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Sections of First-Year Seminar (UCO 1200) and Expository Writing (ENG 1000) visited Special Collections recently to use our collections and expertise for course assignments.
On September 29, Rebecca Keeter's UCO 1200, "Appalachian Music and Dance," students attended a session led by Special Collections Reading Room Manager Dean Williams about genealogy sources. The students have an assignment this semester to trace their family genealogies to an ancestor outside of the United States, and from there, learn a dance of that country and teach it to their classmates. Williams explained how to use the AncestryLibrary database and then the students used the class as a work period to start creating their family trees (pictured).
On October 2 and 14, Preservation and Digital Projects Archivist Pam Mitchem led two instructional sessions for UCO 1200, "Pictures and Stories: Our Place," taught by Chery Zibisky and David Crosby. The students' assignment was to choose a place, which could be and building, area, or landmark, and discuss its history in a research paper. The students used the W.L. Eury Appalachian Collection and the University Archives, including the digitized collection of Appalachian State Historical Photographs.
On October 10 and 13, Lorraine Harris' three sections of ENG 1000, "Expository Writing," met with Reference Archivist/Librarian Greta Browning in Special Collections for a work session using University yearbooks (1922-1992, 2004-2006) and student handbooks (1930s-1980s) for an assignment about historical dating rules and social interaction on campus. Students are pictured above using yearbooks in the Cratis Williams Reading Room.
Our database CQ Researcher is often a good place to start looking at a topic. Each report contains charts, graphs, sidebar articles, a pro-con feature, chronology, lengthy bibliographies, and a list of contacts. They address "hot" topics.
This week's report is "Campus Sexual Assault," by Barbara Mantel.
For more, search "Article Search" and our many databases that will have peer-reviewed research on this topic.
The Library offers on-campus access to Scopus through November 20. Scopus is an Elsevier product (like Science Direct), which can be used to find articles on your topic, articles that cite an article you've already found, and articles that cite you or an author you're interested in. It is especially strong in the sciences, health sciences, and social sciences. (I say articles, but Scopus has also added records for 75,000 books recently.) The "Cited by" and citation analysis functions are similar to what is offered in Google Scholar and Web of Science. We are not likely to keep both Web of Science and Scopus.
It is not currently set up to link to full text of articles, but it will link effectively if we acquire it.
Let us know what you think of this product.
Scopus is not currently available off campus.
We now have full access to current issues of the Journal of American College Health.
We also recently gotten JAMA Internal Medicine.
The Library has access to many health sciences journals. See, for example, this guide for links to:
or search for your favorite journal here.
Humans vs. Zombies
October 24, 9:30-11:30
Belk Library and Nerd Network are hosting a Humans vs Zombies gaming event. Students, faculty, and staff are welcome to play! There will be food available at the beginning of the event. We suggest that you bring your own Nerf gun. The first 45 participants without a Nerf gun will be loaned either a six dart or a three dart Nerf blaster.
Humans vs Zombies is a game of tag. Most of the players begin as humans with the objective to evade the growing number of zombies and be the last human "alive."
Players wanting to do zombie makeup can arrive at 9:00 pm to be zombiefied!
Game Rules
Nerf Gun modifications are allowed, but due to safety reasons, no guns can be in neutral colors (grey, black, green, camo, etc.)
If you have any questions, contact us: Jewel Davis (firstname.lastname@example.com (link sends e-mail)), Beth Cramer (firstname.lastname@example.com (link sends e-mail)), Scott Rice (firstname.lastname@example.com (link sends e-mail)) or Megan Johnson (email@example.com (link sends e-mail))
October is North Carolina Archives Month. This year's theme is "North Carolina at Play: Health and Leisure in Our State." In honor of this, we are highlighting our Camp Catawba Collection in an exhibit located in the Cratis Williams Reading Room on the fourth floor of the library.
Located near Blowing Rock North Carolina, Camp Catawba was an overnight summer camp for boys aged 6 to 12. It operated from 1944-1970 under the direction of Jewish-German poet and educator Vera Lachmann.
Camp Facilities included twenty acres and three buildings. Art, music, and drama were emphasized. Lachmann taught Greek myths and directed theatrical productions. Her partner, Tui St. George Tucker, provided musical instruction. Campers participated in an array of outdoor activities including horseback riding, swimming, and hiking.
This exhibit focuses on the camp's boys at play. It includes images of camp life and a map developed as part of a game. View the rest of the collection as well as our many other collections in the Dougherty Reading Room.
More information about Archives Month is available from the Society of North Carolina Archivists' website.
Study Space
And have some fun too!
Works by Automotive Artist Carlo Demand on Display in the Library
Art from the Mark & Barbara Moskowitz Collection is currently on display in the fourth floor atrium of Belk Library as well as several locations in the Turchin Center for the Visual Arts. German-born artist Carlo Demand is known for his depictions of race cars, airplanes, trucks, and other automotive vehicles. Much of his work was done in charcoal or gouache. He published several books of his work and also did commercial art and illustrations for books, magazines, and newspapers. He was a founding member of the Automobile Fine Arts Society. Demand died in 2000. Exhibit closes December 5, 2014.
An Evening with
Norman Jordan: West Virginia's Most Published Affrilachian Poet
Thursday, October 9
6:00-8:00 pm
Room 114 Belk Library
An Evening with Norman Jordan
Come have your mind blown. Evening will begin with a short biographical film entitled, "Life as a poet in Cleveland, Ohio in 1972." Mr. Jordan will read his work as well as speak on Affrilachia, Affrilachian poetry, & West Virginia. See the flier here.
Sponsored by:
Appalachian State University's Center for Appalachian Studies, College of Arts and Sciences
Co sponsored by:
Department of Cultural, Gender, and Global Studies
Department of English
Richard T. Barker Friends of the University Libraries
Center for Multicultural Student Development
Department of Sociology


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4800 West 92nd Avenue Westminster, CO 80031
Home | Safety | Police Department | Kid's Corner | Teen Sexual Assault
Sexual assault is a very traumatic experience for anyone to live through. It violates your most private sense of self and changes your perception that you are in control of your life and body. One of the most important things to remember as you start the recovery process is that you didn't ask for this to happen and it was not your fault.
Reactions to Sexual Assault
Physical -- fatigue, insomnia, hyper-insomnia, changes in appetite, headaches and digestive problems.
Emotional -- shock, disbelief, embarrassment, shame, guilt, powerlessness, fear, anxiety, anger and depression.
Behavioral -- hyperactivity, difficulty concentrating or remembering things you knew previously, flashbacks, under-activity, nightmares, increased startle reactions and wanting to isolate from friends and family.
These are just some examples of ways that your body may attempt to deal with trauma. It is important to remember that these reactions are normal and will not last forever.
Recovery from Sexual Assault
Recovery from any traumatic incident takes time, effort and support from family and friends. It is important to remember that you are safe now. Also try not to blame yourself irrationally for the assault. You did not ask to be assaulted. This may be especially difficult in the case of date or acquaintance rape where you may feel betrayed and worry about your judgment. Remember that the perpetrator used your trust against you and that the assault was not your fault.
Start taking steps to take control of your emotions and return to a normal level of functioning. One way is to keep your day to day activities scheduled, that way you won't find yourself with a lot of free time allowing yourself to dwell on the assault. Indulge yourself in an activity that is good for you such as practicing relaxation techniques, exercising, treating yourself to a special treat or spending time with friends or family. Call a rape crisis center if you need to talk to someone. Most crisis centers have a 24-hour hotline.
Remember that it takes time to recover from any traumatic experience. If you find yourself not being able to recover from the assault after a period of time, consider talking to a therapist who understands the dynamics of sexual assault.
Some important things to think about
Since your assault was of a sexual nature, you now need to consider things like sexually transmitted diseases, HIV and pregnancy. Even if you went to the hospital after the assault it is a good idea to follow up with either your regular doctor or a heath care center that conducts confidential or anonymous testing for sexually transmitted diseases and pregnancy. It is important to undergo any follow up tests recommended by the doctor as some diseases such as HIV can become present after a period of time.
Ways to stay safe in the future
Self-defense classes -- Not only is this a good way to release pent up emotions such as anger, but it can help you regain your self confidence and learn how to avoid and defend yourself from any future attacks.
Take safety precautions -- Never go anywhere with someone you just met, especially in a vehicle or a room where you would be alone.
Date rape drug awareness -- Never leave your drink unattended or allow someone to bring you a drink at a party, date rape drugs have no taste or color and can take affect in as quick as 15 minutes.
Important Numbers
RAAP (Rape Assistance & Awareness Program) 24 hour hotline: 303-322-7273
Confidential test site for sexually transmitted diseases: 303-436-7251
Planned Parenthood: 303-425-6624
Denver AIDS Prevention: 303-436-7221
Colorado Department of Health: 303-692-2700
Denver Health Medical Center: 303-436-8100

subset: commoncrawl


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Today, I got up extra early to curl my hair because I wanted to look nice at school for a change. After coming downstairs my mom yells at me and says, "See, when you don't wake up on time your hair looks like that. You could have atleast combed it!" FML
by Rai / 03/24/2009 at 12:11pm / Canada (Ontario) / Miscellaneous
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Cheats and Walkthroughs(63)
Cheats and Walkthroughs(63)
There is one advantage to getting games late: You'll know if they're any good by release date time. Section 8 is an example. The derivative shooter from Time Gate has been out on the 360 and PC for over six months, and hasn't exactly set the world on fire during that time -- X-Play's 2 out of 5 review was echoed across most outlets.
Originally the game was announced as a PS3, 360 and PC game, but the PS3 version didn't drop back in September, leading many to assume that it was canceled. Nope. According to IGN, It's still coming, although no date has been announced.
There's always the chance that the PS3 version will contain the DLC released for the 360 version, and that improvements will have been made. If so, and it was offered for a slightly lower price, Time Gate might be on to something.
Source: IGN


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Video: '13 Shelby Mustang GT500 Takes On Europe At Goodwood Festival Of Speed
The ever-popular 2013 Shelby GT500 is a beast to be reckoned with, that's for sure. With this new Shelby Mustang putting down a first-underestimated 662 horses, this car has been putting Camaro fan boys to shame. The brand new Mustang has been seen around being tested all over the place, mainly pitted against it's domestic rival, the Camaro ZL1. Not this time.
This time the Shelby tore it up overseas at the Goodwood Festival of Speed in West Sussex, England. The '13 Shelby GT500 was brought to Europe for an annual hill climb which is a 1-mile track that raises above 300 feet. As suspected it did well with the 662 horsepower 5.8-liter V8, dominating previous models in terms of performance.
The brand spankin' new 2013 Shelby GT500 features an air splitter, new forged-aluminum wheels, a quad-exhaust setup and a downforce-generating front grille. One available option is the Performance Package which has electronically adjustable dampers which allows the driver to switch from daily driver mode to high-performance track mode with the push of a button.
Herman Salenbauch, director of Ford Advanced Production Creation said, "The Shelby GT500 takes muscle car performance to new heights. We encapsulated every aspect of performance in this car—whether it's 0-60 mph, top speed, racetrack, or quarter-mile times."
It's one impressive car being the fastest production street-legal V8 for Ford yet capable of reaching 200 mph. That exhaust note is about perfect without any beefy aftermarket exhaust. Also, check out the rest of the driving going on! That would have been a fun event to attend.
Source: [StangTV]
One Comment
Hi there, I found your website via Google while looking for a related topic, your site came up, it looks great. I've bookmarked it in my google bookmarks.


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Welcome to our website
Kawhatau Valley Walk is a 1, 2 or 3 day farm walk package over scenic Rangitikei hill country. Your private walk is at your own pace, with minimal gear, over superb hill country farms with spectacular views.
A walking holiday blending quality accommodation with the sights and sounds of rural New Zealand.
Featuring stunning views of the Ruahine Range, Mount Ruapehu and the Kawhatau River Valley, this farm walk is a great escape.
We also offer a great opportunity to cycle through the unique landscape of the Rangitikei. Whether you select one of the many preset rides, or customise your own route to meet your needs, we can drop you off and pick you up from any location.
We also offer accommodation for walkers, cyclists and those just wanting a quiet escape and a rest, Our historic "Shearers Quarters" and "The Green Trout" both offer modern accommodation with facilities and breathtaking views. We also offer meal options too for those wanting a full service package.


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In this blog, we wanted to show you another great video from the team at ArkCase! In this video blog, you will see how easily ArkCase allows you to customize your dashboard. This intuitive feature allows for increased user experience through delivering the users the information the need, where they want to receive it within their dashboard.
Armedia Blog
Posts Tagged 'Case Management'
NEW VIDEO: ArkCase – Customizing Your Dashboard
April 2nd, 2015 by Allison Cotney
In this blog, we wanted to show you another great video from the team at ArkCase! In this video blog, you will see how easily ArkCase allows you to customize your dashboard. This intuitive feature allows for increased user experience through delivering the users the information the need, where they want to receive it within their dashboard.
NEW VIDEO: ArkCase- Quick Access to a Case
March 3rd, 2015 by Allison Cotney
VIDEO: Armedia Case Manager – Editing Your User Profile
January 20th, 2015 by Allison Cotney
We have uploaded a new video to the Armedia YouTube Channel! In this video we demonstrate how users can update or change their profile information within Armedia Case Manager.
These changes could include items such as groups that the user belongs to or subscriptions the user may have. And of course, the user profile picture is always customizable.
Stay tuned for more Armedia Case Manager Videos!!
VIDEO – Armedia Case Manager: Generating a Report
January 16th, 2015 by Allison Cotney
Check out our new video blog giving you an inside look at Armedia Case Manager!
In this post, Ronda Ringo demonstrates how users can generate a report within Armedia Case Manager.
Stay tuned for more videos coming soon! To see all of our Armedia Case Manager Videos, CLICK HERE.
Adding Full Text Search to Ark via Spring and JPA
June 24th, 2014 by David Milller
What, No Full Text Search Already?
My project ArkCase is a Spring application that integrates with Alfresco (and other ECM platforms) via CMIS – the Content Management Interoperability Standard. ArkCase stores metadata in a database, and content files in the ECM platform. Our customers so far have not needed integrated full text search; plain old database queries have sufficed. Eventually we know full text search has to be addressed. Why not now, since ArkCase has been getting some love? Plus, high quality search engines such as SOLR are free, documented in excellent books, and could provide more analytic services than just plain old search.
What do we want from SOLR Search integration?
- We want both quick search and advanced search capabilities. Quick search should be fast and search only metadata (case number, task assignee, …). Quick search is to let users find an object quickly based on the object ID or the assignee. Advanced search should still be fast, but includes content file search and more fields. Advanced search is to let users explore all the business objects in the application.
- Search results should be integrated with data access control. Only results the user is authorized to see should appear in the search results. This means two users with different access rights could see different results, even when searching for the same terms.
- The object types to be indexed, and the specific fields to be indexed for each object type, should be configurable at run time. Each ArkCase installation may trace different object types, and different customers may want to index different data. So at runtime the administrator should be able to enable and disable different object types, and control which fields are indexed.
- Results from ArkCase metadata and results from the content files (stored in the ECM platform) should be combined in a seamless fashion. We don't want to extend the ECM full-text search engine to index the ArkCase metadata, and we don't want the ArkCase metadata full text index to duplicate the ECM engine's data (we don't want to re-index all the content files already indexed by the ECM). So we will have two indexes: the ArkCase metadata index, and the ECM content file index. But the user should never be conscious of this; the ArkCase search user interface and search results should maintain the illusion of a single coherent full text search index.
Both Quick Search and Advanced Search
To enable both quick search and advanced search modes, I created two separate SOLR collections. The quick search collection includes only the metadata fields to be searched via the Quick Search user interface. The full collection includes all indexed metadata. Clearly these two indexes are somewhat redundant since the full collection almost certainly includes everything indexed in the quick search collection. As soon as we have a performance test environment I'll try to measure whether maintaining the smaller quick search collection really makes sense. If the quick search collection is not materially faster than the equivalent search on the full index, then we can stop maintaining the quick search collection.
Integration with Data Access Control
Data access control is a touchy issue since the full text search queries must still be fast, the pagination must continue to work, and the hit counts must still be accurate. These goals are difficult to reach if application code applies data access control to the search results after they leave the search engine. So I plan to encode the access control lists into the search engine itself, so the access control becomes just another part of the search query. Search Technologies has a fine series of articles about this "early binding" architecture: http://www.searchtechnologies.com/search-engine-security.html.
Configurable at Runtime
ArkCase has a basic pattern for runtime-configurable options. We encode the options into a Spring XML configuration file, which we load at runtime by monitoring a Spring load folder. This allows us to support as many search configurations as we need: one Spring full-text-search config file for each business object type. At some future time we will add an administrator control panel with a user interface for reading and writing such configuration files. This Spring XML profile configures the business object to be indexed. For business objects stored in ArkCase tables, this configuration includes the JPA entity name, the entity properties to be indexed, the corresponding SOLR field names, and how often the database is polled for new records. For Activiti workflow objects, the configuration includes the Activiti object type (tasks or business processes), and the properties to be indexed.
Seamless Integration of Database, Activiti, and ECM Data Sources
The user should not realize the indexed data is from multiple repositories.
Integrating database and Activiti data sources is easy: we just feed data from both sources into the same SOLR collection.
The ECM already indexes its content files. We don't want to duplicate the ECM index, and we especially don't want to dig beneath the vendor's documented search interfaces.
So in our application code, we need to make two queries: one to the ArkCase SOLR index (which indexes the database and the Activiti data), and another query to the ECM index. Then we need to merge the two result sets. As we encounter challenges with this double query and result set merging I may write more blog articles!
Closing Thoughts
SOLR is very easy to work with. I may use it for more than straight forward full text search. For example, the navigation panels with the lists of cases, lists of tasks, lists of complaints, and so on include only data in the SOLR quick search collection. So in theory we should be able to query SOLR to populate those lists – versus calling JPA queries. Again, once we have a performance test environment I can tell whether SOLR queries or JPA queries are faster in general.
Writing a Framework is Not Like Developing an Application!
May 28th, 2014 by David Milller
ArkCase is both a framework and an application. As a framework, ArkCase provides a scaffolding to write case management applications tailored to custom-fit a specific customer. As an application, ArkCase provides pre-built web application archives (WAR files) suitable for generic customers. For example, we provide a law enforcement WAR and an inspector general WAR.
So we've known for a long time ArkCase should be both a software development tool to write case management applications, and also a standard out-of-the-box case management app. Like JIRA is both a software defect and issue tracking application, and also a tool to specialize your own defect and issue tracking app. Rational ClearQuest is the same way: it is both a default out of the box application life cycle management solution, and a tool to specialize your own such solution.
So how does ArkCase support these twin goals? We all know it's an order of magnitude easier to write a purpose-built app to specific requirements than it is to write a software development tool for other people to write their own purpose-built apps.
To write a purpose-built app we can naively map requirements to the technical architecture. Does Customer X need a case file attribute that will never be needed by any other customer? We just add the column to the database, add a field to our model objects, update our MVC controllers to pass the field around, and update our view to show it. When it comes time to deliver another version of the system to Customer 99, they get all Customer X's special fields… or else we have to make a special effort to remove Customer X's special fields, perhaps by maintaining a branch per customer. Shortly it becomes impossible to keep straight which customers get which fields. We don't really have a framework at all; we have many different purpose-built apps, one per customer.
To write a framework for building case management applications, we have to add a Core Object Model. Then we write a standard library of components, implemented in terms of this Core Object Model. Then we write our pre-built case management WAR files using the standard library and the Core Object Model.
For ArkCase, our Core Object Model includes:
- ArkBusinessObject – real world objects tracked by our customers (persons, organizations, firearms)
- ArkContainer – case management objects that manage business objects (case files, documents)
- ArkRelation – links (unidirectional or bidirectional) between business objects, other business objects, and containers (a vehicle contained contraband)
- ArkExternalEvent – real world events that form the history of a container (subject was arrested; a vehicle was stopped at the border)
- ArkAction – user actions that change the state of business objects or containers (split one document into two; consolidate two case files into one)
- ArkBusinessRule – constraints or guidelines that can be changed at runtime by business analysts (when a document is approved, declare a record in the records management application)
- ArkBusinessProcess – guides the life cycle of a container or business object (documents must be approved)
This object model is the set of design artifacts to write the standard component library and customer-specific applications. The object model is the extra conceptual layer that makes the ArkCase framework different from just naively developing a purpose built application. The proof is in the pudding; we no longer have to maintain one branch per customer; we can have a single ArkCase framework source tree, with customer-specific projects that import the framework artifacts.
Slides From Today's Webinar
March 4th, 2014 by Allison Cotney
In case you missed today's webinar in which we walked through our ArkCase solution framework with Alfresco Records Management, here are the slides from the presentation!!
ArkCase is a web-based, workflow-driven case management software solution designed to help organizations capture, investigate, and manage cases.
Powered by Alfresco, ArkCase provides a complete case management infrastructure to create and manage case information through its lifecycle. From initiation, assignment, investigation, evaluation and disposition ArkCase tracks the case and the relationships to all of the collected information. ArkCase provides pre-built law enforcement and inspector general workflows and data types, and can also support other organization types.
In this webinar, we walked through
- How to declare a record in Alfresco Records Management within ArkCase
- How ArkCase delivers easy compliance with Presidential Memorandum on Managing Federal Government Records as well as paperless initiatives
Stay tuned for a recording of the webinar!
Alfresco Content.gov 2014 – ArkCase Presentation
January 29th, 2014 by Allison Cotney
Thank you to everyone who turned out for our presentation this morning at Content.gov!!
In case you missed the presentation, here are our slides from the event. For more information about ArkCase, CLICK HERE to learn about our upcoming webinar!
ArkCase: Getting Some Love
January 8th, 2014 by David Milller
It's been a long time (OK, a few years) since I last wrote about ArkCase. What's been happening since then?
We wrote the ArkCase framework using Spring and Spring MVC. It was successful: we supported a few customers. One customer was very large and required many customizations. For this customer we extensively modified the framework until this implementation and that customer entwined together into a close-knit whole. Untangling customer-specific code from framework code became very difficult.
We also learned some lessons. Today ArkCase requires extensive custom coding. This is good for small customers that don't require much customizing anyway. And it's good for large customers that can afford extensive bespoke development. But it's not good for mid-size potential customers; they could not afford the amount of customizing necessary for ArkCase to make sense in their environment.
So we are ready to move ArkCase to the next level, giving it the care and loving attention it so richly deserves.
We will support custom workflows via the Activiti workflow engine, not by custom code. Activiti allows us to model the lifecycle for each ArkCase business entity (case files, tasks, documents). More importantly Activiti reduces the time and the custom code required to support each new customer. We will want customers to have just the exact workflow they need; we don't want to force customers to use a pre-defined workflow. Activiti allows us to customize the workflow cost- and time-effectively.
We will implement user actions using the Mule ESB, not custom Spring- based code. Each user action is embodied in a Mule ESB message flow. These Mule message flows will interact with the Activiti workflows. At the most granular level, ArkCase itself will be a large collection of Mule flows. When we configure ArkCase to support a customer, we assemble the desired Mule flows into a specific ArkCase application for that customer. Again, this will reduce the amount of custom code and the time required to deploy an ArkCase solution.
This component-assembly approach also allows us to easily build special-purpose modules such as Records Management support. The first next-generation ArkCase module declares records in the Alfresco RMA.
From a management perspective, we will have a defined engagement model. This engagement model specifies a basic pricing structure and defines how Armedia can host ArkCase implementations on behalf of our customers. Again, this reduces the time and effort required to stand up ArkCase for a customer.
These are exciting times for ArkCase. I hope to report more soon…


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Jayalalitha extends free bicycle scheme to ITI students
Tamilnadu government giving free bicycles to 10th and higher secondary school students of Tamilnadu. Last period, jayalalitha extended this scheme to boys of schools, earlier it had only been given to girls. Now jayalalitha extends this scheme to ITI students. It will cost extra of Rs. 6.36 crores to Tamilnadu government and from this new scheme 21,935 ITI students will get this scheme, jayalalitha said. "It will increase the interest of students to pick this course. It will increase the manpower at technical field in Tamilnadu", jayalalitha added.


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Sandra Adamson Fryhofer, MD
Requests for Single Reprints: Sandra Adamson Fryhofer, MD, 1938 Peachtree Road, Suite 502, Atlanta, GA 30309.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-3040.
Fryhofer SA. Adult Immunization 2012: Politics, Process, and Progress. Ann Intern Med. 2012;156:243-245. doi: 10.7326/0003-4819-156-3-201202070-00389
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© 2016
Published: Ann Intern Med. 2012;156(3):243-245.
This issue of Annals marks the sixth consecutive publication of the annual update of the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule (1). For the first time, the adult schedule and the schedule for children and adolescents (2) are designed to be combined. This editorial highlights the rationale behind key changes.
Recommendations by the committee do not become policy of the Centers for Disease Control and Prevention (CDC) until they are signed by the CDC Director and accepted by the Secretary of the U.S. Department of Health and Human Services. This allows for discretionary oversight (3). These recommendations are considered provisional until published in Morbidity and Mortality Weekly Report(1). Vaccine coverage mandated through the Affordable Care Act should increase access to vaccines but could further politicize this process. Budget concerns could delay, and even prevent, incorporation of ACIP recommendations, including those that also influence insurance coverage in the private sector (4).
In October 2010, the ACIP adopted an evidence-based process modeled after the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines. The committee now evaluates quality of evidence, benefits and harms, values and preferences of affected populations, and economic impact (5). Votes of the ACIP expanding routine human papillomavirus (HPV) vaccination to males and hepatitis B vaccination to young adult diabetics were the first to use this approach.
Human papillomavirus types 6 and 11 are associated with genital warts and recurrent respiratory papillomatosis; types 16 and 18 are linked to cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancer (6-8). Rates of HPV-related oropharyngeal cancer are increasing in men. Risk factors for both men and women include having multiple sex partners and engaging in oral sex. For men, having sex with other men is also a major risk factor (6-8).
Anal cancer is on the rise, with 1600 new cases in women and 900 new cases in men each year. The overall rate and absolute number of anal cancer cases are higher in women (1.4 per 100 000) than in men (1 per 100 000). However, incidence is highest in men who have sex with men (MSM), especially if they are HIV-positive (25 to 100 per 100 000) (6).
The HPV vaccine is a prophylactic vaccine. It is most effective if given before exposure to the virus. Immune response is more robust when the vaccine is administered to younger persons (9-10).
There are distinct differences in the U.S. Food and Drug Administration's (FDA) licensing for the 2 HPV vaccines currently available. The quadrivalent vaccine (HPV4 [Gardasil, Merck & Co., North Wales, Pennsylvania]) protects against types 6, 11, 16, and 18, and is FDA-approved for both females and males aged 9 to 26 years (9). The bivalent vaccine (HPV2 [Cevarix, GlaxoSmithKline, Research Triangle Park, North Carolina]) protects against types 16 and 18 but is FDA-approved only for females (10). Both vaccines prevent cervical cancer; however, only HPV4 is FDA-approved for prevention of vulvar, vaginal, and anal cancer. Efficacy of the HPV4 vaccine for anal intraepithelial neoplasia in MSM ranges from 50% to 78% (11). Only HPV4 protects against genital warts. Although the rationale for protection is certainly plausible, clinical HPV vaccine data are not available for oropharyngeal cancer, recurrent respiratory papillomatosis, or penile cancer (9-10).
The committee's recommendations for HPV vaccination differ from FDA licensing directives. The new, routine HPV4 vaccination recommendation for males—like females—starts at age 11 years but stops short of gender parity. It extends routine vaccination to males only through age 21 years, whereas vaccinating females through age 26 years is established CDC policy. A subgroup of MSM, as well as immunocompromised and HIV-positive males, "should" be vaccinated through age 26 years (12).
Extending HPV4 vaccine coverage to males is more cost-effective when female coverage rates are low; the 2010 National Immunization Survey data on teenagers show just that (13). Fewer than half (48.7%) of teenage girls has received at least one HPV vaccine dose; only about one third (32%) has received all three doses. Trends for increases in HPV vaccine coverage are also blunted (13). Evidence-based data review supports the cost-effectiveness of vaccinating young MSM, but targeted vaccination strategies may stigmatize individuals. Such strategies require self-identification of risk factors and thus may not be successful.
Hepatitis B vaccination is now routinely recommended for unvaccinated diabetic adults through age 59 years. This age cutoff was chosen on the basis of disease risk and cost-effectiveness. There is also a softer recommendation that, at physician discretion, hepatitis B vaccine "may" be administered to older diabetics.
Diabetic patients aged 23 to 59 years have more than twice the risk for hepatitis B than people without diabetes. For diabetics aged 60 years or older, risk for hepatitis B was increased 1.5 times, but this increase was not statistically significant (14).
Nearly one third of patients older than age 65 years have type 2 diabetes (15). Ironically, this group was left out of routine vaccination—initial discussions investigating the need for hepatitis B vaccination in diabetics began with recognition of outbreaks of hepatitis B infection in older patients in assisted-living facilities due to sharing blood glucose–monitoring equipment (16-17). Although hepatitis B vaccine efficacy decreases somewhat with patient age, failing to offer vaccine leads to 100% susceptibility (that is, zero efficacy) (18).
Tetanus, diphtheria, and acellular pertussis (Tdap) booster is designed to protect infants from pertussis. The practice of cocooning infants and young children by vaccinating family and household contacts (and health care personnel) is still recommended. The change is when to vaccinate pregnant mothers. Previous guidance stated that unvaccinated mothers should be given Tdap immediately postpartum; the new strategy begins protection even sooner: Tdap should be given during pregnancy, preferably after 20 weeks of gestation. Protective maternal antibodies then pass to the fetus. Further study is needed to ensure that maternal antibodies do not blunt the infant's own immune response to pertussis vaccination (19).
Egg allergy is no longer a contraindication to influenza vaccination. Data from at least 17 studies of more than 2600 egg-allergic patients have debunked concerns that traces of ovalbumin egg protein could trigger a serious allergic reaction. Egg-allergic patients must get the inactivated flu shot because that is what has been studied. No skin tests are needed before vaccinating, and the entire vaccine dose can be given at one time. Patients should be observed for 30 minutes after receiving the vaccine (20).
A new intradermal flu formulation (Fluzone Intradermal, sanofi pasteur, Swiftwater, Pennsylvania) is now an option for adults aged 18 to 64 years. Its microinjector apparatus features an ultrafine, 0.06-in needle that causes less pain on injection but induces more injection-site reactions. It is also 30% more expensive than prefilled syringes. The dermal layer of skin is rich in dendritic cells that play a key role in triggering immune response (20).
The American College of Physicians has established its first-ever Adult Immunization Technical Advisory Committee. The College has representation at all ACIP meetings and on many ACIP vaccine working groups. Vaccines are vital to ensuring our nation's health. The newly released fourth edition of the ACP Guide to Adult Immunization(21) can help physicians incorporate and improve vaccination strategies in their own practices.
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In this video, Sandra A. Fryhofer, MD, offers additional insight into her editorial, "Adult Immunization 2012: Politics, Process, and Progress.
Sandra Adamson, Fryhofer, MD, MACP
February 10, 2012
Flu Vaccination for Egg Allergic Patients: A Clarification
The 2012 Adult Immunization Schedule has a new feature. It includes a handy table listing "Contraindications and Precautions to Commonly Used Vaccines in Adults." (1) Some Annals readers have suggested the "contraindications table" listing for influenza vaccinations is confusing in light of new ACIP (Advisory Committee on Immunization Practices) guidance. (2)
As indicated on the table for every vaccine, "severe allergic reaction (e.g., anaphylaxis) after previous dose or to a vaccine component" is a contraindication. This is clear. But for TIV (trivalent inactivated influenza vaccine), the additional phrase, "including egg protein," might seem inconsistent with new ACIP guidance. (2) More clarity could have been provided by specifying that milder allergic reactions to eggs are not a contraindication to influenza vaccination.
Egg allergy is no longer a contraindication for TIV influenza vaccination for those with mild symptoms (hives only). Egg allergy is no longer an absolute contraindication for patients with more serious symptoms if benefits of flu protection outweigh the risks of vaccine egg protein exposure. Many TIV package inserts have been revised to say only "severe allergic reaction (e.g. anaphylaxis) to egg protein" is a contraindication. However, egg allergic patients with more serious reactions should be vaccinated only after thoughtful evaluation and in a closely monitored setting, with adequate anaphylaxis management available- -not in drive through clinics or at the grocery store. (2)
Another source of confusion is the description on the table used for TIV: "Influenza, injectable trivalent" (1) does not indicate that TIV is the "inactivated" vaccine. TIV is "injectable," but it is also "inactivated," in contrast to LAIV (live attenuated influenza vaccine), the nasal flu vaccine. The type of influenza vaccine is important. Only use of TIV (inactivated) influenza vaccine in egg allergic patients has been studied. Contraindications for LAIV on the table are clear. (2)
Flu Vaccination for Egg Allergic Patients: A New Frontier
Symptom severity Severity of egg allergy symptoms should be assessed. New CDC guidance published in August 26, 2011, edition of MMWR (2) contains an algorithm for assessing severity of egg allergy symptoms. Patients with history of mild egg allergy symptoms (hives "only") can be given TIV, but should be observed for at least 30 minutes after vaccination. (2) No skin tests are needed; the results aren't predictive. (2) There's no need to divide the dose; single dose studies showed no serious reactions; so you can give the entire vaccine dose at one time. (2) Patients with more "serious" egg related symptoms (hypotension, wheezing, nausea, vomiting, or any reaction requiring epinephrine or emergency medical attention) should be referred to "physician with expertise in management of allergic conditions for further evaluation." (2) Reassuring data presented at the June 2011 ACIP meeting revealed that egg allergy/flu vaccine studies have specifically included more than 200 patients with histories of severe anaphylaxis related to egg ingestion. These patients also tolerated influenza vaccine. (2, 3)
Ovalbumin content The August 26, 2011 MMWR (2) also contains a table listing published maximum content of egg protein (ovalbumin) in many flu vaccines. Available studies have shown that vaccines with ovalbumin content up to 1.4 mcg/ml (adult dose) or 0.7 mcg/0.5 ml (pediatric dose) have been well tolerated. (2)
Type of influenza vaccine (TIV only) Only TIV (trivalent inactivated) should be given because that is what has been studied. (2)
Be prepared Be on alert for adverse reactions and have emergency medications (like epinephrine) available. Observe egg allergy patients for at least 30 minutes after receiving influenza vaccination. (2, 4)
In perspective It is safer to give influenza vaccine in the context of egg allergy than previously thought. (2) Influenza infection causes 200,000 hospitalizations and up to 49,000 deaths each year. (5) For many, maybe most, egg allergic patients, it is safer to get vaccinated than to risk getting the flu. Summary of extensive discussion at the June 22-23, 2011 ACIP proceedings is available on line. (3)
Sandra Adamson Fryhofer MD
1. Advisory Committee on Immunization Practices. Recommended Adult Immunization Schedule: United States, 2012. Ann Intern Med. 2012:156:211-7.
2. Centers for Disease Control and Prevention (CDC). Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011; 60:1128-32. [PMID: 21866086]
3. Summary Report ,ACIP June 22-23, 2011 meeting. CDC website. Assessed February 9, 2012. Available at http://www.cdc.gov/vaccines/recs/acip/downloads/min-jun11.pdf).
4 CDC. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011;60(No. RR-2). 5 " Have You Heard?" CDC Recommendations for Influenza Antiviral Medications Remain Unchanged, CDC website. Assessed February 9, 2012, Available at http://www.cdc.gov/media/haveyouheard/stories/Influenza_antiviral.html
I am a member of the ACP Adult Immunization Technical Advisory Committee
Infectious Disease, Vaccines/Immunization, Prevention/Screening.
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Oral history interview with Nancy Holt, 1992 July 6
Holt, Nancy
b. 1938
Sculptor, Filmmaker, Installation artist
Active in Galisteo, N.M.
Sound recording 1 sound cassette.
Transcript 24 p
Collection Summary: An interview of Nancy Holt conducted 1992 July 6, by Scott Gutterman, for the Archives of American Art. Interview of Nancy Holt conducted by Scott Gutterman for the Archives of American Art, at Nancy Holts home or studio on July 6, 1992. Holt speaks of growing up and living in Massachusetts and New Jersey; attending school at Tufts and Jackson; spending time in New York; her early artist training and exposure to museums; the New jersey landscape; Dark Star Park; Sky Land; her first trip out West; Robert Smithson; her family life and relationship with her parents; studying biology; lectures at MIT; moving to New York; Richard Serra; perceptual art; becoming friends with Robert Smithson; peyote; quiet inner-transformation; locator pieces; creating artwork; Hampton Air; Rock Rings; focus on place; feminism; land art; Buried Poems; documenting work; working for Harpers Bazaar; Westbeth; living in New York; video art; Points of View; working in a gallery format; writing; Sky Mound; working with landfills and alternate energy; creating public art; working with space; plumbing systems; learning by doing; working with artisans; Sun Tunnels; resonance; catalogs; Holt also talks a bit about Alan Ginsberg, Fred Mcdarrah, Dan Flavin, Mark di Suvero, Joan Joas, Peter Campas, David Hammond, and Rupert Sheldrake.
Biographical/Historical Note: Nancy Holt (1938- ) was a sculptor and filmmaker from N.M.
These interviews are part of the Archives of American Art Oral History Program, started in 1958 to document the history of the visual arts in the United States, primarily through interviews with artists, historians, dealers, critics and administrators. Funding for this interview was provided by the Horace W. Goldsmith Foundation.
Funding for the digital preservation of this interview was provided by a grant from the Save America's Treasures Program of the National Park Service.
How to Use this Interview
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Q: How does buying stocks "on margin" work?
— J.M., Kalamazoo, Mich.
A: It's when you invest with money borrowed from your brokerage, paying interest for the privilege. Using margin will amplify your gains — but also your losses.
An extreme example: Imagine that you hold $100,000 in stocks and you borrow $100,000 on margin to invest in more stock. If your $200,000 portfolio doubles in value to $400,000, you'll have earned an extra $100,000 (less interest expense), thanks to margin.
But if your holdings drop by 50 percent, they'll be worth $100,000 and you'll still owe $100,000 (plus interest). That will leave you with ... nothing. Your holdings dropped by 50 percent, but margin amplified that to a
100 percent loss. Margin cuts both ways.
Consider the interest expense, too. If you're borrowing on margin and paying 9 percent interest, you should be pretty confident your borrowed stocks will appreciate more than 9 percent. If they fall below a certain level, you'll receive a "margin call." If you can't pay the required additional money, the brokerage will sell some of your holdings to generate the cash, possibly resulting in short-term capital gains taxed at high rates.
Only experienced investors should use margin, and many have done well without ever using it.
Fool's school: Be wary of overhyped stocks
When we run across a mailing or online post hyping a little-known stock as the next great investment, it can be hard to resist. But that's very often the right thing to do. Most of the stocks that are breathlessly promoted are risky "penny stocks" (priced below $5 a share).
Some red flags to watch out for:
• Lots of capital letters and exclamation marks, along with appeals to your emotions. If you're being told about "an Oil-Stock Gusher" or that a company has a deal in the works that "points to HUGE Profits for early shareholders," be wary.
• Strangely specific claims, such as that a deal "will soon drive the stock above $20!" or that you can expect a newsletter's future recommendations to rise more than 30 percent in less than 30 days. At such a rate of return, a $1,000 investment would grow to more than
$6.8 billion in just five years.
• An unprofessional company website. If you look up the company's website and it features poor grammar and misspellings and pages "under construction" or absent, that's a bad sign.
Foolish trivia
Two brothers founded me in 1871 in Ohio. Today, I'm the largest domestic pottery company, specializing in high-fired, lead-free glazes. Based in West Virginia now, I employ more than 1,100 people. For a time, I made toilet ware, such as china basins. In the early 1900s, I had the world's largest pottery plant and boasted about 10 percent of U.S. pottery-production capacity. In the 1950s, facing competition from inexpensive imported dinnerware, I expanded into hotel and restaurant offerings. You might expect food at Spanish religious festivals to be served on my flagship dishes. Who am I?
Last week's trivia question: Based in Tennessee, I trace my history to the 1878 founding of The Penny Press in Cleveland. I became one of the most-successful newspaper publishers and later an operator of many local television stations. I grew into one of America's biggest cable-TV operators. I sold my cable business to Comcast. I later spun off my local television and newspaper businesses but kept my national cable-TV brands. Who am I?
Answer: Scripps Networks Interactive
Got a question for the Fool? Send it in care of this newspaper.


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32nd Annual Norman Pro Am
PDGA Sanctioned - B-Tier
May 29-30, 2010
Griffin Park & NE Lions Park - Norman, OK
Tournament Director: Steve King
Email: [email redacted] (click the dots to reveal)
Phone: (405)365-8038
Quick LinkTM: Players / Results
Online registration preferred. Registration day of (if spots are still available) starts at 8:30am.
Field limited to 144 players.