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subset: commoncrawl


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When planning for the new year, try something new.
Instead of writing your plans on your computer or a notepad, get
some 20x23 inch stickie notes and some colored markers.
Gather a few colleagues and brain storm your plans on the giant
paper. List your goals (even the ones that feel slightly out of
reach), projects you want to work on, unproductive business
practices you would like to avoid and people you want to connect
Hang these notes where you see them regularly and let them inspire
and guide you through the new year.
This tip is courtesy of Leanna Hamill, attorney at law, a
member of the Law Practice Management Section Council.
Published January 14, 2010


text:
By Kelly April Tyrrell
For too many years in the last century, Delaware led the nation in the total number of cancer deaths.
Since then, Delaware's overall cancer incidence and mortality rates have declined relative to the rest of the nation.
The latest cancer statistics, released Tuesday by Delaware Health and Social Services, show the state continues to make improvements -- but not in all areas.
Delaware's cancer death rates decreased nearly 19 percent in the five-year rolling measurements recorded between 1995-1999 and 2005-2009, a 50 percent greater decline than the rest of the nation. Delaware now ranks 14th nationwide for cancer mortality.
But Delaware still has work to do, particularly when it comes to lung cancer.
The number of overall cases and deaths from lung cancer in Delaware is statistically higher than the rest of the U.S., and accounted for 15 percent of all cancers in Delaware in the most recent years for which data are available, between 2005 and 2009. It also accounted for nearly a third of all cancer deaths in the state.
And the number of women dying from lung cancer is 20 percent higher in Delaware than the rest of the country, making the state's lung cancer death rate among women fourth-highest in the nation.
"Despite all the efforts and progress lung cancer continues to play an enormous role in Delaware's overall cancer burden," Rita Landgraf, secretary of Delaware Health and Social Services, told an audience of medical professionals, patients, health care workers and more gathered at Christiana Care's Helen F. Graham Cancer Center on Tuesday for the release of the most recent cancer numbers.
Also troubling are the most recent rates for skin cancer.
The incidence of malignant melanoma, a form of skin cancer, is on the rise everywhere in the U.S., but the rate of increase in Delaware is more than triple the national average.
Still, the main topic Tuesday was lung cancer -- and smoking.
According to the Centers for Disease Control and Prevention, lung cancer kills more men and women than breast, prostate and colon cancers combined. More people die from lung cancer than from any other type of cancer, and smoking is the number one risk factor. As many as 90 percent of all lung cancers are known to be caused by smoking cigarettes.
"It takes about 20 years to develop cancer after someone begins smoking," said Dr. Karyl Rattay, director of the Delaware Division of Public Health. "There was a point in time where smoking rates were higher in women than in men, so it's kind of that lag time that we're dealing with. But why lung cancer seems to be more aggressive in women than in men is unclear, and that's the case nationally."
Speakers Tuesday also spoke of progress made in the last decade.
The news was brighter for African-American males, for whom lung cancer deaths are down 40 percent in Delaware over the last decade.
In 2002, with Gov. Ruth Ann Minner"s signing of the Clean Indoor Air Act, the First State became the second state in the nation to ban smoking in indoor workplaces and in public places. Since that time, other proactive and often controversial steps have been taken across the state to reduce smoking and secondhand smoke exposure.
For instance, the University of Delaware became a smoke-free campus late last year, Beebe Medical Center began refusing to hire smokers at the beginning of 2013 and several Delaware beaches have banned smoking or are considering bans.
"What we forget about is there is secondhand smoke and thirdhand smoke and we know that second- and thirdhand smoke is just as dangerous as smoking a cigarette directly," said Dr. Nicholas Petrelli, medical director of the Graham Cancer Center. "So what we're seeing -- we're in a transition period here so it's not only the Clean Indoor Act making an impact, but it's also the smoking cessation programs that we have across the state and the Quit Line ... and the tremendous educational programs."
"I think over the next five, 10 years you're going to going to see a dramatic drop," Petrelli added.
Theresa Young, vice president of the American Cancer Society of Delmarva, echoed Petrelli.
"We are seeing a reduction of smokers in the state of Delaware but the impact on mortality rates is going to take time," Young said.
Earlier this year, the first screening guidelines for lung cancer were published in the American Cancer Society's journal Cancer, but they apply only to heavy smokers. Screening and affordable treatment are known to play a major role in improving incidence and mortality rates of other types of cancer.
Screening has paid off elsewhere.
Last year, Christiana Care oncologist Dr. Steve Grubbs announced the disparity in colorectal cancer incidence between African-Americans and whites had been eliminated in Delaware, thanks to a program in which community navigators helped connect people to free or affordable screening and treatment.
The results of that Delaware Cancer Consortium program were estimated to have saved $8.5 million annually from reduced incidences of cancer and detection of cancers at earlier stages, more than offsetting the $6 million cost of the program.
Other efforts in Delaware are aimed at reducing cancer incidence rates and mortality, initiatives Rep. John Carney has long been a part of. A decade ago, Carney said, Delaware was in the top 10 for cancer death rates, a spot no one in the state wanted to occupy.
"So the government, going back to Mike Castle and a special commission formed by Gov. Minner, decided to put together a working consortium, put real dollars behind it using tobacco settlement funds to fund treatment for cancer for those who can't afford it," Carney said.
Source: http://johncarney.house.gov/index.php?option=com_content&view=article&id=444:the-news-journal-cancer-fight-shows-progress-in-delaware&catid=10:in-the-news&Itemid=53


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I have had two Fraxel ReStore (the mildest method) 4-5 months ago. The lapse time between I had those two procedures was about 1.5 months. I understand that Fraxel needs to be done in series. So my question is should I do a third one in a month (that is the only time when I can take time off for recovery) or should I wait till when I have the time to do a series with much less time between again? Thank you!
Does Fraxel really need to be done in a series?
Doctor Answers 2
Sseveral types of Fraxel lasers
There are now several types of Fraxel lasers. All of them with the exception of Fraxel Repair
often require more than 1 treatments,
Learn more: http://www.finetouchdermatology.com/los-angeles-fraxel-laser/
Fraxel's benefit can be seen even when treatments occur sporadically
There is a minimum number of days that should be allowed for one to heal after a Fraxel Restore treament before another treatment is done. As there is minimal downtime and success is greater with several treatments rather than one, the company suggested that patients undergo a series so that the results are seen sooner. however, the collagen is produced and not temporary so that treatment after treatment, regardless of how long apart, the newer collagen will build upon the last. Some people with very deep acne scarring can get wonderful results with many more treatments than the five or six that are done in normal series, so it does behoove people to have Fraxel every few weeks to capitalize on this benefit, especially if they eventually will have many treatments.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.


text:
Diaz, Mercedes Deal Gem in Salem's 7-1 Win
Red Sox Complete Week-Long Trip with 4-3 Record
By Salem Red Sox | April 21, 2014 11:27 PM ET
Winston-Salem, NC (April 21, 2014) - Luis Diaz and Simon Mercedes combined to three-hit the Dash on Monday night, working efficiently and effectively as the Sox cruised to a 7-1 victory, wrapping up a 3-1 series win over Winston. Carson Blair commenced the scoring with a first inning solo homer, while Matty Johnson collected two extra base hits and scored a pair of runs in Salem's 10th win of the year.
Diaz remained perfect until Adam Heisler singled with two outs in the third inning. He had set down 13 of the first 14 when Joey DeMichele tripled with one out in the fifth. A sacrifice fly from Michael Marjama plated the Winston's only run of the night, and Diaz worked around a leadoff double from Heisler in the sixth. The Venezuelan righty needed only 60 pitches in six innings of work, eagerly throwing to contact, evidenced by his collecting only one strikeout.
In relief, Simon Mercedes flashed his mid-90s fastball and remained perfect through the game's conclusion. He set down all nine men he faced, striking out three, and receiving some solid glovework from his teammates in the outfield. With his three scoreless frames, Mercedes was credited with the save. On the evening, the Dash only had 30 men come to the plate, three more than the minimum.
Offensively, the Sox scored in five different innings, beginning with Blair's towering solo shot in the first. Two innings later, Johnson doubled, moved to third on a wild pitch, and scored on Jonathan Roof's sac fly to left.
It became 4-0 in the fourth, when Kevin Heller worked a two-out walk and came around on Aneury Tavarez' ensuing triple. Mario Martinez promptly singled home Tavarez to add to Salem's lead.
Although Dash starter Brad Goldberg set down the final seven men he faced in his six-inning performance, the right-hander suffered his third loss of the year, yielding four runs on four hits. A pair of lefty relievers named Sean both gave up runs in the late innings. Salem scored twice against Bierman in the seventh and once more against Hagan in the ninth.
The victory improved the Red Sox to 10-8 overall, 8-3 on the road, heading into a week-long homestand at LewisGale Field. Following a day off on Tuesday, Salem will host the Lynchburg Hillcats on Wednesday night, with Corey Littrell scheduled to start opposite Jarrett Miller, with the first pitch slated for the traditional time of 7:05.
This story was not subject to the approval of the National Association of Professional Baseball Leagues or its clubs.View More


text: Main event: With unemployment on the rise and the nation`s manufacturing sector displaying symptoms of anemia, pressures are building for the Federal Reserve Board to curb interest rates. But progress is barely inching along, with rates remaining mostly steady. This week may clarify whether the Fed is free to move more rapidly. Wholesale prices for November will be reported Friday, amid the possibility of more bad news. A month ago, an unexpected spike in food costs sent wholesale prices for October surging. If there are additional signs of prices breaking their bonds during November, the Fed might feel compelled to show restraint on interest rates, worsening chances of a quick economic rebound.


text:
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text:
LinkedIn is extending its Sponsored InMail product to mobile devices as it continues to build up mobile advertising on the professional networking site.
The format, introduced on the desktop in 2009, allows marketers to send targeted email promotions to LinkedIn users. To keep from flooding inboxes with offers and annoying users, LinkedIn limits Sponsored InMail messages to one every 60 days.
With more of its traffic coming from mobile -- 41% -- it's a natural step for LinkedIn to bring the email marketing tool to devices. The company says more than half of LinkedIn inbox page views now take place in mobile.
According to a Yesmail Interactive study released Tuesday, half of consumers overall read emails exclusively on mobile devices as of the fourth quarter of 2013.
Like its Sponsored Update units that run in users' news feeds, the company describes Sponsored InMail as a native ad placement. But unlike the former, people receive an alert on their home screen when they get a sponsored email message to make sure they don't miss the bimonthly ad.
The company pitches Sponsored InMail as a vehicle for generating leads, boosting awareness, sending personalized attention to events and building communities and followers by driving traffic to specific groups on LinkedIn.
The email ads are bought on a cost-per-send basis and allow targeting by criteria including geography, industry, job title and company size.
In a blog post Wednesday, Dan Gonzalez, a senior global product marketing manager at LinkedIn, said LinkedIn has optimized Sponsored InMail for running campaigns across Android devices, the iPhone and the mobile Web.
The interesting question around this move is how the new law in Canada will impact marketing. The Canadian Anti-spam law comes into effect on July 1, 2014 and it DOES apply to non-Canadian companies marketing to Canadians through any online tool.


text:
About the Book
This book is a compilation of photos from the summer 2009 Avera Wellness Camp at Lee Valley Ranch in the Black Hills of South Dakota.
Features & Details
- Category Sports & Adventure
Small Square, 7×7 in, 18×18 cm
40 Pages
- Publish Date Mar 08, 2010
- Tags Avera. Avera Mckennan Fitness Center, Wellness Camp, adult adventure camp, Lee Valley, Lee Valley Ranch, Black Hills, South Dakota
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text:
A woman was taken to hospital after being slashed with a Stanley knife during a dispute in a South Oxhey convenience store on Saturday.
The woman, believed to be in her 40s, was taken to Watford General Hospital, after being involved in a confrontation at Nisa, in St Andrew's Road.
Police were called to the store at 6.30pm after an argument erupted between two women.
One woman then allegedly left the shop and came back with a friend and a fight broke out between the three.
Two women sustained injuries from a Stanley knife and a woman in her 40s was taken to the Vicarage Road hospital.
Her injuries are not believed to be life-threatening.
Police are investigating what happened on Saturday and are appealing for witnesses to call Hertfordshire Constabulary on 101.


text:
Back to articles
Problem: What if My Shredder is jammedSolution: Ensure the wastebasket is empty then move power switch to the REVERSE position. This will reverse the jammed paper out of the shredder. If shredder jams again, alternate control switch slowly between REVERSE and AUTO (l) positions to attempt to move jammed paper completely through the shredder. If the shredder jams in reverse mode, move the switch to AUTO (l), depress the manual forward button located on the center of the shredder head and allow to run for five seconds. If jam does not clear, move switch to REVERSE again and allow to run for five seconds. Repeat this process until jam is cleared. If necessary, turn off shredder and use care to grasp the paper and carefully pull out to clear jam. Once cleared, move switch to AUTO (l) to continue shredding. The jamming may be happening because the cutting cylinder needs to be oiled. See oiling instructions below.Problem: My Shredder will not operateSolution: First, make sure the shredder is plugged in. Move power switch to AUTO (l) position. Cutting cylinders will run for one to two seconds. Feed paper straight into entry until shredder automatically begins shredding. For safety reasons, cross-cut shredders will operate only if the shredder head is in the correct position on the basket. Place the shredder head on the basket with the tab on the side of the basket aligned with the slot at the side of the shredder head. The basket must be pushed all the way into the cabinet.Problem: Shredder runs continuously when switch is in AUTO (l) positionSolution: Move the power switch to the OFF (O) position and unplug the shredder. Use a Q-Tip/cotton swab (from the top of the unit) to clear the paper blockage at the auto-start sensor (center) location. Move the power switch to AUTO (l) position and depress the manual forward button for five seconds to clear paper blockage.Problem: How do I clean the sensors on my DM12C shredderSolution: Move the power switch to the off position and unplug the shredder. Remove the media guide safety cover and throat guide screws to allow access to clean the auto start sensors. For a PFD version of the complete procedure click here.Problem: Shredder suddenly stops while shreddingSolution: Move power switch to OFF (O) position and allow shredder motor to cool down for 20-30 minutes. Check to see if the shredder is jammed.Problem: Shredder will only run in reverseSolution: Move the power switch to AUTO (l) position and depress the manual forward button for five seconds to clear paper blockage. Make sure the paper is engaging sensor located in the center of the shredder opening.Problem: Shredder motor runs, but shredder will not accept paperSolution: When motor is running, look to see if the cutters are turning. The cutters can be seen by looking into the throat of the shredder. If the cutters aren't moving, the gears may have been stripped and shredder needs to be repaired or replaced.Problem: Red display light turns on and shredder will not operateSolution: If paper appears to be jammed, see above "Shredder is Jammed" solution. If the shredder doesn't appear to be jammed, check that the basket is pushed all the way under the cabinet. Also, the shredder may need a rest. Turn switch to the REVERSE position for two seconds and then back to AUTO (l) position. Move power switch to OFF (O) position and allow shredder motor to cool down for 20-30 minutes.Problem: Shredder makes a loud squeaking or rubbing noiseSolution: Cross-cut shredders require monthly oiling of the cutting cylinders to maintain proper operation. Failure to oil the blades regularly could result in excessive noise during operation. See oiling instructions below.Problem: Shredder shreds less than capacitySolution: Your shredder's cutting cylinders probably need oiling. See oiling instructions below.Problem: Shredder continues to run for 1-2 seconds after shredding has been completedSolution: The shredder runs for a few seconds longer in order to keep the cutters clear of paper particles and reduce the chance of jamming.Problem: Paper is wrapping around cuttersSolution: Empty the wastebasket and clear any jammed paper.Oiling Your Shredder's Cutting BladesTo keep your shredder in top condition, the cutting blades need to be oiled every so often (for frequency, please refer to your owner's manual). We recommend using Powershred® Lubricant or a vegetable-based oil (such as corn or canola) in a non-aerosol container with an extension nozzle. Caution: Never use flammable synthetic oil, petroleum-based, or aerosol lubricants to oil the cutting blades. Some agents may combust, causing serious injury. NEVER USE WD40.
Repeat steps three and four above at least three times. For all your Fellowes shredders and accessories visit: www.theshreddersupermarket.com
Posted: 7 May 2010
my scredder cover that goes over where you stick the paper in got got in the screder and now the piece don;t look too brite so if lyou can email me a at firstname.lastname@example.com in the next few days to give me an idea on how much that piece would cost that would be great if you have any questions please feel free to call my cell at 815-644-0224 thanks and have a blessive day.
y shredder goes only in reverse not forward i hold it in forward position for 15-30 seconds and again reverse it is not responding. Even i followed the direction on your website there is not jam paper left i have revoved it manually as well
shredder will not shredd only makes holes in paper
motor running but will not accept paper
Shredder P-35C goes in reverse but not forward .Website instructions say to press manual forward button but don't seem to have one,
paper is not being totally shredded. large pieces of paper remain after going thru shredder
I think you should do a more thorough explanation about how to be sure the cover is on to the basket in your instruction manual as explained in the answer above to the question about it not starting. That helped us get it going properly. Otherwise we thought it was already broken.
I have a jammed cutter head. I have cleared oll paper from under. Still have jammed headQuestion : When I look into the where the paper is inserted I see a clear round disc, is that part of the machine or is it my problem? Should I remove it? Hope to get an answer. 616-240-3804 email@example.com
Machine will only run in reverse, forwards it's just dead. Not even a sound. Cutting wheel is clean, no jammed paper. How can I start it forward again?
Yellow lock light stays on and the shredder will not work - I move the switch to all different areas and the red light goes on (in the middle no light) and yellow light goes on in locked position. any ideas what to do; is it possible to repair the shredder
I can not get the shredder out of lock position. Suggestion please. If won't work, where do I return the shredder for a replacement?
Both the forward and reverse and the lock switches will not move from the locked position also there are no lights showing?
I have a cd stuck in my cross-cut shredder. The reverse button didn't release it.I turned the power off overnight.I'll add oil and try the reverse button again.Any other suggestions?
The shredder motor runs, the cutters are moving, but it will not accept paper. We do regular oiling. How can we get it to accept paper?
What is the point of submitting a comment when no answers appear to be given? i have the reverse only problem other people have already reported (exactly as per Anne Metcalfe).
I have a MC8 shredder and it stopped working except in reverse like many other comments. It was jammed with paper at the top. This happens if you overfill the basket and it seems to get worse if you put it in reverse which many of us naturally do to try to clear it. But all that does is jam up the paper in the narrow gap above the cutters. I got mine out slowly with a knife but I'm sure that's not recommended. If you do, make sure it is unplugged, not just switched off at the wall, so no child/pet/slip of the hand can accidentally turn the power on. Then put 1-2 sheets through first when it starts working again, and that should clear any remaining bits. I now empty my basket when it gets anywhere near full.
Where is the manual foreword button
The "Blue Light" on top of my Fellowes 58-99Ci is no longer on. The "Red Light" come on when the basket is removed. I have held the activation button on by hand, with no results.
shredder runs but will not accept paper ?
Paper is stuck in the shredder but wont come through the blades, will not come out on top .how do i get it out
Resolution to only going in reverse. I had this problem about 5 yrs ago and it was the mother board that had gone out and no resolution except for using my warranty .
Motor runs, but after troubleshooting, only 1 roller with the cross cut blades is turning. How do you clear? Sounds like I hear something loose?
Shredder makes a high pitched squeal when feeding it paper, like a fan belt slipping.
p35 ccutters seem to be slipping when paper is feed into shredder gear prob or something looseany idears pls
I have a P-8C and while shredding it stopped working but not jammed. I read comments and done all suggested. Is there a reset button?? There is simply no power.
My unit only goes in reverse, tried your trouble shooting tips but nothing works. Any ideas?
cleaned the eyes. But as soon as you put paper between them it shuts off. Without paper it keeps running does not shut off.
when you put a paper between the eyes it shuts off .cleaned eyes still does it. what part do I need?
Shredder won't operate at all. Red light has stopped. M-C8. What can be done
Question: Am refurbishing a Fellowes DM12ct shredder. The internal reduction gears need some fresh grease on on them. Any suggestion what type of grease is best to use?
Where do I find your responses ton the above questions.? Seems silly to not be able to see your possible fixes. My problem: Motor not running in fwd; rev works, no red indicator lights illuminated, JPS system still detects paper as normal. Reply to firstname.lastname@example.com I see others with this problem and it looks like the fix is a new motherboard.
My eba 1126 c Front roller don't turn and clicks back roller ok both work in reverse please helpThanks in advanced
Anyone know where I can down load a pdf service manual or can anyone email me one to email@example.com thanks I don't want to take it apart without one
my shredder will only go reverse cannot go forward.
I Have problem with my Mercury REX1023 shredder motor running reverse can you let me know the solution.
Had a Fellowes DM12c... It still runs paper through in the forward on position, but the auto function stopped, sort of the point of buying a machine with that feature! I slacked and did not return to Costco in a timely manner. I have taken the thing apart, cleaned it very well with tweezers, needle nose pliers, a cloth for the supposed sensor, and it still does not work with the Auto shut-off feature.SOLUTION: I bought a ROYAL MC14MX. It's great! Not super fast, but the thing has NEVER JAMMED. The blades sound loose, making almost a ringing sound when I move the machine. I thought is was broken when I first bought it. However, it seems the key is that the blades are loose enough to not catch all the little pieces that gum up other shredders and cause paper jams. On occasion I have to go in and (when UNPLUGGED!!) grab some of the more sticky shredded items such as an address label from an insulated mailing envelope which does pose a bit of a challenge for the cutting mechanisms.
My relatively new and expensive to me Fellowes shredder was working fine and I have been keeping it properly oiled.... I checked the alignment of the lid to the basket which is fine. I went to do more shredding and suddenly it is dead. No light on it and nothing is working. That strikes me as electrical. The motor....had been running fine. Help me and others by posting the solution because the solutions in won't work posted don't apply. Thank you!
My PS-67c shreader won't run. I cleared allpaper from it but the red light stays on,what should do next?
cutters not moveing
green light is on motor is running but cutters not moveing have oiled and emptiedbin


text:
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text:
Historiae Romanae
Cassius Dio
Thus they granted him a triumph, as over Cleopatra, an arch adorned with trophies at Brundisium and another in the Roman Forum.
Reprinted by permission of the publishers and the Trustees of the Loeb Classical Library from Cassius Dio: Roman History (Volume VI. Books 51-55), Loeb Classical Library Vol. 83, translated by Earnest Carey, Herbert B. Foster, Cambridge, Mass.: Harvard University Press, © 1917, by the President and Fellows of Harvard College. The Loeb Classical Library ® is a registered trademark of the President and Fellows of Harvard College.


text: To get from Dalmine to Udine by train you can catch one of the 21 trains that everyday travel between these two cities. The first train to Udine leaves from Dalmine at 06:29 and the last train departs at 19:29. The trip by train from Dalmine to Udine last on average 03:08 travelling with high-speed trains (Frecciarossa or Italotreno) If you choose a local train the trip lasts on average 04:31 hours. For your trip from Dalmine to Udine by train you can choose to leave from one of Dalmine main stations: Levate, Milano Porta Garibaldi On Wanderio you can compare all schedules, fares and railway companies to Udine and book the best itinerary starting from Dalmine.


text:
The Midnight Writer
The Midnight Writer is a freelance writer and contributor to popular websites and magazines. He's written three humor books and often writes while under the influence. Under the influence of what, he will not say.
Polly was crazy. I wasn't positive of this until my father, never one to mince words or use words to speak unkindly about another person, called to say, "Son, I think Polly is crazy."
St. Patrick's Day is a few days away. On Sunday, you'll be downing pints before you even get a chance to admire the head.
Bret Michaels, the former leader of Poison, winner of 'Celebrity Apprentice' and driving force behind all those awesome seasons of 'Rock of Love' turns 50 years old today.
Leprechauns, the faires of Irish folklore (no disrespect) are popular symbols this time of year. With St. Patrick's Day on the horizon, the little men with their hidden coins, pots of gold and ginger muttonchops are running rampant through the streets spreading their magical mischief...
After signing an enormous deal to return to the Baltimore Ravens, Super Bowl MVP Joe Flacco is probably feeling pretty good about himself. He's feeling so good he's being a little more forthcoming with his opinions about a myriad of topics -- one being former teammate Ray Lewis.
"If you're not living on the edge, you're taking up too much space!" - Macho Man Randy Savage
Everyday, in the United States, we celebrate a national "something" day. There is a National Pancake Day because we're all fat. There is National Donut Day because...wait explained that. It's absurd. It's time for a holiday that celebrates one of our national treasures -- Randy 'Macho Man' Savage.
Taco Bell has been an integral block of my food pyramid for almost two decades. Here is where things get a little odd though -- rarely do I stray from the regular. In the beginning the order was always the same -- three Soft Taco Supremes and three regular crunchy tacos -- with an occasional Grilled Stuft Burrito with beef. Boring but always delivered.
The ability to shoot video on anything -- smart phones, wristwatches and specially marked cans of Mr. Pibb -- has brought a litany of otherwise unseeable sports moments to the world.
McDonald's is shaking up its menu. Except, instead of adding a hundred new items as usual, the Golden Arches is giving the golden axe to some crowd favorites.
Broken Lizard have performed together for over twenty years. First in college, at Colgate University, then in successful feature films like 'Super Troopers', 'BeerFest' and 'Club Dread' and on a massive comedy tour.
The excruciatingly long, mind-numbing minutes between 8pm and 11pm, all 180 of them, is the worst part of my day.
Vontae Davis of the Indianapolis Colts knows how to play defense. Vontae Davis does not know the rules of the NFL in regard to free agency and tampering, how hacking works, the rules of capitalization and that Twitter has a delete function...
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The Ontario government is riding to the rescue of cities and towns battered by last year's ice storm, promising an estimated $190-million to cover the costs of dealing with the damage.
"What set this event apart from others is the duration and the size of the storm," Municipal Affairs Minister Linda Jeffrey said at the legislature Wednesday. "The effects of the storm were substantial, and our response will also be substantial."
Municipal leaders, who met with Ms. Jeffrey last month to ask for provincial dollars, cheered the decision. They had initially asked the province to pay just one-third of the cost; Ms. Jeffrey's announcement signalled Ontario will pay significantly more than that.
"What the province came through with today, in my opinion, is even better [than what we wanted]," said Mississauga Mayor Hazel McCallion, who led the push for compensation.
Ontario officials are assessing the damage and will recommend how much money to give to each municipality. Ms. Jeffrey said the total payout is a fluid number and could go up or down.
The funds will cover things such as the cost of setting up warming centres, overtime for hydro crews and cleaning up debris. The province will not pick up the tab for planting new trees or productivity lost because of the storm.
The icy blast, which saw freezing rain sweep through Ontario last December, took down tree branches and power lines, turned roads into skating rinks and shut down parts of Toronto's transit system. Hundreds of thousands of households lost power, some for more than a week.
In the wake of the storm, 32 municipalities appealed to the province for help.
Toronto city manager Joe Pennechetti estimated Toronto's share of the funding would be about $86.5-million – exactly what the city had asked the province for. According to the city's estimates, the lion's share of the ice storm's cost involved cleaning up debris. Restoring electricity, clearing ice off streets and fixing broken pipes were also drains on the city budget.
"[It's] not just good news, this is great news. I'm delighted to hear it," Toronto Deputy Mayor Norm Kelly, who helped direct the city's response to the storm, said at city hall after the announcement. He said that the funding "reflects the nature of the relationship between the city and the province, which is one of partnership."
At the height of the ice storm, Premier Kathleen Wynne worked directly with Mr. Kelly, and not Mayor Rob Ford – the result of a council vote in November after the mayor's crack cocaine scandal that stripped him of many of his powers. When asked whether he thought Mr. Ford could have secured the same deal from the province, the deputy mayor replied: "I'll leave that for you to decide."
Mr. Ford, in Ottawa for a big city mayors' meeting, said in a statement: "This program will help ensure that the significant costs we are facing as a result of this storm do not trickle down to Toronto taxpayers."
Ms. Jeffrey said she wrote to federal Public Safety and Emergency Preparedness Minister Steven Blaney on Wednesday to ask that the federal government help the province cover municipalities' costs. A spokeswoman for the Public Safety Ministry could not say Wednesday whether Ontario would receive any assistance from Ottawa.
The provincial compensation will only apply to municipalities. Other government agencies that had to deal with the storm – such as Hydro One, which handles electricity transmission and also distributes to more than a million households, mostly in small towns and rural areas – will have to pay their own costs from their existing budgets.
The money promised Wednesday only pays for costs related to the ice storm. Damage from other extreme weather, such as the flooding in Toronto last spring, will not be covered.
With a report from Josh Wingrove in Ottawa.Report Typo/Error
Follow us on Twitter: @annhui, @adrianmorrow


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|Statut :
|Organisation :
|Street Kids International
|Acronyme :
|Type :
|Organisme non gouvernemental
|Mandat :
|Street Kids International is a Canadian-based non-profit organization that supports street youth in developing skills, making choices, and accessing opportunities.
Through international efforts, Street Kids International aims to:
- provide training and capacity building opportunities that introduce youth-centred methods for working with street youth
- develop a global network of organizations and front-line workers striving to support local street youth
- co-develop with this global network the best-practices and materials for meeting the needs of street youth
- raise awareness about the needs and rights of street youth
|Adresse :
|P.O. Box 1026 T.D.C. Postal Stn. 77 King Street West
Toronto, Ontario,
|Veuillez visiter le site Internet de l'organisation offrant ce stage pour connaître ses exigences avant de lui envoyer votre curriculum vitae.
|Personne ressource :
|Natasha Cassinath
|Courriel :
|Pays :
|Ville :
|El Alto and La Paz
|Secteur :
|Description du stage :
The objective of the "Innovative Social and Economic Leaders" project is
to strengthen the capacity and skills of adolescents and youth as well as
educational insitutions. This project, initiated in June 2006, will focus on
the use and enhancement of innovative products to improve the quality of life
and social conditions of marginalized youth in order to foster
self-sustainability. The primary target group will be institutional educators
who work with adolescents and youth from the marginalized areas of El Alto and
La Paz.
In Canada
-Uploading information on Street Kids International and it's innovative tools and methodology
-Debriefing with Canadian staff on communications, logistics, expectations, the Bolivian context and deliverables
-Final Reporting
-Debriefing Canadian Staff on lessons learned, challenges and opportunities
Public Engagement
Training Facilitation
- Delivery of entrepreneurship training modules including Street Kids International's own Street Business Toolkit
- Co-facilitation of accompaniment training to equip youth workers with effective strategies to support youth
- Co-ordination and implementation of youth practice business training opportunities
Tool Development
-Collaboration with the CDEA team in the research and development of youth driven materials
|Organisation d'accueil :
|Centro de Desarrollo de Educacion Alternativa
|Détails au sujet de l'organisation d'accueil :
|CDEA (Centre for the Development of Alternative Education) seeks to develop initiatives, actions, and strategies oriented to improve the quality of life and strengthen the potential of populations in social disadvantage. CDEA has directed its efforts to promoting diversity equality, universal human rights and human values through the development and implementation of innovative, educational training programs for both formal and non-formal streams.


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As fields are being scouted for second-generation bean leaf beetles, stink bugs are being found in greater abundance than usual during late summer. These stink bugs are unlikely to cause any economic damage (i.e., damage that would justify an insecticide application). There are three species of stink bugs that are fairly common in Iowa soybean: the green stink bug, brown stink bug, and spined soldier bug. The green stink bug and brown stink bug are both pests and can damage pods. See the August 20, 2001, ICM article [1] on page 121 for information on the green stink bug and damage to soybean. Damage caused by the brown stink bug would be very similar to that caused by the green stink bug. The spined soldier bug is a beneficial insect and feeds on a variety of pest insects, including green cloverworm caterpillars. This insect can be identified by the very sharp "shoulders" and brown spot near the tip of the wings.
Enlarge [2]
|Brown stink bug nymph.
Enlarge [3]
|Brown stink bug adult.
Enlarge [4]
|Green stink bug nymph.
Enlarge [5]
|Green stink bug.
Enlarge [6]
|Spined soldier bug, a beneficial insect.
This article originally appeared on page 181 of the IC-486(22) -- September 17, 2001 issue.


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* All digital cards and invitiations have moved! Check out the new pingg.com >
4/26 previous photo next photo 25 Days of Christmas Tablescape Ideas
Here in the northeast we don't think warm and beachy at Christmastime - unless we're trying to escape the bitter cold and snow. What I love about this coastal Christmas table is how richly winter and festive it looks, all while still incorporating classic seaside details. Starfish and cranberries can work together!
Image via Coral and Coast


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Work confidently in professional, tech-powered workspace at a premier mixed-use development at 3800 North Lamar in central Austin. Accessible from the MOPAC Expressway, this signature location is a recognizable address in an elegantly designed building that's steps away from Central Market and Austin's dynamic medical community.
Lamar Central Center is a convenient site outside of downtown to host meetings or work on the go in our fully equipped business lounge. The center features a dedicated co-working area, giving you an open environment where you can collaborate with your team or connect with professionals in a variety of industries. With retail and restaurants conveniently located on the ground floor, you can grab lunch and take care of business all in one place.
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�Today, there are over 800,000 people receiving lifesaving drugs, and we thank those who are on the ground in the countries around the world who are using taxpayers� money to save lives. We believe that it�s one thing to spend money, we also believe it�s another thing to say that we expect there to be results.�
President George W. Bush
The President�s Emergency Plan for AIDS Relief (Emergency Plan/PEPFAR) has supported the leadership of host nations in the area of treatment. Just three years into the initiative, through the end of fiscal year 2006, PEPFAR has partnered with host nations to support treatment for approximately 822,000 people in the 15 focus nations, as well as 165,100 people elsewhere in the developing world, for a total of 987,100 people receiving HIV/AIDS treatment worldwide.
PEPFAR is dedicated to supporting treatment for both adults and children. Of the people receiving treatment with downstream U.S. Government (USG) support in focus countries, approximately 48,600 � almost nine percent � were children. Reflecting PEPFAR�s commitment to meet the needs of both men and women, 61 percent were female.
In achieving this success, the Emergency Plan has moved faster than any other bilateral or multilateral initiative to support the expansion of HIV/AIDS services, using a network model of care in order to bring treatment to areas that are among the world�s most difficult to serve. This success is providing hope and confidence to people in struggling health systems in many places. It is rapidly transforming the social landscape in many of the nations hardest-hit by HIV/AIDS, and this is an achievement to celebrate.
However, it is not enough to scale up quickly. In the area of treatment, it is particularly essential that programs maintain the highest quality. Establishing and maintaining high-quality, standardized HIV/AIDS treatment programs is a challenge for many host governments, because treatment is complex and consists of many elements. With Emergency Plan support, partners and host governments are using modern approaches to quality improvement. Key to these efforts is the selection and monitoring of essential program quality indicators. Supportive on-site supervision and proven teambuilding approaches are now being used in many programs to benchmark and then improve the quality of services. Supporting partners in their efforts to apply the principles of quality improvement helps the local health workers improve services, not only for HIV/AIDS patients, but in other key health programs, as well.The effects of low-quality treatment go beyond simple waste of scarce resources. Low-quality treatment means increased risk of morbidity and mortality for individual patients and can lead to widespread development of toxicity and transmission of HIV resistant to first-line treatment. Durability of therapy is critical to the long-term success of HIV/AIDS treatment programs. Antiretroviral drug (ARV) regimens need to be effective and have few or at least manageable side effects, and people who start on ART need support to ensure that they take at least 95 percent of their medications. These conditions are more likely to be met with first-line therapy. Second-line therapy is far more expensive, has more side effects, and is more difficult to manage. So far, the number of patients needing these costly medications in PEPFAR programs is less than 10 percent.
The Emergency Plan is building high-quality programs to support patients in their efforts to stay on first-line therapy. Emergency Plan-supported ART programs take a comprehensive approach to care, which includes links to social services and other essential programs. Program monitoring and evaluation systems are being established to be sure that patients receive and take the most appropriate regimens.
To further improve its partnerships with host country ART programs, PEPFAR has collaborated on the development of World Health Organization (WHO) ARV patient monitoring guidelines, which recommend a cohort approach that assesses ART programs based on their success at keeping patients on therapy. Many programs now use the simple WHO-recommended registers and monitoring system to account for each patient started on ART at the end of the reporting period. Determining an outcome at the end of the reporting period such as �alive on therapy,� �lost,� �transferred,� or �died� helps health care providers focus on ensuring adequate support and provides feedback regarding how they are doing.
Another key factor is preventing and monitoring the development of resistance. Good adherence to treatment regimens is one sure way to prevent the development of resistance. However, the Emergency Plan also supports surveillance efforts to monitor levels of resistance in individuals and the community. This is especially critical in order to monitor overall program performance and help set guidelines regarding the most appropriate first-line regimens. Rising drug resistance within the community could be a sign of a poorly performing program and may indicate the need for increased support to improve service delivery and safeguard ARVs to ensure that they are still useful against the virus.
Poor drug quality is another potential threat to ART programs, and depending on the nature of the product, it can directly put patients� lives at risk. To combat this problem, the Emergency Plan insists upon using products approved by the expedited process (described later in this chapter) established by the Food and Drug Administration (FDA) within the Department of Health and Human Services (HHS). The Emergency Plan also created the Supply Chain Management System (SCMS) in order to ensure post-production and post-delivery surveillance of drug quality.
One of the main causes of attrition is mortality, and other patients may transfer or be lost to follow-up. Emergency Plan-supported programs have also found that late initiation of ART is associated with higher death rates, so recruiting patients earlier is a goal. The focus on supporting long-term adherence to ARVs, although challenging in any setting, has resulted in very impressive results.
The emphasis on ensuring quality services has paid off � in many programs the percentage of patients who are still on treatment after a year is very high. For example, in Ethiopia, the survival rate after 12 months on ART is nearly 89 percent, and a partner in Uganda was pleasantly surprised to report that more than 90 percent of the patients on therapy had almost undetectable viral loads. In other words, the patients were not only returning to the clinic regularly for follow-up, but were also taking all of their medications.
The quality assurance/quality improvement process is designed to help strengthen the capacity of facilities to improve their quality of care and increase the long-term sustainability of their programs. In general, quality assurance programs are evidence-based and use on-site supervision, chart abstraction, adherence surveys, and in some cases viral loads with a sample of patients. The process often follows the �plan-do-study-act� model, and Emergency Plan partners work with the local staff to interpret results and identify small changes that can be implemented to improve the quality of care. These changes are then monitored to see if they have an impact; if so, they can be implemented more broadly.
The Emergency Plan thus is devoting intensive resources to strengthening the systems that are necessary to ensure that the treatment offered to HIV-positive people in the developing world is of high quality.
Additionally, it is critically important to ensure adherence to and availability of lifesaving ART. When managed with ART, HIV is a chronic condition, but patients who begin therapy must maintain it for the rest of their lives. If people on ART lose their access to medications, they will die. Therefore, an uninterrupted supply of ARVs also is essential to preclude the development of drug-resistant HIV.
During 2006, the newly-established SCMS played a critical role in preventing stock-outs of key HIV/AIDS commodities. Emergency Plan countries called on SCMS to provide technical assistance, and in some cases, to arrange for the emergency delivery of life-saving products. When requested by the host government, SCMS worked with other multilateral organizations such as the Global Fund to intervene to avoid stock interruptions (see the section on �Actions to Prevent Stockouts,� later in this chapter).
Sustainability for the indefinite future is critical for ART efforts, and as with all HIV/AIDS responses, this can only be guaranteed by local leadership and ownership. For this reason, the Emergency Plan focuses its efforts on working with host nations to develop critical health network systems. PEPFAR forms partnerships with these nations in order to build capacity by leveraging and maximizing not only other sources of funding, but also the countries� own resources to treat their people for the long term.
It is important to remember that adults and children living with HIV/AIDS may require a broad range of additional health interventions. Therefore, the Emergency Plan promotes a comprehensive package of other services to prevent infections that can lead to illness or death; these interventions are classified as �care� for PEPFAR purposes, and are described at greater length in the Care chapter. PEPFAR�s adult and pediatric preventive care packages include lifesaving interventions such as cotrimoxazole prophylaxis to prevent opportunistic infections (including diarrheal diseases); screening for tuberculosis; prevention of malaria using long-lasting insecticide-treated mosquito nets; support for therapeutic nutrition for children and, on a time-limited basis, severely malnourished adults; and safe water. For further information on ARVs, please see PEPFAR�s 2006 Congressional Report, Bringing Hope: Supplying Antiretroviral Drugs for HIV/AIDS Treatment at http://www.PEPFAR.gov/progress/.
Results: Rapid Scale-Up
In fiscal year 2006, ART� including ARV drugs and services, as well as laboratory support � received approximately $819 million in Emergency Plan funding, or approximately 46 percent of total focus country resources for prevention, treatment, and care activities, excluding funding for pediatric AIDS.
As a result of this unprecedented commitment to partnership with host nations, PEPFAR has supported ART for approximately 822,000 people in the focus countries through September 2006. Of these people, approximately 528,300 benefited from site-specific �downstream� support, while approximately 293,700 benefited from �upstream� support from public- and private-sector networks and systems for the provision of ART. Of those receiving downstream support, approximately 249,000 were on treatment during fiscal year 2005 (see the accompanying box for more information on downstream and upstream support for treatment).
The Emergency Plan features a growing commitment to pediatric AIDS treatment (see the section on pediatric treatment), and approximately nine percent of those who received treatment at downstream sites where implementing partners reported the age of those served were children age 14 or under. PEPFAR also is committed to ensuring full participation of women in treatment activities and is working with implementing partners toward the goal that all patients who are served are reported by gender. At downstream sites where implementing partners reported results by gender, 61 percent of those receiving PEPFAR-supported ART were female, and 39 percent were male.
Beyond the 15 focus countries, the Emergency Plan also supported ART for approximately 165,100 people through bilateral programs in 40 other nations, for a total of approximately 987,100 people worldwide receiving ART with PEPFAR support.
As part of the massive scale-up in the focus countries, the number of sites providing treatment has increased from 800 in fiscal year 2005 to 1,912 in fiscal year 2006 � a 139 percent increase. Every month during fiscal year 2006, an average of approximately 93 new ART sites came on line. By the end of fiscal year 2006, approximately 50,000 individuals were being added to the growing number of people benefiting from life-extending therapy every month.
This effort represented a 105 percent increase in the number of persons on ART over a 12 month period, keeping the Emergency Plan on target to reach its goal of two million on ART with fiscal year 2008 funding.
Another way to assess the impact of PEPFAR�s partnerships with host nations is to estimate treatment�s effect on the life spans of individuals. The World Health Organization has recently developed a methodology for calculating the number of life-years added by ART; when applied to the number supported by PEPFAR, as shown in figure 2.2, this approach generates very significant results. The more than 822,000 persons who began treatment with support from PEPFAR in the focus countries during fiscal years 2004 through 2006 represent approximately 2,200,000 person-years-of-life added through the end of fiscal year 2009 (September 30, 2009). Projecting the additional number of people expected to be placed on ART by the end of fiscal years 2007 and 2008 under current PEPFAR budget plans, an additional 1,250,000 person-years-of-life would be added by the end of fiscal year 2009. In all, PEPFAR support for treatment is expected to save around 3,450,000 person-years through September 30, 2009, alone and undoubtedly will have much greater effects beyond that time frame.
The Emergency Plan is working to support the implementation of effective monitoring and evaluation (M&E) systems across implementing partners in support of national information systems. This is assisting PEPFAR�s in-country USG teams and implementing partners to monitor and improve delivery of services and, in particular, program quality and adherence to therapy. For example, in KwaZulu-Natal, South Africa, Emergency Plan partners are working with the government to build teams at the facility level to focus on improving patient care services in a number of programs that are essential to people living with HIV/AIDS (PLWHA). Most host countries have recognized the need to combine program indicator data with regular supportive on-site supervision. The regular supervision provides an opportunity to use monitoring data to improve services and conduct brief refresher training. Other innovative M&E programs are being developed for use in focus countries and beyond.
The Emergency Plan is the largest contributor to the Global Fund, providing approximately 30 percent of all resources to date. The Global Fund has reported support for ART for 770,000 people globally as of the end of 2006; strikingly, 418,000 of those were reported in PEPFAR focus countries. For 2005, it was estimated that 80 percent of those receiving Global Fund support in the focus countries also benefited from Emergency Plan bilateral support; this year, it is estimated that all of them do. This is a testament to close country-level coordination in support of national programs.
Pediatric Treatment: the Emergency Plan Response
Preventing, diagnosing, and treating pediatric HIV/AIDS present daunting challenges. The limited capacity of health systems in resource-poor nations hampers pediatric HIV/AIDS care, as it does a range of other health issues.
The most effective way to prevent HIV in children is prevention of mother-to-child transmission (PMTCT). PMTCT is challenging in resource-limited settings, beginning with difficulty in getting pregnant women to access antenatal care and HIV prevention programs in the first place. Even when women are reached with prevention services, there are significant barriers of stigma, reluctance to return for HIV test results, issues related to delivering short-course preventive ARVs in situations where women have their babies at home, and the complexities of infant feeding for an HIV-positive mother.
Diagnosis of children � especially the young children most likely to be infected � is complex and expensive. Technologies to improve pediatric diagnosis are not yet widely available, and shortages of trained health workers are a major problem. In addition to supporting host nations� programs that provide pediatric ART, PEPFAR has also been a leader in expanding a prerequisite to treatment � early infant diagnosis for children under 18 months. PEPFAR supports nations in expanding polymerase chain reaction (PCR) testing of dried blood spots, which require less blood per test than older methods and can be transported to central laboratories for testing.
PEPFAR has supported country-level policy change to allow PCR-based testing in order to reduce the cost and burden of infant diagnosis. As table 2.4 shows, most focus countries have now adopted such policies. In some cases, national policy is behind actual implementation, with 14 focus countries reportedly using PCR testing � making accurate diagnosis and management of pediatric ART a growing reality.
Long-term combination ART for children also poses special challenges. ARVs are often unavailable in pediatric formulations, partly because they are often much more costly than adult drugs. In addition, pediatric regimens can be difficult to follow because of the complexity of dosing by weight. Communities do not always focus on the special issues of children with HIV/AIDS, whose parents may be ill or dead, and their caregivers often lack the needed support. Even where there is a community response, older children in particular have issues which may be neglected.
The Emergency Plan features a growing commitment to pediatric AIDS treatment. In fiscal year 2006, of those people receiving ART at downstream sites for whom partners reported age, approximately 48,600 � almost nine percent � were children. This number is likely understated, as many partners, with PEPFAR support, still are developing systems for reporting adult or child status in all data.
The Emergency Plan embraces a comprehensive approach to addressing the need to increase access to life-saving ART for children. On March 13, 2006, First Lady Laura Bush announced an unprecedented public-private partnership to promote scientific and technical discussions on solutions for pediatric HIV treatment, formulations, and access. Through the Emergency Plan, this partnership encourages innovator and generic pharmaceutical companies, civil society organizations such as The Elizabeth Glaser Pediatric AIDS Foundation, and The Clinton Foundation, WHO, and the UN�s UNAIDS and UNICEF, to work together with agencies across the USG, in order to bring together a wide range of expertise. This new partnership also seeks to maximize the utility of currently available pediatric formulations and to accelerate children�s access to treatment.
This partnership will complement other PEPFAR efforts to support programs that expand treatment for adults and children, such as support for health care capacity-building and expedited regulatory review of drugs through HHS/FDA (discussed later in this chapter), which has made eight new pediatric formulations available for PEPFAR programs. The partnership will offer children and parents hope for a better day, when families can stay together, lead healthy lives, and live positively with HIV/AIDS.
Further information on the challenges and results regarding pediatric AIDS treatment may be found in the chapter on Children.
Sustainability: Supporting Efforts to Build Capacity
Training in ART services for health workers is a major focus; in fiscal year 2006, the Emergency Plan supported training or retraining for approximately 52,000 service providers in the focus countries. These efforts range from lecture format to bedside mentoring and include on-the-job training and other strategies to encourage those who have been trained to remain at their posts. Maintaining systems that support delivery of high-quality care is an important aspect of supporting health care personnel, and the Emergency Plan works closely with partners to improve quality of care through regular on-site supervision, monitoring of key program indicators, distance learning and refresher training programs, and initiatives to support staff to focus on improving service delivery. Also, Emergency Plan-supported activities involve networks of PLWHA to support treatment literacy and adherence, fostering quality as well as sustainability.
Strengthening sites so that they are adequately equipped to provide high-quality ART is critical. This includes addressing deficits in infrastructure, laboratory capacity, and procurement and distribution of ARVs and other commodities. In fiscal year 2006, the Emergency Plan supported 1,912 ART service sites in focus countries, and the new Supply Chain Management System (described in the chapter on Building Capacity: Partnerships for Sustainability) already is making a major contribution to meeting procurement and distribution challenges for ARVs and other commodities needed for quality treatment. PEPFAR support for laboratory capacity � including equipment, training, and quality control � is helping nations improve their ability to monitor responses to treatment and care and make better informed clinical judgments.
Since the majority of people living with HIV/AIDS live far from major medical centers, moving beyond a hospital- and clinic-based model for provision of ART will help make services more widely available and sustainable. Therefore, PEPFAR is supporting development of a widening range of treatment settings. In addition, strengthening linkages under the network model to give patients access to seamless prevention, treatment, and care services is a priority. This is particularly important for persons with tuberculosis (TB), orphans and vulnerable children (OVCs), and mothers, among others.
Savings on Safe and Effective Antiretroviral Drugs
The Emergency Plan remains committed to funding the purchase of the lowest-cost ARVs from any source, regardless of origin � whether they are innovator, generic, or copy drugs, as long as those medications have been proven safe, effective, and of high quality, and their purchase is consistent with international law.
To meet the need for a selection of ARVs that are proven to be safe, effective, and of low cost, in May 2004 HHS/FDA introduced an expedited �tentative approval� process whereby ARVs from anywhere in the world, produced by any manufacturer, could be rapidly reviewed to assess quality standards and subsequently cleared for purchase under PEPFAR. Tentatively approved ARVs meet standards equal to those established for the U.S., ensuring that no drug purchased for use in PEPFAR programs abroad falls below standards for the U.S. market.
As of January 4, 2007, 34 generic ARV formulations have been approved or tentatively approved by HHS/FDA under the expedited review, including eight fixed-dose combination (FDC) formulations containing at least two individual ARVs. FDCs are invaluable because they are easier to manage for patients, health workers, and program managers and can serve as an important bulwark against the development of HIV drug resistance. Three co-packaged triple drug combinations and two triple FDCs have been tentatively approved by HHS/FDA and are available for use by Emergency Plan partners and others. The steady increase in HHS/FDA ARV approvals is shown in figure 2.6.
By late 2006, 14 focus countries had imported HHS/FDA-approved generics. Most approved products to date are widely used, standard, first-line generic ARVs. In many countries, host governments also have requested USG support for more expensive second-line ARVs. As a side benefit of the FDA�s approval process, it has also expedited the availability of five generic versions of ARVs whose U.S. patent protection has expired.
The establishment of the Supply Chain Management System (SCMS) is a key element in efforts to support comprehensive HIV/AIDS programs (for more information, see the chapter on Building Capacity: Partnerships for Sustainability). To date, approximately $94 million of focus country prevention, treatment, and care resources have been provided to SCMS to support procurement of commodities such as ARVs, technical assistance, logistics, and other aspects of supply chain management. Usage of SCMS is expected to increase significantly during its second full year of operation, fiscal year 2007.The HHS/FDA fast-track approval process has supported the increased procurement of high-quality but less-expensive generic ARVs. A recent survey of all 36 USG partners that procured ARVs in the focus countries showed that they spent $109,843,477 to procure ARVs in fiscal year 2006 (see table 2.8 and figure 2.7).
These advances are critical, because they significantly lower the annual price of a standard first-line regimen. The cost savings allow more people to access life extending treatment � and as the number of people on treatment increases, the cost savings also will increase, as greater economies of scale will be achieved (see figure 2.8).
Table 2.9 is drawn from the work of SCMS in fiscal year 2006. By using generics in preference to innovator drugs, SCMS was able to save an estimated $1.7 million � a 42 percent reduction of the cost using innovator drugs (particularly due to major differences in pricing for nevirapine; excluding nevirapine, a more typical reduction is approximately 20 percent). The competition that is now emerging between generic and innovator companies as more products are approved by HHS/FDA is expected to exert further downward pressure on prices in 2007.
The increased use of HHS/FDA-approved generic ARVs has made Emergency Plan resources go farther, giving thousands of additional people access to prevention, treatment, and care. Emergency Plan partners have an incentive to procure the least expensive, highest-quality medications, since this enables them to redirect resources as needed to meet their treatment and other targets. The data collected shows that countries have diversified the procurement of ARVs and purchased from numerous manufacturers (including generic manufacturers) as seen in table 2.10.
Progress on Pediatric Formulations
Overcoming Obstacles to Treatment Scale-up
In addition to review and approval by HHS/FDA, high-quality, lower-cost ARVs still must be reviewed and approved by host government drug regulatory authorities (DRAs). Action on the part of many DRAs can be slowed by weak infrastructure. The process sometimes can be hastened when the host country DRA has comprehensive knowledge of the process that other DRAs have taken when reviewing and approving ARVs. To this end, HHS/FDA conducted a workshop in 2005 for host government DRAs from the focus countries. Since this workshop, HHS/FDA has been in contact with several of these authorities to share information when requested (and when confidential information is shared, with permission of the sponsoring corporation).
Within Emergency Plan focus countries, several host government DRAs also rely on the WHO prequalification drug approval process in their dossier review. To expedite this process, HHS/FDA has entered into a confidentiality agreement with WHO to share dossier information (with permission of the sponsoring corporation), such that the WHO Secretariat can place generic ARVs that have received approval or tentative approval from HHS/FDA immediately on its prequalification list.
In addition to the purchase of HHS/FDA-approved and tentatively approved ARVs by the Emergency Plan, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) now recognizes HHS/FDA tentative approval as approval by a �stringent regulatory authority,� which means Global Fund resources may go to purchase HHS/FDA tentatively approved generic ARVs. In collaboration with PEPFAR, WHO now automatically lists HHS/FDA-approved generics as WHO pre-qualified shortly after the FDA approval is granted. For the complete list go to http://www.fda.gov/oia/PEPFAR.htm, or see Appendix VI: Generic HIV/AIDS Formulations Made Eligible for Purchase by PEPFAR Programs Under the HHS/FDA Expedited Review Process.
Action to Prevent Stockouts
Through its diverse multinational consortium, SCMS already has had a major positive impact by ensuring a regular supply of HIV/AIDS commodities. Large procurements, regional warehouses, a broad consortium of partners, and an ongoing dialogue with major manufacturers give SCMS the flexibility to �pitch in� when routine systems do not work. By working directly with host governments and their partners, SCMS has responded to requests to make emergency procurements in a number of countries. These actions have ensured that programs can continue to provide life-saving medications and products to PLWHA.
With the growing numbers of patients on treatment, it has become increasingly important that the major partners work ever more closely together to ensure continuity of treatment. Constant availability of high-quality drugs is critical to ensure appropriate treatment and decrease the risk of drug resistance. In addition, the constant availability of HIV test kits is essential to ensure continued prevention of infection, while also providing a critical entry point for treatment. Strengthening systems to ensure that clinics have the drugs and HIV test kits they need, when they need them, is essential. As PEPFAR and its partners respond to make drugs available to those in need, it is essential that their efforts are coordinated, in order to alleviate the risk of clinics either overstocking or stocking out the products. For example, PEPFAR has worked with partner governments through SCMS to avoid a number of stockout situations that could have disrupted services for patients:
In each case in which stockouts or near stockouts have occurred, SCMS has offered to work with partner governments and implementing partners to improve planning and forecasting to prevent future shortages and emergency purchases. SCMS�s objective is to support partners in establishing a regular, flexible product supply that can be adjusted to meet actual demands and avoid the risk of stockouts and treatment interruptions.
Key Challenges and Future Directions
As noted above, delivering ART to HIV-positive children is also a major challenge, due in large part to the difficulty of infant diagnosis of HIV. The Emergency Plan has launched a major effort to meet and overcome this and other obstacles, and is greatly expanding its pediatric treatment efforts. In 2006, PEPFAR teams reported 14 countries that are in various stages of implementing the PCR-based technology to test dried blood spots to diagnose HIV-1 infections in children under two years of age.1 This technology involves the use of a small sample of blood from a finger or heel that can then be transported, often days later, to a central laboratory that has the capacity to perform PCR testing. Using this approach, countries such as Botswana and Namibia are establishing a network of health care facilities and public health laboratories that will make more accurate diagnosis and management of pediatric ART available to thousands of children. For more information on pediatric treatment, see the chapters on Children and Building Capacity: Partnerships for Sustainability.
As noted, ensuring adherence to ART is a critical challenge the Emergency Plan is working to confront. Treatment partners are collecting client-level data to document 95 percent adherence and are reporting cohort data to monitor patient retention. Additionally, information regarding the proportion of patients on second-line therapy is used to monitor program progress. The Emergency Plan also is expanding support for testing for resistance and toxicities in order to adjust treatment, as well as laboratory support for testing to determine when a person needs to begin HIV treatment and to monitor that therapy.
Quality is also being addressed with a number of system-strengthening approaches, including monitoring and evaluating programmatic indicators, on-site supervision, and district, national, and international ART program reviews. Reviews involve international and local experts from a variety of technical backgrounds, including prevention, treatment, care, and laboratory and supply chain management. Review participants work in teams and use a standardized approach to developing consensus facility and program level recommendations for the host government and partners. The Emergency Plan�s interagency ART Technical Working Group has guided such efforts, and the information now is being used to improve programs. PEPFAR provides intensive technical assistance to ensure treatment quality, supporting such activities as equipment procurement, review and development of operating procedures, improvement of store management, and management and information systems.
One promising approach to meeting the challenge of reaching HIV-positive people with ART is the formation of public- private partnerships (for additional information, see the Building Capacity: Partnerships for Sustainability chapter). Among these partnerships are workplace efforts, through which PEPFAR is partnering with employers to support ART for employees and their families. In some cases, the Emergency Plan conducts training while the employer procures the ARVs. A number of U.S. Embassies have demonstrated leadership by instituting ART workplace programs for their own employees.
Human capacity constraints remain a serious impediment to ART scale-up, a situation which is exacerbated by the �brain drain� of health workers to developed countries and also by the toll HIV/AIDS has taken on health workers. Administering ART requires training, which the Emergency Plan is working to provide through innovative school and on-the-job methods. Despite the shortage of health workers, some countries are reluctant to expand responsibility for ART administration and monitoring beyond physicians. The Emergency Plan has been working with governments to promote the �network model,� which seeks to allocate highly trained health workers � such as physicians with specialized training � to referral centers where their level of training is essential, while allowing non-physicians trained in ART to administer treatment at field sites. The soaring demand for ART in resource-poor nations and the lack of access to urban centers of excellence require a flexible health workforce, and PEPFAR supports policy initiatives to permit such flexibility and innovative training programs in order to expand available ART-educated personnel. This topic is also discussed further in the chapter on Building Capacity: Partnerships for Sustainability.
The geographic dispersal of PLWHA, with many living in remote rural areas, provides a key challenge in making ART available to those who need it. PEPFAR efforts to reach rural populations include innovative models, as well as the expansion of the network system to community-based health care facilities and outreach to community- and faith-based providers. A home-based care model for delivery of ART is also being used successfully in many settings; in Nigeria, for example, the community-based Faith Alive program provides home-based care. There are training manuals on home-based care and a network system that links home-based care to services in the area, including pediatric services.
Another key challenge is coordination with other international partners. ARV supply challenges faced by C�te d�Ivoire in 2006 demonstrated the benefit of close cooperation among partners such as PEPFAR, the Global Fund, and the World Bank. There are a number of stakeholders addressing the serious challenges involved in achieving a reliable and sustainable supply chain. In an effort to coordinate scarce resources and remove bureaucratic barriers, the Global Fund, World Bank and Emergency Plan have launched an initiative in six initial countries to identify and remove obstacles and develop a simplified, collaborative approach to supply chain strengthening. Specifically, SCMS will serve as the technical secretariat, and joint missions are planned for early 2007. The Emergency Plan has supported nations that have moved to country-level, unified procurement and distribution systems, such as Rwanda. For more information on collaboration with multilateral organizations, see the chapter on Strengthening Multilateral Action.
Accountability: Reporting on the Components of Treatment
Upstream support is vital to creating sustainable national systems. In Botswana, for example, the government has led an aggressive and highly successful multi-sectoral response with its own resources and significant downstream contributions from the private sector through the African Comprehensive HIV/AIDS Partnerships (funded by the Bill & Melinda Gates Foundation and the Merck Company Foundation). The USG has provided significant contributions to the development and implementation of national systems for training, quality assurance, and guidelines applied to clinical delivery of ART, HIV laboratory, and monitoring and evaluation of the ART program. These contributions strengthen the overall success of Botswana�s national strategy.
This report covers patients who are receiving upstream and downstream Emergency Plan support. The complexities of both forms of support highlight the vital importance of implementing the �Three Ones� agreement (see the chapter on Strengthening Multilateral Action). In working with major partners, including the Global Fund, WHO, and UNAIDS, the Emergency Plan is coordinating its monitoring and evaluation efforts and reporting criteria to develop consistent methodologies to determine the number and attribution of patients receiving treatment through upstream and downstream support from multiple organizations.
Attribution Challenges Due to Country-Level Collaboration. The Emergency Plan supports national HIV/AIDS treatment strategies, leveraging resources in coordination with host country organizations and other international partners to ensure a comprehensive response. Host nations must lead a multi-sectoral national strategy for HIV/AIDS for an effective and sustainable response. International partners must ensure that interventions are in concert with host government national strategies, responsive to host country needs, and coordinated with both host governments and other partners. Stand-alone service sites managed by individual international partners are not desirable or sustainable. In such an environment, attribution is complex, including both upstream and downstream activities, often with multiple partners supporting the same sites to maximize comparative advantages. PEPFAR is conducting audits of its current reporting system to refine methodologies for the future, and continues to assess attribution and reporting methodologies in collaboration with other partners. PEPFAR is conducting audits of its current reporting system to refine methodologies for the future, and continues to assess attribution and reporting methodologies in collaboration with other major partners. PEPFAR and its partners have developed the Monitoring and Evaluation Systems Strengthening Tool, which established guidance to refine methodologies for the improvement of treatment and other indicator data quality. For further information, see the Improving Accountability and Programming chapter.
Treatment Reporting Conventions. During this reporting period, to account for Emergency Plan treatment programming, programming, in-country partners counted those activities that supported ART provision, including training, the provision of ARV drugs, clinical monitoring of ART for people with advanced HIV infection, related laboratory services, infrastructure support, and other activities described above. Where downstream service delivery sites were directly supported by USG funding, distinct individuals receiving services at those sites were counted. Support to a specific site may or may not be in partnership with other funders of HIV prevention, treatment, and care. For example, the USG may fund the clinical staff delivering ARV treatment, while Global Fund monies support the pharmaceuticals used in the clinic. For support to national treatment programs provided upstream (for which funding is not directly given to a specific service delivery site or program), the Emergency Plan estimated, in conjunction with other partners and national governments, the number of individuals receiving treatment or care supported by the USG�s contribution to national, regional, or local activities.
Reporting by Gender and Age. The Emergency Plan requirement that ART service sites report on the gender and adult/child status of those served, in order to ensure that ART activities are reaching women and children, became mandatory for all partners in fiscal year 2006. The Emergency Plan also recognizes the importance of monitoring and evaluating services for pregnant women living with HIV who require ARVs. Helping women to access ARVs is critical not
|only for the health of the mother and unborn child but also to help prevent HIV transmission. However, many programs are reluctant to place pregnant women on life-saving ARVs. The Emergency Plan, through training and technical support, has placed an increased emphasis on ensuring that all HIV-positive pregnant women are screened and receive appropriate ART. Although it is very challenging to monitor pregnancy among women receiving care, Emergency Plan resources now are being used to support the development and implementation of information systems that can track our efforts in this vital area.
1 These countries are Botswana, Cameroon, China, C�te d�Ivoire, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Uganda, and Zambia.
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Altria A Better Stock Play Than Phillip Morris companies where it hurts, with more of them signaling disappointing results than at any time over the past decade. Many bellwether companies have come out in recent days with profit warnings, and the slowing in Europe has been cited as a major factor for those outlooks. Both Pepsi (NYSE:PEP) and FedEx (NYSE:FDX) have warned in the past few days. This indicates that it would be wise to be underweight multinationals with inordinately large exposure to Europe. The predominant stock safe haven of tobacco stocks are also being affected by this scenario. This is pushing more money managers to reduce holdings in Phillip Morris and being overweight Altria Group. Philip Morris International Inc. (NYSE:PM) again lowered its full-year earnings forecast, citing prevailing currency-exchange rates, while the tobacco company also warned of weaker volume trends in the European Union. The company now expects a currency headwind of about 25 cents a share for 2012, compared with a currency benefit of 19 cents a share last year. PM sees a soft second-quarter performance in the EU, reflecting significant quarterly erosion in total industry volume in southern Europe, particularly in Spain and Italy. The region is undergoing a severe economic crisis, and high levels of unemployment were particularly distressing, as lower disposable income can lead customers to trade down and lead to increased counterfeits of established brands and other illicit trade. Though strong demand in Asia, the company's biggest market by volume, has boosted earnings in recent quarters, the mature European market remains a critical part of the business. Cigarette volume in the European Union contributed 23% to Philip Morris's total shipments last year. PM has plans to develop three new products that can reduce the health risks of smoking but these products will not be ready until 2016. PM did unveil a new three-year share-repurchase plan totaling $18 billion, the latest move to return more cash to shareholders. Dividend yields, share repurchases and strong cash flows have driven investors to tobacco stocks of late. which keeps revenue clear of European exposure. cigarette market is in decline, MO is moving to more higher margin smokeless tobacco products for future growth. MO is pushing through a six-cent per-pack price increase across all the tobacco producer brands. The maker of Marlboro and L cigarettes will enact the price increase effective June 18. The move, a sign tobacco continues to command strong pricing power, is the first round of pricing action a producer has taken this year. Analysts see MO revenues rising over 3% in 2012, as higher pricing, line extensions and new product introductions are offset by declining consumption. Altria reaffirmed its 2012 full-year guidance for adjusted diluted EPS to be in the range of $2.17 to $ 2.23, representing a growth rate of 6% to 9% from an adjusted diluted EPS base of $2.05 per share in 2011. Mo has a current dividend yield of 4.84% with dividend s being increased 7.9% in the past year. While both of these tobacco stocks are considered long-term buys, MO will perform best in the next year or so. PM will continue to face headwinds from currency exchange rates and the European crisis which may linger for years. Many astute money managers are moving money from PM to MO until the headwinds die down for PM.


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A new aphid pest has appeared in several Midwestern states. Initial identifications and reports suggested that this insect was the cotton aphid (also known as the melon aphid) but it has now been positively identified as the soybean aphid, Aphis glycines. The aphid is native to southeastern and eastern Asia and may have been in the U. S. during the past couple of years. This year it has been confirmed in eastern Minnesota, Wisconsin, northern Illinois, and Michigan. As of August 17, there were no reports of soybean aphids in Iowa but if it does occur here, it is most likely to be found in the northeastern and eastern counties.
Most of the field problems from this aphid have been detected in Wisconsin. David Hogg and John Wedberg, entomologists at University of Wisconsin-Madison report aphid problems in Grant (which is across the river from Dubuque), Rock and Kenosha counties across the southern Wisconsin to as far north and east as Waushara and Sheboygan counties in the state. Tom Klubertanz, entomologist at UW-Rock County, counted the aphids on whole plants from an infested field. These plants were not stunted and they looked normal at a distance of several feet. But on two plants he counted over 1000 aphids per plant. Over 100 aphids per leaf was common, colonizing the whole plant including the leaves, stems, and pods. Single pods at the R3.5 stage were covered with 50 aphids. More details on the Wisconsin situation can be found at http://ipcm.wisc.edu/wcm/00-22insect1.html .
Kevin Steffey and Mike Gray, entomologists at the University of Illinois, report "aphids in fields of soybeans in some counties in northern Illinois, including Kane and Grundy counties. Some FS fieldmen have reported to Ria Barrido with Growmark, Inc., in Bloomington that they can find aphids in soybean fields in the northern tier of counties in Illinois."
There are no economic thresholds for this insect and Wisconsin entomologists believe that the population is declining so insecticides are unlikely to be necessary. If insecticide information is desired, consult the Illinois newsletter at http://www.ag.uiuc.edu/cespubs/pest/articles/200020d.html .
Entomologists Murray Fletcher and Peter Desborough, New South Wales Agriculture, Australia, have a website that discusses this aphid in detail. Excellent photographs of aphids and colonies on soybean may be found at http://www.agric.nsw.gov.au/Hort/ascu/insects/aglycin.htm . The following information on identification, hosts, damage, and life cycle was taken from this site:
The soybean aphid is a small insect, pale yellow in life, with black cornicles (tailpipes) and a pale tail. No other aphid living on soybeans has the same combination of size and color. Other species of aphids on legumes that might be confused with it are the cotton aphid, Aphis gossypii, which has a shorter, dark tail and the cowpea aphid, Aphis craccivora, which has a black patch on the back of the wingless adults.
Known Hosts
In China and Japan, the soybean aphid alternates between buckthorn bushes, Rhamnus sp., and certain legumes, mainly soybean but also recorded from species of Desmodium. In Australia, the aphid has so far only been found on soybeans.
The soybean aphid is capable of causing significant reduction in growth and seed production in soybeans. A study in China found that seed yields were reduced by 27.8% and plant height decreased by 8 inches in infested plants as compared with the control. The soybean aphid is a known vector of a number of plant virus diseases including soybean mosaic and soybean stunt. In Australia, experience with soybean aphid is very new. Known infestations in crops observed are distributed sporadically through a field and in quite small areas (1 yd2). Thus they can be difficult to detect. Plant damage is in the form of leaf distortion (where very dense aphid populations occur) and severe vigor loss.
Life Cycle
The life cycle was described in Japan and China. Studies indicate that the optimum temperatures for the aphid are 68-75°F. Aphid densities peak in the vegetative plant stage and decline rapidly afterwards or towards the flowering stage.
Natural Enemies
Hover fly or flower fly larvae (Family Syrphidae) and lady beetle larvae (Family Coccinellidae) have been shown to play a role in suppression of soybean aphid populations in soybeans. A number of parasitic wasps in Asia are known to be effective in helping to control numbers of the aphid.
Any reports of large colonies or bunches of aphids in Iowa soybeans should be telephoned in to either myself or Larry Pedigo at Iowa State University (515-294-1101).


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