyd the so called coward beat Marquez who knocked Pacquiao out!
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An inactive boxer don't deserve that slot. Inactivity is tantamount to ducking, avoiding fights, taking less risks, fear of losing, protecting zero, you name it. Don't even know why people are duped into awarding that slot. Even Mayweather would wonder why.
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Viva Gareth Bale!
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I will give credit where it is due and probably out of the lot only Corrales, Oscar and Mosley (he was coming off the KO win over Margarito but you could argue the mental state Margarito would have been in when caught cheating.) are worth mentioning.
In the past 9 years this is who Floyd has fought.
2003 (2 fights)
Victoriano Sosa
Phillip Ndou
2004 (1 fight)
DeMarcus Corley
2005 (3 fights)
Henry Bruseles
Arturo Gatti
Sharmba Mitchell
2006 (2 fights)
Zab Judah
Carlos Manuel Baldomir
2007 (2 fights and arguably his best year)
Oscar De La Hoya
Ricky Hatton
2008 (no fights)
2009 (1 fight)
Juan Manuel Marquez
2010 (1fight)
Shane Mosley
2011 (1fight)
Victor Ortiz
2012 (1fight)
Miguel Cotto
Doesn't look good does it really?
Guy needs to step up. only 4 fights since 2007. He has serious skills but doesn't showcase them half as much as he should to be classed as anywhere near an ATG.
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Wait, so Mayweather KOd Pac lastnight?? lol
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Floyd be always be remembered as a duck. I've been watching this sport for 15 years now and everyone whos been along for the ride for these 15 years also recognize Floyd for ducking the top challenges opting for a easy way out to keep his "0" intact. You do the math.
Also inside those 15 years Ive never seen such a pathetic low life fan base as the flowmos, not even a grain of class, just like their coward idol.
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Since the mid-1970s, there has been a dramatic shift in America's socioeconomic system, one that has gone virtually unnoticed by the general public. Tax policies and their enforcement have become a disaster, and thanks to discreet lobbying by a segment of the top 1 percent, Washington is reluctant or unable to fix them. The corporate income tax, the estate tax, and the gift tax have been largely ignored by the media. But the cumulative results are remarkable: today someone who earns a yearly salary of $60,000 pays a larger percentage of his income in taxes than the four hundred richest Americans.
Pulitzer Prize-winning investigative reporter David Cay Johnston exposes exactly how the middle class is being squeezed to create a widening wealth gap that threatens the stability of the country. By relating the compelling tales of real people across all areas of society, he reveals the truth behind:
"Middle class" tax cuts and exactly whom they benefit.
How workers are being cheated out of their retirement plans while disgraced CEOs walk away with millions.
How some corporations avoid paying any federal income tax.
How a law meant to prevent cheating by the top 2 percent of Americans no longer affects most of them, but has morphed into a stealth tax on single mothers making just $28,000.
Why the working poor are seven times more likely to be audited by the IRS than everyone else.
How the IRS became so weak that even when it was handed complete banking records detailing massive cheating by 1,600 people, it prosecuted only 4 percent of them.
Johnston has been breaking pieces of this story on the front page of The New York Times for seven years. With Perfectly Legal, he puts the whole shocking narrative together in a way that will stir up media attention and make readers angry about the state of our country.
"Readers should take their blood pressure pills." —The Dallas Morning News
"Everyone who wants to understand what's happening with the tax system should read Perfectly Legal … by David Cay Johnston, who shows how idealogues have made America safe for wealthy people who don't feel like paying taxes." —Paul Krugman, The New York Times
"Even if you suspected all along that the system favors the rich, you're going to be shocked to learn just how badly you're being screwed." —Greg Palast, author of The Best Democracy Money Can Buy
"Want to know how business execs get nearly free peraonal trips on their corporate jets? Johnston is your man." —Business Week
"This is a book that will either shame us or prod us into taking back the system." —Ralph Nader
Table of Contents
Chapter 1: Taxes – They're Not for Everyone
Chapter 2: A Nickel an Hour More
Chapter 3: The Rich Get Fabulously Richer
Chapter 4: Big Payday
Chapter 5: Plane Perks
Chapter 6: When the Old Man Is Dead and Buried
Chapter 7: The Stealth Tax
Chapter 8: How Social Security Taxes Subsidize the Rich
Chapter 9: Preying on the Working Poor
Chapter 10: Handcuffing the Tax Police
Chapter 11: Mr. Rossotti's Customers
Chapter 12: For Want of a Keystroke
Chapter 13: Mr. Kellogg's Favorite Loophole
Chapter 14: Mass Market Tax Evasion
Chapter 15: Getting Off the Hook
Chapter 16: Profiting Off Taxes
Chapter 17: Profits Trump Patriotism
Chapter 18: Letters to Switerzland
Chapter 19: Gimme Shelter
Chapter 20: Only the Rich Deserve a Comfortable Retirement
Chapter 21: Is Reform Possible?


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Mind & Body
Pilates Reformer
Total Body Conditioning
Parkinson's Big Strides with Exercise
Bone Builders
Fitness Forward
Fitness Tests
Healthy Hearts
Kids Camp
Moms in Motion
Specialty Classes
Swim Kids USA
Therapeutic Splash
Weight Management & Nutrition Programs
AF Splash – Arthritis Foundation Splash. A group, recreational, water-based exercise program designed specifically for people with arthritis and related diseases. Classes are conducted by an Arthritis Foundation Certified Program Leader in a heated pool, and they are created to help participants improve their joint mobility and reduce pain and stiffness. This class also provides a friendly and fun atmosphere in which participants can be social and try new activities.
Aqua Challenge. This class is for individuals ready for a challenge and who like to have fun! It includes a variety of weight resistance training and cardio.
Aqua Motion. Take the stress out of your program by diving into this high/low impact, deep/shallow water total body workout suitable for all levels.
Aqua Tai Chi. A relaxing form of Tai Chi that increases the flexibility of the limbs and joints through range of motion movements done in the warm water therapy pool.
Aqua Zumba. Blending Zumba and aqua fitness together into a safe, challenging, water-based workout that's cardio-conditioning, body-toning, and most of all, exhilarating beyond belief.
Back in Action. A gentle exercise class designed especially for people who have physical limitations.
Gentle Motion. Gentle, Therapeutic movements to strengthen the body/mind, gain flexibility, and increase balance/coordination. A holistic fitness series, benefiting body/mind/spirit.
Smart Moves Pool Program. Integrative program for those living with Parkinson disease, Muscular Dystrophy or any progressive neurological disorder.
Wet & Wild. Groove to the tunes, sweat while you're wet, and get fit and energized as we take you through fun cardio and resistance exercises for a low impact total body workout.


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A true entrepreneur since the age of 17, Fred DeLuca doesn't shy away from innovation.
As cofounder and president of Milford, Connecticut–based Subway, DeLuca isn't afraid to take risks or listen to the advice of others.
"The owners of our 32,000 stores share a tremendous entrepreneurial spirit, so innovation comes naturally to them," DeLuca says. "So we've built local option capability into the Subway system. That allows many different owners the ability to experiment simultaneously."
And many of those experiments have hit pay dirt.
"The ideas are constantly flowing, and some of them have had lasting effects for the entire chain," he says. "For instance, Subway's '$5 Footlong' campaign was started by a franchisee, and within a year it became a national promotion."
Since 1965, Subway has had a healthier menu than many other quick-serve operations. Through the years DeLuca further established that healthy halo with marketing efforts such as the Jared Fogle commercials, which touted Fogle's 245-pound weight loss from eating a six-inch Subway sandwich at every meal.
This year's tie-in with the Biggest Loser television show further solidifies the sandwich chain's marriage with a healthful image. The chain is paying $1,000 for every pound contestant Shay Sorrells loses.
Now with more than 32,400 stores in 91 countries, Subway continues to roll out new initiatives to keep up with a demanding marketplace.
A Buffalo Chicken submarine sandwich, with only seven grams of fat, was introduced last year, as well as the company's new mobile site, which has a restaurant locator with a map function.
The brand also joined Energy Star, which is a joint program of the U.S. Environmental Protection Agency and U.S. Department of Energy, encouraging businesses and homes to conserve energy. To that end, Subway relocated several distribution centers next to vendor manufacturers, switched to energy-saving light bulbs, and made its napkins from 100 percent recycled materials.
The innovations keep coming from inside the franchisee community, and DeLuca couldn't be more proud.
"A franchisee developed one of our newest and most unique stores, which is now about 100 feet in the air in the Freedom Tower construction site at the World Trade Center," DeLuca says. "That store moves 15 feet higher every few weeks as the steelwork is put in place. That innovation keeps the food close to the construction workers as the building is built, saving time and money.
"Another store was built in a church in Buffalo, where the pastor uses the store to provide job training for local youngsters."
In Sue Morelli's world, extensive customer research is the catalyst for all innovation.
Morelli, president and CEO of Boston-based Au Bon Pain since 2005, has systematically put her stamp on the bakery café by paying close attention to others.
"We do a lot of guest research and, in fact, just finished with a pretty major focus group of more than 50 hours with our heavy users," Morelli says.
During her presidency, Au Bon Pain introduced a new product line called Portions, which features a selection of 14 dishes made fresh daily, packaged individually. Each one is 200 calories or less. The Portions line focuses on vegetables and proteins as the main ingredients, retailing for $2.99 (without meat) or $3.49 (with meat).
"Innovation is a great word, and it's complex," Morelli says. "It has a lot of components: consumer trends, culinary savvy, and talent. And at the end of the day it has to be grounded by product profitability, the economics have to make sense."
According to Morelli, another area heavily impacted by research is speed of service. Au Bon Pain recently underwent a major remodeling program, introducing a design that allows customers to serve themselves.
As a result of the recession, Morelli says consumers are doing more with less. In an effort to capitalize on the new reality, she is pushing the chain to offer "better basic foods that are affordable, fresh, and nutritious and served with speed and warmth."
The 240-unit Au Bon Pain, which means place of good bread, is poised to grow both domestically and internationally.
"We keep a close watch on all the competitors, from fine dining to quick service," she says. "Our executive chef, Tommy John, has the power to drive the concept. He has an extraordinary pulse on the consumer palate."
The company, which was founded in 1976, rolled out a new café called the Bistro in 2006 and has a wide range of real estate applications to offer. In addition, the chain was recognized for its use of touchscreen terminals that offer nutritional information to the guests.
"In our business it is just so easy to put stuff out there and test it," Morelli says. "Patrons are looking for higher quality at the same speed they used to get quick service, and they have a real good sense of what is real quality."


text: Sanus - Wall-Mount Shelf System for A/V Components Flag this deal What's the matter? Choose a reason Dead deal Duplicate Bad link Spam Inaccurate No value Alive again Edit deal eduardo1966 May 20, 2013 Not such a great deal. I got one of these from Meritline with different branding for $35. http://www.meritline.com/loctek-pdh104-plasma-lcd-dvd-stand-black-frame-black-glass---p-57655.aspx Reply Load More Comments


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'The Revenant' First Look: Leonardo DiCaprio Gets Dirty for Alejandro González Iñárritu
Posted on Wednesday, January 21st, 2015 by Angie Han
Alejandro González Iñárritu is not content to rest on his laurels. Even as his Birdman glides trough awards season picking up every nomination in sight, the director is off in Canada shooting his next film The Revenant.
Leonardo DiCaprio, Tom Hardy, Will Poulter, and Domnhall Gleeson the 19th century revenge drama. Get your The Revenant first look after the jump. Read More »


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Internet Software and Services
Company Overview of Reframe It, Inc.
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Daniel Gohl
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Daniel Gohl, Dan serves as President at Ontic Education LLC. Mr. Gohl serves as an Associate Director for STEM Education at Teaching Institute for Excellence in Secondary School Transformation at the District Of Columbia Public School System. Mr. Gohl in partnership with the Bill and Melinda Gates Foundation oversaw the transformation of Anacostia, Ballou, Bell Multicultural, Coolidge, Eastern, MM Washington, Roosevelt, Spingarn, and HD Woodson Senior High Schools and ...
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LANSING - Senate Minority Leader Gretchen Whitmer said if Republicans really want to show that Dave Agema doesn't represent Michigan's GOP, they should support various gay-rights legislation.
"I think it's more important that we walk the walk than talk the talk," the East Lansing Democrat said Thursday morning on the Senate floor, soon after State Sen. Roger Kahn (R-Saginaw) denounced Republican National Committeeman Agema.
In recent days, several top Republicans -- including six Republican members of Congress -- have called for Agema to resign from his committee post following a long series of statements about gays and Muslims. Michigan Gov. Rick Snyder alluded to Agema in his State of the State address last week and urged for a greater degree of civility and respect in public discourse. Snyder refereed to "derogatory" comments but did not call out Agema by name.
Whitmer specifically called on Republicans to update Michigan's Elliott-Larsen Civil Right Act and allow for same-sex marriage.
"That's what it's going to take to show the world that Dave Agema is not the face of the Republican party in Michigan," Whitmer said. "To do less, I would submit, would be viewed as mere lip service."
Last month, Republican lawmakers began talks about updating Elliott-Larsen to include anti-discrimination protections for gays and lesbians.
This week, Republicans are meeting in Washington D.C. for a national party meeting. Agema, one of Michigan's two committee members, told MLive in a statement that he is not attending the meeting because "my liberal critics within the Republican Party have chosen to elevate this discussion to the RNC Meeting and make it a drawn-out fight between liberals and conservatives within the party."
The other committee member from Michigan, former Secretary of State and U.S. Senate candidate Terri Lynn Land, said on Wednesday she has told Agema she does not support him on his statements, but did not call for his resignation.
Before Whitmer spoke, Khan called on Agema to resign. The appropriations chairman said Agema's behavior has been "rejected by leader after leader of our party" and that he is unable to perform the duties of his committee.
"I think the time has come for us to ask Mr. Agema to do the right thing and resign," Khan said. "He represents not our party, not our state, not our country. And so I make this statement today: I hope Mr. Agema hears it and does the right thing."
Fritz Klug is a news buzz reporter for MLive. Contact him at email@example.com or 269-370-0584. Follow him on Twitter, Facebook, Google+ or App.net.


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Group gets together to tie flies, tell stories
The back room is a mess at Lake Erie Ultimate Angler.
Brightly colored fur and feathers are everywhere. Shop owner Steve Brugger jokes that it looks like a rabid dog tore up the characters from "Sesame Street" and left the remains strewed about the back of the shop. It is fly-tying day and a great way for fly fishermen struck with cabin fever to get together with their own, tie some flies and tell fish stories.
Some members of the Gem City Outdoorsmen Club Fly Tiers have been doing this since 1992. Jim Simonelli is one of them. He is busy tying a bright green pike fly. He started the club, and has been sharing his knowledge of fly tying and fishing with local anglers ever since.
"Our whole mission is to tie flies and promote fishing," Simonelli says. "We have no leaders, no president, we just get together and tie flies. When we're not tying, we're fishing."
Josh Hermann, 13, of Millcreek Township, has been a regular at the get-togethers. After suffering a football injury in the fall, fly tying has helped him pass the time.
"He is real active. Just sitting in the house all winter would make him stir crazy," says Josh's father, Scott Herman. "The guys at the club have really taken him under their wing. He just loves doing it."
So does local angler and guide Jim Sharpe.
"Tying flies gets my mind off everything else that is going on in the world," he says. "It really does. You forget about all the other problems. I wish I would have gotten into it many years ago."
The group meets at Lake Erie Ultimate Angler, 3737 W. 12th St., on Saturdays and Gander Mountain on Thursdays.
Go to www.shopultimateangler.com for information. For information about the Gem City Outdoorsmen Club Fly Tiers, visit www.gcocflytier.com.
JACK HANRAHAN can be reached at 870-1696 or by e-mail. Follow him on Twitter at twitter.com/ETNhanrahan.


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The notorious crimes of African warlord Joseph Kony have been highlighted across the globe, thanks to the California-based group Invisible Children.
But some critics have been skeptical of Invisible Children, the non-profit group who produced a viral video exposing Joseph Kony's crimes and the Lord's Resistance Army.
Invisible Children's 30-minute "Kony 2012" documentary has been viewed by more than 75 million people since it was posted on YouTube March 5.
The group said it wants to make Kony famous, and eventually bring justice to the countless children and families he has destroyed.
Yet Monday, Invisible Children CEO Ben Keesey found himself answering questions that have surfaced about his group's intentions and what it does with its finances.
"I understand why a lot of people are wondering is this just some kind of slick, fly-by-night, 'slacktivist' thing, when actually, it's not at all," Keesey said in a brief video posted online responding to his critics.
"It's connected to a really deep, thoughtful, very intentional and strategic campaign," he said.
"Any claims that we don't have financial transparency, or that we are not audited every year by an independent firm -- that we don't have financial integrity -- just aren't true," he later added.
Invisible Children CEO Ben Keesey responds to criticsm of 'Kony 2012' and concerns about how the non-profit spends its money.
The Lord's Resistance Army (LRA) is a rebel group in central Africa known for kidnapping young kids, turning the boys into soldiers and the girls into sex slaves.
"Kony 2012" tells the story of a former child soldier named Jacob. Once captured and tormented by Kony, he watched his brother be killed by the rebels.
"My brother tried to escape," Jacob says in the documentary. "Then they killed him using a panga."
Since the video went viral, hundreds of thousands around the world have helped spread the word about Kony.
But with that success came more scrutiny and some skepticism.
Many have criticized Invisible Children, questioning whether the effort is strong enough to make a difference -- and how the group began.
Keesey said it's been "difficult" seeing some of the negative accusations toward his group.
In addition to the eight-and-a-half-minute video detailing its purpose, Invisible Children has a section on its website detailing the group's goals, programs, the finances needed to stop Kony and the LRA, and an explanation of where the funds go.
"We've done our utmost to be as inclusive, transparent, and factual as possible," the website states. "Let's focus on what matters, and what we DO agree on: Joseph Kony needs to be stopped."
Keesey ended the video encouraging people to ask Invisible Children any other questions on Twitter, using the hashtag #AskICAnything.
'Kony 2012' Exposes Lord's Resistance Army Crimes
Uganda's Lord's Resistance Army Not Christian
US Troops Arrive in Africa for Efforts against LRA
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Are you seeking answers in life? Are you hurting? Are you facing a difficult situation?
Find peace with God, discover more about God or send us your prayer request.
Call The 700 Club Prayer Center at 1 (800) 823-6053, 24 hours a day.
A caring friend will be there to pray with you in your time of need.
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First I had put some of your quotes in my site specifying this website. But later I felt I am doing something wrong. So I removed them. I apologies for putting your quotes. Am your fan, thank you for all your resources for a happy world.
Very profound insight. That is what I used to do consciously and unconsciously, worried about "the things were".
Very true but hard to follow in real life
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