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- Volume 95, Issue 2, August 2016
The American Journal of Tropical Medicine and Hygiene - Volume 95, Issue 2, August 2016
Volume 95, Issue 2, August 2016
- Articles
Protective Efficacy Induced by Genetically Attenuated Mid-to-Late Liver-Stage Arresting Plasmodium berghei Δmrp2 ParasitesPages: 378–382More LessAbstract
Whole parasite immunization strategies employing genetically attenuated parasites (GAP), which arrest during liver-stage development, have been applied successfully for induction of sterile malaria protection in rodents. Recently, we generated a Plasmodium berghei GAP-lacking expression of multidrug resistance-associated protein (MRP2) (PbΔmrp2) that was capable of partial schizogony in hepatocytes but showed complete growth arrest. Here, we investigated the protective efficacy after intravenous (IV) immunization of BALB/c and C57BL/6J mice with PbΔmrp2 sporozoites. Low-dose immunization using 400 PbΔmrp2 sporozoites induced 100% sterile protection in BALB/c mice after IV challenge with 10,000 wild-type sporozoites. In addition, almost full protection (90%) was obtained after three immunizations with 10,000 sporozoites in C57BL/6J mice. Parasite liver loads in nonprotected PbΔmrp2-challenged C57BL/6J mice were reduced by 86% ± 5% on average compared with naive control mice. The mid-to-late arresting PbΔmrp2 GAP was equipotent in induction of protective immunity to the early arresting PbΔb9Δslarp GAP. The combined data support a clear basis for further exploration of Plasmodium falciparum parasites lacking mrp2 as a suitable GAP vaccine candidate.
Calmodulin Polymerase Chain Reaction–Restriction Fragment Length Polymorphism for Leishmania Identification and TypingPages: 383–387More LessAbstract
A precise identification of Leishmania species involved in human infections has epidemiological and clinical importance. Herein, we describe a preliminary validation of a restriction fragment length polymorphism assay, based on the calmodulin intergenic spacer region, as a tool for detecting and typing Leishmania species. After calmodulin amplification, the enzyme HaeIII yielded a clear distinction between reference strains of Leishmania mexicana, Leishmania amazonensis, Leishmania infantum, Leishmania lainsoni, and the rest of the Viannia reference species analyzed. The closely related Viannia species: Leishmania braziliensis, Leishmania panamensis, and Leishmania guyanensis, are separated in a subsequent digestion step with different restriction enzymes. We have developed a more accessible molecular protocol for Leishmania identification/typing based on the exploitation of part of the calmodulin gene. This methodology has the potential to become an additional tool for Leishmania species characterization and taxonomy.
Promising Efficacy of Benznidazole Nanoparticles in Acute Trypanosoma cruzi Murine Model: In-Vitro and In-Vivo StudiesPages: 388–393More LessAbstract
The aim of this study was to evaluate the effectiveness of benznidazole nanoparticles (BNZ-nps) on trypomastigote forms and on intracellular infection in mammalian cells and primary cardiac myocyte cells. Its effectiveness was also evaluated on acute Trypanosoma cruzi Nicaragua mice infection. Trypomastigotes from culture were treated with different concentrations of BNZ-nps to determine the drug concentration that lyses 50% of trypomastigotes (LC50). Infected mammalian cells were incubated with different concentrations of BNZ-nps to determine the percentage of amastigote inhibition. C3H/HeN mice with lethal acute infection were treated with 10, 25, and 50 mg/kg/day of BNZ-nps for 30 and 15 days to control the survival rate of animals. BNZ-nps having a mean particle size of 63.3 nm, a size distribution of 3.35, and a zeta potential of −18.30 were successfully prepared using poloxamer 188 as a stabilizer. BNZ-nps 25 and 50 μg/mL showed no significant differences in the percentage of inhibition of infected mammalian cells. Infected mice treated with BNZ-nps (50, 25, and 10 mg/kg/day) for 30 days and with BNZ-nps (50 and 25 mg/kg/day) for 15 days presented a 100% survival, whereas the animals treated with 10 mg/kg/day for 15 days of BNZ-nps showed a 70% survival rate. The results obtained demonstrate, for the first time, that benznidazole nanoparticles are a useful and attractive approach to treat Chagas disease in infected mice.
Associations Between Helminth Infections, Plasmodium falciparum Parasite Carriage and Antibody Responses to Sexual and Asexual Stage Malarial AntigensPages: 394–400More LessAbstract
Infections with helminths and Plasmodium spp. overlap in their geographical distribution. It has been postulated that helminth infections may influence malarial transmission by altering Plasmodium falciparum gametocytogenesis. This cross-sectional study assessed the effect of helminth infections on P. falciparum gametocyte carriage and on humoral immune responses to sexual stage antigens in Gabon. Schistosoma haematobium and filarial infections as well as P. falciparum asexual forms and gametocyte carriage were determined. The antibody responses measured were to sexual (Pfs230, Pfs48/45) and asexual P. falciparum antigens (AMA1, MSP1, and GLURP). A total of 287 subjects were included. The prevalence of microscopically detectable P. falciparum asexual parasites was higher in S. haematobium–infected subjects in comparison to their uninfected counterparts (47% versus 26%, P = 0.003), but this was not different when filarial infections were considered. Plasmodium falciparum gametocyte carriage was similar between Schistosoma- or filaria-infected and uninfected subjects. We observed a significant decrease of Pfs48/45 immunoglobulin G titer in S. haematobium–infected subjects (P = 0.037), whereas no difference was seen for Pfs230 antibody titer, nor for antibodies to AMA1, MSP1, or GLURP. Our findings suggest an effect of S. haematobium on antibody responses to some P. falciparum gametocyte antigens that may have consequences for transmission-blocking immunity.
Comparative Diagnosis of Strongyloidiasis in Immunocompromised PatientsPages: 401–404More LessAbstract
Strongyloides hyperinfection syndrome and disseminated strongyloidiasis frequently occur in immunocompromised persons and can lead to high complication and mortality rates. Thus, detection of Strongyloides stercolaris in those patients is crucial. The present study aimed to determine the prevalence of strongyloidiasis and compare the detection rates of different strongyloidiasis detection methods. We conducted a cross-sectional study of 135 adults with various immunocompromising conditions (corticosteroid usage, chemotherapy, hematologic malignancies, organ transplants, use of immunosuppressive agents, and symptomatic human immunodeficiency virus infection) in Phramongkutklao Hospital, Bangkok, Thailand. All patients were asked to undergo serology testing for Strongyloides IgG by indirect enzyme-linked immunosorbent assay (ELISA), and 3 days of stool collection for use in a simple smear along with formalin–ether concentration and agar plate techniques. Prevalence rates of strongyloidiasis were 5% by stool concentration technique, 5.4% by IgG-ELISA, and 6.7% by agar plate culture. Three of the eight strongyloidiasis cases in this study had hyperinfection syndrome. The tested risk factors of age, sex, occupation, and immunocompromising condition were not associated with Strongyloides infestation. Serology was only 42.9% sensitive (positive predictive value), but it was 96.3% specific (negative predictive value). In conclusion, prevalence rates of strongyloidiasis in this study were 5–7%. Although agar plate culture was the most sensitive technique, the other diagnostic methods might be alternatively used.
Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, ItalyPages: 405–409More LessAbstract
Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach.
Anisakiasis Causing Acute Dysentery in MalaysiaPages: 410–412More LessAbstract
Human anisakiasis is a zoonosis acquired by eating raw or undercooked infected seafood. Herein, we report a case of acute dysentery caused by anisakiasis in a 64-year-old man in Malaysia. A colonoscopy was performed and a nematode larva was found penetrating the mucosa of the ascending colon. Bleeding was observed at the site of penetration. Y-shaped lateral epidermal cords were seen from the cross section of the worm, which is a prominent feature of Anisakis larva. Molecular analysis using polymerase chain reaction of cytochrome oxidase 2 (cox2) gene confirmed the specimen to be larva of Anisakis simplex.
Cross-Reactivity Pattern of Asian and American Human Gnathostomiasis in Western Blot Assays Using Crude Antigens Prepared from Gnathostoma spinigerum and Gnathostoma binucleatum Third-Stage LarvaePages: 413–416More LessAbstract
Gnathostomiasis is a zoonotic parasitosis endemic in many Asian and some Latin American countries. Most human infections are caused by Gnathostoma spinigerum in Asia and Gnathostoma binucleatum in the Americas, and recently, imported cases have been increasing among travelers returning from endemic regions. Confirmation of the clinical diagnosis relies largely on serologic tests, with a G. spinigerum-antigen-based immunoblot currently being the diagnostic method of choice. However, we repeatedly experienced that sera from patients with clinically suspected American gnathostomiasis gave negative results in this assay. Therefore, we used homologous methods to prepare G. spinigerum- and G. binucleatum-antigen-based immunoblot assays, and evaluated the cross-reactivity of the two assays. The results show incomplete cross-reactivity between the two assays: the G. spinigerum-antigen-based immunoblot apparently only detects Asian gnathostomiasis caused by G. spinigerum, whereas the G. binucleatum-antigen-based immunoblot is apparently capable of detecting American as well as Asian gnathostomiasis.
The Imaramagambo Onchocerciasis Focus in Southwestern Uganda: Interruption of Transmission After Disappearance of the Vector Simulium neavei and Its Associated Freshwater CrabsPages: 417–425More LessAbstract
It was not until early 1990s that, when the Imaramagambo focus of southwest Uganda was mapped, mass treatment with a single annual dose of ivermectin for onchocerciaisis control commenced. However, comprehensive investigations on its transmission were launched after a nationwide policy for onchocerciasis elimination in 2007. Entomological surveys throughout the focus from 2007 to 2015 have yielded few or no freshwater crabs (Potamonautes aloysiisabaudiae), which serve as the obligate phoretic host of the larvae and pupae of the vector Simulium neavei. No S. neavei flies have been observed or collected since 2007. Skin snips (microscopy) from 294 individuals in 2008 were negative for skin microfilariae, and of the 462 persons analyzed by polymerase chain reaction skin snip poolscreen in 2009, only five (1.08%) persons were indicated as infected with onchocerciasis. All five of the positive persons were at least 40 years old. Serosurvey results showed negative exposure among 3,332 children in 2012 and 3,108 children in 2015. Both were within the upper bound of the 95% confidence interval of the prevalence estimate of 0.06%, which confirmed the elimination of onchocerciasis. Treatment coverage in Imaramagambo was generally poor, and transmission interruption of onchocerciasis could not be attributed solely to annual mass treatment with ivermectin. There was sufficient evidence to believe that the possible disappearance of the S. neavei flies, presumed to have been the main vector, may have hastened the demise of onchocerciasis in this focus.
Two Unusual Cases of Human Immunodeficiency Virus–Negative Patients with Talaromyces marneffei InfectionPages: 426–430More LessAbstract
Talaromyces marneffei (formerly known as Penicillium marneffei) is a dimorphic fungus endemic in south and southeast Asia. It is not only commonly found in human immunodeficiency virus (HIV)–infected patients, but also among HIV-negative immunocompromised patients. The infection caused by this pathogen can disseminate hematogenously to other locations. Herein, we report for the first time two cases complicated with a rare disease or involving a rare site: in the first case, T. marneffei infection was complicated by Langerhans cell histiocytosis, whereas the second case showed clear etiological evidence of pleural nodules and pleural effusion caused by T. marneffei and diagnosed by thoracoscopic pleural biopsy.
Serodiagnosis of Acute Typhoid Fever in Nigerian Pediatric Cases by Detection of Serum IgA and IgG Against Hemolysin E and LipopolysaccharidePages: 431–439More LessAbstract
Inexpensive, easy-to-use, and highly sensitive diagnostic tests are currently unavailable for typhoid fever. To identify candidate serodiagnostic markers, we have probed microarrays displaying the full Salmonella enterica serovar Typhi (S. Typhi) proteome of 4,352 different proteins + lipopolysaccharides (LPSs), with sera from Nigerian pediatric typhoid and other febrile cases, Nigerian healthy controls, and healthy U.S. adults. Nigerian antibody profiles were broad (∼500 seropositive antigens) and mainly low level, with a small number of stronger "hits," whereas the profile in U.S. adults was < 1/5 as broad, consistent with endemic exposure in Nigeria. Nigerian profiles were largely unaffected by clinical diagnosis, although the response against t1477 (hemolysin E) consistently emerged as stronger in typhoid cases. The response to LPS was also a strong discriminator of healthy controls and typhoid, although LPS did not discriminate between typhoid and nontyphoidal Salmonella (NTS) disease. As a first step toward the development of a point-of-care diagnostic, t1477 and LPS were evaluated on immunostrips. Both provided good discrimination between healthy controls and typhoid/NTS disease. Such a test could provide a useful screen for salmonellosis (typhoid and NTS disease) in suspected pediatric cases that present with undefined febrile disease.
Blood Group O–Dependent Cellular Responses to Cholera Toxin: Parallel Clinical and Epidemiological Links to Severe CholeraPages: 440–443More LessAbstract
Because O blood group has been associated with more severe cholera infections, it has been hypothesized that cholera toxin (CT) may bind non-O blood group antigens of the intestinal mucosae, thereby preventing efficient interaction with target GM1 gangliosides required for uptake of the toxin and activation of cyclic adenosine monophosphate (cAMP) signaling in target epithelia. Herein, we show that after exposure to CT, human enteroids expressing O blood group exhibited marked increase in cAMP relative to cells derived from blood group A individuals. Likewise, using CRISPR/Cas9 engineering, a functional group O line (HT-29-A−/−) was generated from a parent group A HT-29 line. CT stimulated robust cAMP responses in HT-29-A−/− cells relative to HT-29 cells. These findings provide a direct molecular link between blood group O expression and differential cellular responses to CT, recapitulating clinical and epidemiologic observations.
Fatal Melioidosis in a Newborn from Hainan, ChinaPages: 444–446More LessAbstract
Herein, we report a case of fatal melioidosis in a newborn. The newborn died of serious melioidosis with respiratory and multiorgan failure at 16 days of age despite extensive treatment with antibiotics and methylprednisolone. Burkholderia pseudomallei was isolated from the infant's blood and cerebrospinal fluid and identified as a novel sequence type (ST-1341). His father had cough and fever when the newborn was born, and a localized patchy infiltration on the right upper lung was seen in chest radiography, but B. pseudomallei was not isolated. Two years later, the father developed cough and fever again, and the same novel sequence type of B. pseudomallei was isolated from the blood of the father. It is postulated that transmission of B. pseudomallei from the father to the newborn might have occurred during close contact in the first couple of days after birth. Given the high mortality of neonatal melioidosis, particular attention must be paid when the caretakers of the newborn develop fever of unknown origin in a melioidosis-endemic region.
Scrub Typhus in a Tertiary Care Hospital in North IndiaPages: 447–451More LessAbstract
Scrub typhus, a zoonotic disease caused by the bacterium Orientia tsutsugamushi, has become endemic in many parts of India. We studied the clinical profile of this infection in 228 patients that reported to this tertiary care center from July 2013 to December 2014. The median age of patients was 35 years (interquartile range = 24.5–48.5 years), and 111 were males and 117 females. A high-grade fever occurred in 85%, breathlessness in 42%, jaundice in 32%, abdominal pain in 28%, renal failure in 11%, diarrhea in 10%, rashes in 9%, and seizures in 7%. Common laboratory abnormalities at presentation were a deranged hepatic function in 61%, anemia in 54%, leukopenia in 15%, and thrombocytopenia in 90% of our patients. Acute kidney injury (32%), acute respiratory distress syndrome (ARDS) (25%), and disseminated intravascular coagulation (DIC) (16%) were the commonest complications. A hepatorenal syndrome was seen in 38% and multiple organ dysfunction syndrome (MODS) in 20% patients. The overall case fatality rate was 13.6%. In univariate analysis, ARDS requiring mechanical ventilation, acute kidney injury requiring hemodialysis, hypotension requiring inotropic support, central nervous system dysfunction at presentation, and MODS were inversely associated with survival. Survival was significantly higher in patients that presented with a duration of fever < 10 days compared with those that presented ≥ 12 days (P < 0.05) after onset. In conclusion, scrub typhus has become a leading infectious disease in north India and an important cause of infectious fever. An increasing awareness of this disease coupled with prompt management will go a long way in reducing both morbidity and mortality from this disease.
A Mixed Outbreak of Epidemic Typhus Fever and Trench Fever in a Youth Rehabilitation Center: Risk Factors for Illness from a Case-Control Study, Rwanda, 2012Irenee Umulisa, Jared Omolo, Katherine A. Muldoon, Jeanine Condo, Francois Habiyaremye, Jean Marie Uwimana, Marie Aimee Muhimpundu, Tura Galgalo, Samuel Rwunganira, Anicet G. Dahourou, Eric Tongren, Jean Baptiste Koama, Jennifer McQuiston, Pratima L. Raghunathan, Robert Massung, Wangeci Gatei, Kimberly Boer, Thierry Nyatanyi, Edward J. Mills and Agnes BinagwahoPages: 452–456More LessAbstract
In August 2012, laboratory tests confirmed a mixed outbreak of epidemic typhus fever and trench fever in a male youth rehabilitation center in western Rwanda. Seventy-six suspected cases and 118 controls were enrolled into an unmatched case-control study to identify risk factors for symptomatic illness during the outbreak. A suspected case was fever or history of fever, from April 2012, in a resident of the rehabilitation center. In total, 199 suspected cases from a population of 1,910 male youth (attack rate = 10.4%) with seven deaths (case fatality rate = 3.5%) were reported. After multivariate analysis, history of seeing lice in clothing (adjusted odds ratio [aOR] = 2.6, 95% confidence interval [CI] = 1.1–5.8), delayed (≥ 2 days) washing of clothing (aOR = 4.0, 95% CI = 1.6–9.6), and delayed (≥ 1 month) washing of beddings (aOR = 4.6, 95% CI = 2.0–11) were associated with illness, whereas having stayed in the rehabilitation camp for ≥ 6 months was protective (aOR = 0.20, 95% CI = 0.10–0.40). Stronger surveillance and improvements in hygiene could prevent future outbreaks.
Opossums and Cat Fleas: New Insights in the Ecology of Murine Typhus in Galveston, TexasPages: 457–461More LessAbstract
Murine typhus is an acute undifferentiated febrile illness caused by Rickettsia typhi. The classic reservoir (Rattus spp.) and flea vector (Xenopsylla cheopis) were once culprits of murine typhus in the United States. Vector and rodent control efforts have drastically decreased the prevalence of disease, except in a few endemic foci where opossums and cat fleas play a role in transmission. Since 2012, there has been a reemergence of murine typhus in Galveston, TX. We hypothesize that opossums and cat fleas are involved in the transmission of R. typhi in Galveston. To explore this, we sought to find the seroprevalence of typhus group antibodies from opossums. We also sought to find the prevalence of R. typhi in fleas parasitizing these animals. We collected blood from 12 opossums and found that eight (66.7%) had the presence of anti-R. typhi antibodies. All opossums were infested with fleas; a total of 250 Ctenocephalides felis fleas were collected from these animals. Seven opossums (53.8%) were infested with fleas that had molecular evidence of R. typhi infection, while six (46.2%) were infested with fleas that contained Candidatus Rickettsia senegalensis, an organism closely related to R. felis. The minimum flea infection rate for R. typhi was 7.0%. The minimum infection rate for Candidatus R. senegalensis was 6.1%. Our study demonstrates that fleas infected with R. typhi parasitize opossums in Galveston. It is therefore likely that opossums and their fleas play a role in the city's recent reemergence of murine typhus.
Evidence of Rickettsia and Orientia Infections Among Abattoir Workers in DjiboutiPages: 462–465More LessAbstract
Of 49 workers at a Djiboutian abattoir, eight (16%, 95% confidence interval [CI]: 9–29) were seropositive against spotted fever group rickettsiae (SFGR), two (4%, 95% CI: 1–14) against typhus group rickettsiae, and three (6%, 95% CI: 2–17) against orientiae. One worker (9%, 95% CI: 2–38) seroconverted against orientiae during the study period. This is the first evidence of orientiae exposure in the Horn of Africa. SFGR were also identified by polymerase chain reaction in 32 of 189 (11%, 95% CI: 8–15) tick pools from 26 of 72 (36%) cattle. Twenty-five (8%, 95% CI: 6–12) tick pools were positive for Rickettsia africae, the causative agent of African tick-bite fever. Health-care providers in Djibouti should be aware of the possibility of rickettsiae infections among patients, although further research is needed to determine the impact of these infections in the country.
Prevalence and Diversity of Bartonella Species in Rodents from Georgia (Caucasus)Pages: 466–471More LessAbstract
Bartonella infections are widespread and highly prevalent in rodents. Several rodent-associated Bartonella species have been related to human diseases. Recently, Bartonella species was reported as the etiology of a human case in the country of Georgia (Caucasus). However, information on Bartonella in rodents in Georgia is absent. Rodent hearts were collected from Georgia to investigate the presence and diversity of Bartonella species. Bartonella bacteria were cultured from 37.2% (16/43) of rodents examined, while Bartonella DNA was detected in 41.2% (28/68) of rodents by polymerase chain reaction targeting citrate synthase (gltA) gene. Sequences of gltA showed that rodents in this region harbored multiple Bartonella strains, including Bartonella elizabethae, Bartonella tribocorum, Bartonella grahamii, and an unknown genogroup. The first three Bartonella species, known to be rat-associated and human cases linked, were commonly observed in wood mice (Apodemus [Sylvaemus] uralensis) (5/8 positive with B. elizabethae and B. tribocorum) and social voles (Microtus socialis) (4/6 positive with B. grahamii and B. elizabethae) in this study. The frequent distribution of these Bartonella species suggests that they may contribute to unidentified clinical infections. The unknown genogroup was observed in 24 Bartonella isolates and/or DNA extracts from heart tissues, all of which were obtained from Libyan jirds (Meriones libycus). Further characterization of the bacterial cultures based on sequence analysis of four additional genes (ftsZ, nuoG, rpoB, and ssrA) supported that the jird-associated Bartonella strains comprise a distinct monophyletic clade. The impact of this bacterium on wildlife and human health needs to be determined.
Tuberculosis Treatment Outcome and Drug Resistance in Lambaréné, Gabon: A Prospective Cohort StudySabine Bélard, Jonathan Remppis, Sanne Bootsma, Saskia Janssen, Davy U. Kombila, Justin O. Beyeme, Elie G. Rossatanga, Cosme Kokou, Kara K. Osbak, Régis M. Obiang Mba, Harry M. Kaba, Afsatou N. Traoré, Jonas Ehrhardt, Emmanuel B. Bache, Arnaud Flamen, Sabine Rüsch-Gerdes, Matthias Frank, Ayôla A. Adegnika, Bertrand Lell, Stefan Niemann, Peter G. Kremsner, Marguerite M. Loembé, Abraham S. Alabi and Martin P. GrobuschPages: 472–480More LessAbstract
Despite overall global progress in tuberculosis (TB) control, TB remains one of the deadliest communicable diseases. This study prospectively assessed TB epidemiology in Lambaréné, Gabon, a Central African country ranking 10th in terms of TB incidence rate in the 2014 World Health Organization TB report. In Lambaréné, between 2012 and 2014, 201 adult and pediatric TB patients were enrolled and followed up; 66% had bacteriologically confirmed TB and 95% had pulmonary TB. The human immunodeficiency virus (HIV) coinfection rate was 42% in adults and 16% in children. Mycobacterium tuberculosis and Mycobacterium africanum were identified in 82% and 16% of 108 culture-confirmed TB cases, respectively. Isoniazid (INH) and streptomycin yielded the highest resistance rates (13% and 12%, respectively). The multidrug resistant TB (MDR-TB) rate was 4/91 (4%) and 4/13 (31%) in new and retreatment TB cases, respectively. Treatment success was achieved in 53% of patients. In TB/HIV coinfected patients, mortality rate was 25%. In this setting, TB epidemiology is characterized by a high rate of TB/HIV coinfection and low treatment success rates. MDR-TB is a major public health concern; the need to step-up in-country diagnostic capacity for culture and drug susceptibility testing as well as access to second-line TB drugs urgently requires action.
Elevated Values of Clinically Relevant Transferases Induced by Imported Infectious Diseases: A Controlled Cross-Sectional Study of 14,559 Diseased German Travelers Returning from the Tropics and SubtropicsPages: 481–487More LessAbstract
The aim of this controlled cross-sectional study was to assess the clinical validity of elevated values of three clinically relevant transferase enzymes (aspartate transaminase [AST], alanine transaminase [ALT], and gamma-glutamyl transferase [GGT]) induced by imported infectious diseases (IDs) seen among patients consulting the Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (from 1999 to 2014) after being in the sub-/tropics. Data sets of 14,559 diseased German travelers returning from Latin America (2,715), Africa (4,574), or Asia (7,270) and of 1,536 healthy controls of German origin without recent travels were analyzed. Among the cases, the proportions of those with elevated values of AST (7.8%) and of ALT (13.4%) were significantly larger than among controls (4.0% and 10.6%, respectively), whereas for GGT, no significant difference was found (cases: 10.0%; controls: 11.4%). The study identified IDs with significantly larger proportions of both AST and ALT (hepatitis A [100%/100%], cytomegalovirus [CMV] infection [77%/81%], chronic hepatitis C [67%/67%], infectious mononucleosis [65%/77%], typhoid fever [50%/50%], cyclosporiasis [45%/66%], dengue fever [43%/35%], malaria [20%/27%], and rickettsiosis [20%/24%]), of AST alone (paratyphoid fever [42%]), of ALT alone (giardiasis [20%]), and of GGT (hepatitis A [100%], infectious mononucleosis [71%], CMV infection [58%], rickettsiosis (20%], and dengue fever [19%]). The study demonstrates that the determination of AST and ALT among travelers returning from the sub-/tropics has a high clinical validity, as their elevated values are typically caused by several imported viral, bacterial, and protozoan IDs, whereas no additional clinical validity was found by the determination of GGT.
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Epson TM U220B - receipt printer - two-color Product Details
All three printer models in Epson's TM-U220 series are optimized for high-speed throughput so customer receipts and kitchen orders print faster than ever. For maximum efficiency, the TM-U220A, TM-U220B and TM-U220D all offer drop-in paper loading and two-color, black and red printing to highlight special offers and print more impactful logos, and an adjustable paper width feature that allows you to use 58, 70 or 76mm paper rolls for more flexibility and greater cost savings.
With Epson's TM-U220 series, you have the freedom to select the model that best fits your needs. The TM-U220B comes with an autocutter so you can choose between a full or partial cut, and an Auto Status Back function that automatically transmits changes in the printer status. The TM-U220B has a wall-mounting option that prints the receipt right side up for easy reading right out of the printer. And of course, it features the quality, reliability and advanced printing technology that Epson is famous for.
Printer Type: Receipt printer - dot-matrix - 9 pin - two-color (monochrome)
Enclosure Color: Dark gray
Print Speed: Up to 6 lines/sec - max speed
Built-in Devices: Cutter
Connectivity Technology: Wired
Interface: Parallel
Max Resolution (B&W): 17.8 cpi
Language Simulation: EPSON ESC/POS
Character Sizes (mm): 0.047 in x 0.122 in, 0.063 in x 0.122 in, 0.067 in x 0.122 in, 0.075 in x 0.122 in, 0.079 in x 0.122 in
Columns: 33, 35, 40, 42
Auto Cutter: Yes
Media Handling
Max Media Size: Roll (3 in)
Max Media Size (Custom): 3 in
Media Sizes: Roll (2.75 in), Roll (3 in), Roll (2.3 in)
Media Thickness Range: 0.0024 in - 0.0033 in
Roll Maximum Outer Diameter: 3.3 in
Total Media Capacity: 1 roll
Media Feeders: 1 x manual - 1 roll - Roll (3 in)
Expansion / Connectivity
Expansion Slots: 1 x expansion slot
Connections: 1 x parallel
Mounting Kit: Optional
MTBF: 180,000 hour(s)
Features: Wall mountable
Compliant Standards: FCC Class A certified, CSA, UL, TUV, EN 60950, VCCI Class A ITE, EN55024, EN55022 Class B, AS/NZ 3548 Class B
Power Device: Power adapter - external
Power Consumption Operational: 31 Watt
Power Consumption Stand by / Sleep: 2.2 Watt
Manufacturer Warranty
Service & Support: Limited warranty - 2 years
Environmental Parameters
Min Operating Temperature: 32 °F
Max Operating Temperature: 122 °F
Humidity Range Operating: 10 - 90%
Dimensions & Weight
Width: 6.3 in
Depth: 9.8 in
Height: 5.5 in
Weight: 5.51 lbs
Warranty and Returns
Manufacturer Warranty
Support URL: www.epson.ca
Support Phone Number: 1-905-709-3839
Return PolicyClick for return policy details.
Manufactured by: Epson Canada
Warranty provided by: Epson Canada
UPC No:
Mfg Part No: C31C517653
Box Size:
( Length:0, Width:0, Depth:0)
Shipping Weight: 8.6500 pound(s)
Click here for full warranty and support information
- Epson Canada logos are registered trademarks of Epson Canada. All others trademarks and copyrights mentioned herein are the property of their respective owners.

subset: commoncrawl


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With my second blogoversary drawing ever closer, I recently decided to really try and step up my blogging (probably because it's about that time of year when my hosting fees are due – it makes me want to get my money's worth!). Therefore I decided to make a few little adjustments to my blogging routine to try and keep things more consistent, and hopefully give my blog a little boost in time for its' second birthday.
And to my surprise, my little adjustments seem to have worked! Now we're not talking about double the page views and hundreds of new followers here: it's more like 20 more Bloglovin followers (which considering the fact I seemed to have stalled at about 150 for months, I'm pretty happy about!), a few more page views, my Twitter followers finally topping 700, and my comment count increasing. I know it's not all about numbers, but it's nice to see your efforts paying off! I especially love getting more comments, as I've always felt like one of the best things about blogging is getting to talk to people who share your interests, and comments are one of the main ways of doing this.
Anyway, I thought I'd do a quick post about the little things I've done to boost my blog, and I'd love to know if you have any tips yourself!
- Scheduling tweets
Twitter is a social media platform I really like, but have previously only tended to use sporadically. I seem to spend a lot of time on there browsing, but always forget to regularly post links to my blog posts.
Enter my Twitter saviour: Buffer. I started scheduling a couple of tweets a day with links to my blog using Buffer, and so now I can browse to my heart's content without having to remember to tweet my posts. I have definitely found myself getting more blog traffic and more interactions on Twitter by posting more consistently in this way, and I think I've got more Twitter followers through it seen as my feed no longer looks like it should have tumbleweed blowing across it!
I guess it's a fine line with this one though, as you don't want to absolutely bombard your followers with links and you probably want to post some spontaneous, off-the-cuff stuff too so you people know you're not a robot!
- Linking to old posts
It always seems like a bit of a shame that as you publish more and more posts on your blog, the old ones seem to get lost amongst the crowd. Therefore I've been trying to promote my old blog posts a bit more recently, seen as newer followers (or even older ones!) may not have seen them. Plus I don't like to think of my old posts feeling all sad and neglected!
- Commenting more
Commenting on other blogs is one of my favourite parts of blogging, so it's a huge shame that it seems to be one of the first things that falls by the wayside when I'm busy or tired. It's so easy to find yourself just churning out your own posts when you're short on time and not make time for commenting, so recently I've been making a concerted effort to do it more (even if it's just a short commenting session on my lunch break at work).
I've also been trying to comment back more when people have commented on my blog, as well as…
- Visiting new blogs
It's easy to fall into the habit of just visiting and commenting on the same handful of blogs, and whilst it's great to be a loyal member of a blog's readership and to make blogging friends, it's also good to meet new bloggers and find new blogs. This is something I've been trying to do more of lately, and it has been really nice to widen my circle a bit and get to know some new bloggers.
- Posting more consistently
Now this is one area where I've been really trying, but haven't been completely successful. I've been making an effort to post every two or three days, but sometimes it's tough, especially as I still don't have any Wi-Fi and so have to go to my parent's house to post anything.
I've definitely found that posting more often really pays off though, as logically by giving people more to read they'll come back more often. Hopefully once my Wi-Fi issues are sorted this will get a lot easier (and I will be moving back into a house with Wi-Fi at the end of this month! Hooray!)!
…and a few blogging goals:
There are a couple of little things I still want to work on in the future to boost my blog further, so I thought I'd mention them too!
- I want to continue to try and blog more consistently, and will hopefully be a bit better with this in the future!
- I want to write my blog posts further in advance and then have them scheduled so that writing them is less stressful. I sometimes see other bloggers say that they have weeks worth of posts scheduled, and am just like 'what is this sorcery!?'
- I'd also like to take part in a Twitter chat, and make more of an effort with my Instagram (which also looks like there should be tumbleweed blowing across it!).
So what is your current blogging routine, and are there any things you have done to give it that little boost? Have you got any blogging goals?


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After two rounds of two-night Democratic primary debates, one thing should be abundantly clear — the party needs to walk away from its loveless marriage to MSNBC and CNN and put on its own shows.
When you think about it, it's actually pretty crazy that the party entrusts its signature talent showcase to self-interested cable networks that thrive on dramatic confrontations. Or that it leaves the agenda up to moderators who seem bent on framing their questions with conservative assumptions, trying to get the candidates to knife each other on stage while totally ignoring critical issues like voting rights.
You don't have to get too deep into any of this week's transcripts to see how this is a problem. In the very first post-opening remarks exchange on Tuesday, CNN anchor Jake Tapper asked Sen. Bernie Sanders a health-care question, which he framed with this: "You support Medicare-for-all, which would eventually take private health insurance away from more than 150 million Americans, in exchange for government-sponsored health care for everyone." When he turned to Elizabeth Warren, Tapper asked, "Are you also, quote, 'with Bernie' on Medicare-for-all when it comes to raising taxes on middle-class Americans to pay for it?"
This language — of the government "taking away" health insurance and inflicting massive tax raises on the middle class, is precisely how President Trump and his Republican allies are going to frame the issue. And while it's good to be prepared for the tough questions to come in the general election, there's no need to spend the next year having Democratic ideas get beaten up by moderators who think their job is to conduct an inquisition. Because that's exactly what these first two debates have often felt like. It has not been enjoyable.
Wednesday night's fixation on getting Kamala Harris and Joe Biden to go after each other in the nastiest way possible typifies the nightmare that the cable behemoths are foisting on us. The network's fight club framework left no room for a discussion, for example, of H.R. 1, the Democrats' sweeping political reform bill, or gerrymandering. It was up to Cory Booker to squeeze in a moment on voter suppression, in response to another stupid question about who is the best person to beat Donald Trump. It was up to Kirsten Gillibrand to bring up issues of women's work, again in the context of an unrelated prompt.
The one time the discussion turned to "free college," it was only in the context of whether these benefits should be extended to undocumented immigrants — once again the Republicans' dream framing. There was no real discussion of parental leave or early childhood education. Nothing on Iran. Nothing on North Korea. Nothing on the galloping theocratic movement to make abortion illegal. At this point, the absence of these issues — signature Democratic priorities — from the debates is shameful. And the fault falls squarely on the shoulders of the networks.
In a bygone age, entrusting primary debates to TV news networks made a lot of sense. As recently as the turn of this century, CNN and the big three over-the-air networks enjoyed relatively broad trust with the public. While hardcore conservatives have been sniping about liberal media bias for decades, it was really the rise of Fox News which destroyed whatever consensus existed about the value of non-partisan journalism. President Trump has ginned up a murderous hatred of CNN and many other journalists, Democrats won't debate in front of Fox moderators, and Republicans won't touch MSNBC. And it feels like the MSNBC and CNN moderators have internalized the hatred directed at them by the right, and are processing it by trying to appear as combative as possible with everyone in the Democratic field. The whole model is completely broken.
In theory, the Fake News Left Wing Conspiracy networks CNN and MSNBC, which have taken nonstop fire from the president and his apologists for three years, might seem like friendly territory. The problem is that this is not at all how the networks or the moderators see themselves. Tapper and Dana Bash and Chuck Todd all want to burnish their national reputations by asking "tough" questions, which in this context means either hitting the candidates with right-wing narratives and seeing how well they respond, or setting two contenders up for a yelling match.
And that's fine — journalists should ask bracing questions. It's why every once in a while people tweet out clips of some BBC journalist sticking it to a politician in a way that would be shocking stateside. There's nothing wrong with a sharp exchange. If Kamala Harris were to sit down one-on-one with Rachel Maddow, she should absolutely expect an interrogation. The real question, one that seems not to have occurred to anyone in Democratic leadership, is whether they want their candidates grilled by these journalists for months and months when there is another way forward, and when this is really the best opportunity the party will ever have to run a months-long, free advertisement for the Democratic Party.
What should Democrats do? For one, the Democratic National Committee could stage its own debates, on college campuses, worker centers and union halls around the country, and invite the networks to broadcast them. If the big cable stations don't want to play ball, the Democrats can start their own streaming service, or throw the debates up on Facebook. They don't need million-dollar stages and handsomely remunerated cable anchors and hyperbolic countdown clocks, all needless frills that reinforce the alienation of ordinary people from this critical process. Instead, they could hand the questioning to other prominent Democrats, or even to recognized experts in their fields.
A health-care debate could be moderated by experts from the Kaiser Family Foundation. A foreign policy conversation could be hosted by the new anti-war think tank The Quincy Institute. A debate about child care policy could be put on by the National Partnership for Women and Families. And the climate debate that so many have asked for could actually happen. The networks could still have their post-debate panels full of well-known talking heads.
Other events could be moderated by leading thinkers from left-leaning pressure groups like Indivisible and Our Revolution, or by public-facing scholars well-versed in the issues at hand. That doesn't mean that the debates would be some kind of ideological monoculture — there are vast policy and stylistic issues on the left. But they would be litigated by progressives, for progressives. The point would be to highlight and promote and argue about and refine Democratic ideas, not to run them down.
Think about it — instead of giving such tremendous narrative power to CNN anchors (again: I mean no disrespect to CNN anchors! They have their uses! I'm sure they work very hard!), the Democratic debates could become a showcase for the broad and rich universe of progressive institutions and ideas. There would still be moderates and progressives arguing about health care and foreign policy up on stage. There would be no shortage of meme-able moments and comments that light Twitter on fire. But the party could make sure that its debate season is curated by people who have the best interests of Democrats and progressives at heart, rather than the bottom lines of underwriters, advertisers and cable executives.
Go ahead. Debate me.


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Sales Have Ended
Sales Have Ended
Thank you for your interest in volunteering for Hack for the Community! Hack for the Community is a 36 hour hack-a-thon that gathers Nashville's best IT professionals to help nonprofits make a big difference in our community.
Please click register to view projects needing back end developers and register for the project that meets your skills and interests. If you are flexible to volunteer with any project, you can register for the "Floating Back End Developer" project and join whatever project needs you most. Please only register for one project.
A few additional details about the event are listed below. If you have additional questions, please visit HackfortheCommunity.com or contact email@example.com.
Commitment: Volunteers must participate on both April 12 & 13. Hack for the Community will start at 8:00 a.m. on Thursday, April 12 and continue unitl 7:30 p.m. on Friday, April 13. Each team will identify its own schedule inside the 36 hour window, according to each team member's needs.
Volunteering during the workday: All Hack for the Community Partners have approved their employees' participation in this special initiative. Please check with your employer about how to record your participation in this event.
No all-nighters: No volunteers will spend the night at the hack-a-thon. The venue will close at 11 PM on April 12 and re-open at 7 AM on April 13.
Devices: We encourage you to use your personal laptop for this event.Please check with your employer before using your work laptop.
Food & Drink: All food and beverages will be provided.
Volunteer Orientation: All volunteers are invited to participate in a virtual volunteer orientation session on March 29 from 12:00 - 1:00 PM.
What's Hack for the Community look like? Visit HackfortheCommunity.com to watch the video from our 2016 hack-a-thon.
Thank you for your commitment to serving our community! We look forward to seeing you at the hack-a-thon.


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Welcome to Rathangan.net a community website for the Rathangan / Cleariestown area of County Wexford. It was set up in 2005 by the Rathangan Hall Committee.
Rathangan.net aims to be to be the hub of local activity. So whether you want to find out who has won the Community Lotto, how to book Rathangan Hall or what are the mass times in the Churches, just browse the site using the menu above. All who have left the area and are spread all over the world can now keep up to date with all our local News & Events which will be updated every week.
While the staff here in the office will keep the information updated, this site depends on the Groups, Organisations and the Community providing us with news that tells about life in Rathangan / Cleariestown Parish.


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As longtime correctional officers in Victoria, British Columbia, Alena Huntjens and her husband, Mark, spent 17 and 20 years, respectively, working inside a jail.
However, they recently realized that their careers — and their futures — were being locked up along with the prisoners they watched.
"We just got sick of working for the government, being told when to take our lunch breaks, being told when to take our holidays, and just being restricted," Alena explained.
Worst of all was the fact that, despite the long hours, the dangerous conditions and the high stress levels, the couple still worked extremely hard, but didn't see a return for their effort.
"It's not a job where the harder you work, the more money you make," said Alena. "So we just thought that we would try our own business." Continue reading "Franchise Operator Spotlight: Breaking Free From A Career Behind Bars"


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We are the Largest privately owned feed mill in the great state of South Carolina. Serving the dairy, beef, poultry, swine and horse industries since 1985.
Our production plant in Newberry, SC is within a few hours of any customer in South Carolina and eastern Georgia. We can receive goods from rail or truck. Operating a eight tanker fleet, we can provide fresher feed which is more appetizing and retains more nutrients than warehoused feeds.
We carry feed for horses, cattle, goats, chickens, pigs, sheep, as well as your dogs and cats. Cattle is a valuable commodity to this country. Whether you raise cattle for Diary, Beef or Pets, we have a feed blend for you. Feeding a horse the right feed can be confusing. No two horses are the same. So, whether you trail ride, compete or breed horses, we have many choices of bag feeds to chose from. We also sell minerals. We are now a dealer for Callaway Farms. We offer their Triple Select and Iron Horse shavings. We also have a small tack shop equipped with horse and rider supplies.
|Main Office and Retail Store
|Mill and Bulk Feed Division
|Wholesale Division
|PO Box 355
760 Kendall Road
Newberry, SC 29108
Toll-free: 844-276-0330
Local: 803-276-0330
Monday-Friday: 8am-5pm
| 2431 Vincent St.
Newberry SC 29108
Toll Free: 866-386-5633
Local: 803-276-6200
Monday-Friday: 8am-5pm
|Ron Differ


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With just six games of the regular season remaining we take a look at how this weekends Premiership action is shaping up…
Bath v Sale
Although Bath are set to be missing a number of key players on Friday night, it's hard to see anything other than a home victory. Sale managed to pull off an impressive victory down at The Rec last year however, so this one should be a tight affair, especially given the Sharks will have a full compliment of players to choose from.
Prediction – Bath by 5
Exeter v London Welsh
It doesn't take a genius to see which way this game is going, it's more just a case of by how many points. The high flying Chiefs are in superb form whilst the Exiles don't look like they could buy a victory this season. Given the home advantage, it's easy to see Exeter racking up their points difference on Saturday.
Prediction – Exeter by 45
Harlequins v London Irish
A few months ago the smart money would have been on Quins, however an improving Irish side coupled with the home team struggling somewhat makes this an interesting encounter. Quins will still be without a number of key players who are away on England duty, however home advantage should just about give them the edge.
Prediction – Harlequins by 8
Gloucester v Northampton
At this stage it looks like nobody will topple Northampton. Even with a number of players unavailable through injury or international selections they are still steamrollering their way to victories. Gloucester look to be improving, however given the form of Saints they are unlikely to be able to stay with the league leaders.
Prediction – Northampton by 12
Wasps v Saracens
This has to be the most difficult of all the weekends action to predict. Wasps are currently on a decent run, whilst Sarries are having a bit of a rough patch, however these sides look like they could cancel each other out right now. This is likely to be a tight game and could come down to which side misses their internationals most.
Prediction – Wasps by 7
Newcastle v Leicester
The game at Kingston Park this weekend should be an intriguing affair as an ever improving Falcons side prepare to face the Tigers who have had a very mixed season. Until last weekend you would have to say the artificial pitch would favour Newcastle of late, however Tigers demonstrated they still have what it takes against Sale in their last game.
Prediction – Leicester by 3
Agree with our predictions?
For all the latest betting offs head over to Coral now and get your free £20 bet.


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Properties for sale in surrounding suburbs
For Sale & LeaseSave
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Land Area: 1967 SQM
Floor Area: 1967 SQM
Prime exposure to major traffic-flow corridor - If you are seeking business exposure to vast numbers of passing traff...
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Fine Launceston Hotel - Development Opportunity - Built in the 1960's by Boags Brewery, 122 York Street was The Exchange...
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Contact Agent
Land Area: 4740 SQM
Floor Area: 4740 SQM
Connector Park - Vacant Industrial Site - Great opportunity to purchase a very desirable block in the popular Connector ...
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Contact Marcus Douglas
Showrooms/Bulky GoodsLand/DevelopmentRetail
Land Area: 2761 SQM
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Individual Prime Invermay Rd Lot 3 For Sale - Opportunity is there to acquire this prime Invermay Rd Lot. Further scope...
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Land Area: 1 Hectares
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1.48HA Industrial Land - Mowbray Industrial Precinct - Featuring a vast 77 metre frontage, this flat block with 'General...
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Premium Development Block - Located among Big Box Retail Royalty this 2,566 sqm block, zoned "Commercial", is one of th...
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Prime High Viz Development Site
Land Area: 2559 SQM
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Prime Commercial land with immense development potential - Prime Commercial land with immense development potential. 24...
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Unique Property With Multiple Options - Without a doubt this 2532m2 Light Industrial and 2559m2 Commercial Mowbray St si...
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Land Area: 3 Hectares
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Strategic Commercial Site - Immense Development Opportunity - An exceptional offering in Launceston's northern suburbs c...
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Exciting Land Release - A limited number of blocks are being released to the market in Launceston's major Industrial Est...
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Airport development land, with current income - At the head of the cul-de-sac of Hughes Court, and accessed from Transli...
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Launceston Airport environs development land. Few opportunities remain - The very recent sale of Lot 12 at Hughes Court,...
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Contact Joel Harwood
Land Area: 6295 SQM
Floor Area: 1 SQM
The Only Block For Sale On Evandale Road! - Offered for sale is this extremely high profile and generous parcel of land,...
Surrounding suburbs of Blackstone Heights, Tasmania 7250


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pull up to the september installment of #nvrsleep.
cross pollination between the city of brotherly love,
+ the city that nvr sleeps is the wave we're on.
link up at silk city, thursday september 21st for an evening of 90z RnB blended with contemporary hip-hop.
jamaal fisher
dj hvn lee
Silky Black
+ special guests.
drink specials all night long
a music platform + party for today's creative class.
no cover. no dress code. no bullshxt.
if you have questions contact us at 347.690.7677.
nvr sleep organizers have the
right to take photos/videos during the function. these flicks may end up on the net, print, etc.


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Small businesses are finally getting the attention they deserve. The House of Congress recently approved the Jumpstart Our Business Startups (JOBS) Act by an incredibly wide margin of 390 to 23, reports the New York Times. This shows signs of hope that both Republicans and Democrats will step up to answer the needs of small businesses, as they are beginning to realize the huge role small businesses play in revitalizing the economy. Here is a guide to the newly introduced JOBS Act:
Introduction to the JOBS Act 101
Reopening American Capital Markets to Emerging Growth Companies Act
This part of the JOBS Act aims to lower the costs of going public for small companies, by slowing down the application of certain regulations by the Securities and Exchanges Commission (SEC). This bill designates emerging growth companies, which will generally appear to have less than $1 billion in annual gross revenue. This act also aims to protect investors by requiring the emerging companies to provide audited financial statements, which seems like a way to compensate for the decreased SEC regulations.
The Access to Capital for Job Creators Act
Do not be misled by the name: it's not very clear why this was specifically named for "Job Creators," except perhaps as a shout-out that businesses create jobs. In 1982, the SEC established a rule that banned small businesses from using advertisements to solicit investors. In other words, as a small business, you could not seek funding through print or broadcast advertising; nor could you solicit investors at a public, generally advertised event. This new act would remove that ban, hopefully giving businesses a new avenue for seeking capital.
The Entrepreneur Access to Capital Act
The SEC also had restrictions on crowdfunding that allows entrepreneurs to raise capital by a general solicitation, and which may or may not be right for your small business. Generally speaking, the SEC placed a cap on the number of investors a small business could have before entering into tricky legal territory. By allowing crowdfunding, this law lets small businesses raise capital from a "large pool of small investors," or a big group of people who each want to contribute a small amount.
With the JOBS Act, each investor can contribute up to $10,000 of 10 percent of his or her annual income, whichever is the lower amount. A company can raise up to $1 million without registering with the SEC or $2 million if the company can provide audited financial statements. This is fairly up-to-date legislation, as you can find a lot of crowdfunding online at websites like Kickstarter and RocketHub.
The Small Company Capital Formation Act
This act is much like "Reopening American Capital Markets" Act, since it allows more companies to enter the public market unimpeded. Companies were usually exempt from SEC registration if they kept their offering under $5 million. That exemption amount has just been raised to $50 million. With such a huge jump, this act seems to benefit companies that really toe the line between small and big businesses.
The Private Company Flexibility and Growth Act
In 1964, the SEC ruled that companies would have to register as a public company if they had 500 or more shareholders. The new act would raise that threshold to 1000 companies. This is fairly similar to the legislation that opens up crowdfunding for small businesses.
The Capital Expansion Act
Similar in tone to the last act, this legislation allows community banks to accept more shareholders without added regulation. Community banks were once limited to 500 shareholders, but now they can have up to 2,000 shareholders. Hopefully, with this new act, small business owners and entrepreneurs will have more access to community bank loans. This would be a boon for many small business, as community banks typically have more favorable interest rates than the big banks, according to a report by Bankrate.com.


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Sandra Furick wants the students of Colvin Run Elementary School to appreciate what they have. That is why she is putting a strong emphasis on the school's Character Education program.
"It's a dynamic program, and we evaluate it every year to see how we can make it stronger," said Furick, principal of Colvin Run.
Last year the Colvin Run students collected bicycles for needy school children in Fairfax County. However, Furick wanted to make the program more than just donations.
"They can bring in bikes, they can bring in money, but what do they learn about these kids?" asked Furick.
Subsequently, over the summer Colvin Run's Student Council Association (SCA) donated $1,000 to the school's business partner ThinkFun! for the purpose of creating game mats for summer school children.
"The kids didn't really understand that there are kids in Fairfax County that didn't have games in their home," said Furick.
The game mats were a big hit, and Furick currently has a closet full of handmade thank you notes from the students who received them.
"That's the essence of service education," said Furick. "It's not just understanding needs, it's learning about the world."
Furick said it is her personal goal to convey this message to her students.
"I want to be actively involved in the service learning programs because I see where the children make connections," said Furick.
This is Colvin Run's fourth year of operation, and Furick's fourth year as principal. In its first year, the school opened with an enrollment of 667 students – it now has an enrollment of 830 students. Furick said that the Colvin Run faculty is constantly evaluating its curriculum and looking at ways to improve it.
"The classroom teachers are always coming up with new strategies, so looking at instructional programs is an ongoing thing for us," she said.


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Published on March 29th, 2014 | by Natural Awakenings Staff0
Supplements Could Save $70 Billion in Medical Costs
In a Frost & Sullivan study report authored by Christopher Shanahan and Robert de Lorimier, Ph.D., the use of dietary supplements, including B vitamins, phytosterols and dietary fiber, could reduce the cost of treating coronary artery disease in the U.S. by nearly $50 billion over the next seven years. In addition, healthcare costs related to diabetes, vision problems and osteoporosis could be reduced by nearly $20 billion collectively with the use of certain supplements.
The projections were based on cost-benefit analysis comparing a series of scenarios to assess the effect on overall disease management costs if an identified high-risk population were to avoid costly medical events by increasing their intake of dietary supplements purchased out-of-pocket versus no supplement usage.
"The healthcare system spends a tremendous amount of money treating chronic disease, but has failed to focus on ways to reduce those costs through prevention," says Steve Mister, president of the Council for Responsible Nutrition Foundation. According to the Centers for Disease Control and Prevention, only 3 percent of U.S. healthcare costs are spent on the prevention of chronic diseases.