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Directly observed treatment short course (DOTS), the global control strategy aimed at controlling tuberculosis (TB) transmission through prompt diagnosis of symptomatic smear-positive disease, has failed to prevent rising tuberculosis incidence rates in Africa brought about by the HIV epidemic. However, rising incidence does not necessarily imply failure to control tuberculosis transmission, which is primarily driven by prevalent infectious disease. We investigated the epidemiology of prevalent and incident TB in a high HIV prevalence population provided with enhanced primary health care.
Methods and Findings
Twenty-two businesses in Harare, Zimbabwe, were provided with free smear- and culture-based investigation of TB symptoms through occupational clinics. Anonymised HIV tests were requested from all employees. After 2 y of follow-up for incident TB, a culture-based survey for undiagnosed prevalent TB was conducted. A total of 6,440 of 7,478 eligible employees participated. HIV prevalence was 19%. For HIV-positive and -negative participants, the incidence of culture-positive tuberculosis was 25.3 and 1.3 per 1,000 person-years, respectively (adjusted incidence rate ratio = 18.8; 95% confidence interval [CI] = 10.3 to 34.5: population attributable fraction = 78%), and point prevalence after 2 y was 5.7 and 2.6 per 1,000 population (adjusted odds ratio = 1.7; 95% CI = 0.5 to 6.8: population attributable fraction = 14%). Most patients with prevalent culture-positive TB had subclinical disease when first detected.
Strategies based on prompt investigation of TB symptoms, such as DOTS, may be an effective way of controlling prevalent TB in high HIV prevalence populations. This may translate into effective control of TB transmission despite high TB incidence rates and a period of subclinical infectiousness in some patients.
Citation: Corbett EL, Bandason T, Cheung YB, Munyati S, Godfrey-Faussett P, Hayes R, et al. (2007) Epidemiology of Tuberculosis in a High HIV Prevalence Population Provided with Enhanced Diagnosis of Symptomatic Disease. PLoS Med 4(1): e22. https://doi.org/10.1371/journal.pmed.0040022
Academic Editor: Mario Raviglione, Stop TB-World Health Organization in Switzerland
Received: May 10, 2006; Accepted: October 30, 2006; Published: January 2, 2007
Copyright: © 2007 Corbett et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: This study was funded by the Wellcome Trust. The funders had no role in the design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: CI, confidence interval; DOTS, directly observed treatment short course; IRR, incidence rate ratios; OR, odds ratio; PAF, population-attributable fraction; TB, tuberculosis; TST, tuberculin skin test; VCT, voluntary counselling and HIV testing; WHO, World Health Organization
Editors' Summary
Around eight million people develop tuberculosis (TB) disease every year and of these nearly two million die. However, many more people are infected than have symptoms; perhaps one-third of the world's population is currently infected with TB. Most people infected with TB have what is termed "latent infection," or in other words they are infected with the bacterium but do not experience any symptoms of disease. Individuals infected with TB who also have a weakened immune system, for example through HIV/AIDS, are much more likely to develop TB disease. In some regions HIV is very common—for example, approximately 11% of sub-Saharan African adults are HIV positive—and because of this cases of TB disease have risen substantially as HIV spreads. The Word Health Organization has a recommended international strategy for control of TB called "DOTS" (Directly Observed Therapy, Shortcourse). Among the five main elements of DOTS are mechanisms for promptly diagnosing and treating people who have TB disease. It is hoped that this strategy will help to reduce the number of new cases of TB diagnosed each year, because individuals promptly diagnosed and treated will then be less likely to transmit the disease to others.
Why Was This Study Done?
In this study the investigators wanted to find out if intensive DOTS, combined with giving people better access to test facilities to diagnose TB disease, could be effective in reducing the spread of TB from one person to another in Africa. It is not clear whether DOTS alone can control the spread of TB in populations with high numbers of HIV-positive people already infected with TB and so at high risk of going on to develop TB disease. Specifically, they wanted to collect data on the number of new TB cases being diagnosed per year and how that related to the proportion of the overall population that had infectious undiagnosed TB at any given point in time. They also wanted to find out whether providing good access to services for diagnosis and treatment of TB would affect either the number of new TB cases or the proportion of a given population that had infectious undiagnosed TB.
What Did the Researchers Do and Find?
This research study was carried out as part of a trial in which two different strategies for providing testing and counseling for HIV in the workplace were being compared. The trial took place within 22 companies in Harare, Zimbabwe, where HIV is very common in the adult population. Along with HIV testing and counseling, the trial provided for close follow-up and testing of anyone presenting with TB-like symptoms, with the aim of detecting as many cases in the population as possible. At the end of the two-year period, all workers were checked for undiagnosed TB disease, and cultures were carried out to find out how many of these people had infectious TB (but who might not necessarily have had symptoms). 6,440 workers were recruited into the study, of whom 19% were HIV positive. During the period of follow-up, 106 cases of TB were seen, and HIV-positive workers were far more likely than HIV-negative workers to experience TB disease. At the end of the study, 4,668 workers were checked for the presence of undiagnosed TB and 27 individuals were found to be affected, but not all of these people experienced any symptoms of disease.
What Do These Findings Mean?
At the end of this study, the proportion of workers found to have undiagnosed TB was fairly low—lower than the level found in other studies carried out in other parts of the world with a high burden of TB disease but low burden of HIV. The researchers therefore concluded that the systems set up within the trial (for close follow-up and testing for TB disease) were an effective way of controlling the overall proportion with infectious TB, even though HIV infection rates were also high. This is likely to mean that the spread of TB infection to others—a prerequisite for achieving TB disease control—was also well controlled. However, more intensive efforts to reduce the risk of TB disease in HIV-positive Africans already infected with TB are also needed, although this study did not aim to find out about the impact of such strategies.
Additional Information.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0040022.
- Information from the World Health Organization on DOTS, the internationally recommended TB control strategy; a factsheet on TB is also available
- The STOP TB Partnership is an international initiative involving several agencies seeking to combat the rise of tuberculosis
- The US National Institute of Allergy and Infectious Diseases also publishes a factsheet for patients
- US Centers for Disease Control, information for patients and professionals about TB
Box 1: Definitions of Prevalent and Incident TB as Used in This Article
Point prevalence of TB: the fraction of people surveyed at any given point in time with active TB (here given as the number of cases per 1,000 population). In this study, patients on TB treatment were not considered to have active TB unless they were culture positive.
Incidence of TB: the rate at which TB develops over time (here given as the number of cases per 1,000 person-years).
Determining incidence requires longitudinal (cohort) studies, whereas cross-sectional (prevalence) surveys are used to determine prevalence.
Tuberculosis (TB) disease can result from either rapidly progressive disease following recent infection with Mycobacterium tuberculosis or from reactivation of latent TB infection. Reactivational disease predominates in countries that have achieved good control of transmission, but most disease in endemic countries is due to recently transmitted infection [1]. Accordingly, directly observed treatment short course (DOTS), the TB control strategy of the World Health Organization (WHO), aims to reduce the burden of prevalent smear-positive TB through prompt diagnosis and effective treatment of symptomatic patients with infectious disease [1]. In theory, successfully reducing point prevalence will lead to falling TB incidence rates as TB transmission goes into decline (see Box 1) [1]. DOTS has had notable success in a number of countries with low HIV prevalence, and world-wide, it is considered one of the most cost effective of all health interventions [2].
Trends are very different in Africa, however, with the HIV epidemic driving rapid increases in TB case-notification rates despite implementation of DOTS [3,4]. A pressing and undetermined question is whether or not DOTS has also failed to contain TB transmission rates [4,5]. This cannot be assumed, as TB incidence would be expected to rise during the course of an HIV epidemic, even if TB transmission rates were in decline, simply because of increased numbers of highly susceptible individuals [4].
Prevalent infectious TB is the direct source of TB transmission events (Box 1). Evidence from South African gold miners suggests that a DOTS-based approach successfully controlled prevalent TB during a severe epidemic of HIV and HIV-related incident TB [5]. These divergent trends between prevalence and incidence were ascribed to much more rapid self-presentation of HIV-related TB, and offer hope that TB transmission rates were also contained [5]. However, gold miners are unusual because of occupational exposure to silica dust, and although the point prevalence of TB was stable, it was high in both HIV-positive and HIV-negative subpopulations [5]. Also, studies among HIV-positive persons attending for voluntary counselling and testing and in home-based HIV/AIDS care patients have consistently reported high rates of undiagnosed prevalent TB [6–8].
The main aims of this study were to investigate the impact of HIV on the point prevalence and incidence of TB, and to investigate the extent to which infectious (culture-positive) prevalent TB can be controlled by ready access to diagnosis and treatment of symptomatic TB disease in a high HIV prevalence population. For logistical and ethical reasons, the study was nested within a cluster-randomised trial comparing two different strategies of providing voluntary counselling and HIV testing (VCT) at 22 different workplaces in Harare, Zimbabwe. Company clinics were the unit of randomisation, and both VCT strategies were linked to the same package of basic HIV care, including isoniazid preventive therapy for HIV-positive, tuberculin skin test (TST)-positive employees [9].
Study Participants and Cohort Follow-Up
Twenty-two small and medium-sized enterprises (100 to 600 employees) in Harare were enrolled between September 2001 and July 2002, and followed up for 2 y at each site. Most were manufacturers. None involved exposure to silica dust or other occupational risk factors for TB, and none provided accommodation. All employees were asked to consent to a baseline questionnaire including questions about smoking, previous TB treatment, and household contact, and to provide blood for HIV testing, with written informed consent. There was no active screening for TB symptoms or disease at enrolment, but employees were informed that diagnosis and management of common adult illnesses, including HIV and TB, could be obtained through their occupational clinic. VCT was available for workers wishing to know their HIV status. Companies were randomly allocated to either company clinic or voucher-based VCT in a cluster-randomised study [9]. Payrolls were checked every 3 mo for loss to employment and new employees.
Company clinics were provided with a project nurse trained in integrated management of common adult illnesses, adapted from WHO guidelines [10]. Patients presenting with cough for 3 wk or more were investigated with three sputum smears and cultures, including one early morning specimen ("spot-morning-spot"), followed by repeat specimens and chest radiography if symptoms persisted after broad-spectrum antibiotics. Employees diagnosed with TB outside the project were asked to report to their project nurse and provide three sputum specimens for smear and culture, with the incentive of household screening. We monitored employer TB notifications, routinely sent by the Environmental Health Department of Harare City Health to notify employers of TB if a workplace address is provided by the patient on registration, and screened workers retiring because of ill health, or off sick for more than 2 wk.
HIV Care
Workers testing HIV positive by VCT were provided with basic HIV care including cotrimoxazole (if in WHO stages 2 to 4) and isoniazid preventive therapy for 6 mo (if the TST ≥ 5 mm, or if previously treated for TB > 2 y earlier) [11]. Active TB was excluded (symptom screening, with chest radiography and TB smears and cultures if symptomatic) immediately before starting isoniazid. (HIV-positive employees were not otherwise routinely screened for tuberculosis.) Antiretroviral therapy (ART) was not widely available in Zimbabwe at the time of this study and was not provided, although referral was made to outside providers.
Prevalence Survey
After 2 y, each workforce was screened for TB using symptoms (cough, fever, hemoptysis, night sweats, and unintentional weight loss) and TB cultures. Three sputum specimens were collected from all participants. Smears and cultures were processed immediately for participants with one or more symptoms. For asymptomatic participants, a single pooled specimen was cultured, with storage of three smears for reading if the pooled culture was positive. Concentrates were stored at −20 °C, and retrieved for redecontamination and repeat culture in case of initial culture contamination. Confidential HIV tests were requested, with the option of VCT. TB suspects (symptoms or positive screening culture) had repeat sputum microscopy, culture, and chest radiography, and were followed until TB was confirmed or excluded.
TB Case Definitions
Incident TB.
Definite TB was defined as compatible illness plus positive smear or growth of M. tuberculosis from two or more sputum specimens, or positive smear or growth of M. tuberculosis from one specimen with suggestive radiological abnormalities and response to TB treatment.
Probable TB was defined as compatible illness with response to TB treatment following failure to respond to broad-spectrum antibiotics. Suspected pulmonary, pleural, or miliary TB was confirmed by radiological response. Radiographs were read by two independent readers. Other forms of extrapulmonary TB were confirmed by clinical response (weight gain and resolution of symptoms within 2 mo).
A number of patients were diagnosed and started on TB treatment by outside providers. TB clinic records, sputum smear results, and radiographs were used to apply case definitions, but cultures were not usually obtained before treatment was started. For the purposes of analysis, we have assumed that such patients were culture positive if smear positive, and culture negative if smear negative.
Prevalent TB.
Case definitions could not be met on the basis of prevalence screen results alone: additional evidence of TB from follow-up investigations was required, such as confirmatory positive smears or cultures, or radiological evidence of TB. Patients taking TB treatment were not considered to have active TB unless they were still culture positive. Screening (not follow-up) results defined smear and culture status for the point prevalence estimates.
Definite TB was defined as growth of M. tuberculosis from two or more sputum specimens, or from one specimen together with suggestive radiological abnormalities.
Probable TB was defined as compatible radiological features, with response to TB treatment within 2 mo following failure to respond to broad-spectrum antibiotics.
Laboratory Methods
Decontamination with 4% NaOH and Lowenstein-Jensen (LJ) slopes were used for TB culture. M. tuberculosis was speciated by colonial morphology and failure to grow at room temperature and at 45 °C, and on PNB-containing LJ slopes. Both negative and positive controls were routinely included in each batch of cultures. Concentrated smears were stained with auramine O and read by fluorescence microscopy by two readers. Only smears subsequently confirmed with Ziehl-Neelsen staining were reported as positive.
Confidential HIV serology used Determine (Abbott Diagnostics, http://www.abbottdiagnostics.com), with all positives and 10% of negative specimens being confirmed by Unigold (Trinity Biotech, http://www.trinitybiotech.com) for serum specimens. Dried blood spots or oral mucosal transudate were collected from participants not willing to provide serum, and were tested using Determine/Vironostika and OraQuick/Vironostika (OraQuick, Abbott Diagnostics; Vironostika, bioMérieux, http://www.biomerieux.com), respectively.
Ethical Approval
Approval was granted by the Ethics Committees of the London School of Hygiene and Tropical Medicine, Biomedical Research and Training Institute, Harare, Zimbabwe, and Medical Research Council of Zimbabwe, Harare, Zimbabwe. Written informed consent was provided by all participants. All information obtained from participants was kept confidential. Individual medical records were stored in locked cupboards at the respective company clinics. At the end of the study period, medical records were made available to remaining clinic staff, if shared confidentiality was requested by the employee, to enable ongoing care; otherwise medical records were removed.
Data Analysis
Data were captured using EpiInfo 2002 (Centers for Disease Control and Prevention, http://www.cdc.gov/EpiInfo) and analyzed with Stata 7.0 software (http://www.stata.com).
Follow-up of each workforce started when TB diagnosis became available at company clinics and continued for 2 y. Follow-up for any given employee was from the later of either the date that workforce follow-up started or the date of joining the workforce, until the earlier of either the date that workforce follow-up stopped or the date of leaving the workforce. The prevalence survey started the day after follow-up finished at each site, and so prevalent cases were not included in the incident cohort analysis. Sixty-one participants were HIV negative at baseline, but HIV positive at the prevalence survey. None had incident or prevalent TB. Their data are analyzed as HIV negative for the incidence cohort and HIV positive for the prevalence survey.
Poisson regression and logistic regression were used for multivariate analysis of the cohort and cross-sectional data, respectively. Adjusted odds and rate ratios were used to calculate adjusted population-attributable fractions (PAFs) [12]. Robust confidence intervals (CIs) were used to adjust for clustering by site. Bootstrapping was used to calculate 95% confidence limits for disease duration estimates based on the ratio of prevalence and incidence of TB, and for disease duration ratios [5].
Participation rates are shown in Figure 1. Baseline characteristics of the 6,440 participants are shown by HIV status in Table 1. HIV prevalence was 19%. HIV-positive workers were more likely to have been treated for TB in the past (11% versus 2%, p = 0.027), to have had household contact with a TB patient (22% versus 15%, p < 0.001), and to be middle aged (p = 0.01). They were also more likely to be current or former smokers and to be manual workers (p < 0.001 for both). Workforce turnover was higher for HIV-positive than HIV-negative workers, with 69% and 78%, respectively, remaining in the workforce at the end of follow-up (p < 0.001).
HIV-ve, HIV negative; HIV+ve, HIV positive.
Baseline Characteristics
Incidence of TB Disease
A total of 106 patients with definite or probable TB occurred during cohort follow-up, of whom 61 (58%) were smear or culture positive. An additional 11 patients were treated for TB that did not meet case definitions. Overall TB incidence was 9.9 (95% CI = 7.8 to 12.9) per 1,000 person-years follow-up for all definite and probable disease. A breakdown of incidence rates by HIV status and smear and culture category is shown in Table 2 and Figure 2. Univariate- and multivariate-adjusted incidence rate ratios (IRRs) and PAFs for all TB cases and for culture-positive TB disease are shown in Table 3.
TB Incidence Rates (per 100,000 Person-Years Follow-Up), TB Point Prevalence per 100,000 Population, and HIV Rate Ratios for Incident and Prevalent TB
Columns are divided into smear-positive (dark portion) and smear-negative culture-positive TB (light portion).
Risk Factors for Incident and Prevalent TB: Multivariate-Adjusted IRRs and ORs, and Population Attributable Fractions
Incidence and risk factors for culture-positive TB disease.
The incidence of culture-positive TB was significantly higher in HIV-positive than HIV-negative participants (overall rates, 25.3 and 1.3 per 1,000 person-years follow-up, respectively; univariate IRR = 20.0 (95% CI = 10.5 to 38.0). Previous TB treatment (IRR = 3.6; 95% CI = 1.9 to 6.9), male sex (IRR = 4.0; 95% CI = 0.9 to 17.8), being a current or former smoker (IRR = 1.9; 95% CI = 1.2 to 3.0), older age (IRR = 1.2 per group above 16 to 24 y; 95% CI = 1.1 to 1.3), manual job type (IRR = 1.3; 95% CI = 1.04 to 1.6), and having been a household contact of a TB patient (IRR = 2.3; 95% CI = 1.1 to 5.0) were each significantly associated with an increased rate of culture-positive TB.
However, there was considerable confounding by HIV, and on multivariate analysis, only HIV (adjusted IRR = 18.8; 95% CI = 10.3 to 34.5) and male sex (adjusted IRR = 4.4; CI = 1.0 to 19.8) remained significant (Table 3). Adjusted PAFs are also shown in Table 3, with the highest fractions (78% and 75%, respectively) being for HIV infection and male sex.
Prevalent TB Disease
A total of 4,668 cohort participants (874 HIV positive and 3,794 HIV negative) were screened for prevalent TB at the end of follow-up. The participation rate for employees remaining in employment was 96%. Active TB was detected in 27 participants, giving a workforce point prevalence of 5.8 per 1,000 for all TB, and 3.2 and 1.3 per 1,000 for culture-positive and smear-positive TB, respectively.
A breakdown of prevalence by HIV status and smear and culture category is shown in Table 2 and Figure 2. A high proportion of patients with prevalent TB had subclinical disease at the time of screening, with 11 (41% of all prevalent cases and 73% of culture-positive cases) detected only through screening culture. Symptoms had developed in all but two by follow-up.
Univariate- and multivariate-adjusted odds ratios (ORs) are shown in Table 3, together with PAFs for variables included in the multivariate models. HIV infection was a significant risk factor for prevalent TB (unadjusted OR = 4.1; 95% CI = 1.9 to 8.9), as were smoking (unadjusted OR = 3.6; 95% CI = 1.5 to 8.8), and older age (unadjusted OR = 1.2 per category above 16 to 24 y; 95% CI = 1.05 to 1.4). Previous TB treatment was not a significant risk factor for prevalent TB in either univariate or multivariate analysis (PAF = 3% in both analyses).
Risk factors for prevalent culture-positive TB disease.
Statistical power was limited by the small numbers, but there were no significant risk factors for prevalent culture-positive TB. The adjusted odds ratio and PAF for HIV infection were 1.7 (95% CI = 0.5 to 6.8) and 14%, respectively.
Duration of disease before TB diagnosis.
The ratio of prevalent to incident TB provides an estimate of mean duration of disease before diagnosis (a measure of the case-detection rate) [5]. Precision was limited by small numbers, but duration was significantly shorter for HIV-related TB, with mean duration of smear positivity of 6 wk, and of 12 wk for culture positivity. This compares with 53 and 108 wk, respectively, for HIV-negative TB. The ratio of duration for HIV-positive compared to HIV-negative TB was 0.12 (95% CI = 0 to 0.70) for smear positivity and 0.11 (95% CI = 0.02 to 0.37) for culture positivity (Table 4).
Indirect (Point Prevalence Divided by Incidence) Estimates of Duration of Infectiousness before Diagnosis of TB Disease, According to HIV Status
Effect of VCT, Isoniazid Preventive Therapy, and HIV Care on TB Epidemiology
In addition to facilitated diagnosis, employees were provided with VCT linked to isoniazid preventive therapy. A total of 403 (33%) HIV-positive workers had VCT during the course of the study, and so became eligible for HIV care, and 75 (6% of all HIV-infected employees) received isoniazid. The main factor limiting isoniazid delivery was a low rate of tuberculin positivity (25% of TST-tested HIV-positive participants), as reported elsewhere in Africa [13–15]. TB was diagnosed in eight employees (9% of all incident TB cases in HIV-positive employees) as the result of preisoniazid screening. The potential impact of the HIV care program on incident and prevalent TB was, therefore, limited (employees were not screened for active TB unless they were TST positive or otherwise eligible for isoniazid) and is not considered here because of the statistical complexities of including an intervention delivered through a cluster-randomised trial design. Similarly, antiretroviral therapy is known to affect TB incidence [16], but was only accessed by 21 employees during this study, and so is not considered in the analysis.
The results of this study suggest that passive case finding and treatment, the cornerstone of global TB control, may still be an effective way to control prevalent TB in high HIV prevalence populations, even when control of TB incidence has been apparently unsuccessful. This has major implications for TB control prospects, as it supports an approach whereby DOTS retains the essential role of controlling TB transmission rates, with the addition of integrated HIV/TB care aimed at providing individual protection from the very high risks of TB morbidity and mortality that are a striking feature of HIV disease in TB endemic areas [4]. The overall point prevalence of smear-positive TB after 2 y of easy access to diagnosis was 1.3 per 1,000 population in this study. This is considerably lower than most other reports of adult and whole-population point prevalence estimates from Africa [5,17–25] and Asia [26–34], and below the burden in Africa [17] in the pre-TB treatment era (Figure 3). Although this may in part reflect a "healthy worker" effect in this study, the high HIV prevalence of 19%, our inclusion of all employees who were on sick-leave during the prevalence survey, and the high TB incidence rates argue against this as the sole effect. Of note, our study population was predominantly male and middle-aged, both of which are strong risk factors for prevalent TB disease in other settings [26–29].
Bars are divided into smear-positive (dark portion) and smear-negative culture-positive TB (light portion). Not all studies used cultures, so only the prevalence of smear-positive disease is shown for these. Italic text indicates the current study results (HIV-positive participants, HIV-negative participants, and overall symptomatic burden). Otherwise, data were extracted from references [5,17–25] (Africa) and [26–34] (Asia). Ranking is by point prevalence of smear-positive disease. Whole-population estimates are typically 30%–50% lower than adult point prevalence estimates, because point prevalence of TB is negligible in children. Adult prevalence is shown whenever possible.
* Methodology varied, but studies in which asymptomatic participants were screened for disease are included in the top half of the graph, whereas the bottom half shows results from studies in which only participants reporting one or more TB symptoms were screened further, with comparable results for symptomatic TB from the current study.
A low point prevalence of infectious TB is likely to be associated with low TB transmission rates. In this respect, the very low point prevalence of symptomatic infectious TB (0.9 per 1,000 population for culture-positive TB) is also notable. Symptomatic TB disease developed within a few weeks in all but two of the initially asymptomatic patients detected through the prevalence survey. Patients with subclinical TB have been consistently reported from previous prevalence surveys [27,30,35,36], and present a particular challenge to delivery of preventive therapy because they are at high risk of being inadvertently considered disease-free and so started on preventive therapy, usually a single drug. The high proportion of subclinical cases in this prevalence survey may reflect the unusually good access to investigation of TB symptoms with sensitive smears and culture. Infectiousness may be low in relatively asymptomatic patients, since coughing is important in TB transmission, and so control of secondary TB transmission events may be even better than is implied by the overall point prevalence estimates.
The results of this study are consistent with our previous finding in South African gold miners that HIV has a less pronounced impact on the point prevalence of active TB disease than on TB incidence rates, at least in the context of ready access to diagnosis of symptomatic TB [5]. The standard finding among HIV-negative persons that the burden of prevalent TB disease exceeds the annual TB incidence rate was reversed among our HIV-positive participants (Figure 2). This may be an intrinsic feature of HIV-related TB, due to rapid progression of TB disease and early onset of symptoms resulting in more rapid case finding as the duration of disease before diagnosis was significantly shorter for HIV-positive than HIV-negative TB patients in this and in the South African study [5]. Future studies are now needed to establish whether this relationship holds when access to diagnosis is more limited, and whether it can be replicated without use of culture and sensitive microscopy as first-line investigations.
As in South Africa [5], most patients in this study with prevalent smear- or culture-positive TB were HIV negative, and overall point prevalence predominantly reflected control in the HIV-negative subpopulation. In the current study, only 33% of patients with prevalent culture-positive TB were HIV positive compared to 82% of those with incident culture-positive TB, and the adjusted PAFs for HIV were much lower for prevalent than incident culture-positive TB (14% and 78%, respectively). Prevalent smear-positive TB is the primary driving force of TB transmission, and the finding that the impact of HIV on prevalent smear-positive TB is relatively modest is consistent with the finding that DOTS appears to have been more successful in controlling TB transmission than TB incidence rates in some high HIV prevalence countries [37–39].
The HIV diagnosis and care provided during the study may have contributed to rapid diagnosis of TB. Once diagnosed, HIV-positive workers were offered regular 3-monthly follow-up, and were treated for latent TB infection if they were tuberculin positive. However, only 23% of HIV-positive TB patients had VCT before their TB diagnosis, and TB incidence rates remained high despite the intervention. This was anticipated [40]. We have not considered the effects of isoniazid preventive therapy, administered during the course of the study, or antiretroviral therapy, because of the low coverage and complexity of adjusting for these effects. One other limitation is that capture of incident TB cases may have been incomplete, so that TB incidence may have been underestimated.
The power to identify risk factors for prevalent TB was limited by the success of the intervention, leading to low point prevalence, but HIV infection and smoking were of borderline significance on multivariate analysis when all TB cases (including culture negative) were included. Smoking has been identified as an important cause of morbidity and mortality from TB in India [41], but in this study the effect of smoking was less marked and was nonsignificant once adjustment for confounding with HIV status was made. Previous TB treatment, a major risk factor for prevalent TB disease in the pre-DOTS era [42], was not a significant risk factor for prevalent TB disease in this population, although we relied on self-reporting and so may have had incomplete capture.
In summary, we have demonstrated that a strong program based on case finding and treatment of self-presenting TB patients was associated with a burden of prevalent infectious TB disease well below annual TB incidence rates in this high HIV prevalence population. Most patients with prevalent smear- or culture-positive TB were HIV negative and asymptomatic at the time of screening, as previously reported from a similar study in South Africa [5]. This underscores the importance of including HIV-negative individuals in intensified TB control efforts. There has been a growing consensus that efforts to control TB in Africa need to be intensified [4,43,44]. The new global TB control strategy, the Global Plan to Stop TB 2006–2015, emphasises the need to apply existing diagnostic techniques, such as culture and sensitive microscopy techniques as used in this study, as well as the need to develop new diagnostic tools and expand joint TB/HIV activities [43]. Mathematical modelling suggests that better case finding and treatment for infectious TB will be among the most effective and cost-effective interventions [45,46]. Given the already brief duration of HIV-related TB disease before self-presentation, the added value of routine periodic screening for asymptomatic TB among known HIV-positive persons needs to be determined [4,43]. It will also be important to investigate the impact of antiretroviral therapy on the subclinical period of infectiousness among HIV-positive TB patients [4]. If generalisable, the current study results imply that well-implemented, intensified case finding and treatment may prove capable of reducing TB incidence in high HIV prevalence settings in the long term, despite the disappointing short-term response [4,44], if applied widely and intensively enough to maintain low levels of prevalent infectious TB for a sufficiently prolonged period.
ELC had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We thank the project nurses, data and laboratory teams, and all participants. Harare City Health managed the TB patients and provided access to records and radiographs required for TB case definitions.
Author Contributions
ELC, SM, RH, GC, and AB designed the study. ELC, TB, YBC, SM, PGF, RH, and AB analyzed the data. ELC, TB, YBC, SM, PGF, RH, GC, AB, and PM contributed to writing the paper. PM was responsible for all of the laboratory data and for ethical approval and monitoring of ethical issues regarding patients.
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- 11. World Health Organisation UNAIDS (1999) Preventive therapy against tuberculosis in people living with HIV. Wkly Epidemiol Rec 74: 385–398.
- 12. Greenland S, Drescher K (1993) Maximum likelihood estimation of the attributable fraction from logistic models. Biometrics 49: 865–872.
- 13. Mwinga A, Hosp M, Godfrey-Faussett P, Quigley M, Mwaba P, et al. (1998) Twice weekly tuberculosis preventive therapy in HIV infection in Zambia. AIDS 12: 2447–2457.
- 14. Whalen CC, Johnson JL, Okwera A, Hom DL, Huebner R, et al. (1997) A trial of three regimens to prevent tuberculosis in Ugandan adults infected with the human immunodeficiency virus. Uganda-Case Western Reserve University Research Collaboration. N Engl J Med 337: 801–808.
- 15. Hawken MP, Meme HK, Elliott LC, Chakaya JM, Morris JS, et al. (1997) Isoniazid preventive therapy for tuberculosis in HIV-1-infected adults: Results of a randomized controlled trial. AIDS 11: 875–882.
- 16. Lawn SD, Badri M, Wood R (2005) Tuberculosis among HIV-infected patients receiving HAART: Long term incidence and risk factors in a South African cohort. AIDS 19: 2109–2116.
- 17. Roelsgaard E, Iversen E, Blocher C (1964) Tuberculosis in tropical Africa: An epidemiological study. Bull World Health Organ 30: 459–518.
- 18. Beyers N, Borgdorff M, Jithoo A, Lawrence KA, Gie R, et al. (2003) The prevalence of tuberculosis in a high incidence area in the Western Cape, South Africa. S Afr Respir J 9: 123.
- 19. Demissie M, Zenebere B, Berhane Y, Lindtjorn B (2002) A rapid survey to determine the prevalence of smear-positive tuberculosis in Addis Ababa. Int J Tuberc Lung Dis 6: 580–584.
- 20. Guwatudde D, Zalwango S, Kamya MR, Debanne SM, Diaz MI, et al. (2003) Burden of tuberculosis in Kampala, Uganda. Bull World Health Organ 81: 799–805.
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- 24. 2003 Rapid assessment of tuberculosis in a large prison system—Botswana, 2002.. MMWR Morb Mortal Wkly Rep 52 250 252
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- 31. National Tuberculosis Institute B (1974) Tuberculosis in a rural population of South India: A five-year epidemiological study. Bull World Health Organ 51: 473–488.
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- 35. Churchyard GJ, Charalambous S, Moloi V, Fielding K, Day J, et al. (2002) Population based screening for active tuberculosis in a community with endemic TB. 33rd World Conference on Lung Health, 2002, Montreal, Canada. Int J Tuberc Lung Dis 6: S41.
- 36. Marais BJ, Obihara CC, Gie RP, Schaaf HS, Hesseling AC, et al. (2005) The prevalence of symptoms associated with pulmonary tuberculosis in randomly selected children from a high burden community. Arch Dis Child 90: 1166–1170.
- 37. Tanzania Tuberculin Survey Collaboration (2001) Tuberculosis control in the era of the HIV epidemic: Risk of tuberculosis infection in Tanzania, 1983–1998. Int J Tuberc Lung Dis 5: 103–112.
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- 39. Glynn JR, Crampin AC, Ngwira BM, Mwaungulu FD, Mwafulirwa DT, et al. (2004) Trends in tuberculosis and the influence of HIV infection in northern Malawi, 1988–2001. AIDS 18: 1459–1463.
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- 44. De Cock KM, Chaisson RE (1999) Will DOTS do it? A reappraisal of tuberculosis control in countries with high rates of HIV infection. Int J Tuberc Lung Dis 3: 457–465.
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- 46. Currie CS, Floyd K, Williams BG, Dye C (2005) Cost, affordability and cost-effectiveness of strategies to control tuberculosis in countries with high HIV prevalence. BMC Public Health 5: 130.


text: On 1 Aug 2002, Bill Rankin wrote: > Good morning, > > I have a bunch of nodes that I am trying to kickstart install and I am > having some slight difficulties. > > The nodes are Tyan-2466s w/ Intel E1000 GigE cards and a cheap AGP video > card. > > The machines come up just fine with a RedHat 7.3 boot disk image > (bootnet.img) using the on-board NIC. The problem is that I want to > configure them to boot and install over the E1000 so I can just > kickstart them at any time without swapping around network cables (the > E1000 will be the only live interface in the final configuration). > > I ripped apart the bootnet image and added the e1000.o file to the > module directory (compiled and tested on a working machine), but the > node would not recognize it on boot. > > Does anyone have experience with attempting this? > > Any advice would be greatly appreciated. Thanks, > > -bill > > There's a PCI device table listing in the boot image somewhere. you'll have to update it with the PCI vendor string and which module to use. -- Rocky McGaugh Atipa Technologies rocky at atipatechnologies.com rmcgaugh at atipa.com 1-785-841-9513 x3110 http://1087800222/ perl -e 'print unpack(u, ".=W=W+F%T:7\!A+F-O;0H`");'

subset: commoncrawl


text:
Picking up steam
Mashing modern days with the Victorian age excites role players, artists, and other fans of steampunk
When Bruce and Melanie Rosenbaum bought a 1901 home in Sharon, they wanted to restore it top to bottom. And rather than force a modern interior design, they remodeled it with a Victorian twist.
In the kitchen, an antique cash register holds dog treats. A cast iron stove is retrofitted with a Miele cooktop and electric ovens. In the family room, a wooden mantle frames a sleek flat-screen TV, and hidden behind an enameled fireplace insert, salvaged from a Kansas City train station, glow LED lights from the home-entertainment system.
Unknowingly, the Rosenbaums had "steampunked'' their home, that is, added anachronistic (and sometimes nonfunctioning) machinery like old gears, gauges, and other accoutrements that evoke the design principles of Victorian England and the Industrial Revolution.
"When we started this three years ago, we didn't even know what steampunk was,'' said Bruce, 48. "An acquaintance came through the house and said 'You guys are steampunkers.' I thought, 'Wow, there's a whole group out there that enjoys blending the old and new.''
It's not just the Rosenbaums cobbling together computer workstations from vintage cameras and manual typewriters. Local enthusiasts are mounting steampunk exhibits, writing books, creating objets d'art, and dressing up in steampunk garb for live-action role playing games.
To be sure, steampunk has been part of the cultural conversation for the past several years, as DIY-ers embraced the hand-wrought, Steam Age aesthetic over high-tech gloss. But recently, it seems to be gaining a wider appeal, especially here.
"Boston lends itself to steampunk,'' said Kimberly Burk, who researched steampunk as a graduate student at Brandeis. "You have the MIT tinkerers, the co-ops in JP, the eco-minded folks.''
Both a pop culture genre and an artistic movement, steampunk has its roots in 19th- and early-20th-century science fiction like Jules Verne's "20,000 Leagues Under the Sea'' and H.G. Wells's "The Time Machine.'' Its fans reimagine the Industrial Revolution mashed-up with modern technologies, such as the computer, as Victorians might have made them. Dressing the part calls for corsets and lace-up boots for women, top hats and frock coats for men. Accessories include goggles, leather aviator caps, and the occasional ray gun. And there's a hint of Sid Vicious and Mad Max in there, too.
Still, steampunk defies easy categorization. It can be something to watch, listen to, wear, build, or read, but it's also a set of loose principles. Steampunk attracts not only those who dream of alternative history, but those who would revive the craft and manners of a material culture that was built to last.
"The acceleration of the present leaves many of us uncertain about the future and curious [about] a past that has informed our lives, but is little taught,'' said Martha Swetzoff, an independent filmmaker on the faculty of the Rhode Island School of Design who is directing a documentary on the subject. "Steampunk converses between past and present.''
It also represents a "push back'' against throw-away technologies, Swetzoff said, and a "culture hijacked by corporate interests.''
For Burk, steampunk is more akin to the open source software movement than a retro-futuristic world to escape into. "Steampunk isn't about how shiny your goggles are,'' she said. "It's about how cleverly you create something.''
The urge to rescue and repurpose forgotten things led the Rosenbaums to spread the steampunk gospel. They've founded two companies: Steampuffin and ModVic, which infuse and rework 19th-century objects and homes with modern technology. They're working on a book about the history of steampunk design. And, hoping some steampunker might want to live in a pimped-out Victorian crib, they purchased a second home in North Attleboro, restored it using their "back home to the future'' philosophy, and put it on the market.
Bruce is also curating two steampunk exhibits. One will be displayed at Patriot Place's new "20,000 Leagues'' attraction, an "hourlong, walk-though steampunk adventure,'' scheduled to open in December, according to creator Matt DuPlessie.
Meanwhile, "Steampunk: Form and Function, an Exhibition of Innovation, Invention and Gadgetry'' recently opened at the Charles River Museum of Industry and Innovation in Waltham, a former textile mill already filled with steam engines and belt-driven machines.
"Form and Function'' includes a juried show of steampunked objects (many by local artists) like a steam-electric hybrid motorcycle called "the Whirlygig,'' an electric mixer powered by a miniature steam engine, and a flash drive made with brass, copper, and glass. Perhaps the most impressive piece is a rehabbed pinball machine whose guts look like Frankenstein's lab — down to the colored fluids bubbling through vintage glass tubes.
"I like giving things a new life,'' said Charlotte McFarland of Allston, exhibiting her first-ever steampunk creation, "Spinning Wheel Generator.''
Such functional art objects tap into a nostalgia for a mechanical, not electronic, age. Unlike the wireless signals, microwaves, and motherboards of today, the 19th century's gears, pistons, and tubes were visible and visceral. While the workings of a laptop can seem impenetrable, we can fathom the reality of moving parts.
"As the world becomes more digital, the world less and less appreciates machines, which will be lost,'' said Elln Hagney, the museum's acting director. "We are trying to train a new generation to appreciate this and keep these machines running.''
Some of the most committed local steampunkers dress up in period garb and take part in live-action role playing games. Most "LARPs'' (think Dungeons & Dragons but in costume) are swords and sorcery-based, but Boston's Steam & Cinders is one of only a couple of steampunk-themed LARPs anywhere.
Once a month, some 100 players gather for a weekend at a 4-H camp in Ashby. The game's premise? A crashed dirigible has stranded folks at a frontier town called Iron City, next to a mysterious mine. Engineers, grenadiers, and aristocrats vie for supremacy. There are plenty of robots to fight (players dressed in cardboard costumes sprayed with metallic paint), and potions to mix (appealing to the mad scientist in us all). Players stay in character for 36 hours straight.
"Yes, it's a fantasy world and it's not England,'' said Steam & Cinders founder Andrea DiPaolo of Saugus. "But getting to dress in British garb and speak in a British accent is something I enjoy.''
Meanwhile, publishers are striking while the steampunk iron is hot.
"We can tap into the enthusiasm of a reader who can imagine an alternative version of the 19th century,'' said Cambridge resident Ben H. Winters, author of this summer's mash-up book "Android Karenina.''
Winters steampunked Tolstoy's novel by re-envisioning Anna Karenina in a 19th-century Russia with robotic butlers, mechanical wolves, and moon-bound rocket ships. Sample line: "When Anna emerged, her stylish feathered hat bent to fit inside the dome of the helmet, her pale and lovely hand holding the handle of her dainty ladies'-size oxygen tank . . .''
"Hopefully,'' explained Winters, who also wrote 2009's "Sense and Sensibility and Sea Monsters,'' "we'll be adding to the fandom of the mash-up novel by introducing a new fan base: the sci-fi crowd.''
Climb to Bruce Rosenbaum's third-floor study and you feel as if you've entered one of those mash-ups. The attic space feels like a submersible, packed with portholes, nautical compasses, and a bank vault door. His desk is ornate and phantasmagorical, ringed with pipes from a pipe organ. It's a place where you can imagine Captain Nemo banging out an ominous dirge.
"There's freedom with steampunk,'' Melanie added. "Almost anything goes.''
Ethan Gilsdorf is the author of "Fantasy Freaks and Gaming Geeks: An Epic Quest for Reality Among Role Players, Online Gamers, and Other Dwellers of Imaginary Realms,'' now in paperback. He can be reached at ethangilsdorf.com.


text:
Aldo Moro was the leader of the Christian Democratic Party in Italy. In 1978 he was kidnapped and eventually murdered by Communist terrorists called the Red Brigades, who were then in the midst of a terror spree that included numerous assassinations. Moro's murder is said to have had a traumatic impact on Italy's politics not unlike the impact the assassination of John Kennedy had in the U.S.
Now, twenty-five years later, the "truth" about Moro's murder is finally coming out. The photo below is from a new Italian movie called, in English, "The Plaza of the Five Moons." The actor on the left is Donald Sutherland. As reported by the Associated Press, the movie "expounds a sensational conclusion: both the American CIA and the Soviet KGB were behind the kidnapping, united in blocking the prospect of a 'historic compromise' under which Catholics would have worked shoulder-to-shoulder with Communists."
Well, it isn't any stupider than the conspiracy theories about the Kennedy assassination. It is striking that in both cases, the murders were done by self-proclaimed Communists. But this hasn't stopped leftists from fantasizing conspiracy theories in which the murderous Communists are transformed into the innocent victims of the conspiracy.
The AP says that "The Plaza of the Five Moons" is being billed as a "docudrama" and was "financed by Britain, France, Germany and Italy."
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"Arise and take our stand for freedom as in the olden time." Winston Churchill
"Proclaim Liberty throughout All the land unto All the Inhabitants Thereof." Inscription on the Liberty Bell


text:
R.U.S.E. is a one-of-a-kind real-time strategy game that allows players to bluff their enemies to lead their nation to victory, controlling the action using views that range seamlessly from the heart of the battlefield to the full theatre of war. Players will be plunged into the action thanks to the exclusive IRISZOOMTM Engine which offers an intuitive interface that allows for smooth, rapid transitions from a birds-eye view of the entire conflict, down into the heat of the battle and vice versa.
Multiplayer betas are an opportunity for developers to iron out the kinks based on gamer feedback. But in the case of Ubisoft's upcoming World War II RTS R.U.S.E., "massive" feedback told the developer it doesn't just need an iron, it needs an entire tool kit. Read More »
Ubisoft and developer Eugen Systems have officially announced a new IP in the form of R.U.S.E. This "one-of-a-kind" real-time strategy title will arrive on PC, PlayStation 3 and Xbox 360 sometime during fiscal year 2009/2010 and the PC version will be optimized for the latest Intel Core i7 processors. Read More »
You've probably read the official announcement by now: The Eugen-developed, Ubisoft-published R.U.S.E. will shake the RTS's foundations with its combination of high-tech and ingenious design. It's the same thing we hear whenever a publisher announces an RTS game that doesn't play like Total War, Company of Heroes or StarCraft, and the point is typically always the same: "Our game will actually work on consoles." I suppose a few have come close, but none close enough. R.U.S.E., which is also coming out on PC, has a fighting chance, at least based on what I saw earlier this week during a demo hosted by Ubisoft. It's set in World War II, and looks like it operates a world apart from other games like it. What follows are three reasons why it may actually work. Read More »
Also known as: Ruse, R.U.S.E. The Art of Deception
Also available on: PlayStation 3, PC


text:
Summary: In recent years, nuts have received considerable attention as one of the foods that have beneficial effects for cardiovascular health. As a measure to curb post harvest losses of peanuts, its development into spread and butters have gained much recognition, thus, the research to improve this product development.
Food Research Institute is located Adjacent to Ghana Standards Authority, Near Gulf House, Tetteh Quarshie Interchange, Accra, Ghana. We are open to the general public from Monday to Friday 7:30am - 5:00pm, excluding holidays. If you need any additional information or have a question, please contact us on 0302-519091/+233-243302980 or email us at firstname.lastname@example.com or email@example.com.


text:
Powerful tornado strikes Gloucester: Three dead; Page Middle School devastated
The storm, which struck around 7 p.m., caused at least three deaths and profound damage in Gloucester. A large portion of Page Middle School, about 10 school buses and an undetermined number of homes were destroyed. Trees were down in large swaths along Hickory Fork and Cedar Bush roads.
The freakish nature of the tornado became apparent as miles of roadside appeared undisturbed, every lawn ornament and dogwood blossom in place in front yards. Turning a bend in the road, one would suddenly come upon rows of homes with pine trees through the roofs, alleys of pines snapped off and pushed from the roadsides…and on some home sites, everything gone down to the foundations.
Names of the dead were not released as of Sunday morning, although Sheriff Steve Gentry had scheduled a press conference at noon at Gloucester High School to discuss the disaster and the county's response to it.
Gazing at the foundations of the home, commercial shop and garage on his property on Cedar Bush Road, Roger Hogge, 45, bandaged and limping, with his arm in a sling, said, "I'm so happy. You just don't know."
That is because he, his 13-year-old son Jesse, and fiancée Lisa Vandyke were in the eye of the tornado, huddled together in the bathtub as it approached. One minute later, everything was gone.
"We were at home, watching TV, and the satellite dish went out because of the rain," Hogge said Sunday. "The wind stopped. It was the calm before the storm.
"My girlfriend said the sky was green and that she had always heard that if a tornado is coming, the sky will turn green.
"She stood up and looked out the window and said 'Oh my God,' said the sky was black and spinning. My kid heard it, he came and ran to the window and said 'Oh my God,' and then I went to the window and saw the trees blowing. Then I saw the whole tornado coming. I saw shingles and roofs and trees and limbs 200 feet up in the air," Hogge said.
"I said 'get in the bathroom now' and we got in the tub, the three of us. I was thinking it would blow by but you could hear it coming. It was just like a train, like they say.
"All of a sudden we felt the wind, the pressure on the house and on our ears. About that time it felt like the house slipped about a foot off the foundation and then stopped.
"Then all hell broke loose. We went around four or five times, from the tub to the ceiling to the walls to the tub, glass breaking, white powder from the sheetrock in the air."
The bathroom then came to an abrupt stop, Hogge said. The ordeal had lasted about 20 seconds but "it seemed like 20 minutes. It was the longest, scariest ride I've ever been in. Busch Gardens has nothing to compare.
"As soon as we stopped, my son was headed out the door … or the opening of the house. I was behind him. He said, 'Where's Lisa?' and I said, 'I don't know.' She was still in the tub, bleeding; and my son was cut bad on his hand.
"We got to her and she said she couldn't get out. It took us a minute or two to get her to her feet, and we stomped through all that glass barefoot and never got a cut," Hogge said.
The bathroom end of the house was the only piece left intact. It had flipped over several times and come to a rest against the trees. When they got outside, and dark had fallen by then, the yard was laid bare and was full of waste.
"We got in the truck. The road was blocked by trees both ways. We got out and walked to our neighbors' house" and by good fortune, two nurses were having dinner there and attended to the injuries sustained by all three.
Hogge, his son and Vandyke were finally able to get in touch with emergency help and learned that their area was in the eye of the trouble. Eventually they were taken to Riverside Walter Reed Hospital for CT scans and x-rays. "Everybody at Walter Reed were angels to us," Hogge said. "Lisa has a concussion, my son has cuts and a fractured ankle, and my shoulders and ankle are messed up."
But looking at the foundation where his house had sat, where the 50x75-foot commercial building from which he operated his business, Hogge's Septic Tank and Grease Trap Service, at the foundation of the garage, he reflected that the trio who rode out the tornado has much to be thankful for. And as friends and neighbors sorted through the debris, hanging up clothes, and gave them all hugs, Hogge said "we're going to be O.K."
Page Middle School
Damage was apparent in all three sections, although the eighth grade wing seemed to be nearly destroyed, with large sections of walls and the roof torn away.
Like so many of those on the scene, he said "it could have been a lot worse," because the storm happened on a Saturday when no one was in the building so that no one was hurt at the school.
"We can deal with buildings," Kiser said, explaining that he and fellow administrators will be working out a plan so that the 580 students at Page can complete the school year. "We will make it happen," he said.
"Gloucester is a strong community. We have great children, strong families, and resilient people. We bounce back from things, most recently Hurricane Isabel. The community comes together in times of trouble," Kiser said.
Bobby Crewe, Gloucester Point district member of the county's board of supervisors, said, "I've lived here all my life and I've been through four hurricanes" in three states, including Hurricane Isabel in Gloucester in 2003. "I've never been through anything like this."
He said that he and his wife were at home around 7:30 p.m. Saturday, and that "I told my wife, this doesn't look good." The lights went out, and he came up Route 17 to look for the source of the trouble.
"That's when I saw the power pole" in front of Page Middle School broken off and some debris scattered along the road, but due to the darkness, "I couldn't see any of this damage."
Crewe repeated the refrain heard so often Sunday morning; that the tornado, horrible as it had been taking three lives elsewhere in the county, was a "blessing in disguise" as it did not strike during school hours.
Part of Route 33 closed
All travel lanes of Route 33 in Middlesex County have been closed from North End Road (Route 631) east so Virginia Department of Transportation crews can clear debris from the roadway.
Message boards have been posted west of the road barricades, at Stampers Bay Road (Route 630), to inform motorists of the closure. Motorists will be turned around at Stampers Bay Road unless they reside between Stampers Bay Road and North End Road.
Vehicle traffic is being temporarily restricted to allow VDOT work crews and Dominion Virginia Power to clear travel lanes on Route 33 and the surrounding roadways. Crews are also working to clear debris from multiple primary and secondary roads in the neighboring counties.
Virginia State Police is providing traffic control at the road closure site.
Antioch church
The tornado ripped off much of the roof of Antioch Christian Fellowship's church building on Cedar Bush Road.
Pastor Leonard Marble said that he visited the 80-year-old frame structure just after the storm and could not see much of the damage then. By Sunday's daylight, the problems were much clearer.
A chimney was knocked over. Much of the metal roof had been peeled back. Inside, a large crack in the front wall showed that the building had taken quite a shaking.
No service was held there Sunday. The pastor visited all the rooms, shaking his head at the apparent load of work ahead. "It looks worse in the daylight," he said. "But we're a lot better off than a lot of people. Stuff can be replaced."
County board
Speaking on behalf of his fellow supervisors, chairman Christian "Buddy" Rilee said that "we are very saddened and shocked by the turn of events as the result of Saturday's tornado. Our thoughts and prayers are with the families of those who were so tragically affected. The board will do anything within its power to assist in recovery. So many have stepped up—fire and rescue, local Sheriff's department, State Police, emergency responders and many others. Our community will pull together and come back even stronger."
National Weather Service
National Weather Service spokesperson Christopher Vaccaro said NWS officials from Wakefield are out in the affected areas today doing a storm assessment.
"The teams will review the damage and determine what kind of tornado caused" the damage, he said. Vaccaro said the assessment team will determine the tornado's wind speed, its width and its path. The team will also determine if the tornado lifted off, and if it touched down and where, he added.
Mathews County
Mathews County suffered slight damage as compared to Gloucester.
David Burns, emergency services coordinator, said emergency dispatch received 11 calls for aid Saturday night. Of these, three involved serious damage such as trees on houses, he said. Most of the calls came from North.
The remainder of the calls involved property damage of some sort such as siding torn from homes, trees down in the yard, etc. One woman was trapped in her home at North by debris at the front and back doors, but was not injured, Burns said. In another case, a tree fell across the corner of the carriage house at Kingston Plantation.
No person was hurt and there were no rescue calls, Burns said. The Mathews Volunteer Fire Department provided mutual aid to Gloucester during the night, he said.
'Trust God'
Among the many rescue workers, utility workers, passersby and others viewing the destruction, one car made a number of stops. In front of damaged homes and buildings, Cecil Smith posted signs stating, "No Matter What Trust God." He is from a ministry of the same name founded in Newport News by James "Peter" Person, according to a business card.
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text:
Vail, CO (February 26, 2013) – Starting tomorrow through March 2nd, tune-in to watch world-class slopestyle and halfpipe snowboarding competitions at the Burton US Open Snowboarding Championships presented by MINI. The 31st annual Burton US Open takes place at Vail Mountain and will draw over 100 top riders, including Shaun White, Mark McMorris, Iouri Podladtchikov, Ayumu Hirano, Kelly Clark, Enni Rukajärvi, Jamie Anderson and many more.
Burton is rolling out five hours of live programming on Universal Sports and NBC Sports Network, plus an additional 22 hours of original live coverage on Burton.com/USO so viewers around the world can watch the most anticipated snowboarding event of the season. Burton.com programming includes "The Board Room," a new online talk show about snowboarding. If you can't make it to Vail, below is a complete broadcast schedule by date, time and network. Times and events listed are Mountain Time (MT) and are subject to change, so please consult your local listings.
Where to Watch the 2013 Burton US Open
Date/Time Network Event
Wednesday, February 27: Burton.com/USO Men's & Women's Slopestyle Semi Finals
8:45am – 3:15pm
Thursday, February 28: Burton.com/USO Men's & Women's Halfpipe Semi Finals
8:45am – 3:15pm
Friday, March 1:
9:35am – 2:45pm Burton.com/USO Men's & Women's Slopestyle Finals
10:30am – 12:00pm Universal Sports Network Men's Slopestyle Finals
1:30pm – 2:30pm Universal Sports Network Women's Slopestyle Finals
Saturday, March 2:
9:35am – 2:45pm Burton.com/USO Men's & Women's Halfpipe Finals
10:30am – 2:00pm NBCSN Men's Halfpipe Finals
1:30 – 2:00pm Universal Sports Network Women's Halfpipe Finals
Sunday, March 10:
8:30am – 9:00am Universal Sports Network US Open Slopestyle Highlight Show
1:30pm – 2:00pm Universal Sports Network US Open Halfpipe Highlight Show
Tuesday, March 5:
8:30pm – TBD Universal Sports Re-Air: US Open Qualifiers
Sunday, March 17:
3:00pm – 3:30pm Universal Sports Network US Open Lifestyle Show
For the entire broadcast schedule, including additional airings of the above programs, go to Burton.com/USO. In addition to coverage of the competitions,you can also check out US Open preview videos, find live scoring, live chats, real-time standings, run replays, tour rankings, rider interviews and bios as well as full webcasts for on-demand viewing at www.burton.com/USO. And remember to follow our line throughout the US Open at facebook.com/burtonsnowboards, #BurtonUSOpen, twitter.com/burtonsnowboard and @burtonsnowboard on Instagram.
A big thanks to the following partners for their support of the 31st edition of the Burton US Open: MINI, Vail Resorts, Mountain Dew®, Town of Vail, Nokia, Paul Mitchell, 3M™ Thinsulate™ Insulation, GoPro, G-SHOCK, Shiseido, Matador, Clif, Transworld, Snowboarder, Analog, anon. and the World Snowboard Tour.
About Burton
In 1977, Jake Burton Carpenter founded Burton Snowboards out of his Vermont barn and has dedicated his life to snowboarding ever since. Burton has played a pivotal role in growing snowboarding from a backyard hobby to a world-class sport by creating groundbreaking products, supporting a team of top snowboarders and pushing resorts to allow snowboarding. Today, Burton designs and manufactures industry-leading products for snowboarding and the snowboard lifestyle, including snowboards, boots, bindings, outerwear and layering as well as year-round apparel, packs/bags and accessories. Privately held and owned by Jake and his wife, Burton President Donna Carpenter, Burton's headquarters are in Burlington, Vermont with offices in Austria, Japan, Australia and California. For more information, visit www.burton.com. Follow our line at: facebook.com/burtonsnowboards, twitter.com/burtonsnowboard and @burtonsnowboard on Instagram.
About MINI
MINI is involved in action sports around the world through cooperation and sponsoring activities. As a partner of trend-conscious sports, MINI supports young and creative sports people and, in so doing, promotes the development of their sport. MINI has been the official presenting partner for the Burton Global Event Series since 2011.
About Vail Mountain
Celebrating its 50th anniversary throughout the 2012-2013 season and coveted as the largest ski resort in the United States with more than 5,200 acres of skiable terrain and seven legendary Back Bowls spanning seven miles, Vail is an extraordinary winter vacation destination. Under blue skies more than 300 days each year and with more groomed terrain than anywhere on the planet, families reconnect and celebrate here from year to year and generation to generation. The vacation experience is world class, from the Vail Ski & Snowboard School to the events, activities and festivals, the shops and spas, abundant culinary experiences and luxurious accommodations. Coupled with the vision inherent in the spirit of Vail's founders, and a modern day commitment to excellence in all aspects of guest service and operations, Vail can still credibly lay claim to being a resort like nothing on earth www.vail.com.


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SAN DIEGO (AP) — The San Diego Zoo said Monday that a female Malayan tiger was fatally mauled by her intended mate during an attempt to breed.
The female tiger, named Tiga Tahun, died Saturday of neck injuries and breathing difficulties, the zoo said. It was the first breeding encounter for either animal, the only Malayan tigers at the facility. No visitors saw the attack.
"(The encounter) began with positive interaction between the two big cats. Unfortunately this changed quickly and zookeepers were unable to separate the two animals," the zoo said in a statement.
The tigers had rotated between being on exhibit and in their bedrooms, making them familiar with the other's scent, zoo spokeswoman Jenny Mehlow said. They had seen each other often and even touched noses, separated by a barrier.
Their interactions led zookeepers to believe the timing was right.
"Everything was spot on," Mehlow said.
There are about 60 Malayan tigers in captivity in North American zoos, said Dan Cassidy, general curator of Omaha's Henry Doorly Zoo & Aquarium in Nebraska, which owned the female tiger. Fewer than 500 are believed to be living in the wild worldwide.
Fatal attacks are rare, but behavior can be unpredictable during breeding, Cassidy said. Zoos typically prepare by having tigers touch noses or paws before allowing them to interact without barriers.
Tiga Tahun's intended mate, Connor, was born at the San Diego Zoo in 2011. He is one of seven Malayan tigers born at the San Diego Zoo since 2005.
Tiga Tahun was born in 2009 at the Bronx Zoo, where her mother was transferred from Omaha.
"That cat had never been in Omaha, so it wasn't like we had a personal connection, but everyone is saddened by the loss," Cassidy said.
In November, a 5-year-old female lion was fatally bitten on the neck by a male lion at the Dallas Zoo in full view of visitors and families watching the exhibit.
Caption 1:
This undated photo released by the San Diego Zoo shows a female Malayan tiger named Tiga Tahun in her habitat at the San Diego Zoo. The zoo said Monday Dec. 23, 2013, that Tiga, died Saturday of neck injuries and breathing difficulties after being mauled by a male tiger. The tigers were introduced to each other for breeding purposes. She was born in 2009 at the Bronx Zoo but was owned by the Omaha Zoo. No visitors saw the attack. (AP Photo/San Diego Zoo/Ken Bohn)


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<Composite manuscript in Ottoman Turkish> (1r–144v) <Kīmyā risālẹsi> An unidentified and anonymous treatise on chemistry and alchemy. Dated 1253/1837–8. (145r–150v): Serḥ-i Ve ż-Żuḥà: A treatise concerning Qur'ān Sūra 93, al-Ḍuḥà, and its use as a supplicatory prayer by an unknown author. Undated. (152v–161v): Sūret Ve ż-Żuḥànıñ sekiz günde oḳunacaḳ Esmā-'i şerīfleri beyān ider. Instructions for recitation of Sūrat al-Ḍuḥà (93) of the Qur'ān in order to secure a favourable answer to one's prayers. Dated 1[?]48 (probably 1248/1832–3). (162r–164r): [Talismanic charts and prayers] Early 19th century.


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Now, there are type of type of stores or should i say Retail Stores or better known as supermarkets, are essential for the world to survive, because it allows us to purchase food and other necessities. We obviously need food to survive. The greatest advantage of these supermarkets is that we, the consumers are able all of the things we need, all in one place, and in some cases very low prices.
Various stores that gives you different varieties of products, convenience store provides limited amount of merchandise at more than average prices with a speedy checkout. This store is ideal for emergency and immediate purchases as it often works with extended hours, stocking everyday.


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Message Board
Allan Folsom Message Board
Talk about the novels, new and used books that Folsom has written!
Author Folsom's Book Reviews
Day after Tomorrow
A doctor sees the man who murdered his father twenty years ago. A LA cop is helping Scotland Yard solve some murders where the victim's heads have been surgical removed. These are some of the threads to a sinister nazi conspiracy that spans two continents and that threatens the free world. Folsom propels himself in the leagues of Ludlum, Forythe and Jack Higgins in this action-packed and chilling thriller that packs more violent action, intrigue then ...
Day Of Confession
Harry Addison's cushy LA lifestyle is turned upside down after a telephone call from his long estranged brother, David, a priest at the Vatican. Having learned of his brother's death after the phone call, Harry travels to Rome to bring back the body for a proper burial. It is during this period that his life takes on nightmarish proportions as he inadverdently becomes involved in murder, policical and religious clandestine operations, the behind the scen...


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Chappelle's Show is a comedy sketch program hosted by stand-up comedian Dave Chappelle. It airs on Comedy Central.
In episode 210, a skit called Knee High Park parodied Sesame Street, and taught urban children the dangers of STDs and drugs. Puppeteers included Pam Arciero, Jim Kroupa, Tim Lagasse, Anney McKilligan and Noel MacNeal. Lagasse was also the puppet coordinator.


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Ashley Greene's Ever-Changing 'Twilight' Wig: Finally Just Right
She's been through three installments of the Twilight franchise and now it's onto the fourth — Breaking Dawn Part 1 — and finally, Ashley Greene feels comfortable with the wig she wears to play Cullen sister Alice. "We wanted to make it a little more modern," Greene told reporters at Comic-Con in San Diego Thursday when referencing the latest version of the super-short hairpiece. "We were trying to get it exactly right and tweaking it a little bit every time." The challenge for Greene and director Bill Condon, who helped with the evolution of the looks, was to tailor the wig to their likings without alienating fans with too drastic of a change. Luckily, the latest incarnation seems to be just right. "I was very excited," Greene said of working with Condon, plus the hair and makeup team, to finalize the latest look. "We made Alice a little more modern. It's always been really fun to play Alice."


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First, just a reminder that Sunday, November 28th, 2010, is our monthly exercise in folly, Savoy Cocktail Book Night at Alembic Bar. If any of the cocktails on this blog have captured your fancy, stop by after 6 and allow the skilled bartenders (and me) to make them for you. It is always a fun time.
Warday's Cocktail
1 Teaspoonful Chartreuse. (1 tsp Green Chartreuse)
1/3 Italian Vermouth. (3/4 oz Carpano Antica Vermouth)
1/3 Dry Gin. (3/4 oz Miller's Gin)
1/3 Calvados or Apple Brandy. (3/4 oz Montreuil Calvados Reserve)
Shake (I stirred) well and strain into cocktail glass.
Like the Victor Cocktail, you just kind of wonder what the Gin is doing in this cocktail.
Does it have an intended flavor contribution to the cocktail, or is it just an extender for the rather expensive other spirits in the drink.
In the case of the Warday's, I think it does have a bit of a function, providing a bridge between the flavor of the Calvados and that of the Chartreuse, but I bet this cocktail would be even better with Aquavit!
Hm, and today's Warday's Cocktail cocktail coincides with November's Mixology Monday, hosted by Denis over at Rock & Rye:
The challenge this month is to bring to light a drink that you think deserves to be resurrected from the past, and placed back into the spotlight. It could be pre-prohibition, post-war, that horrible decade known as the 80?s, it doesn't really matter. As long as it is somewhat obscure, post it up. If possible try to keep to ingredients that are somewhat readily available. While we all appreciate the discovery of an amazing cocktail, if we can't make it, it's no fun for anyone.
Not sure if this is quite cool enough to be a truly awesome "Forgotten Cocktail", but it is quite tasty, and as far as I can tell obscure enough to be included, especially since contributors in the comments have noted it is very similar to Jeffy Morgenthaler's Norwegian Wood. Oh, and, apparently a version of the Warday's is found in regular rotation at the New York City members only club, Milk and Honey.
This post is one in a series documenting my ongoing effort to make all of the cocktails in the Savoy Cocktail Book, starting at the first, Abbey, and ending at the last, Zed.


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Hey everybody!
Since I bought a new computer I have some trouble with my beloved DOSBox: The mouse locking ain't working no more, at least the mouse's X axis.
If I start the games without a lock, everything works fine (besides the cursor moving out of the window). However, once I press Ctrl+F10 to enable the mouse lock, strange things happen:
- in The Settlers, the cursor jumps to the right-hand-side of the screen. I can perfectly move the cursor up and down, but the X-Axis seems to be completely dead, I can't get the cursor away from the right edge of the screen.
- in Duke Nukem 3D something similar happens once MouseLock is on: The Y-Axis (say, up and down) works as it should, but the X-Axis always makes me turn right whenever I touch the mouse. So, if I do nothing then it stands still, but if I try to turn left then the game turns right instead. (But it's not inverted, so if I try to turn right then he will also turn right.)
Does anyone have an idea?
Thank you for any hints!
Ulf Schaper
My system:
AMD64 Gentoo Linux, stable.
xorg 7.2 Dualhead (xinerama)
dosbox 0.7
Optical IntelliMouse Explorer V1, xorg-driver "mouse"
Linux 2.6.22 (gentoo-sources)
And to be complete:
Asus P5B Deluxe Wifi AP
Intel Core2Duo E6600
Matrox MGA G450 PCI & some cheap ATI PCIe card


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I'm pretty sure "True Blood" just went over the deep end.
Here's a quick summary of what went down tonight:
A hate group recruiting Hoyt, who suddenly is a really, really bad person.
The smoke monster chuckling.
Pam sporting crimped hair.
Lafayette has his lips sewn shut by Jesus' witchcrafty family.
Sam Merlotte sniffing around like a bloodhound.
Jason shooting Jessica in the head.
Oh, and Lilith rising from blood like Carrie and blowing blood mist while sounding like a wounded baby raptor from "Walking With Dinosaurs."
I don't even know where to begin. Sure, there were funny moments. But when the best...


text: Creating an upscale fashion look but not slapping on the upscale price tag has been Nine West's specialty ever since it first opened its doors. You'll feel the glitz and glamour of a Hollywood A-lister when you slip into any pair of Nine West heels. There are plenty of colours, designs and accentuations that will have even the most bombastic of shoe hoarders green with envy. Whether it's a casual night out or formal dinner wear, Nine West has the heel that's just right for you and the occasion.


text: On Fri, 17 Jan 2003, Andrew Shewmaker` wrote: > On Thu, 16 Jan 2003 12:48:54 -0600 > "Henderson, TL Todd" <Todd_Henderson at isl-3com.com> wrote: > > > Does anyone have any experience with the Netgear GA621 fiber NIC and RedHat > > 8.0? > > > > They ship drivers for RH 7.1, should the these drivers be close enough to > > compile and work under 8.0? > I believe I have used the kernel's ns83820 driver, rather than the drivers > that shipped with that card. Until recently the ns83820.c driver had significant performance "issues". My ns820.c driver was about 2.5X faster. This has led to an undeserved bad reputation for the NatSemi gigabit chip. (The 83820 does have higher overhead, especially on non-x86 systems, because it cannot byte-align the received packets. But that's exactly the same limitation as the highly regarded Tulip chip.) -- Donald Becker becker at scyld.com Scyld Computing Corporation http://www.scyld.com 410 Severn Ave. Suite 210 Scyld Beowulf cluster system Annapolis MD 21403 410-990-9993


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When it comes to the national and international transportation of patients who require medical treatment or care, we offer three options:
- A medical repatriation service, for when a patient needs to be transferred from Sierra Leone to their home country.
- Medical repatriation to Sierra Leone: we can collect a patient at any time using an air ambulance (either an ambulance jet or an ambulance helicopter), no matter where they are in the world, and fly them back to Sierra Leone, accompanied by medical personnel.
- We transport patients within Sierra Leone as part of the national air ambulance service.
Medical repatriation from Sierra Leone
There are many reasons a patient might need a medical evacuation, or medevac, during a stay in Sierra Leone. They may fall ill unexpectedly, have an accident, injure themselves, or suffer from a flare-up of an existing medical condition. If repatriation from Sierra Leone is necessary, our staff will organise the air medevac of the patient to their home country, and will also arrange ambulance transport to and from the aircraft to guarantee the highest level of safety and care for each patient. We are happy to provide impartial, no-obligation advice in relation to medical repatriation from Sierra Leone – call us or fill in our contact form.
Medical repatriation to Sierra Leone
Have you fallen seriously ill or been injured in an accident abroad? Do you require a medical repatriation to Sierra Leone to receive medical care in your home country? Medical Air Service's medevac service will collect you, wherever you are, and bring you back to Sierra Leone. Our control centre is staffed 24/7 so you can contact us at any time. You will find all our contact information here.
Air ambulance within Sierra Leone
We also provide modern, fully medically equipped air ambulances all over Sierra Leone for internal medical flights and patient transfers. Depending on the patient's condition, we can organise intensive care transport in a Learjet or patient transfer by helicopter. In addition, we can arrange ground transport to the nearest airport using a suitable ambulance to reduce the journey time as much as possible.
If you have any other questions or require a no-obligation quote on air ambulance services in Sierra Leone, please call us at any time or contact us here.


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Getty Images
Arizona Cardinals head coach Bruce Arians has another familiar face set to join his coaching staff.
According to his son Lance, a radio host on Sports Talk 790 and contributor to the Houston Chronicle, former Pittsburgh Steelers assistant Larry Zierlein is joining the Cardinals as an assistant offensive line coach.
Zierlein served as the offensive line coach for the Steelers for three seasons (2007-2009) alongside Arians and Cardinals offensive coordinator Harold Goodwin. Zierlein has also spent time with the Buffalo Bills and Cleveland Browns.


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Disney's 3-D animated summer movie "Planes" appears to have some lift as a home entertainment title, soaring to the top of Rentrak's DVD and Blu-ray sales chart in its first week in release.
Featuring the voice of comedian Dane Cook, the "Cars" spinoff beat Warner Bros.' R-rated comedy "We're the Millers," which made more money than "Planes" at the box office. The Disney movie generated $90.2 million in domestic ticket sales, while "We're the Millers," starring Jason Sudeikis and Jennifer Aniston, took in $150 million during its run.
Taking third place on the DVD/Blu-ray chart was another newcomer, "2 Guns," the action comedy with Denzel Washington and Mark Wahlberg as a pair of undercover agents. The trio of new releases knocked last week's No. 1, "Man of Steel," down to fourth place.
Also debuting on retail shelves was the boozy sci-fi comedy "The World's End," directed by Edgar Wright and starring Simon Pegg and Nick Frost. It came in at No. 7.
"The Heat," a buddy cop comedy with Sandra Bullock and Melissa McCarthy, was the top rental in its sixth week on the market.
PHOTOS: Billion-dollar movie club
Here are Rentrak's rankings for the week that ended Nov. 23 for sales and Nov. 24 for rentals.
Top 10 DVD and Blu-ray sales
1. "Planes" (Disney). Week 1.
2. "We're the Millers" (Warner Bros.). Week 1.
3. "2 Guns" (Universal). Week 1.
4. "Man of Steel" (Warner Bros.). Week 2.
5. "Turbo" (Fox). Week 2.
6. "Monsters University" (Disney). Week 4.
7. "The World's End" (Universal). Week 1.
8. "The Hobbit: An Unexpected Journey" (Warner Bros.). Week 36.
9. "Grown Ups 2" (Sony). Week 3.
10. "The Heat" (Fox). Week 6.
Top 10 DVD and Blu-ray rentals
1. "The Heat" (Fox). Week 6.
2. "Grown Ups 2" (Sony). Week 3.
3. "White House Down" (Sony). Week 3.
4. "Pacific Rim" (Warner Bros.). Week 6.
5. "The Internship" (Fox). Week 5.
6. "The Hangover Part III" (Warner Bros.). Week 7.
7. "The Conjuring" (New Line Cinema). Week 5.
8. "Monsters University" (Buena Vista). Week 4.
9. "The Croods" (Fox). Week 8.
10. "The Purge" (Universal). Week 7.
'Frozen,' 'Catching Fire' set Thanksgiving-weekend records
TV ratings: NFL big for NBC; 'Charlie Brown' surges; Lady Gaga soft
Morning Fix: 'Catching Fire' red hot. Hollywood scrambles after Paul Walker's death.
Follow on Twitter: @rfaughnder
ON LOCATION: People and places behind what's onscreen PHOTOS: Biggest box office flops of 2013 PHOTOS: Celebrity production companies
ON LOCATION: People and places behind what's onscreen
PHOTOS: Biggest box office flops of 2013
PHOTOS: Celebrity production companies


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We're zipping along with development of the new Firefox Affiliates program. In preparation for launching the new program this quarter and to help us plan features of v2, we'll be holding irc chats next week.
To accommodate interested Mozillians all over the world, we'll be holding two chat sessions in #affiliates.
The first will be next Tuesday, August 9 at 9 a.m. Eastern Time (2 p.m. GMT, 6 a.m. PT). Then we'll do it all again next Wednesday, August 10 at 6 p.m. Eastern Time (11 p.m. GMT, 3 p.m. PT).
If you can't make the chat sessions, please feel free to drop in your ideas at https://wiki.mozilla.org/Websites/Affiliates/Future_Goals or contact me directly.
Looking forward to chatting with you!


text: On Sunday 30 April 2006 00:12, John Hearns wrote: > On Sat, 2006-04-29 at 18:08 -0700, David Kewley wrote: > > What does it mean to say that 32 is "standard"? Why shouldn't 40 be > > standard, other than perhaps 32 is more typically done? > > Surely related to the maximum amperage you supply to the rack? > With dual cores and now quad socket systems current draws per node are > going up. In European installs, I see 2 times 32 Amp feeds per rack > being normal. But there's not a "standard" maximum amperage you can supply to a rack. As long as you have the power available, and have the means to remove the heat, you can do what you want. We're an example, and I would be astonished if we're the only example. If we are, it seems to me something is wrong with "standard" ways of thinking. My point is, the word "standard" tends to suggest that doing anything else is to be discouraged, out of the ordinary, etc. I see *no* reason that 32 nodes should be considered "standard". If you can only supply 20 A to a rack, *your* standard will be just a few nodes per rack. If you can supply 100 A to a rack, *your* standard will be much higher. So there is no "standard" that applies to all sites. No? David


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Our offering comprises 5 family rooms, 3 apartments, 3 double rooms and 3 multi-bed rooms.
All rooms are comfortably appointed and offer shower/WC en-suite; telephone, radio, balcony, satellite TV
The kitchen on the first floor is open to our guests 24 hours a day. Facilities include two hotplates, a microwave oven, a refrigerator, a bottle warmer, and crockery and cutlery.
We provide plenty of hiking equipment and child facilities to save you the hassle of carrying excess luggage. Just tell us what you need upon reservation!
Holidays = family time! We offer inexpensive package deals for families (including accommodation in family rooms).
Many advantages for families with children: quiet and safe location, well-structured, large playground with trampoline and many toys and toy cars. We know that parents can only fully enjoy their holidays when their little ones are kept busy and happy.
We are a founding member of "Stodertaler Zwerge", an initiative promoting family holidays since 1997. Together with our partner businesses we offer a varied family program six days a week.
Walking in the Stoder Valley makes for an unparalleled nature experience at any time of the year. Marvel at flower-strewn meadows in spring, and enjoy mild temperatures and clear views in autumn!
Located on a lovely plateau at an altitude of 800 m above sea level, our house is the perfect base for numerous walks and hiking tours. We offer numerous facilities and amenities for walking and hiking enthusiasts. Your host is a qualified mountain guide and will be happy to show you the most beautiful spots in the area.
Hinterstoder Alps is only one of 21 resorts in Austria, Germany, Italy, France and Switzerland to be entitled to carry the official name "Alpine Pearl".
The area boasts wonderful panorama, great infrastructure and is perfectly connected to public transport - a sign of its commitment to "soft mobility" - sustainable, eco-friendly tourism.
Easy to reach per train from all parts of Europe, the area offers many special deals - let us take care of your luggage and use our shuttle buses to get to your hotel. Other eco-friendly offers include free bike rental, free use of public transport, taxis, rides on horse-drawn carriages, free use of cable cars and many hiking trails.
Save on luggage and make full use of our facilities!
We have:
baby cots, children's beds, baby and child ware, tubs, baby monitors, diaper changing units, diaper bin, high chairs, switch covers, prams, buggy, baby back carriers etc. Please tell us what you need when booking!
We have a guest kitchen on the first floor which is open 24 hours a day. There are a microwave oven, two hot plates, a fridge, a bottle warmer and crockery.Special rooms for holidays with baby Family rooms for holiday with toddlers
Baby clothing is washed and dried for free once during your stay. Additional washing: EUR 5 per laundry load
The same applies to toddlers' and children's laundry.
EUR 5 for adults' laundry + drying


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I would definitely check a PCV (cheap, fast, easy) at a minimum or a full CBC on Monday to see where Tucker's red cell count is. When the red cells decrease slowly, they can get REALLY low before pets show clinical signs because they compensate gradually too.
is the PCV the test where they look for volume of cells in the blood? if so, we've done that when he was in for the ultrasound. his reticulocytes or whatever they were very high, lots and lots of immature cells. his hematocrit was low, and his WBC was actually a bit low low, too.
We've done full CBC workups every week since this started, so we can monitor. his RBC goes up and down, but he's consistently anemic. organ function appears normal each time, too.


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The Mother of All Brow Kits
Anastasia Soare, of Anastasia Beverly Hills is the reigning pro when it comes to eyebrow specialists. Her hard work and talent have earned Anastasia not only her own salon and a cosmetics line but also a stellar reputation among Hollywood's A-list stars. Now, thanks to this amazing and affordable 5 Piece Brow Kit you can buy all of the basics to create your own wow brows.
Inside the cute travel-sized case, you'll find a pair of tweezers, brow powder, four brow stencils, one angled-cut duo brush, and a brow gel. Use the stencil first, then fill in your arch with the brow powder using the angled brush. Next, gently tweeze the extra hairs around where you have stenciled, then top it off with brow gel to keep your perfectly shaped arches in place. The kit, which you can buy here for $65, comes in four shades: Ash Blonde, Medium Ash, Strawburn, and Brunette. Just be sure to chose a brow shade that's one shade deeper than your hair color.


text: On Tue, 25 Feb 2003, Bob Drzyzgula wrote: > * i suspect we really won't know if these devices > * are ``too good to be true'' until we start > * passing frames at a much higher rate, but so far, > * so good. [...] Regarding the benchmarking of switches, I'll allow myself to point to an upcoming paper of our group. It will be published at the Workshop for Communication Architectures for Clusters (CAC 03): "Cost/Performance Tradeoffs in Network Interconnects for Clusters of Commodity PCs" (http://www.cs.inf.ethz.ch/CoPs/publications/). In the paper we are mainly interested in bandwidth (not latency) and examine a few different networks on our 128 node cluster "Xibalba" [1]: - A cheap Fast Ethernet network with one small switch per cabinet and a Fast Ethernet uplink (only a maintenance network) - A medium Fast Ethernet switch with bad performance (Matrix E7) - A high-end Fast Ethernet switch with near perfect performance (Matrix ER16) - Myrinet as a high-performance Gigabit network We use for example the following benchmarks: All-to-all personalized communications and Dolly (our cloning tool [2]). With Dolly, every participating node sends and receives data at full speed for a long period of time, which puts a maximal load on the switch. Interestingly the Matrix E7 switch fails misserably despite its promising data sheets. So, if you want to measure the throughput of your switch under a heavy load conditions, you might want to try out Dolly. Mail me if you want the source of most recent version (I should finally update that web page...). Later in the paper we relate the performance of the network with more realistic benchmarks like the HPL and a car traffic simulation. - Felix [1] http://www.xibalba.inf.ethz.ch/ [2] http://www.cs.inf.ethz.ch/CoPs/patagonia/index.html#dolly -- Felix Rauch | Email: rauch at inf.ethz.ch Institute for Computer Systems | Homepage: http://www.cs.inf.ethz.ch/~rauch/ ETH Zentrum / RZ H18 | Phone: +41 1 632 7489 CH - 8092 Zuerich / Switzerland | Fax: +41 1 632 1307