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BrowseUploadSign inJoinBooksAudiobooksComicsSheet MusicWelcome to Scribd! Start your free trial and access books, documents and more.Find out moreNew Alliance for Food Security and Nutrition2013 Progress Report Summary
1. Introduction 2. Key challenges and opportunities 3. New Alliance goals and commitments 4. Progress to date Country-level implementation and coordination Government policy commitments Private sector investment commitments Development partner financial commitments Responsible investment Enabling Actions Expansion 5. Annexes 1 1 2 3 3 3 4 6 6 7 8 8
The New Alliance for Food Security and Nutrition (hereafter New Alliance) was launched in 2012 under the US G8 Presidency. It is a joint initiative between African leaders, the private sector and development partners to accelerate responsible investment in African agriculture and lift 50 million people out of poverty by 2022. The New Alliance aims to catalyse responsible private sector investment in Country Investment Plans and thereby support the Comprehensive Africa Agriculture Development Programme (CAADP) as the guiding framework for agricultural transformation in Africa. The New Alliance works closely with the Grow Africa partnership, convened by the African Union Commission, New Partnership for Africa's Development (NEPAD) and the World Economic Forum, with the shared goal of mobilising responsible private sector investment in line with national agriculture strategies and CAADP plans. This is the first annual progress report on the New Alliance. It draws on six country-level progress reports prepared in April 2013 by the governments of Burkina Faso, Cote d’Ivoire, Ethiopia, Ghana, Mozambique and Tanzania in conjunction with G8 members and private sector partners, as well as a Grow Africa review of progress against private sector commitments set out in Letters of Intent (LOI). This report covers implementation since the launch of the New Alliance in 2012. It is somewhat premature to try and assess the overall impact of the New Alliance to date, therefore the report focuses largely on progress in implementing mutual commitments and issues and challenges emerging from this early experience.
2. Key challenges and opportunities
In its first year the New Alliance has begun to help promote responsible private sector investment in African agriculture, complementing existing efforts that support CAADP’s agricultural transformation agenda. However, there is still much to do to ensure the New Alliance makes a lasting contribution to poverty reduction and food and nutrition security across Africa. This will require strong leadership at all levels and a willingness to work in partnership with, and learn from, other actors. The following key challenges and opportunities have been identified from experience to date and will need to be addressed by the New Alliance in the future: 
Country-level leadership: the New Alliance will only be sustainable at country-level if it is led by
each partner country. While countries are already providing high-level leadership, a key priority for 2013 is to strengthen this and ensure the alignment of the New Alliance with country-level processes and timelines for planning, budgeting, policy making and review. Cooperation Frameworks and other New Alliance tools can then be used effectively to catalyse investment in Country Investment Plans.
Facilitating a new type of dialogue: Cooperation Frameworks provide an important tool to track
and account for mutual commitments. To add real value, these commitments need to be developed through on-going dialogue involving all stakeholders (government, local and international private sector, development partners and civil society), rather than through a series of bilateral negotiations.
Institutional ‘pace’ and capacity: private sector partners report a considerable mismatch
between the response speed and capacity of government agencies and the pace of reform, on the one hand, and the responsiveness expected or required by the private sector to reassure investors and deliver on their investment, on the other.
Joined-up government: high-level leadership and commitment in each country has been critical
to the progress so far, but this leadership needs to be reflected in the priorities and commitments of line ministries and local government, who provide the day-to day contact points for local and international companies.
Access to finance: access to investment and working capital in agriculture remains a major
constraint to investment despite efforts to improve these services. While the New Alliance is seeking to improve access to finance in some areas through the ‘Enabling Actions’, further action by governments, financial institutions and development partners needs to be identified.
competitive investment needs and market failures that constrain progress on investment projects. The New Alliance needs to find ways to support governments to assess and prioritise these constraints and to reflect them in Country Investment Plans. Public investment from governments and development partners can then be targeted strategically to address these gaps. 
Leveraging and focusing public investment: private sector partners identify many pre-
Women’s economic empowerment: improving women’s access to productive assets and to
agricultural services and supporting women as entrepreneurs in agriculture would make a significant contribution to the New Alliance’s goals. 
Learning how to work with smallholders at scale: there are already some good examples of
smallholder engagement in new investment projects, but the New Alliance needs to learn how to engage with smallholders at scale and how to help those that can, to make the transition to small, commercially viable family farms.
Engaging local and global civil society organisations (CSOs): many existing partners
recognise the contribution CSOs could play, for example in supporting smallholder aggregation or assessing the impact of investment projects. There is a need for closer engagement with CSOs and greater transparency on the New Alliance in order to address their concerns and draw on their expertise and insights.
3. New Alliance goals and commitments
The overall goal of the New Alliance is to raise 50 million people out of poverty by 2022 whilst contributing to improved food and nutrition security. The New Alliance aims to achieve this goal primarily by stimulating responsible private sector investment in agriculture, contributing to inclusive agricultural sector growth. The New Alliance Cooperation Frameworks in each country outline mutual commitments of governments, the private sector and development partners, including targeted public investment and crucial policy reforms. These coordinated, complementary commitments aim to create an enabling environment for responsible investment and address critical market failures, in order to accelerate private sector investment in support of Country Investment Plans. A New Alliance Accountability Framework, (a draft of which is now under consultation) will set out how we will track and report results and impact in future years, in line with the overall CAADP results framework and as an input into its monitoring and evaluation framework at national, regional and continental level. It is intended that the Accountability Framework will be presented for approval at the next Leadership Council, for implementation in 2014. While the evidence suggests a clear, positive relationship between agricultural sector growth and poverty reduction, understanding of the linkages between investment, agricultural growth and other important development outcomes, such as food security, nutrition and women’s economic empowerment is still
relatively weak. The New Alliance provides an opportunity for all stakeholders to investigate and develop a better understanding of these linkages in order to facilitate responsible public and private sector investments that contribute to these outcomes at scale.
Country-level implementation and coordination
 An important added value of the New Alliance is its contribution to the CAADP facilitated dialogue between government, private sector, development partners and civil society in each country to identify key constraints to Lozane Farms are a seed company working in Mozambique. Lozane Farms have started responsible investment in agriculture and to contracts with farmer group leaders and are now in advance coordinated action to address these the process of entering into Memorandums of constraints. This dialogue needs to be Understanding with individual farmers. Lozane aligned with and support the existing policy Farms are investing in a seed processing plant as and planning processes in each country. demand grows ($150-180,000), and are extending Cooperation Frameworks are intended to capture the outcome of this dialogue. They should be reviewed and updated regularly to reflect evolving circumstances and commitments.
business linkages and partnerships with local companies to foreign partners. They have formal relationships with 425 maize and soya (intercropping) farmers for seed supply and procurement.
Developing this multi-stakeholder, countrylevel dialogue and establishing clear leadership to drive and track progress has taken time across the initial six New Alliance partner countries. Progress has been mixed, reflecting different capacity, priorities and events in each country. This is an issue also identified by the private sector, including some companies that have already signed LOIs but without participation in this type of exchange. There is also a particular need to engage civil society proactively in this dialogue and as a partner in investment projects.
 The Cooperation Frameworks agreed in the six New Alliance partner countries include a total of 97 government policy commitments to be implemented to different deadlines over a three-year period (see Annex 1 for more details). Of these 97 commitments, 27 have already been implemented in full, most of them in advance of their agreed deadline. Progress is underway implementing a further 55 commitments, approximately three-quarters of which are on a timeline beyond May 2013.
Government policy commitments in Burkina Faso, Cote D’Ivoire, Ethiopia, Ghana, Mozambique and Tanzania TOTAL Due by May 2013 Due after May 2013 TOTAL 25 72 97 No progress 1 14 15 Some progress 16 39 55 Completed 8 19 27
Of the 25 government policy commitments due to be completed by May 2013, around a third have already been completed, while just under two-thirds have made some progress. Of the 72 policy commitments with a timeline for completion beyond May 2013, just under a third have been completed and some progress has been made implementing half of these. While these aggregate figures suggest reasonable progress, the numbers conceal a much more complex and mixed picture, with notable successes on key policy reforms in some countries, including seed sector reform and land titling, and less progress, even delays, in implementing other policy reform commitment areas. It is too early to draw any clear conclusions from the progress reports to date, but in the coming years it will be important to understand what factors affect progress and, critically, to what extent policy implementation results in a tangible improvement in the investment climate for small and large farms and agribusinesses. Many important reforms in the enabling environment cut across different sectors and require concerted action across multiple line ministries. The New Alliance could potentially help leverage action at this level. More consideration must be given to how policy reforms in Cooperation Frameworks can promote and incentivise responsible investment. A number of Cooperation Frameworks As part of the Burkinabe Government policy reforms to already include policy actions to tackle improve efficiency and transparency in commercial and undernutrition and advance the customs procedures for agricultural commodities, the implementation of the, ‘Voluntary customs authorities have established an electronic platform called the Virtual Link System for Imports of operations and Guidelines on the Responsible Exports, which is currently being rolled out. Governance of Tenure of Land, 1 Fisheries and Forests’ endorsed by the The platform ensures liaison between customs and Committee on World Food Security on government departments (Health, Laboratory Service, 11 May 2012. Strengthening the policy Department of Plant Protection, Department of Pharmacy and Medicine, etc.) and private organisations (banks, dialogue in each country with the close insurance, CCVA, etc.) that issue documents required for and continued involvement of both local customs clearance. It enables the collection of electronic and international private sector and civil documents and accelerates clearance procedures. society organisations could help shape and prioritise policies reforms that encourage responsible investments.
Private sector investment commitments
 In 2012, over 80 companies made investment commitments covering Burkina Faso, Cote d’Ivoire, Ethiopia, Ghana, Mozambique and Tanzania. In March-April 2013, Grow Africa undertook a review2 of progress against LOI commitments in all New Alliance partner countries except for Cote D’Ivoire, where a review was led by the Ministry of Agriculture. The Grow Africa review was based on selfreporting by companies, against a qualitative questionnaire as well as a set of performance indicators.
For more information, see http://www.fao.org/nr/tenure/voluntary-guidelines/en/. NB The Grow Africa review and the aggregate statistics on LOI progress included in this section also included LOIs in Kenya and Rwanda. The full st review is included in Grow Africa’s 1 Annual Report: http://growafrica.com/Grow_Africa_Annual_Report_May_2013.pdf
Of the 79 investment projects which reported Tanseed are supporting a nutrition-enhanced progress to Grow Africa (out of a total of 97 quality protein maize project in Tanzania, projects): 100% are moving forward with internal working with over 8,000 smallholders for company approvals; 94% have begun preparatory production and distribution of seed. Tanseed work, including market research, field visits, have initiated testing of drought-tolerant maize partnership exploration/negotiation, and hybrids for possible registration in Tanzania and stakeholder consultation; and 61% have started to have finalised a partnership agreement with invest with tangible progress on-the-ground. Many USAID to support certified rice seed production of these are in a pilot stage awaiting scale-up, but that will benefit 16,667 smallholder farmers. about 40% are at investment stage with operations moving to scale in at least one component of their overall commitment. Investments in production and processing are taking longer than those for inputs and sourcing from farmers for existing supply chains. These investments include a variety of business models and institutional arrangements, some facilitated by Grow Africa, including joint ventures between multinational and local companies, publicprivate partnerships and partnerships between private companies and NGOs. New models of smallholders entering value chains are also emerging. Private sector partners have reported a number of significant constraints to implementing their investment plans (see the diagram below based on Grow Africa’s review). The three most common challenges identified in all countries were: (a) Laws, policies or regulations that constrain business operations (b) Government capacity to respond quickly (c) Access to capital
There is also a clearly identified need for enhanced communication between governments and the private sector, including opportunities for continued dialogue, as companies refine business plans. This requires companies to have a strong presence on the ground to facilitate regular, face-to-face engagement with governments and local partners. Another recurring barrier is the lack of adequate finance to kick-start activities. Access to appropriate capital is a particular challenge for farmers and small and medium enterprises (SMEs), but is also a concern raised by many larger companies. Several companies have established input pre-financing arrangements with smallholders supplying them to address gaps in local commercial credit markets. However in many value chains this is not a suitable, sustainable or competitive solution.
Development partner financial commitments
 In the six existing New Alliance partner countries, a total of almost $4 billion has been committed from 2012-2015 in support of Country Investment Plans and the goals of the New Alliance. Based on a very approximate assessment of progress to date, reported in the table below, disbursement of funds at this aggregate level is broadly on track in four out of the six countries.
Country G8 commitments 2012-2015 (USD) $644m $290m $1,199m $542m $384m $894m $3,952m Estimated proportion committed to end April 2013 $361m $59m $485m $151m $134m $264m $1,455m Disbursement to date % disbursed against committed to April 2013 87% 34% 131% 91% 79% 41% 91%
Burkina Faso Cote d'Ivoire Ethiopia Ghana Mozambique Tanzania Total
$313m $20m $637m $138m $106m $109m $1,323m
NB: All figures are rounded to the nearest million USD. Commitments are taken from Cooperation Frameworks, with 2013 commitments prorated. Disbursement figures are from G8 members and may differ from those listed in Country Reports due to exchange rate differences, th reporting on commitments, rather than disbursements or varying report periods used. USD conversion has been done at exchange rates on 8 May 2013 except in the case of the Japanese Yen where OECD DAC 2012 rates have been used.
Cote d’Ivoire made a number of policy commitments with the objective of securing rural land tenure and facilitating access to land for smallholder farmers and private enterprises. A pilot of the Rural Land Act, implemented through programmes to demarcate village land and through the issuance of land tenure certificates, is due to be completed in Cote d’Ivoire by December 2015. Already, a national programme for land rights is being implemented; a pilot programme is being signed with the EU. The Government of Cote d’Ivoire has also acted on their commitment to increase access to land for women and youth from rural areas by ensuring development programmes are targeted to reach at least 15% rural women and 40% youth.
 At this stage, it is not possible to comment on how these funds have been allocated or to assess their contribution to leveraging private sector investment. Not all progress reports provided detailed information on how development partner funding was aligned with the Country Investment Plan (see Annex 3 for more details). Future reporting will assess more closely if and how development partner funding is aligned with Country Investment Plans.
Despite clear progress on disbursement and a commitment to align funding with Country Investment Plans, development partner funding could be prioritised more strategically in the future to support governments to address key gaps or bottlenecks that constrain responsible private sector investment and growth.
 Promoting responsible investment is a core New Alliance commitment and concern, incorporating not just measures to ensure investments ‘do no harm’ but also positive action to maximise the positive impact that investments can have on women, smallholder farmers and families’ nutritional status.
One example of this is the commitment in each New Alliance Cooperation Framework to support the implementation of the ‘Voluntary Guidelines on the Responsible Governance of Tenure of Land, Fisheries and Forests’ in the context of National Food Security. Many Cooperation Frameworks include specific policy measures to strengthen land tenure and rights. While it is too soon to evaluate the impact of investment commitments made in 2012, early results reported by companies to Grow Africa include:  More than $60 million invested in activities that incorporate smallholder farmers into commercial, market-based activities.  Approximately 270,000 metric tonnes of commodities sourced within partner countries – the vast majority from smallholders, and the equivalent of around $300 million in sales from these farmers fed into the market system.  Almost 800,000 smallholders reached with a mix of training, service provision and market access.
 At its launch in 2012, the New Alliance supported a package of Enabling Actions that were designed to spur agricultural growth and create the right enabling environment for accelerated private sector investment in Africa, with a focus on smallholder farmers and women. These Enabling Actions The Agriculture Fast Track was launched at the were intended to support the implementation of World Economic Forum in Cape Town, South the New Alliance Country Cooperation Africa. An initial pipeline of projects was developed through a scoping exercise, and the Frameworks and to be integrated into country first two grants are expected to be announced at food security strategies. When implemented the launch event. The Fund currently has $27m in together, in conjunction with coordinated country commitments from the USG, Sweden and the strategies and investment plans and private AfDB, and additional donors, including Denmark sector investments, these actions will be an and Norway, have expressed an interest in participating. effective catalyst for accelerated agricultural sector growth and sustained poverty reduction. In 2013, the United States has continued to lead on these commitments and substantial work has been done to bring several prioritised activities to fruition, focused initially on New Alliance partner countries (See Annex 4 for details). The Enabling Actions moving forward in 2013 include:
Launching an Agriculture Fast Track Fund that supports the preparation and financing of bankable agricultural infrastructure projects, hosted by the African Development Bank. Setting 10-year targets for yield improvements and the adoption of improved technologies, and launching a Technology Platform with the Consultative Group on International Agricultural Research and the Forum for Agricultural Research in Africa in consultation with the Tropical Agricultural Platform and the Coalition for African Rice Development (CARD). Launching a Scaling Seeds and Other Technologies Partnership, housed and coordinated by the Alliance for a Green Revolution in Africa (AGRA). Convening an international Conference on Open Data for Agriculture in April 2013, hosted by the United States Government and the World Bank, to develop options for the establishment of a global platform to share reliable agricultural and related information specifically of relevance to African countries, farmers, researchers and policymakers. Launching the Platform for Agriculture Risk Management (PARM) as a facilitative entity, drawing from the collective expertise of its contributing entities, connecting demands in low-income countries and lower middle-income countries.
Completing National Agricultural Risk Assessments in three New Alliance countries, conducted by the World Bank in close partnership with New Alliance countries. Supporting the Scaling Up Nutrition (SUN) movement, and committing to a process to improve tracking and disbursements for nutrition across sectors and ensuring the coordination of nutrition activities across sectors. The Global Agriculture and Food Security Program (GAFSP) had raised an additional $375 million at the end of 2012, as part of the Public Sector Window’s $1.2 billion recapitalization campaign.
 Sustained progress towards the New Alliance goal of lifting 50 million people out of poverty by 2022 relies on more countries joining the New Alliance and working in partnership to unlock private sector investment and growth. Four new potential partners expressed an interest in joining the New Alliance in 2013: Benin, Malawi, Nigeria and Senegal. All of these have shown a commitment to and have made progress under the CAADP framework. They have all demonstrated a commitment to, and readiness for, a policy reform process to promote responsible private sector investment in agriculture; and all four have the necessary backing of development partners. Nigeria, Malawi and Benin have been developing new Cooperation Frameworks as a joint effort between government leads, development partners, private sector and civil society. These will be formally launched at a New Alliance event on 8 June 2013. It is anticipated that Senegal will finalise their Cooperation Framework later in 2013.
Annexes to follow. For more information on the New Alliance, visit: http://bit.ly/New-Alliance
This report has been produced by the Department for International Development (DFID) with the support of the other two convening co-chairs of the Leadership Council, the African Union Commission and the World Economic Forum. It draws on country reports produced by the governments of Burkina Faso, Cote d’Ivoire, Ethiopian, Ghana, Mozambique and Tanzania and a Grow Africa review of private sector investment commitments. The full report and its annexes are available to view at: www.gov.uk/government/news/new-alliance Department for International Development 22 Whitehall London SW1A 2EG UK and at: Abercrombie House Eaglesham Road East Kilbride Glasgow G75 8EA UK Tel: +44 (0)20 7023 0000 Fax: +44 (0)20 7023 0016 Website: www.gov.uk/dfid Facebook: www.facebook.com/ukdfid For further enquiries, in the first instance please email: newalliance8june@dfid.gov.uk
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d8iopo comments on Get on my level - Phreakjump to contentmy subredditsannouncementsArtAskRedditaskscienceawwblogbookscreepydataisbeautifulDIYDocumentariesEarthPornexplainlikeimfiveFitnessfoodfunnyFuturologygadgetsgamingGetMotivatedgifshistoryIAmAInternetIsBeautifulJokesLifeProTipslistentothismildlyinterestingmoviesMusicnewsnosleepnottheonionOldSchoolCoolpersonalfinancephilosophyphotoshopbattlespicsscienceShowerthoughtsspacesportstelevisiontifutodayilearnedTwoXChromosomesUpliftingNewsvideosworldnewsWritingPromptsedit subscriptionsfront-all-random | gadgets-sports-gaming-pics-worldnews-videos-AskReddit-aww-Music-funny-news-movies-books-history-food-philosophy-television-Jokes-Art-DIY-space-Documentaries-Fitness-askscience-nottheonion-todayilearned-personalfinance-gifs-listentothis-IAmA-TwoXChromosomes-creepy-nosleep-GetMotivated-WritingPrompts-LifeProTips-EarthPorn-explainlikeimfive-Showerthoughts-Futurology-photoshopbattles-mildlyinteresting-dataisbeautiful-tifu-OldSchoolCool-UpliftingNews-InternetIsBeautiful-sciencemore » leagueoflegendscommentsrelatedwant to join? sign in or create an account in seconds|Englishlimit my search to /r/leagueoflegendsuse the following search parameters to narrow your results:subreddit:subredditfind submissions in "subreddit"author:usernamefind submissions by "username"site:example.comfind submissions from "example.com"url:textsearch for "text" in urlselftext:textsearch for "text" in self post contentsself:yes (or self:no)include (or exclude) self postsnsfw:yes (or nsfw:no)include (or exclude) results marked as NSFWe.g. subreddit:aww site:imgur.com dogsee the search faq for details.advanced search: by author, subreddit...this post was submitted on 09 Jun 2013297 points (78% upvoted)shortlink: remember mereset passwordloginSubmit a new linkSubmit a new text postleagueoflegendssubscribeunsubscribe687,844 readers11,678 users here now
created by kayden0000a community for 5 yearsmessage the moderatorsMODERATORSBuckeyeSundaeadagiosummonerLilybet - NA/EUWp00rleno**Out of the country! Don't PM me!**TheEnigmaBlade(NA)TjonkeTjonkeAurori[Aurori] (EU-W)xzile[Zxile] (NA)Merich[Merich] (NA)LeagueOfLegendsBotaznegglover[SoopaTomato] (NA)...and 14 more »296297298Get on my level - Phreak (youtube.com)submitted 1 year ago by Ryanw185[Ryan Is Here] (NA)62 commentssharecancelsorry, this has been archived and can no longer be voted onloading...sorted by: besttopnewhotcontroversialoldrandomq&ayou are viewing a single comment's thread.view the rest of the comments →[–]d8iopo 32 points33 points34 points 1 year ago (1 child)sorry, this has been archived and can no longer be voted onBut he never actually said get on my level :(
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1. Nosocomial Infections - Kalpesh Zunjarrao
2. Nosocomial Infections  Infection developing in patients after admission to the hospital, which was neither present nor in the incubation period at the time of hospitalization  They may become evident during patient’s stay or after their discharge  Hospital acquired infections  Hospital associated infections  Hospital infections
3. Where do the microbes come from? o Patient's own flora o Cross infection from medical personnel o Cross infection from patient to patient o Hospital environment (inanimate objects): - Air - Water - Dust - IV fluids & catheters - Washbowls - Bedpans - Endoscopes - Ventilators & respiratory equipment
4. Sources of Infection Endogenous:  Patients own flora may invade patient’s tissue during some surgical operations or instrumental manipulations  Normal commensals of the skin, respiratory, GI, UG tract Exogenous:  From another patient / staff member / environment in the hospital  Environmental sources: Inanimate objects, air, water, food  Cross infection from: other patients, hospital staff (suffering from infections or asymptomatic carriers)
5. Microorganisms  Any pathogen , on occasion, can cause HAI  Those that are able to survive in hospital environment & develop resistance to antibiotics & disinfectants: major cause  Commensal bacteria: found in the normal flora of healthy people. significant protective role by preventing colonization by pathogenic microorganisms. Some commensal bacteria may cause infection if the host is compromised. Eg: Staphylococcus epidermidis (cause of i.v. infections), Escherichia coli (cause of urinary infections).  Pathogenic bacteria: they have greater virulence, and cause infections (sporadic or epidemic) regardless of host status.
6. Bacteria: Gram positive bacteria: • Staphylococus aureus: bacteria that colonize the skin, nose and throat of patients and hospital staff. They cause a wide variety of lung, bone, heart and bloodstream infections and are frequently resistant to antibiotics. • In hospitals commonly 40-50% of S. aureus isolates are MRSA. • Staph epidermidis & Group D Streptococci • Streptococci: Streptococcus hemolyticus, Streptococcus Pyogenes • Clostridium tetani spores: survive in dust for very long time
7. Multidrug resistant Staphylococcus aureus (MRSA): colonize hospitals & cause Nosocomial infections. Thus, known as ‘Hospital Staphylococci’
8. Gram negative bacteria: • In recent decades, enteric Gram negative bacilli → most important group of hospital pathogens • Enterobacteriaceae: (E. coli, Proteus, Klebsiella, Enterobacter, Serratia) may colonize sites when the host defences are compromised. They may also be highly antibiotic resistant. • Pseudomonas spp: - often isolated in water and damp areas. They may colonize the digestive tract of hospitalized patients. - Ability to survive & multiply at low temp - Resistance towards antibiotics & disinfectants
9. Viruses: • HIV and Hepatitis B & C viruses: transmitted through blood & blood products • Viral diarrhea & Chickenpox can be spread in hospitals • Cytomegalovirus, Herpes virus, Influenza, Enteroviruses & Arenaviruses can cause HAI Fungi: • Candida albicans, Aspergillus, Mucor Protozoa: • Entamoeba histolytica, Plasmodia, Toxoplasma gondii, Pneumocystis carinii
10. Modes of Transmission 1. Contact: Most common route of transmission  Hands or Clothing: - Hands of staff: important vehicle of spread - Contact of hands & clothing of attendants Eg: Staphylococcus aureus, Streptococcus pyrogenes  Inanimate objects: - Improper disinfection of Instruments: endoscope, bronchoscope, cystoscope Eg: Pseudomonas aeruginosa
11. 2. Airborne:  Droplets: - Droplets of Respiratory infections: transmitted by inhalation  Dust: - Dust from bedding, floors, wound exudates & skin Eg: Pseudomonas aeruginosa, Staphylococcus aureus  Aerosols: - Aerosols from nebulizers, humidifiers & AC Eg: Legionella pneumophila
12. 3. Oral Route: - Hospital food may contain Antibiotic-resistant bacteria → may colonize intestine → can cause infections 4. Parenteral route: - Disposable syringes & needles - Certain infections may be transmitted by blood transfusion, tissue donation, contaminated blood products Eg: Hepatitis B, HIV
13. Common Nosocomial Infections  UTI: o Most common HAI (40% of Nosocomial infections) o Usually associated with catheterization or instrumentation of urethra, bladder or kidneys o Eg: E. coli, Klebsiella, Proteus, Serratia, Pseudomonas, Candida albicans  Pneumonia (Respiratory Infections): o Leading cause of mortality in patients suffering from HAI o During aspiration in unconscious patients & pulmonary ventilation o Eg: Staph. aureus, Klebsiella, Enterobacter, Serratia, Proteus, Pseudomonas, Acinetobacter, Legionella, E. coli
14.  Wound & skin sepsis: o Follow surgical procedure where causative agents are introduced into the tissue during operations o Higher in elderly patients o Manifest within a week of surgery o Non-surgical wounds due to burns, bed sores. o Eg: Staph aureus, Pseudomonas aeruginosa, E. coli, Proteus, Enterococci  Gastrointestinal infections: o Food poisoning due to Salmonella, Shigella sonnei o Enterotoxic manifestation due to Staphylococcal contamination of cooked food o Diarrhea due to E. coli
15.  Bacteremia & Septicemia: o Bacterial invasion of bloodstream in various HAIs o Mostly caused by infected intravenous cannulae o Gram negative bacilli: common pathogens  Tetanus: o Inadequate attention to aseptic precautions during surgery o Use of contaminated dressings or improperly sterilized dressings o Improper disinfection of site of intramuscular injection o Inadequate care while cutting umbilical cord of new-born
16. Diagnosis  HAIs may occur sporadically or as an outbreak  Diagnosis by routine bacteriological methods: o Direct smear examination Culture Sensitivity testing o o  Identification & elimination requires sampling from possible sources of infections such as hospital personnel, inanimate objects, water, air or food  Typing of isolate (phage, bacteriocin): may indicate a causal connection
17. Prevention  Administration of antibiotic therapy to the carrier staff or source patients to destroy the pathogenic agents  Proper sterilization & disinfection of inanimate objects. This helps to control the source of infection  Disinfection of excreta & infected material is necessary to control the exit point of infection  Transmission can be controlled by regular washing of hands, disinfection of equipments & change of working cloths  Use of sterile dressings, surgical gloves & face-masks further contribute in control of nosocomial infection  Pre-operative disinfection of patient’s skin  Proper investigation of HAI & treatment of such cases
18. Hospital Infection Control Committee (HICC)  Every hospital must have an effective Hospital-acquired Infection Control Committee  Responsible for the control of HAIs
19. The membership of the hospital ICC should reflect the spectrum of clinical services and administrative arrangements of the health care facility. The committee should include: 1. Chief executive, or hospital administrator or Medical superintendent (Chairperson). 2. Clinical microbiologist (Infection control officer). 3. Infection Control Nurse (ICN). 4. Infectious Diseases Physician (if available) 5. Chief of nursing services. 6. Medical record officer (if available). 7. Representative from the major clinical specialties. 8. Additionally representatives of any other department (pharmacy, maintenance, housekeeping, etc) may be invited as necessary
20. Functions:  To formulate & update policies on matters related to hospital infections  Review and approve surveillance and infection prevention program, emergence of drug resistance  Use of different antimicrobial agents  Proper sterilization & disinfection procedures  To assess and promote improved practice at all levels of health facility.  To Obtain and manage critical bacteriological data and information, including surveillance data
21.  To ensure appropriate staff training  Safety management  Development of policies for the prevention and control of infection  To develop its own infection control manual  Monitor and evaluate the performance of program  To recognize and investigating outbreaks of infections in the hospital and community
22. Hospital Infection Control
23. • Reduce patient exposure to pathogens • Reduce the number & virulence of nosocomial pathogens • Use of aseptic technique during patient care • Hand washing • Proper isolation of patients known or suspected of harboring infectious diseases • Whenever possible, avoid crowding wards • Use gloves when necessary • Wash hands immediately after glove removal and between patients • Masks, Eye protection, Gown: Wear during activities likely to generate splashes or sprays • Gowns: Protect skin and soiling of clothing
24. Sharps: • Avoid recapping of needles • Avoid removing needles from syringes by hand • Place used sharps in puncture-resistant containers Ensure clean environment: • Establish policies and procedures to prevent food and water contamination • Establish a regular schedule of hospital cleaning with appropriate disinfectants in, for example, wards, operating theaters, and laundry • Dispose of medical waste safely • Needles and syringes should be incinerated • Other infected waste can be incinerated or autoclaved for landfill disposal
25. Your Hands can be Dangerous… Wash them with Soap & Water to keep bacteria away
26. Hand Hygiene is the single most effective intervention to reduce the cross transmission of Nosocomial infections
27. Handwashing: • Must be "bacteriologically effective" • Wash hands before any procedure in which gloves and forceps are necessary • After contact with infected patient or one colonised with multiresistant bacteria • After touching infective material • Use soap and water (preferably disinfectant soap)
28. Standard safety measures to minimise the infection: • Assume that all specimens/ patients are potentially infectious for pathogens • All blood specimens or body fluids must be placed in leak-proof impervious bags for transportation to the laboratory • Use gloves while handling blood & body fluid specimens & other objects exposed to them
29. • If there are chances of spattering, use face masks and glasses • Wear laboratory coat or gowns while working in the laboratory. These should not be taken outside • Never pipette by Mechanical pipetting should be used mouth. devices • Decontaminate laboratory work surfaces with appropriate disinfectant after the spillage of blood or other body fluids
30. • Limit use of needles & syringes to situations for which there are no other alternatives • Biological safety hoods should be used for laboratory work • All potentially contaminated materials of laboratory should be decontaminated before disposal or reprocessing • Always wash hands after completing laboratory work • Remove all protective clothings before leaving the laboratory

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Amazon.com: A. Bellini's review of The Sims 3: Ambitions
After Day One of Game-Play, June 2, 2010
By A. Bellini
This review is from: The Sims 3: Ambitions (Video Game)
I have been playing Sims since The Sims 2 was released and I haven't felt much excitement playing The Sims 3 until I bought a copy of The Sims 3: Ambitions. I, too, became quickly bored with World Adventures, and was hoping this new expansion was a bit more substantial than the last. When I was through with my first 8-hour game-play session with Ambitions, I was left with a new-found love of the Sims and also some new gripes.First, I must say that I loved going through the Stylist Profession and liked that I did not complete the whole entire profession in one gaming binge. I enjoyed being actively involved in my Sims' career path and I enjoyed making Sims over. I personally have a lot of custom content installed and the residents of my town ended up getting much-needed styling. The most valuable new addition in this profession was the new hair options for men. (Previously, I repeatedly used the same hairstyle for many male Sims, as I hated all the other styles and custom hair for men is not abundantly available.) There are several new hair options for female Sims as well, but I don't use them since I have so many custom options that are much more attractive. While you do only receive 2-3 job opportunities per work day as a stylist, you can go back to the salon once you complete those opportunities and continue to style other Sims to gain job experience, and you can also buy a drafting table for your Sim to research new design ideas and further increase your job experience, which allows you to be promoted.Active participation in professions is very time consuming, which I love and am annoyed by at the same time. Like the reviewer before me stated, if you have multiple Sims in your household, there isn't really much time in a day to be actively involved in their lives when you are so busy with your Sim with an active profession. I found myself only tending to my other Sims' needs when my Stylist Sim had a day off. If there is a way to send your Sim to their Ambitions profession and turn off the active involvement for a period of time, I have not found it yet, and it's been impossible for me to fulfill opportunities for other Sims in the household when my one professional Sim is always busy. This is my biggest gripe about Ambitions so far, but compared to World Adventures and The Sims 3 base game, this expansion is quite impressive.I also added a SimBot to my household. I did not have an issue with my SimBot breaking things- in fact, she repairs everything that breaks and came to my household with a good amount of Handiness skill. This SimBot is a robot that you can control just like any other Sim, but the robot has different and interesting needs.Another thing I love about this new expansion pack is that it contains elements of Open for Business from The Sims 2. For example, my child Sim can make numerous baked goods using his toy oven and sell them at a newly-purchasable baked good stand in front of the house, and anything your Sim creates can be sold for good money (depending on your skill level) at the consignment shop. You can also choose to be self-employed and make good money fishing, farming, sculpting, painting, and more, and I really enjoy the options that this new expansion pack allows for.Overall:This is definitely a major improvement over World Adventures, and I think this new expansion pack allows for a more active and engaging gaming experience, which I personally like, aside from the fact that I am alienating my other Sims. I think this EP was worth the money because of how it changes game-play and doesn't just add new items, interactions, and wishes as some other EPs have done. I can't wait to explore more professions, and hopefully there will be more available to us all in the future. Happy Simming!
The Sims 3: Ambitions B003AMOK9M
After Day One of Game-Play
Initial post: Apr 30, 2012 1:13:47 PM PDT
Is this stand alone or do I need to purchase the regular Sims 3 in order to be able to play it?
Do you think this post adds to the discussion? In reply to an earlier post on Aug 23, 2012 12:34:29 PM PDT
You'll have to buy the Sims 3, as Ambitions is an expansion of that game. You could also buy The Sims 3 Deluxe edition which is the core game plus this expansion pack. :)
Location: Edgewater Park, NJ USA
Top Reviewer Ranking: 732,073

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Top of the flops! Modric and Song voted worst signings of the season in Spain By
Two former Premier League stars have been voted as the worst signings of the season in La Liga, by readers of Spanish newspaper Marca. Luka Modric, who left Tottenham for Real Madrid after protracted negotiations, and Alex Song, who signed for Barcelona from Arsenal, were the worst rated, with Modric gaining 32.2 per cent of the vote.Croatian Modric initially impressed on debut for Jose Mourinho's side, but has failed to push on and claim a regular role either as a deep-lying playmaker like Xabi Alonso, or attacking midfielder like Mesut Ozil. Flop: Both Luka Modric and Alex Song have struggled to adapt to life in Spain
In total, he has scored once in 19 appearances, though they only total 717 minutes, or around eight full matches. Speaking to Sportske.net, Modric said: 'This is Real Madrid, I know the huge media pressure on transfers. 'I'm not looking for an alibi, I'm not that guy, but it's very demanding to adjust to a huge club like Real Madrid.'I have had a number of solid performances, I failed in some but overall I proved I can offer something.'As for Song, the Cameroon international has featured in just seven games, the majority of which have come at centre-back as opposed to his preferred midfield role.Another former Premier League star did receive acclaim, though, with Obafemi Martins coming second in the poll for best signing of the season. New lease of life: Obafemi Martins has hit the ground running at Levante
The former Newcastle and Birmingham City striker is now at Levante, where he has scored six times in 21 appearances. Barcelona's Jordi Alba won the vote. In the same survey, Lionel Messi unsurprisingly won the player of the year title with a staggering 60 per cent of the vote, ahead of Cristiano Ronaldo (14.4 per cent) and Radamel Falcao (10.6 per cent). Elsewhere, Mourinho, Pep Guardiola and Tito Vilanova were all beaten to the coach of the year gong by Atletico Madrid boss, the former Argentina international Diego Simeone. So, with La Liga passing judgement on their top and flop stars, we asked Sportsmail writers for their signings of the season so far...Santi Cazorla (Arsenal)The midfielder may also rival Gareth Bale for the best dive of the season which earned a penalty against West Brom, but he made an immediate impact when he joined Arsenal and has continued to impress. England’s Jack Wilshere can only learn from playing with the diminutive Spaniard, whose balance, vision and close ball control is simply a pleasure to watch.LAURA WILLIAMSON Santi's come to town: Arsenal's Santi Cazorla has been excellent since joining
Steven Nzonzi (Stoke City) I struggled to see the point of Nzonzi at Blackburn but all has become clear since his switch to Stoke. Big and strong, he looks tailor-made for Tony Pulis’ side, but there is far more to him than brawn. His composure on the ball and distribution are qualities Stoke have been crying out for in central midfield. Nearly everything goes through him.JOHN EDWARDS Solid at the back: Sebastien Bassong
Sebastien Bassong (Norwich) The Cameroonian, a snip at under £3m, is the leader of defence and a big factor why they are over-achieving. Calming influence and set-piece threat, scoring three times.LAURIE WHITWELL Steven Fletcher (Sunderland) Martin O’Neill’s No1 summer target has shown fans what all the fuss was about and in the early weeks of the season his goals kept Sunderland afloat.COLIN YOUNG Michu (Swansea)Considering Michael Laudrup’s extensive experience of European football, Michu was hardly a discovery, but in an era when foreign players are given six months to settle, Michu took to life in the Premier League straight away.Signed from Rayo Vallecano for £2.2million, 13 League goals so far is a remarkable return. Shows desire, application and the right attitude. Good on him.NEIL ASHTON Jan Vertonghen (Tottenham)When Ledley King's knees finally gave way, Spurs looked short of real class at the back, but Vertonghen has stepped in with ease. The former Ajax captain is comfortable on the ball and, though not the fastest, makes up for it by reading the game well.He can provide cover at left back and is a threat going forward as he proved by scoring the opener in Spurs' win at Old Trafford. His £10m price tag has been easily justified.ANDREW MAGEE

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Ruins by Orson Scott Card - Read Online
544 pages8 hours
From the author of Ender’s Game, the soon-to-be major motion picture!
A complex fate. A deadly path. Book two in the New York Times bestselling series Publishers Weekly calls “an epic in the best sense.”
When Rigg and his friends crossed the Wall between the only world they knew and a world they could not imagine, he hoped he was leading them to safety. But the dangers in this new wallfold are more difficult to see. Rigg, Umbo, and Param know that they cannot trust the expendable, Vadesh—a machine shaped like a human, created to deceive—but they are no longer certain that they can even trust one another. But they will have little choice. Because although Rigg can decipher the paths of the past, he can’t yet see the horror that lies ahead: A destructive force with deadly intentions is hurtling toward Garden. If Rigg, Umbo, and Param can’t work together to alter the past, there will be no future.
The adventure, suspense, and time travel continue in this second installment in the critically acclaimed New York Times and Publishers Weekly bestselling Pathfinder series.
Publisher: Simon PulseReleased: Oct 30, 2012ISBN: 9781442414280Format: book
Read More From Orson Scott Card
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Ruins - Orson Scott Card
Rigg saw the stream before any of the others.
Loaf was an experienced soldier; Olivenko not so experienced, but not untrained, either; and Umbo had grown up in the village of Fall Ford, which was almost like living in the woods.
But only Rigg had tramped the high forests above the Upsheer Cliffs, trapping animals for their fur while the man he called Father taught him more than Rigg ever thought he would need to know. Rigg practically smelled water like an animal. Even before they crested the low grassy rise he knew that there would be a stream in the next crease between hills. He even knew it would be only a rill, with no trees; the ground here was too stony.
Rigg broke into a jog.
Stop, said the expendable they were calling Vadesh.
Rigg slowed. Why? That’s water, and I’m thirsty.
"We’re thirsty," said Umbo.
You cannot drink there, said the expendable.
Cannot? There’s some kind of danger? asked Rigg.
Or a law, suggested Olivenko.
You said you were leading us to water, said Loaf, and there it is.
That’s not the water I’m taking you to, said Vadesh.
Only now did Rigg realize what he wasn’t seeing. It was his inborn gift that all the paths of the past were visible to him. Humans and animals all left traces behind them, paths in time. If they ever traveled through a particular place, Rigg could tell where they had gone. It was not something he saw with his eyes—his eyes could be closed or covered, or there could be walls or solid rock between him and a path, and he would still know where it was, and could figure out what kind of creature made it, and how long ago.
There had been no human traffic at this stream in ten thousand years. More tellingly, few animals had come there, and no large ones.
It’s poisonous, said Rigg.
Is that a guess? asked his sister, Param, or do you know somehow?
Even animals don’t come here to drink, said Rigg. And no human for a long time.
How long? asked Vadesh.
Don’t you know? asked Rigg.
"I’m curious about what you know, said Vadesh. I have not known a human who can do what you can do."
Nearly as long as since the beginning of human settlement on this world. Rigg had a very clear idea of what paths that old were like, since he had just crossed through the Wall between his home wallfold and this one, by clinging to an animal that, in the original stream of time, had died in the holocaust of humans’ first coming to the planet Garden.
That is off by only a little less than a thousand years, said Vadesh.
I said ‘nearly,’ answered Rigg.
A thousand years this way or that, said Param. Close enough.
Rigg still didn’t know Param well enough to tell if her sarcasm was friendly teasing or open scorn. What kind of poison? he asked Vadesh.
A parasite, said Vadesh. "It can live out its entire lifecycle in the stream feeding off the bodies of its siblings, ancestors, and descendants, until one of them eats it. But if a larger animal comes to drink, it attaches to the face and immediately sends tendrils into the brain."
It eats brains? asked Umbo, intrigued.
No, said Vadesh. It infiltrates them. It echoes the neural network. It takes over and controls the host’s behavior.
Why in the world would our ancestors bring along such a creature when they came from Earth? asked Umbo.
They didn’t, said Olivenko.
How do you know that? asked Loaf. His tone showed he was still skeptical of Olivenko, who was only a member of the city guard in Aressa Sessamo, rather than a real soldier.
Because if they had, it would exist in every wallfold, said Olivenko, and it doesn’t exist in ours.
Olivenko thinks the way Father taught me, thought Rigg. Don’t assume: Think it through.
Vadesh was nodding. A very tough little creature, the facemask.
Facemask?
What the humans of this wallfold named it. For reasons that would have become tragically obvious if you had bent over to drink from the stream.
Something didn’t ring true about this. How can a creature that evolved on Garden successfully take over the brains of creatures from Earth? asked Rigg.
I didn’t say it was successful, said Vadesh. And you are now as close as is safe. To avoid picking up facemasks from the wet ground beside the stream—they can attach to any skin and migrate up your body—you should follow in my footsteps exactly.
They followed him in single file through the grass, with Rigg bringing up the rear. The path Vadesh took them on was the highest ground. Each time they reached a damp patch they jumped over it. The rill was narrow here. No one had trouble overleaping it.
Only when they got to higher ground several rods beyond the rill was Rigg able to continue the conversation. If the parasite wasn’t successful, why is it still alive here?
The parasite is successful in attaching to humans and Earthborn beasts of all kinds, said Vadesh. But that’s not really how we measure success in a parasite. If the parasite kills its host too quickly, for instance, before the parasite can spread to new hosts, then it has failed. The goal of a parasite is like that of any other life form—to survive and reproduce.
So these facemasks kill too quickly? asked Umbo, shuddering.
Not at all, said Vadesh. I said ‘for instance.’ He smiled at Rigg, because they both knew he was echoing Rigg’s earlier testy reply when Vadesh told him his time estimate was off by a millennium.
So in what way did this parasite fail? asked Rigg—the way he would have pushed Father, an attitude that came easily to him, since not just in face and voice but in evasiveness, smugness, and assumption of authority this expendable was identical to the one that had taken Rigg as an infant from the royal house and raised him.
I think that with native species, said Vadesh, the parasite rode them lightly. Cooperating with them. Perhaps even helping them survive.
But not with humans?
The only part of the earthborn brain it could control was the wild, competitive beast, bent on reproduction at any cost.
That sounds like soldiers on leave, said Loaf.
Or academics, said Olivenko.
Vadesh said nothing.
It sounds like chaos, said Rigg. You were there from the beginning, weren’t you, Vadesh? How long did it take people to learn of the danger?
It took some time for the facemasks to emerge from their chrysalises after the disaster of the human landing, said Vadesh. And still longer for the people of Vadeshfold to discover that facemasks could infest humans as well as cattle and sheep.
The herders never got infected? asked Loaf.
It took time for a strain of facemasks to develop that could thrive on the human body. So at first it was like a pesky fungal infection.
And then it wasn’t, said Rigg. Facemasks are that adaptable?
It’s not blind adaptation, said Vadesh. They’re a clever, fascinating little creature, not exactly intelligent, but not completely stupid, either.
For the first time, it occurred to Rigg that Vadesh was not just fascinated by the facemasks, but enamored of them.
They can only attach to their host in the water, said Vadesh, answering a question no one had asked. And once they attach to an air-breather, they lose the ability to breathe in water. They only get their oxygen from the blood. You know what oxygen is?
The breathable part of air, said Umbo impatiently. Olivenko chuckled. Of course, thought Rigg—Olivenko was a scholar, and Umbo had studied for a time with Rigg’s father.
But Rigg noticed that Loaf and Param seemed to have no idea what Vadesh meant. How could air be divided in parts? Rigg remembered asking Father exactly that question. But there was no point in explaining the point now or soon or, probably, ever. Why would a soldier-turned-innkeeper and a royal heiress who had fled her throne require a knowledge of the elements, of the behavior of gases and fluids?
Then again, Rigg had thought, all through his years of education, tramping with Father through the woods, that he would never need anything Father taught him except how to trap, dress, and skin their prey. Only when Father’s death sent Rigg out in the world did he learn why Father had trained him in languages, economics, finance, law, and so many other subjects, all of which had proven vital to his survival.
So Rigg started to explain that invisible air was really made of tiny particles of several different types. Loaf looked skeptical and Param bored, and Rigg decided that their education wasn’t his job.
He fell silent and thought about parasites that could only attach to humans in water, and then they lost the ability to breathe on their own. Rigg filed the information away in his mind, the way Father had taught him to do with all seemingly useless information, so he could recall it whenever Father decided to test him.
I’ve been on my own for a year, thought Rigg, and still in my thoughts he’s always there, my pretended father, my kidnapper for all I know. He’s the puppeteer who, even dead, is pulling all the strings inside my mind.
Lost in such thoughts, Rigg did not notice the first building that came in sight. It was Loaf, ever alert as a soldier should be, who saw the glint of metal. It’s like the Tower of O, he said.
It was indeed, in that it was tall and of a similar substance. But it did not rise to a point and was not rounded like a cylinder. And there were several of them nearby, and none of them was half so tall as the Tower of O.
But they were impressive nonetheless, and tall enough that it took two more hours of walking after they first saw them for their little group to come close enough to see that these towers were made from the same material, and formed the skyline of a city.
How could they build with this . . . substance? asked Loaf. People have tried to cut into the Tower of O many times over the years, and neither tool nor fire can affect it.
Who would try to damage it? asked Umbo.
Conquerors who want to show their power, said Olivenko. Rigg’s and Param’s people arose only lately. The Tower has been there ten thousand years.
The talk of duration made Rigg realize something he should have noticed at once, as soon as they knew it was a city they were coming to. There were human paths again, as there had not been near the stream, but all of them were old. None more recent than ten thousand years.
How long has this city been abandoned? asked Rigg.
It isn’t abandoned, said Vadesh.
There hasn’t been a human being here for a long time, said Rigg.
But I’ve been here, said Vadesh.
You’re not a human being, Rigg wanted to say. You’re a machine; you leave no path. A place that contains only you is uninhabited. But it seemed too rude to say aloud. Rigg saw the absurdity of his attitude: If he truly thought of Vadesh as only a machine, rudeness would not be an issue.
Where did the people go? asked Param.
People come and go in the world, and where there once were cities there are only ruins, and where once there was nothing, cities rise, said Vadesh.
Rigg noticed how nonresponsive Vadesh’s answer was, but did not challenge him. Rigg trusted Vadesh too little to want him to know he wasn’t trusted.
And there’s water here? asked Loaf. Because my need for it is getting pretty urgent.
I thought you field soldiers drank your own piss, said Olivenko.
We do pee into canteens, said Loaf. But only so we can bring it back for the officers of the city guard to drink.
It could have been a quarrel, but to Rigg’s relief, Olivenko just smiled and Umbo laughed and it went nowhere. Why did they still irritate each other so much, after all they had been through together? When would rivals become comrades?
So all the people of this city were gone. Rigg began to scan for the paths that would show a great migration out of the city, but before he could make much progress, Vadesh led them into a low building of ordinary stone, which showed its many centuries of weathering.
Did someone live here? asked Umbo.
It’s a factory, said Vadesh.
Where did all the people sit to work? asked Olivenko.
A mechanical factory, said Vadesh. And most of it is underground. I still use it, when I need any of the things the factory makes. But they needed safe water for the supervisors and mechanics, and for the people who hauled things in and hauled things out. He led them through a doorway into a dark chamber. As they passed through the door after him, a bright light came from above. The whole ceiling was aglow, very much like the lights inside the Tower of O.
The others gasped in awe, but Rigg was noticing that the paths of humans into this chamber were few and ancient. This building had only been used for a few decades at the most. It had been abandoned by the same generation of people who had built it.
Vadesh touched the front of a thick stone pillar and at once they heard the sound of running water inside the pillar. Then he touched another place, and a portion of the pillar came away in his hand. It was a stone vessel halfway between a drinking mug and a waterbucket in size. He handed it to Loaf. Because your need was so urgent, said Vadesh.
Is it safe? asked Rigg.
It’s filtered through stone. No parasites of any kind can possibly get into this water.
Again, Rigg noticed that while Vadesh answered, he only answered about the likelihood of parasite infestation, not the actual question Rigg had asked.
Loaf handed the water to Param without tasting it. You need this most, he said.
Because I’m a frail princess? Param asked with a hint of resentment.
Well, she was physically frail and she was a princess. Until their mother tried to kill her and Rigg, she was assumed to be heir to the Tent of Light. Years of living in the narrow bounds of captivity had made her physically weak, and the journey to the Wall had only improved her stamina by a little. But no one was rude enough to point this out to her.
"You need it most because you and Umbo lived on your water for an extra week that we didn’t live through," said Loaf.
Param took the water and drank. It’s perfect, she said. It tastes fresh, and nothing else. Except a tinge of something . . .
Trace metals, said Vadesh. From the rock it filtered through.
Umbo drank next. He tried to pass it to Rigg, but Rigg would not take any until Loaf and Olivenko had also drunk.
There’s plenty, said Vadesh.
Then finish it, Loaf, said Rigg. I’ll drink from the second serving.
He thinks I spit in it, said Umbo.
Didn’t you? said Loaf. You usually do. Then Loaf drank it off. Delicious, he said, as he handed the empty vessel to Vadesh for refilling.
Rigg did not know why he did not trust Vadesh. This expendable had no mannerisms that were not identical to those of Rigg’s father. Perhaps that was the cause of his suspicions. But he was sure that Vadesh was deceptive and dangerous, not because he deflected questions and clearly had his own agenda—those were Father’s constant attributes as well—but because of which questions he wouldn’t answer.
Father would have told me why the people were gone from this place. It would have been the first thing he explained, because telling me why people do the things they do was always his favorite topic.
Vadesh isn’t educating me, that’s why he doesn’t explain it.
But Rigg did not believe his own excuse. As Father had taught him, he did not believe the first explanation his mind leapt to. "It will often be right, and as you get more experience of life it will usually be right. But it will never be reliably right, and you must always think of other possible explanations or, if you can’t, then at least keep your mind open so you will recognize a better explanation if one emerges."
So Rigg did not trust Vadesh. Moreover, he was sure that Vadesh knew that Rigg did not trust him—because Father would have known.
When Rigg got his water from the second cupful, it was as delicious as the others said.
He poured the last water from his canteen onto the floor and then moved to put it into the space the stone vessel came from.
No, said Vadesh. One reason this water can be trusted is that it is never used to fill any container but this one. It won’t work anyway. It only pours out water when this is in place. Vadesh reinserted the stone cup, and again the water could be heard gushing into the stone.
They all emptied their canteens of the stale traveling water they obtained when they last filled at a stream two days before, then refilled them from the stone vessel. With enemies pursuing them, they had not dared to stop even for water on that last day before they crossed the Wall.
It’s getting near dark outside, said Loaf. Is there a safe place to sleep in this city?
Everywhere here is safe, said Vadesh.
Rigg nodded. No large animals ever come here, he said.
"Then is there a comfortable place here? asked Umbo. I’ve slept on hard floors and on grass and pine needles, and unless there’s a bed . . ."
I don’t need beds, said Vadesh, and I didn’t expect company.
You mean they didn’t make their beds out of stuff that never decays? asked Olivenko.
There is nothing that doesn’t decay, said Vadesh. Some things decay more slowly than others, that’s all.
"And how slowly do you decay?" asked Rigg.
Slower than beds, said Vadesh, but faster than fieldsteel.
And yet you seem as good as new, said Rigg. That’s a question.
Vadesh stood by the water pillar gazing at him for a long moment. Deciding, Rigg supposed, how to respond without telling him anything useful.
My parts are all replaceable, he said. And my knowledge is fully copied in the library in the Unchanging Star.
Who makes your new parts? asked Rigg.
I do, said Vadesh.
Here? asked Rigg. In this factory?
Some of the parts, yes, said Vadesh.
And the other parts?
Somewhere else, obviously, said Vadesh. Why do you ask? Do you think any of my parts are defective?
Now, that was interesting, thought Rigg. I was going to ask him if he ever had enough parts to make a complete new copy of himself, but he assumed I was doubting that he was functioning perfectly.
This made Rigg assume that Vadesh himself had doubts about his functionality.
How could I know if a machine so perfect that I could live with one for thirteen years without realizing it wasn’t human is not up to par? he asked.
Exactly, said Vadesh, as if they had been arguing and Vadesh had just proved his point.
And maybe we were arguing, thought Rigg. And whatever Vadesh might have done since I met him, he certainly did not prove anything. All he did was make me wonder if he’s broken somehow. Did he do that for a purpose? Is it an illusion, so I will underestimate his ability? Or is it a symptom of his imperfection, that he could raise doubts in my mind when his goal was to reassure me?
Thanks for the water, said Rigg. I think we’ll go out of the city to sleep on softer ground. Unless there’s a couple of you who want to sleep on stone.
There were no volunteers. Rigg led the way out of the building, following their own paths back out of the empty city. At first Vadesh seemed to assume he was welcome to come with them, but Rigg disabused him of that notion. I don’t believe you sleep, Rigg said to him. And we won’t need you to find us a resting place.
Vadesh took the hint and returned into the factory—leaving no trace of himself for Rigg to follow. Just like Father, Vadesh was pathless; only living beings made paths through time. Machines might move about, but they left no track visible to Rigg’s timesense.
It would have been so useful to trace Vadesh’s movements through these buildings over the past ten thousand years, since all the people left. And perhaps even more interesting to trace his movements for the thousand years before that, when the people were still here. What was he doing when they left? Why did he still come here, if all the people were somewhere else?
Barbfeather
Rigg found that most of the paths of the ancient inhabitants of the city did not follow the road, and he stopped to see where they had led.
We’re supposed to sleep here? asked Loaf.
Rigg looked around. The ground was stony and they were at the crest of a hill.
This doesn’t look comfortable at all, said Param. Is this the kind of place you slept when you were living as a trapper?
I would never sleep on ground like this, said Rigg.
Weren’t you leading us to where we’re going to spend the night? asked Olivenko.
I was getting us out of the city, said Rigg. I didn’t have any particular sleeping place in mind.
Well, you seemed to know where you were going, said Umbo. So we followed you.
This isn’t a good place to sleep, said Rigg. Very stony, and no protection from wind.
"Well, we can see that," said Loaf.
"What were you doing, if you weren’t finding us a hostelry?" asked Param.
Sorry, said Rigg. I got caught up in following paths.
I thought you said there weren’t any.
None recent, said Rigg. I was trying to make sense of the old ones.
From ten thousand years ago, said Umbo.
Since Rigg didn’t understand what it was that he hadn’t understood about the paths, there was no way to explain. So he returned to the immediate subject. There’s a stand of trees over there, said Rigg. That’ll probably have soft ground. And we’ll all sleep in the lee of Loaf, so we’ll have shelter from the wind.
Very funny, said Loaf.
Then Rigg came to a conclusion about what had puzzled him. I think they may have died, said Rigg.
The trees? asked Param.
The people here. If they moved away, peacefully I mean, then the most recent paths should have them leaving the city on the road. But the most recent people on the road only come in.
Maybe they left another way, said Olivenko.
Death is another way, thought Rigg. But he kept it to himself. I don’t know if we can believe anything Vadesh says, said Rigg. Umbo, I want to follow a path and go back and see.
See what? asked Loaf.
If I knew, said Rigg, I wouldn’t have to go back.
Let’s see, said Umbo. Going into the past has brought us exactly what, so far?
Saved our lives, said Loaf, and almost at the same time Param said, You set me free and saved . . .
Olivenko added, It was ten thousand years ago that all the people left this city.
Or died in it, said Rigg. It could have been a plague.
Cities rise and fall, said Olivenko. "That’s what history is."
Let’s find a way to be comfortable here tonight, said Loaf. I wish we were still mounted. We could just leave this place.
Leave our only known source of safe water? asked Param.
Then they were among the trees, and the conversation turned to other things. Rigg only happened to stop and look back at the moment that Umbo bent down, picked something up, and tucked it into his pocket. Rigg was too far away to casually say, Find something? or Drop something? It’s not as if he even had a right to ask. Umbo didn’t owe him explanations.
At the same time, there had been something furtive in the way Umbo pocketed it and then glanced around. Yet Umbo hadn’t looked at Rigg or any of the others to see if they were observing him. On the contrary, he specifically glanced around as if looking for someone else. The person who might have dropped whatever Umbo picked up? Without even thinking about it, Rigg scanned for paths. No one had been here since the city was abandoned, and that long ago it was doubtful that there was a grove of trees here, anyway.
But animals came and went all the time here, Rigg could see. One in particular had been in and out of this grove several times in the past few hours. He recognized its path.
We have a friend here, said Rigg.
The others looked around, startled.
Our feathered friend, said Rigg. The beast that led us into the past and through the Wall.
I thought he went crazy when we popped back into the present and the Wall came back, said Loaf.
He’s not in the Wall anymore. He came here. He’s been going up to the trees. Tree to tree.
He didn’t look like a climber to me, said Loaf.
Or a bark-eater, said Umbo.
"We wouldn’t know what he looked like, said Olivenko. There aren’t any like him in the modern world."
He can’t have gotten far, said Rigg. He was here not half an hour ago.
You know we only have that Vadesh’s word that the water’s not safe, said Olivenko.
He can’t lie, said Umbo.
And who told us that he can’t? asked Olivenko. ‘Hi, I can’t possibly lie to you.’ Isn’t that the first thing a liar would say?
He’s just like Father, said Rigg, and Father never lied to me.
He didn’t exactly open up and bare his soul to you, either, said Loaf.
He didn’t tell you about me, said Param.
Rigg started to answer. He did when he was . . . But then he realized that Father hadn’t been dying, he had just been hiding behind a fallen tree, pretending to be trapped under it. Lying to Rigg.
Rigg covered his eyes with one hand. I still live in the world he built around me. All his teachings and talk, and I don’t know what’s true and what isn’t.
Welcome to adult life, said Loaf.
I’m not an adult, said Rigg.
Really? said Umbo. Well, I think when you’re in charge of yourself, you’re an adult.
Oh, right, scoffed Loaf.
Plenty of full-size grownups don’t do half as well as me and Rigg, thanks, said Umbo.
Again Rigg wanted to know what Umbo had found. What he had in his pocket.
They heard a snorting noise from three rods away. Quietly they spread out to surround it. Rigg looked at Umbo and rolled his eyes. None of the others knew how to walk stealthily. Not that they had to. The beast was making so much noise it couldn’t have heard them.
It was indeed the beast with the barbed feathers, and it was hitting the side of its head against a tree, then scraping the same area on the bark. As Rigg got closer, he could see that he had mud on that side of his head.
Not mud. The thing that looked like mud was actually another creature in its own right. Now that he knew what to look for, he could see its tiny faint path moving through the air right along with the barbfeather’s path the whole time it had been in the woods.
Loaf and Umbo, who had both dealt with animals, were much closer to it now; Olivenko and Param were hanging back. They were city people.
Don’t get too close, said Rigg.
What’s it got on its face? asked Loaf.
My guess is it drank from the stream, said Umbo.
I think so too, said Rigg.
You mean it picked up that parasite? That facemask thing? asked Olivenko.
Whatever it’s got on its head, it’s alive. A separate creature. With its own path.
Every time the beast smacks it or scrapes at it, said Umbo, it gets bigger. Spreads more, I mean. There’s a strand of it going into the poor beast’s ear.
So all the barbfeather’s efforts to get rid of it are actually helping it attach more firmly, said Rigg.
What a clever evolutionary ploy, said Olivenko. Facemasks that could make use of the beating and scraping would have a better chance of survival.
Maybe all the fear and aversion allow the facemask to find the right parts of the brain to attach to in order to get control, suggested Rigg.
You sound so excited, said Param. Has anybody noticed what this means?
That Vadesh wasn’t lying about the parasite, you mean? asked Loaf. That’s obvious.
I mean that we’re totally dependent on Vadesh for our drinking water, said Param.
You know, said Umbo, I’m thinking we ought to be able to find a place to slink back through the Wall and just figure out how to stay alive in our own wallfold.
Let’s see, said Loaf. A land with one dangerous parasite, or a place where thousands of soldiers will be looking for us and everybody else will be happy to turn us over to them in exchange for a reward. He made weighing motions with his hands.
They’re only looking for me and Param, said Rigg. Why don’t the rest of you go back?
And leave us here alone? Param didn’t even try to conceal the panic in her voice.
They’d still catch us, said Loaf. And then torture us till we told them where you were. And since they wouldn’t believe the truth . . .
"I was just saying that you don’t have to stay here, said Rigg. I didn’t claim it would be perfectly safe."
What do we do about this poor animal? asked Param.
Rigg looked at her in surprise. Do?
It’s in so much distress, said Param.
Of course it is, said Rigg. It’s got a parasite sticking to its head that’s trying to invade its brain.
Well, we brought it here, said Param.
I suppose we did, said Rigg. "But it’s from this world and, if Vadesh is telling the truth—and about these facemask things he seems to be—then the parasites are natives here, just like old barbfeather. So if we hadn’t pulled him to now to run into this parasite, he might just as easily have had exactly the same thing happen to him back then."
Except that the world was just about to end for him anyway, said Loaf. "Our ancestors were about to wipe him out along with all his cousins, right? We saved him."
I can see now that he ought to be grateful, said Param.
Look, if you gave him a choice between parasite on his face and dead, what do you think he’d choose? asked Rigg.
"Look what he actually is choosing," said Umbo.
Param nodded but she clearly didn’t like it. Life, she said.
Animals that don’t cling to it no matter what don’t survive long enough to make babies, said Olivenko. We don’t want to die.
Then how do you explain suicides? asked Loaf.
I don’t, said Olivenko.
Wasn’t Father’s death a kind of suicide? asked Param.
It took Rigg a moment to realize that even though Param was his full sister, she wasn’t talking about the man he had called Father—the Golden Man, the Wandering Man, the machine called Ram, who had trained her and Umbo and Rigg in how to use their time-altering talents. She was talking about their real father, whom Rigg had never met: Father Knosso, who had passed unconscious through the Wall on a boat, and then was dragged from the boat and drowned by some kind of manlike sea creatures in another wallfold.
It wasn’t suicide, said Olivenko angrily. As a young scholar in the Great Library he had been Knosso’s friend and assistant. He didn’t intend to die.
No, said Param. But he knew he might, and he threw his life at it as if nothing else mattered. Not me, certainly.
He loved you, said Olivenko.
But he loved his experiment more, said Param.
The barbfeather, Rigg noticed, had stopped beating and scraping its face against the tree. It was turning its gaze toward each one of them who spoke. And it didn’t just turn the eye that wasn’t covered by the facemask. It turned as if it had two good eyes. As if it could still see through the thing.
In the silence after Param’s last few bitter words, the barbfeather trotted straight toward Rigg.
Rigg! shouted Umbo.
It’s coming at you! warned Loaf.
Rigg reached out his hand and the barbfeather stopped and sniffed it. "He wasn’t charging at me," said Rigg.
Keep your hand away! said Umbo. Do you want the facemask to jump over to you?
Vadesh says they can only attach in water. And not after they’ve already attached to . . . something. Rigg had almost said somebody.
So we’re believing everything he says now? asked Umbo.
He didn’t lie about the facemasks, said Rigg. He might be lying about some things, but he’s not lying about that. And he didn’t follow us here, either, or try to prevent us from leaving. Maybe all he really did was lead us to safe water.
Staying suspicious is what keeps me alive, said Loaf. That survival instinct, you know?
I’m for suspicion, too, said Rigg. But at some point you have to place your bet and let it ride.
The barbfeather was still sniffing his hand.
I think he smells himself on my hand, said Rigg. That’s the hand I held against his back as we went through the Wall.
And there’s no reason he should fear the smell of humans, said Olivenko.
The barbfeather abruptly turned its head, pressing the facemask against Rigg’s fingers. Rigg recoiled at once.
Look at your hand! shouted Umbo. Is anything sticking to it?
What do you think, that the facemask just made my hand pregnant? asked Rigg.
They might have more than one way of reproducing, said Umbo. Vadesh said they were adaptable.
Maybe it makes babies on the surface of its skin, said Param, and rubs them off on you.
Or on tree bark, said Olivenko.
Rigg considered this. It felt dryish and a little rough. Like unglazed clay pots. And there is truly, absolutely nothing on my hand. Now let’s get back to the spot we picked and prepare some food.
What do we do about this . . . this . . . what did you call it, Rigg? asked Param.
Barbfeather. Just a descriptive name. And we’re not going to do anything about it.
What if it follows us to our camp? she asked.
If it lies down, don’t snuggle up to it, said Rigg. Those feathers really are barbed.
What do you want me to do, Param, kill it?
Isn’t that what you and your father—I mean Ram—isn’t that what you did with animals?
We killed the ones whose fur we could sell, said Rigg. "Do you want a coat made out of that?"
Gloves, said Loaf. I think Leaky could use gloves like that—for punching some of our customers who drink too much and won’t leave the roadhouse quietly.
They left the barbfeather and set about making camp. But soon it joined them again. Their provisions were meager, but they had been on the road for a while and they were used to them. Rigg offered some of his food to the beast. It sniffed and then wandered away. Must not smell like anything edible to him, Rigg said.
"Doesn’t taste like anything edible to me," said Olivenko.
Wonder how that barbfeather would taste, said Loaf, if we could talk him into climbing into a stewpot for us.
I don’t think our bodies could make much use of his meat, said Rigg, even if we could keep it inside long enough to digest it.
Pretty image while I’m eating, said Param.
I had no idea you were so fussy, said Rigg, with a grin. Param rolled her eyes.
Why couldn’t we eat it? asked Umbo.
When they were testing me to see if I should get access to the library, said Rigg, I met a scientist in Aressa Sessamo who was separating out the plants and animals that came to this world with our ancestors—which is most of them—and the ones that evolved here, which is only a few. Every single one of them, Father and I had already identified as plants and animals that we can’t eat. Even dead, only certain carrion eaters will go after them. It’s as if we had two separate ecologies twined together. Father called them ‘mildly toxic’ and my guess is he knew.
So maybe that parasite can’t use our bodies either, said Olivenko.
But Vadesh says it can, said Rigg.
And yet you touched it, said Param.
Tomorrow let’s go back in time, said Rigg. When we’re rested and fresh. Come on, we passed through the Wall today. People tried to kill you and Umbo not that many hours ago, Param! Can’t we get some sleep?
But when they finally cleaned up supper, laid out their dosses, and took up their sleeping positions, with Loaf on first watch, Rigg couldn’t sleep. Because as soon as he knew what the facemask’s path looked like, he began to find the same kind of path riding along with humans ten thousand years ago. Vadesh was telling the truth—humans had been infested with facemasks.
And the more of them Rigg followed, the more certain he became of a pattern. At first the facemasks had been rare and were never inside the city. Then they came along with humans when they approached the city in large groups. It looked to Rigg like war, or raiding parties.
But abruptly, about five hundred years before the city emptied out, all the facemasks were inside the city, and the only human paths without facemask paths traveling with them were outside the city—again in raiding parties.
The conclusion was obvious to Rigg. Halfway through the history of humans in this city, the ones infested with the facemask parasite became the possessors of the city, and the uninfected people were the ones who lived outside.
And the tallest buildings were not built until the city belonged to the infested ones. Rigg knew this because none of the human paths rose up into the sky inside those towers until the relatively newer ones, the ones with facemask companions.
This is a city whose greatest buildings were erected by people with parasites embedded in their brains.
Now that was something Vadesh might have told them, if he were actually obeying the command to tell them everything. Which meant that he was deceiving them. He must have found some logical loophole in the orders Rigg had given him. Or maybe there was no deep law that required him to obey the first humans to pass through a Wall.
Eventually, exhaustion won and Rigg slept.
From the moment Vadesh walked up to them on this side of the Wall, Umbo had felt a sick dread. Now it was clear to him that passing through the Wall had been a very bad idea. At the time it seemed