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* This is the Professional Version. *
Patient Education
- Extraintestinal Protozoa
- Introduction to Extraintestinal Protozoa
- African Trypanosomiasis
- Babesiosis
- Chagas Disease
- Free-Living Amebas
- Leishmaniasis
- Malaria
- Toxoplasmosis
Malaria is infection with Plasmodium sp. Symptoms and signs include fever (which may be periodic), chills, sweating, hemolytic anemia, and splenomegaly. Diagnosis is by seeing Plasmodium in a peripheral blood smear. Treatment and prophylaxis depend on the species and drug sensitivity and include the fixed combination of atovaquone and proguanil, artemisinin derivatives, doxycycline, mefloquine, chloroquine, and quinine. Patients infected with P. vivax and P. ovale also receive primaquine to prevent relapse.
Malaria is endemic in Africa, much of South and Southeast Asia, North and South Korea, Mexico, Central America, Haiti, the Dominican Republic, South America (including northern parts of Argentina), the Middle East (including Turkey, Syria, Iran, and Iraq), and Central Asia. The Centers for Disease Control and Prevention (CDC) has an online map application that shows recent data on malaria prevalence throughout the world; also included are type of malaria, resistance patterns, and recommended prophylaxis (see CDC Malaria Map Application).
There are 300 to 500 million infected people worldwide, with about 655,000 deaths yearly, mostly in children < 5 yr in Africa. Malaria once was endemic in the US. About 1500 cases/yr occur in the US. Nearly all are acquired abroad, but a small number result from blood transfusions or rarely from transmission by local mosquitoes that feed on infected immigrants.
The Plasmodium species that infect humans are
Concurrent infection with more than one Plasmodium species is uncommon.
Also, simian malaria has been reported in humans; P. knowlesi is an emerging pathogen in Southeast Asia. The degree to which P. knowlesi is transmitted from human to human via the mosquito, without the natural intermediate monkey host, is under study.
The basic elements of the life cycle are the same for all Plasmodium sp (see Figure: Plasmodium life cycle.). Transmission begins when a female Anopheles mosquito feeds on a person with malaria and ingests blood containing gametocytes. During the following 1 to 2 wk, gametocytes inside the mosquito reproduce sexually and produce infective sporozoites. When the mosquito feeds on another human, sporozoites are inoculated and quickly reach the liver and infect hepatocytes. The parasites mature into tissue schizonts within hepatocytes. Each schizont produces 10,000 to 30,000 merozoites, which are released into the bloodstream 1 to 3 wk later when the hepatocyte ruptures. Each merozoite can invade an RBC and there transform into a trophozoite. Trophozoites grow and develop into erythrocyte schizonts; schizonts produce further merozoites, which 48 to 72 h later rupture the RBC and are released in plasma. These merozoites then rapidly invade new RBCs, repeating the cycle. Some trophozoites develop into gametocytes, which are ingested by an Anopheles mosquito. They undergo sexual union in the gut of the mosquito, develop into oocysts, and release infective sporozoites, which migrate to the salivary glands.
Plasmodium life cycle.
With P. vivax and P. ovale (but not P. falciparum or P. malariae), tissue schizonts may persist as hypnozoites in the liver for years. Relapse of P. ovale has occurred as late as 6 yr after an episode of symptomatic malaria, and the infection was transmitted by blood transfusion from a person who was exposed 7 yr before donating blood. These dormant forms serve as time-release capsules, which cause relapses and complicate chemotherapy because they are not killed by most antimalarial drugs, which typically act on bloodstream parasites.
The pre-erythrocytic (hepatic) stage of the malarial life cycle is bypassed when infection is transmitted by blood transfusions, by sharing of contaminated needles, or congenitally. Therefore, these modes of transmission do not cause latent disease or delayed recurrences.
Rupture of RBCs during release of merozoites is associated with the clinical symptoms. If severe, hemolysis causes anemia and jaundice, which are worsened by phagocytosis of infected RBCs in the spleen. Anemia may be severe in P. falciparum or chronic P. vivax infection but tends to be mild in P. malariae infection.
Falciparum malaria
Unlike other forms of malaria, P. falciparum causes microvascular obstruction because infected RBCs adhere to vascular endothelial cells. Ischemia develops with resultant tissue hypoxia, particularly in the brain, kidneys, lungs, and GI tract. Hypoglycemia and lactic acidosis are other potential complications.
Resistance to infection
Most West Africans have complete resistance to P. vivax because their RBCs lack the Duffy blood group, which is required for the attachment of P. vivax to RBCs; many African Americans also have such resistance. The development of Plasmodium in RBCs is retarded in patients with hemoglobin S, hemoglobin C, thalassemia, G6PD deficiency, or elliptocytosis.
Previous infections provide partial immunity. Once residents of hyperendemic areas leave, acquired immunity wanes over time (months to years), and symptomatic malaria may develop if they return home and become reinfected.
Symptoms and Signs
The incubation period is usually 12 to 17 days for P. vivax, 9 to 14 days for P. falciparum, 16 to 18 days or longer for P. ovale, and about 1 mo (18 to 40 days) or longer (years) for P. malariae. However, some strains of P. vivax in temperate climates may not cause clinical illness for months to > 1 yr after infection.
Manifestations common to all forms of malaria include
The malarial paroxysm coincides with release of merozoites from ruptured RBCs. The classic paroxysm starts with malaise, abrupt chills and fever rising to 39 to 41° C, rapid and thready pulse, polyuria, headache, myalgia, and nausea. After 2 to 6 h, fever falls, and profuse sweating occurs for 2 to 3 h, followed by extreme fatigue. Fever is often hectic at the start of infection. In established infections, malarial paroxysms typically occur every 2 to 3 days depending on the species; intervals are not rigid.
Splenomegaly usually becomes palpable by the end of the first week of clinical disease but may not occur with P. falciparum. The enlarged spleen is soft and prone to traumatic rupture. Splenomegaly may decrease with recurrent attacks of malaria as functional immunity develops. After many bouts, the spleen may become fibrotic and firm or, in some patients, becomes massively enlarged (tropical splenomegaly). Hepatomegaly usually accompanies splenomegaly.
P. falciparum causes the most severe disease because of its microvascular effects. It is the only species likely to cause fatal disease if untreated; nonimmune patients may die within days of their initial symptoms. Patients with cerebral malaria may develop symptoms ranging from irritability to seizures and coma. Acute respiratory distress syndrome (ARDS), diarrhea, icterus, epigastric tenderness, retinal hemorrhages, algid malaria (a shocklike syndrome), and severe thrombocytopenia may also occur. Renal insufficiency may result from volume depletion, vascular obstruction by parasitized erythrocytes, or immune complex deposition. Hemoglobinemia and hemoglobinuria resulting from intravascular hemolysis may progress to blackwater fever (so named based on the dark color of the urine), either spontaneously or after treatment with quinine. Hypoglycemia is common and may be aggravated by quinine treatment and associated hyperinsulinemia. Placental involvement may lead to low birth weight, spontaneous abortion, stillbirth, or congenital infection.
P. vivax, P. ovale, and P. malariae typically do not compromise vital organs. Mortality is rare and is mostly due to splenic rupture or uncontrolled hyperparasitemia in asplenic patients. The clinical course with P. ovale is similar to that of P. vivax. In established infections, temperature spikes occur at 48-h intervals—a tertian pattern. P. malariae infections may cause no acute symptoms, but low-level parasitemia may persist for decades and lead to immune complex–mediated nephritis or nephrosis or tropical splenomegaly; when symptomatic, fever tends to occur at 72-h intervals—a quartan pattern.
In patients who have been taking chemoprophylaxis (see Table: Prevention of Malaria), malaria may be atypical. The incubation period may extend weeks to months after the drug is stopped. Those infected may develop headache, backache, and irregular fever, but parasites may initially be difficult to find in blood samples.
Fever and chills in an immigrant or traveler returning from an endemic region should prompt immediate assessment for malaria. Most cases occur within the first 6 mo, but onset may take up to 2 yr or, rarely, longer.
Malaria can be diagnosed by finding parasites on microscopic examination of thick or thin blood smears. The infecting species (which determines therapy and prognosis) is identified by characteristic features on smears (see Table: Diagnostic Features of Plasmodium Species in Blood Smears). Blood smears should be repeated at 4- to 6-h intervals if the initial smear is negative.
Thin blood smears stained with Wright-Giemsa stain allow assessment of parasite morphology within RBCs, often speciation, and determination of percentage parasitemia. Thick smears are more sensitive but more difficult to prepare and interpret as the RBCs are lysed before staining. Sensitivity and accuracy of the results depend on the examiner's experience.
Commercial rapid assays are based on the presence of certain plasmodium antigens or enzymatic activities. Assays may involve detection of a histidine-rich protein 2 (HRP-2) associated with malaria parasites (especially P. falciparum and P. vivax) and detection of plasmodium-associated lactate dehydrogenase (pLDH). The rapid tests are comparable in sensitivity to microscopy in detecting low levels of parasitemia; However, they do not differentiate single infection from concurrent infection with more than one Plasmodium sp or allow speciation except for P. falciparum.
Light microscopy and rapid assays are complementary tests, and both should be done when available. They have similar sensitivity. Negative results in both does not exclude malaria in a patient with low parasitemia.
PCR and species-specific DNA probes can be used but are not widely available. Because serologic tests may reflect prior exposure, they are not useful in the diagnosis of acute malaria.
Diagnostic Features of Plasmodium Species in Blood Smears
Antimalarial drugs are chosen based on the clinical manifestations, the infecting Plasmodium sp, known resistance patterns of strains in the area of acquisition, and the efficacy and adverse effects of drugs available.
In some endemic areas, a significant proportion of locally available antimalarial drugs are counterfeit. Thus, some clinicians advise travelers to remote, high-risk areas to take along a full course of an appropriate treatment regimen to be used if medically confirmed malaria is acquired despite prophylaxis; this strategy also avoids depleting limited drug resources in the destination country.
Malaria is particularly dangerous in children < 5 yr (mortality is highest in those <2 yr), pregnant women, and previously unexposed visitors to endemic areas. If P. falciparum is suspected, therapy should be initiated immediately, even if the initial smear is negative. P. falciparum and, more recently, P. vivax have become increasingly resistant to antimalarial drugs. For recommended drugs and doses for treatment and prevention of malaria, see Table: Treatment of Malaria and Prevention of Malaria. Common adverse effects and contraindications are listed in Adverse Reactions and Contraindications of Antimalarial Drugs. See also the CDC web site (Malaria Diagnosis and Treatment in the United States), or call their malaria hotline at 770-488-7788 (after hours, weekends, or holidays, call 770-488-7100) for consultation about treatment.
In case of a febrile illness during travel in an endemic region, prompt professional medical evaluation is essential. When prompt evaluation is not possible (eg, because the region is very remote), self-medication with artemether/lumefantrine or atovaquone/proguanil can be considered pending evaluation. If travelers present with fever after returning from an endemic region and no other diagnosis is made, clinicians should consider giving empiric treatment for uncomplicated malaria even when malaria smears and/or rapid diagnostic test are negative.
Treatment of Malaria
Adult Dosage
Pediatric Dosageb
P. falciparum or unidentified species acquired in all malarious regions except those specified as chloroquine-sensitive—Oral drugs
Drugs of choice
4 adult tablets once/day for 3 days
< 5 kg: Not indicated
5–8 kg: 2 pediatric tablets once/day for 3 days
9–10 kg: 3 pediatric tablets once/day for 3 days
11–20 kg: 1 adult tablet once/day for 3 days
21–30 kg: 2 adult tablets once/day for 3 days
31–40 kg: 3 adult tablets once/day for 3 days
> 40 kg: 4 adult tablets once/day for 3 days
6 doses (1 dose = 4 tablets) over 3 days (at 0, 8, 24, 36, 48, and 60 h)
6 doses at intervals as for the adults; dose =
5–< 15 kg: 1 tablet
15–< 25 kg: 2 tablets
25–< 35 kg: 3 tablets
≥ 35 kg: 4 tablets
Quinine sulfate plus one of the following:
650 mg salt tid for 3 or 7 dayse
10 mg salt/kg q 8 h for 3 or 7 dayse
100 mg bid for 7 days
2.2 mg/kg bid for 7 days
250 mg qid for 7 days
6.25 mg/kg qid for 7 days
7 mg/kg tid for 7 days
7 mg/kg tid for 7 days
Alternative (if other options cannot be used)
750 mg salt, then 500 mg salt 6–12 h later
15 mg salt/kg, then 10 mg salt/kg 6–12 h later
P. falciparum and unidentified species acquired in chloroquine-sensitive areas (Central America west of Panama Canal, Haiti, Dominican Republic, most of the Middle East) and P. malariae and P. knowlesi in all regions—Oral drugs
Drugs of choice
Chloroquine phosphatei,j
1 g salt (600 mg base), then 500 mg salt (300 mg base) at 6, 24, and 48 h
10 mg base/kg (up to 600 mg base), then 5 mg base/kg at 6, 24, and 48 h
800 mg salt (620 mg base), then 400 mg salt (310 mg base) at 6, 24, and 48 h
10 mg base/kg, then 5 mg/kg at 6, 24, and 48 h
P. vivax (unless from chloroquine-resistant area) or P. ovale—Oral drugs
Drugs of choice
Chloroquine phosphatei,j or hydroxychloroquinej dosed as above
30 mg base once/day for 14 days
0.5 mg base/kg once/day for 14 days
P. vivax acquired in areas known to harbor chloroquine-resistant P. vivaxl (Papua New Guinea, Indonesia)—Oral drugs
Drugs of choice
A. Quinine sulfate plus one of the following:
650 mg salt tid for 3 or 7 dayse
10 mg salt/kg tid for 3 or 7 dayse
100 mg bid for 7 days
2.2 mg/kg bid for 7 days
250 mg qid for 7 days
6.25 mg/kg qid for 7 days
B. Atovaquone/proguanilc
4 adult tablets once/day for 3 days
< 5 kg: Not indicated
5–8 kg: 2 pediatric tablets once/day for 3 days
9–10 kg: 3 pediatric tablets once/day for 3 days
11–20 kg: 1 adult tablet once/day for 3 days
21–30 kg: 2 adult tablets once/day for 3 days
31–40 kg: 3 adult tablets once/day for 3 days
> 40 kg: 4 adult tablets once/day for 3 days
C. Mefloquineh
750 mg salt, then 500 mg 6–12 h later
15 mg salt/kg, then 10 mg/kg 6–12 h later
Regimen A, B, or C plus
30 mg base once/day for 14 days
0.5 mg base/kg once/day for 14 days
Severe infection, all Plasmodium —Parenteral drugs
Drugs of choice
Quinidine gluconatem plus one of the following dosed as above:
10 mg salt/kg loading dose in normal saline over 1 h, then continuous infusion of 0.02 mg salt/kg/min for at least 24 h
24 mg salt/kg loading dose over 4 h, then 12 mg salt/kg infused over 4 h q 8 h, starting 8 h after the loading dose
Once parasite density is < 1% and patient can take oral drugs, complete treatment with oral quinine dosed as above
Same as for adults (except doxycycline and tetracycline are not used in children)
or (investigational)
Artesunatep,q plus one of the following dosed as above:
As per investigational new drug protocol (contact CDC for drug and dosing information)
Same as for adults (except doxycycline is not used in children)
Prevention of relapses: P. vivax and P. ovale only
Drug of choice
30 mg base po once/day for 14 days after leaving the endemic area
0.5 mg base/kg po once/day for 14 days after leaving the endemic area
aSee table: Adverse Reactions and Contraindications of Antimalarial Drugs for adverse reactions and contraindications. If malaria develops during prophylactic drug therapy, that drug should not be used as part of the treatment regimen.
bThe pediatric dose should not exceed the adult dose.
cAtovaquone/proguanil is available as a fixed-dose combination tablet: adult tablets (250 mg atovaquone/100 mg proguanil) and pediatric tablets (62.5 mg atovaquone/25 mg proguanil). To enhance absorption, patients should take it with food or whole milk. This combination is contraindicated in patients with creatinine clearance < 30 mL/min. Generally, this combination is not recommended for pregnant women, particularly during the 1st trimester, because safety data are insufficient; it may be used if other options are unavailable or are not tolerated and benefits outweigh risks. Twice/day dosing reduces nausea and vomiting as does taking it with food or milk. If patients vomit within 30 min of taking a dose, the dose should be repeated.
dArtemether/lumefantrine is available as a fixed-dose combination tablet of 20 mg/120 mg. Generally, this combination is not recommended for use in pregnant women, particularly during the 1st trimester, because safety data are insufficient; it may be used if other options are unavailable or are not tolerated and benefits outweigh risks. Patients should take the drug with food or whole milk. If patients vomit within 30 min of taking a dose, the dose should be repeated.
eIn the US, quinine sulfate capsules contain 324 mg, so 2 capsules are sufficient for adults. For children, dosing may be more difficult because noncapsule forms of quinine are not available. In Southeast Asia, relative resistance to quinine has increased, and treatment should be continued for 7 days. In other regions, treatment is continued for only 3 days. To reduce risk of GI adverse effects, patients should take quinine with food. Quinine plus doxycycline or tetracycline is generally preferred to quinine plus clindamycin because there is more data on efficacy.
fUse of tetracyclines is contraindicated during pregnancy and in children < 8 yr. In children < 8 yr with chloroquine-resistant P. vivax, mefloquine is recommended. If these drugs are not available or are not tolerated and if the benefits of treatment outweigh the risks, atovaquone/proguanil or artemether/lumefantrine can be used instead.
gClindamycin is to be used during pregnancy and in children < 8 yr.
hMefloquine is not recommended unless other options cannot be used because the rate of severe neuropsychiatric reactions is higher with mefloquine than with other options. Mefloquine is also not recommended for infections acquired in Southeast Asia because resistance to mefloquine has been reported in some areas (eg, the Myanmar borders with Thailand, China, and Laos; Thailand-Cambodia border; southern Vietnam).
iTo reduce risk of GI effects, patients should take chloroquine phosphate with food.
jChloroquine or hydroxychloroquine is recommended for chloroquine-sensitive infections; however, regimens used to treat chloroquine-resistant infections may be used if they are more convenient or preferred or if chloroquine is unavailable.
kPrimaquine is used to eradicate any hypnozoites that may remain dormant in the liver and thus prevent relapses in P. vivax and P. ovale infections. Because primaquine can cause hemolytic anemia in patients with G6PD deficiency, G6PD screening must occur before starting treatment with primaquine. For patients with borderline G6PD deficiency or as an alternate to the above regimen, primaquine 45 mg po once/wk may be given for 8 wk; clinicians should consult with an expert in infectious disease and/or tropical medicine if this alternative regimen is being considered for G6PD-deficient patients. Primaquine should not be used during pregnancy.
lIf patients acquire P. vivax infection in regions not known to harbor chloroquine-resistant P. vivax infection, treatment should start with chloroquine. If they do not respond, treatment should be changed to a chloroquine-resistant P. vivax regimen, and clinicians should notify the Centers for Disease Control and Prevention (CDC) Malaria Hotline (770-488-7788 or, after hours and on weekends and holidays, 770-488-7100).
mThe CDC recommends that patients with severe malaria be treated aggressively with parenteral (IV) quinidine started immediately with a loading dose. If patients have received > 40 mg/kg of quinine in the preceding 48 h or mefloquine within 12 h, the quinidine loading dose should be omitted. Consultation with a cardiologist and a physician with expertise in treating severe malaria is advised. BP monitoring for hypotension, cardiac monitoring for widening of the QRS complex or lengthening of the QTc interval, and blood glucose monitoring for hypoglycemia are necessary. Malaria is considered to be severe when patients have ≥ 1 of the following: impaired consciousness, coma or seizure, severe normocyctic anemia, renal failure, pulmonary edema, acute respiratory distress syndrome, shock, disseminated intravascular coagulation, spontaneous bleeding, acidosis, hemoglobinuria, jaundice, or parasitemia > 5%. Severe malaria is most often caused by P. falciparum.
nIf patients cannot take oral doxycycline, 100 mg is given IV q 12 h, then switched to oral administration as soon as patients are able. Rapid IV administration should be avoided. Treatment course is 7 days.
oIf patients cannot take oral clindamycin, a loading dose of 10 mg base/kg is given IV, followed by 5 mg base/kg q 8 h, then switched to oral administration as soon as patients are able. Rapid IV administration should be avoided. Treatment course is 7 days.
pIn the US, artesunate for IV administration is available only as an investigational new drug (obtained through the CDC by calling the CDC Malaria Hotline [770-488-7788]).
qOne of the following (using oral treatment doses) should be given with artesunate:
G6PD = glucose-6-phosphate dehydrogenase.
Adapted from the Centers for Disease Control and Prevention: Malaria diagnosis & treatment in the United States. Available at http://www.cdc.gov/malaria/diagnosis_treatment/index.html; last accessed on January 24, 2014.
Adverse Reactions and Contraindications of Antimalarial Drugs
Prevention of Relapses of P. vivax or P. ovale Malaria
Hypnozoites must be eliminated from the liver with primaquine to prevent relapses of P. vivax or P. ovale. Primaquine may be given simultaneously with chloroquine or afterward. Some P. vivax strains are less sensitive, and relapse may occur, requiring repeated treatment. Primaquine is not necessary for P. falciparum or P. malariae because these species do not have a persistent hepatic phase. If exposure to P. vivax or P. ovale is intense or prolonged or if travelers are asplenic, a 14-day prophylactic course of primaquine phosphate starting when travelers return reduces the risk of recurrence. The main adverse effect is hemolysis in people with glucose-6-phosphate dehydrogenase (G6PD) deficiency. G6PD levels should be determined before primaquine is given.
Primaquine is contraindicated during pregnancy and breastfeeding, unless the infant has been shown not to be G6PD deficient. In pregnant women, chemoprophylaxis with weekly chloroquine can be given for the remainder of pregnancy, and after delivery, women can be given primaquine, provided they are not G6PD deficient.
Travelers to endemic regions should be given chemoprophylaxis (see Table: Prevention of Malaria).
Malaria during pregnancy poses a serious threat to both mother and fetus. Chloroquine can be used during pregnancy in areas where Plasmodium sp are susceptible, but there is no other safe and effective prophylactic regimen, so pregnant women should avoid travel to chloroquine-resistant areas whenever possible. The safety of mefloquine during pregnancy has not been documented, but limited experience suggests that it may be used when the benefits are judged to outweigh the risks. Doxycycline, atovaquone/proguanil, and primaquine should not be used during pregnancy.
Artemisinins have a short half-life and are not useful for prophylaxis.
Prophylactic measures against mosquitoes include
Using permethrin- or pyrethrum-containing residual insecticide sprays (which have prolonged duration of action) on clothing or in homes and outbuildings
Placing screens on doors and windows
Using mosquito netting (preferably impregnated with permethrin or pyrethrum) around beds
Applying mosquito repellents such as DEET (diethyltoluamide) 25 to 35% to exposed skin
Wearing protective long-sleeved shirts and pants, especially between dusk and dawn, when Anopheles mosquitoes are active
People who plan to use repellents that contain DEET should be instructed to
Apply repellents only to exposed skin as directed on the label and use them sparingly around ears (they should not be applied to or sprayed in the eyes or mouth)
Wash hands after application
Not allow children to handle repellents (adults should apply the repellent to their hands first, then gently spread it on the child's skin)
Apply just enough repellent to cover the exposed area
Wash the repellant off after returning indoors
Wash clothing before wearing again unless indicated otherwise by the product label
Most repellents can be used on infants and children < 2 mo. The Environmental Protection Agency does not recommend additional precautions for using registered repellents on children or on pregnant or breastfeeding women.
Vaccines are under development. A large clinical trial of the RTS,S recombinant vaccine based on the P. falciparum circumsporozoite protein showed moderate efficacy, resulting in 46% fewer cases of clinical malaria in young children living in endemic regions of Africa. The results are encouraging, but it is unclear when a vaccine is likely to become available for military personal and international travelers.
Prevention of Malaria
Adult Dosage
Pediatric Dosage
In all areas
1 adult tablet once/day
5–8 kg: one-half pediatric tablet once/day
> 8–10 kg: three-fourths pediatric tablet once/day
> 10–20 kg: 1 pediatric tablet once/day
> 20–30 kg: 2 pediatric tablets once/day
> 30–40 kg: 3 pediatric tablets once/day
> 40 kg: 1 adult tablet once/day
Begun 1 to 2 days before travel and continued daily during the stay and for 7 days after leaving
Chloroquine phosphate
Only in areas with chloroquine-sensitive Plasmodium
500 mg salt (300 mg base) po once/wk
8.3 mg salt/ kg (5 mg base/kg), up to maximum 500 mg salt (300 mg base) po once/wk
Begun 1–2 wk before travel and continued weekly during the stay and for 4 wk after leaving
In all areas
100 mg po once/day
> 8 yr: 2.2 mg/kg (up to 100 mg) po once/day
Begun 1–2 days before travel and continued during the stay and for 4 wk after leaving
An alternative to chloroquine in areas with chloroquine-sensitive Plasmodium
400 salt mg (310 mg base) po once/wk
6.5 mg salt/kg (5 mg base/kg), up to 400 mg salt (310 mg base) po once/wk
Begun 1–2 days before travel and continued during the stay and for 4 wk after leaving
In areas with mefloquine-sensitive Plasmodium
250 mg salt (228 base) po once/wk
≤ 9 kg: 5 mg salt (4.6 mg/kg base) once/wk
> 9–19 kg: one-fourth tablet once/wk
> 19–30 kg: one-half tablet once/wk
> 30–45 kg: three-fourths tablet once/wk
> 45 kg: 1 tablet once/wk
Begun ≥ 2 wk before travel and continued during the stay and for 4 wk after leaving
For prophylaxis for brief travel in areas known to harbor mainly P. vivax
30 mg base (52.6 mg salt) po once/day
0.5 mg base/kg (0.8 mg salt /kg) up to adult dose po once/day
Begun 1 to 2 days before travel and continued daily during the stay and for 7 days after departure
For terminal prophylaxis to prevent relapse of or infection in people with prolonged exposure or prior infection
Dosed as above
Dosed as above
Given daily for 14 days after departure from endemic area
aSee table: Adverse Reactions and Contraindications of Antimalarial Drugs for adverse reactions and contraindications.
bAtovaquone/proguanil is available as a fixed-dose combination tablet: adult tablets (250 mg atovaquone/100 mg proguanil) and pediatric tablets (62.5 mg atovaquone/25 mg proguanil). To enhance absorption, patients should take the drug with food or a milky drink. Atovaquone/proguanil is contraindicated in patients with a creatinine clearance < 30 mL/min. This combination is not recommended for children weighing < 5 kg or for pregnant or breastfeeding women.
cUse of tetracyclines is contraindicated during pregnancy and in children < 8 yr.
dHydroxychloroquine is contraindicated during pregnancy and in children < 8 yr.
eMefloquine has not been approved for use during pregnancy. The drug is contraindicated in patients who have active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures; if patients have psychiatric disturbances or a previous history of depression, the drug should be used cautiously. The drug is not recommended for patients with cardiac conduction abnormalities.
fPrimaquine is used as terminal prophylaxis to reduce risk of relapse in people who have taken chloroquine or a drug active against chloroquine-resistant malaria and have had prolonged exposure to P. vivax and/or P. ovale. Primaquine alone can also be used for primary prophylaxis in people at risk of malaria, particularly that due to P. vivax. It is contraindicated in people with G6PD deficiency and in pregnant or breastfeeding women (unless the breastfed infant has a normal G6PD level).
G6PD = glucose-6-phosphate dehydrogenase.
Adapted from the Center for Disease Control and Prevention (CDC): Infectious diseases related to travel. In the Yellow Book. Available at http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/malaria; last accessed on January 24, 2014.
Key Points
There are 300 to 500 million people infected with malaria worldwide; about 660,000 deaths occur yearly, mostly in children < 5 yr in Africa.
P. falciparum causes microvascular obstruction and tissue ischemia, particularly in the brain, kidneys, lungs, and GI tract of nonimmune infants and adults; patients may die within days of their initial symptoms.
P. vivax, P. ovale, and P. malariae typically do not compromise vital organs; mortality is rare.
Manifestations include recurrent fever and rigor, headache, myalgia, and nausea; hemolytic anemia and splenomegaly are common.
Diagnose using light microscopy of blood (thin and thick smears) and/or rapid blood assays.
Treat with antimalarial drugs based on the species (if known) and drug resistance patterns in the area in which infection was acquired.
Give chemoprophylaxis to travelers to endemic areas, and teach them ways to prevent mosquito bites.
- Extraintestinal Protozoa
- Introduction to Extraintestinal Protozoa
- African Trypanosomiasis
- Babesiosis
- Chagas Disease
- Free-Living Amebas
- Leishmaniasis
- Malaria
- Toxoplasmosis
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The Powerful Difference Between Lecture and Lab
Just because a person has read a flight manual doesn't mean that person knows how to fly an airplane. When it comes to flying an airplane, the person who has only read the flight manual is a good deal more dangerous than the person who has never studied such materials—for no reason other than that the unlearned person is fully aware of how little he actually knows!
This is also true methods that are employed in discipling followers of Jesus. Almost all our methods are message-centered. By message-centered I mean lecture. In fact, our churches are designed for lecture—row after row of neatly arranged chairs all facing a stage where one or two people lecture so that "learning" can take place. This is precisely because our churches are genetically related to universities. This genetic relationship exists precisely because we value knowledge and safety. We want things that we can preach precisely in four, or perhaps six weeks, and we want the process to be safe—which is to say, free from risk.
Knowledge, doctrine, and theology are all important (I don't know anyone arguing for a dumber gospel), but they are not nearly as important as the way in which they are learned. Safety is a good thing, too, but not at the expense of a risk-taking culture that allows disciples to have the sort of life experiences that can grow real learning and knowledge.
There are untold thousands of Christians who can take the "God test" and get all the answers right, but who remain unformed and unchanged. There are untold thousands of pastors who can accurately teach the theology of God's omnipresence, but have never actually experienced the God who is everywhere all the time. Where else would we settle for this sort of knowledge?
There is a process for becoming a disciple of Jesus. You can't simply read your way into a transformed life. You can't study (read, listen to sermons, go to college, learn ancient languages) enough to see your life begin to conform to the image of Jesus. And on this point be thankful—otherwise the gospel would only be for the brilliant and studious! Yet the church in America has become message-centered. We meet together to listen to lectures. The center of the meeting for the evangelical church is when the pastor stands up and delivers the message.
There are at least three factors that have lead to this model:
1) Jesus did it! This means preaching and teaching is good. It's something we should do.
2) We're Protestants! The Reformation took a lot of debate about doctrine. Invisibly, the center of gathered worship moved, based upon our values, from the body and blood of Jesus to the message.
3) We're enlightened! The cultural shift of the Enlightenment crashed upon us like a great wave from the sea. We are all products of the scientific method and scientific reason. The gospel was put under the microscope—examined, defined, labeled, and studied. In the absence of personal experience the miracles became myths, and an intellectual approach to faith in Jesus took root—an approach that exalts ideas over personal experience.
Jesus is, after all, called the logos—the word of God—but we have forgotten that he is the word of God even when he isn't speaking. Jesus was the word of God even when he was asleep in a boat in the middle of a storm—and that was the message! In order to reproduce disciples who look like the master, we must recapture the master's message, the parts that he spoke, and parts that he demonstrated.
How we come to know something is perhaps more important than the bare facts that we accumulate. Just because a person can get all the answers right on a test doesn't mean a person really knows anything (and by the way, it's a test that will never be given, at least not in a direct question and answer form).
This is especially true in the church where most of our models for making disciples center around "educating" people with the gospel. It's little wonder that we have a church culture full of people able to give right answers, but powerless to display right answers. There are countless people who "know" that God loves them, but precious few who feel it and, as a result, spend their entire lives trying to earn the affection of a Father who is already pleased with them.
Jesus was able to reproduce his life in the disciples—supernatural healing and deliverance, powerful preaching, and sacrificial leadership that caused nearly every one of the twelve to die violent deaths for the sake of the gospel. This was not superficial transformation, it was to the core.
The methods we employ when making disciples are radically important. If we make discipleship primarily a school, a lecture-based exercise, we'll reproduce experts for sure, experts with all the right answers but devoid of life.

subset: commoncrawl


text:
|Discovering DIY
Event Type: 1Early Literacy and Early Learning
Age Group(s): Children, Preschool
Date: 13/01/2017, 20/01/2017, 27/01/2017, 03/02/2017, 10/02/2017, 17/02/2017, 24/02/2017
Start Time: 10:30 AM
End Time: 11:30 AM
This specialty program for 2 to 4 year olds introduces DIY projects in an interactive and hands on environment. A caregiver must attend this program with child. Registration begins on January 6.Library: Main Library
Location: James J. Brown Auditorium
Contact: Becky
Presenter: Becky
Status: Waiting List (1)
|Please Note


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Bootloop from trying to install Cyanogenmod11 onto Sprint LG G2 KitKat
I am very new to rooting, and just rooted my Sprint LG G2 with 4.4.2 KitKat through IORoot 25 and then used AutoRec as my TWRP. I then downloaded Cyanogenmod11 from its website onto my phone, and tried to flash install it through AutoRec. However, when I try to install the CM11 ROM, I get the "MD5 not found" message, and when I try to reboot after this, my phone goes into what I think is Bootloop (the LG home screen continuously turns on for a couple seconds, then stops for a split second, and then turns back on for a couple seconds). Fortunately, I am was able to hard restart my phone by holding Power and Volume Up together while this screen is on, and I was able to restore my phone with the backup I made, and my phone is now working fine with the stock ROM. Has anyone else had this problem before, and if so is there a better way for my to install custom ROM, and/or fix that MD5 message? Does anyone know what that MD5 message means?
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|1 Quart
|Instant non-fat dry milk
|1⁄4 Cup (4 tbs)
|2 Tablespoon (Your Own Or Commercially Made)
Combine the milk and non-fat dry milk in a heavy pan; bring slowly to the boiling point, stirring.
As soon as it boils, remove from heat and cool to about 115° (you can put the pan in a bowl of cold water to speed the cooling).
If you don't have a thermometer, put a drop of milk on your wrist; it should feel warmer than lukewarm.
Blend a little of the warm milk with the yogurt until smooth, then stir the yogurt mixture into the warm milk.
At this point the object is to maintain the milk at about 115° for 6 to 8 hours (if it goes below about 95°, the action stops).
You can leave the milk in a bowl, if well covered, but it may be easier to handle if transferred to a prewarmed glass jar.
If you have a gas oven, the temperature inside with just the pilot light on may be about right€"the temperature must never go over about 120° or your culture will be killed.
Most people simply wrap the container of warm milk in some good insulating material, such as a heavy wool blanket.
Various insulated boxes and picnic bags work successfully, too; you can prewarm them by letting jars of very hot water stand in them while you are preparing the milk.
Be sure to place the insulated container of warm milk in a spot where the rate of cooling will be slow€"on a high shelf, in a cupboard above a wall oven (turned on), in the car parked in the sun with windows closed, or near the hot water heater.
During the 6 to 8 hours it usually takes to make yogurt, the milk should not be disturbed.
Recipe Summary
Rate It
Nutrition Rank
Nutrition Facts
Serving size: Complete recipe
Calories 792 Calories from Fat 285
% Daily Value*
Total Fat 32 g48.8%
Saturated Fat 18.3 g91.4%
Trans Fat 0 g
Cholesterol 112.2 mg37.4%
Sodium 689.9 mg28.7%
Total Carbohydrates 81 g27%
Dietary Fiber 0 g
Sugars 78.6 g
Protein 52 g104.3%
Vitamin A 19.9% Vitamin C 4.8%
Calcium 179.2% Iron 1.7%
*Based on a 2000 Calorie diet


text:
[img_assist|nid=3115|title=|desc=|link=none|align=right|width=250|height=225]Junkies, today is a big day in Siglerism. As reported in the Global Print Monitor, I have launched the future platform of world destruction. Say hello to my little friend: Dark Overlord Media! I have partnered with Audacity Events, a San Diego company run by Junkie AlphaGirl, to establish my own small press imprint.
Dark Overlord Media Launches, Publishing Books By Established Online Personalities
San Francisco, CA (August 19, 2009) – New York Times best-selling author Scott Sigler today announced the formation of Dark ∅verlord Media, a publishing house created to produce books and other properties for established online personalities.
"Entertainers are using the internet to establish their own audiences," Sigler said. "You no longer need a big publisher or a network marketing machine generate a fan base. Dark ∅verlord Media wants to help those entertainers and journalists create tangible products that will make their audiences happy, then facilitate selling directly to those audiences."


text:
Four Slovenian officials have been suspended following allegations that they rigged the results to help world renowned violinist Vanessa-Mae qualify for the Winter Olympics.
Ms Mae competed in the women's giant slalom at the Sochi Olympics coming last at 67. She raced as part of the Thai team using her father's surname Vanakorn.
The Slovenian Ski Association (SSA) said today that it had found evidence indicating that a preliminary race that the country had hosted prior to the Games was "fixed at the behest of Thai ski officials to meet her qualifying criteria for Sochi," according to AP.
President of the association, Jurij Zurej, reportedly said that the alleged irregularities included falsification of times and rankings.
Briton Ms Mae, 35, had to take part in games in Sweden, Norway, Slovenia and Switzerland in January, in order to earn enough points to take her into the Games in February.
"The starting list included a person who did not even compete, a racer who fell was registered as finishing high in the standings," Mr Zurej said.
"In addition, the dates of the competitions did not match the actual state when the races were held."
The SSA said that it found breaches of International Ski Federation (FIS) rules, which it has passed to the country's public prosecutor.
Mr Zurej added: "We have discussed the findings and we have discovered that there were clear breaches of the FIS rules and the rules of the Slovenian Ski Association.
"Based on those findings, we have decided that the four persons responsible for that race will not be able to work in the name of the SSA for a period of four years, and we have sent a sample of the findings to the public prosecutor.
"We must state clearly that there is absolutely no proof any athlete including Vanessa was [knowingly] involved in any activities that would breach any of our rules or those of FIS."
Additional reporting by agenciesReuse content


text:
I just pulled the leaves off of 3 that I tried yesterday. They are so
beautiful I don't know if I will want to mess them up. I want to make more.
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I think I like the castor bean the best. I had a hard time finding leaves
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that if the leaf has damage then just patch with another piece of a leaf.
It shows a little but now I think I can even do it better.
----- Original Message -----
From: <email@example.com>
To: <email@example.com>
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Subject: Re: [CHAT]Genes greenhouse/ troughs
> In a message dated 9/18/04 8:05:39 AM, firstname.lastname@example.com writes:
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V.19 No.14 |
Oscar-nominated film The Secret of Kells in SF
By Jerry Cornelius [ Fri Apr 9 2010 6:47 PM ]
Inexplicably (to me), Hayao Miyazaki's Ponyo didn't get an Oscar nod for Best Animated Picture, but maybe (just maybe) it was nudged out of the way by this very cool-looking Irish cartoon that New Mexicans can see starting tonight (and running through at least April 15) at Santa Fe's Center for Contemporary Arts. I'll be hitting the 11:30 a.m. Sunday showing if I'm not too hung over, and I recommend you do the same.
The 75-minute film seems entirely OK for kids used to concepts like death and violence and beauty but is Not Rated. CCA says "this fantastical, breathtaking spiritual animation follows as the 12-year-old Brendan fights Vikings and a serpent god to find a crystal and complete the legendary Book of Kells. The story begins when Brother Aidan, a celebrated master illuminator, initiates Brendan into the art of illustration, awakening his hidden, but extraordinary talents. But finishing the magnificent book means a remarkable quest beyond the abbey walls and deep into an enchanted forest." Sounds awesome. See ya there.
NEWSLETTERS Great Alibi stories, events and deals delivered to your inbox each week. No fooling!
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Bourbon Pairing Dinner at Pueblo Harvest CaféMore Recommended Events ››
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text:
Matthew 18:3 – Verily I say unto you, Except ye be converted, and become as little children, ye shall not enter into the kingdom of heaven.
Generalissimo Alberto: It's a beautiful day in the neighborhood, a beautiful day for a neighbor. Would you be mine?
LegendaryMonkey: Oh, geez, we're playing Bible verse again too, I see. Alright, at least I know what to expect. Albert, do I need to go count the blue pills? Are you chewing down all your meds again?
GA: No, really. I only had one. It's just a nice day. We should go out and play.
LM: Oooh! This is something I can get into with hand-clapping abandon. Perhaps you can leave the Pinky and the Brain-inspired plans for world domination on hold, and we can kick through the autumn leaves.
"We're Going to Be Friends"
White Blood Cells, 2002
Well here we are, no one else
we walked to school all by ourselves
there's dirt on our uniforms
from chasing all the ants and worms
we clean up and now its time to learn
Numbers, letters, learn to spell
nouns, and books, and show and tell
at playtime we will throw the ball
back to class, through the hallteacher marks our height
against the wall
LM: Here are Jack and Meg as little children playing with bugs and worms on their way to class. You could just cry at the tender purity of the love in this song, a love not yet complicated by sexuality and other grown up issues. It's very rainbows-and-lollipops.
GA: This is the White Stripes most direct Jonathan Richman play. This reversion to childhood would mirror, for example, "Back in Your Life."
There's a big difference in the vibe, though. Richman offers himself up as a fool for love in "Back in Your Life." He's offering himself up for mockery when he expresses a desire to help the girl's mama with the pancakes.
Whereas Jack drops "We Are Going to Be Friends" right in the middle of a collection of otherwise clearly adult songs, without that obvious extreme self-consciousness crowding him.
LM: I dunno, I rather see this as the pinnacle of a very straightforward album. White Blood Cells is the "love" album. Every song has something to do with love and relationships, and as I said, this is the look at love before it gets complicated. But it goes beyond that — this song is as pure as a hymn on Sunday morning, and it's the gleeful top-o-the-world moment on an emotional roller coaster. It's all part of the same cycle — this is just the upswing.
But I don't want to argue. I want to go roll around in the grass and sketch pictures in the dust with a stick. Or maybe climb a tree and skin my knee. And then maybe we can strum on a guitar and sing folk songs!
GA: Okay, let's not start like some Joan Baez pinko folk singer, or I'ma have to start rounding up damned hippies, and putting them to the lash. Tracy Chapman, are you listening?
LM: Now Al, you've been so good up till now. Let's keep it on the love track. How about a nice game of hopscotch?
GA: You mean play a game representing how Jack White's guitar army will leap across the country, seizing territory for The People?
LM: Yes, exactly. I've got some colored chalk. We can draw a map on the sidewalk with all the countries, and we can hopscotch across it.
GA: Wheeeee!
Come hand in hand with us, back to the beginning of WHITE STRIPES NATION!
LegendaryMonkey Alisha Karabinus provides the inner voice of sweet reason for evolved primates at Sudden Nothing.
Al Barger plots the overthrow of the government and his continuing crusade for Moorish dignity at More Things.Powered by Sidelines


text:
The most qualified and knowledgeable GIS professionals in the industry.
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Company Profile
The staff at Quartic Solutions contribute many years of experience to the GIS industry, and have a complete understanding of how to apply GIS technology to achieve efficiency in government and business operations. Quartic Solutions is an award winning ESRI Authorized Business Partner as well as an Azteca Systems Cityworks Business Partner. Our team offers high-level expertise in a wide range of GIS focused applications including the full platform of ArcGIS solutions. There is no team more qualified to assist with your company's GIS consulting and services.
The company's client base currently includes non-profit, local, municipal, utility, regional, and state government. Quartic Solutions is based in San Diego, CA, and also performs GIS services throughout Southern California including Orange County, Riverside County, San Bernardino County and through the greater Los Angeles area.
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Quartic Solutions, in addition to providing long term support to
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SDG&E GEARS Upgrade
GEARS (Geospatial Environmental Analysis and Reporting System) is
Creating Online Mapbooks
Quartic Solutions has recently completed the automation of Water


text:
Delta of Venus
An extraordinarily rich and exotic collection from the mistress of erotic writing
In Delta of Venus, Anais Nin pens a lush, magical world where the characters of her imagination possess the most universal of desires and exceptional of talents. Among these provocative stories, a Hungarian adventurer seduces wealthy women then vanishes with their money; a veiled woman selects strangers from a chic restaurant for private trysts; and a Parisian hatmaker named Mathilde leaves her husband for the opium dens of Peru.
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by Brandonluvshischevy [OP] » May 02 2011, 3:30am
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by NYsteve » Jun 21 2011, 11:32pm
check system working heat quit side again fine sounds cover enough shop last high power make still thanks problem guys issue bought thing black
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Mark Peters : January 30th 2011 - 12:05 CET
LG Smartphone accessories
Accessories for LG Smartphones :
LG Mobile, a leading provider of advanced wireless handsets and Smartphone accessories, has been showcasing the latest in mobile innovations at the CES 2011 Show in Las Vegas offering a wide variety of new Smartphone accessories. LG delivers a well rounded line-up of Smartphones and accessories that create a breadth of choice unlike any before. From the must-have, entry-level LG Optimus Smartphone to the convenience and versatility of the LG HBM-810 Bluetooth headset. LG has the Smartphone accessories that work with every consumer's busy life.
LG Smartphone accessories
Continuing its role as an industry leader in mobile technology, LG highlights a versatile line-up which includes its first 4G Long Term Evolution (LTE) accessories capable of speeds never before seen in the wireless industry. "In an ever changing wireless industry, it is vital that we continue to listen to the voice of our consumers and develop wireless handsets and Smartphone accessories that meet their growing needs," said Tim O'Brien, vice president of marketing. "LG Mobile is dedicated to provide Smartphone users the accessories that embody the latest in innovation and exciting new technologies."
LG HBM-810 Headset
The LG HBM-810 is the ultimate road warrior's headset. Featuring a speakerphone cradle, users can enjoy the ease and privacy of calls via loudspeaker in their own car and when it comes time to hope on the bus or train, the LG HBM-810 headset snaps off to become a sleek headset ready for private calls. The LG HBM-810 headset features up to five hours of talk time and 150 hours of standby time to keep you connected at all times, and when it finally does need to be charged, the cradle does so via solar power, keeping you on the move even when without a power outlet. The LG HBM-810 also features the convenience of auto reconnect, voice dialing with supported mobile phones, Name Alert caller ID, A2DP music play and requires less than two hours to fully charge to keep you in the game while on the road.
LG HBS-700 Bluetooth Headset
The latest in LG stereo Bluetooth headset devices, the LG HBS-700 is a wireless Bluetooth headset that features a new and unique design that is both lightweight and comfortable. Intuitive talk and music controls allow users to answer calls, skip songs and take control of all their features with a press of a button. A unit integrated battery status check allows users to keep their headsets fully charged and ready for the road. With the LG HBS-700, you can stay better connected to your Smartphone.
LG Wireless Charging Pad
The LG Wireless Charging Pad allows users to easily and efficiently charge their Smartphones without the hassle of wires or external connections. Providing industry leading wireless charging, the LG Wireless Charging Pad can fully charge a standard Smartphone in approximately two hours. For easy and intuitive use, the LG Wireless Charging pad features audible and tactile feedback when a Smartphone is placed on the pad as well as multi-colored LED lights to indicate charging status of your Smartphone.
LG VL600 4G LTE USB modem
Ideal for business professionals on-the-go, the LG VL600 LTE USB modem features high-speed 4G internet connectivity, a lightweight design with flip USB cover and sleek outer finish that makes travelling a streamlined, enjoyable experience. Verizon Wireless' 4G LTE will launch in 38 major metropolitan areas, covering more than one-third of all Americans - 110 million people and in more than 60 commercial airports. Staying connected with the LG VL600 is not just a business tool, it's a business revolution.
LG Adrenaline 4G Wireless Network Adapter
The latest in LG LTE capable devices, AT&T USB Connect Adrenaline from LG is a wireless network adapter that connects laptops and computers to AT&T's EDGE, HSPA and upcoming LTE Networks. Available on blazing fast 3G and 4G networks, Adrenaline delivers easy-to-use plug and play functionally and multiple OS support to keep users connected while on-the-go. With a sleek casing and smooth streamlined finish, Adrenaline is equipped with an internal antenna that keeps the device slim and ideal for conducting business or staying in touch with friends and family wherever you are.
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ArtXperience, Ages 10-15
Students will delve into creativity during this three-day long ArtXperience camp! Led by instructor Courtney Mealy, students will experience creativity through art and discover a new medium each day. Projects will include abstract wire sculptures, pet (or animal) portrait paintings and mixed-media project that the participants will vote on! Students will learn the history of each art form and create their own masterpiece.$69 Monday-Wednesday, July 25 - July 27, 8:30 - 11 AMRoom 604, Seneca Building
Pot-Pot-Pottery Youth ages 10-16
Have fun working with clay. Learn hand building and coil construction. You will be able to glaze and fire your work and take home your completed projects. Wear comfortable clothing that you don't mind getting clay on.
Monday-Friday, June 6 - 10
9:30-11:30 AM Ceramics Studio
Pick up day: Monday, June 13, 9:30-10:30 AM
Youth Writing Spectacular!! Ages 9-14
This creative writing camp is for young writers who want to develop their talent and passion for writing fiction, nonfiction and poetry. On the evening of the last day you will sit in our author's chair and share your work with fellow writers, friends and family at the "Open Mic†Celebration from 6-8 PM June 16 in the Harriett B. Wick Chapel. Students should bring snacks for breaks.
Monday-Thursday, June 13 - 16, 9 -11:30 AM McDowell Sport and Fitness Center, Room 158
Pets 'n Vets I and II
The Pets 'n Vets three-day program will include enjoyable, creative and instructional activities centered on children and their pets.Hands-on learning will be the primary focus of this camp experience. Campers should bring their own snacks and drinks.
Both sessions meet in Room 106D Fisher Hall
Session I: For campers who have completed grades 1, 2, or 3Tuesday - Thursday, August 16 -18, 8:30 AM - Noon
Session II: For campers who have completed grades 4, 5, or 6
Tuesday - Thursday, August 16 - 18, 1:30 - 5 PM
Game Programming, Ages 10-16
Use JavaScript to learn video game programming the easy and fun way. Interact with Minecraft characters, create your own Flappy Bird game, join Anna and Elsa from Frozen in a quest, create digital art, and program Droids in Star Wars! You will also get an introduction to Code.org, a free website designed by engineers from Google, Microsoft, Facebook and Twitter that you can use to polish your programming skills afterward at home.
Monday-Thursday, June 20 - June 23
8:30 - 11:30 AM Swarts Hall, Room 236, Pitt-Bradford Campus
Television Studio, Ages 10-16
Join Jeff Gutterman to learn how to create television news broadcasts, televised puppet shows and other types of programs in a real-life, multi-camera digital studio environment. You will learn about the roles both behind and in front of the camera. You will also learn how to perform and produce, direct, and serve as a studio production assistant. This workshop is fast-paced, informative and fun.
Wednesday and Thursday, July 13 and 14
9 AM - Noon, Room 131, Blaisdell Hall (TV Studio) Pitt-Bradford
Photography 101, Ages 10-16
Enjoy the outdoors with a three-day Photography Camp. Bring your camera or smartphone to learn about taking awesome photos outdoors and indoors. Children have a unique eye for seeing things, and this class will tap into their creative side to help them produce visually stunning and breathtaking photos of everyday objects, nature, people and places. Learn what makes a good photo even better and how to take photos from different angles and viewpoints.
Tuesday-Thursday, July 19 – July 21
8:30 – 11:00 AM, Room 158,
McDowell Sport and Fitness Center, Pitt-Bradford
You'll find a lot to do here, particularly if you like doing things outdoors.
Learn more »


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Contact Luxury San Francisco Apartments
Welcome to Carmel Rincon, our stunning community of San Francisco luxury apartments. Contact us today to arrange a tour with a friendly leasing associate. We look forward to hearing from you.
Office Hours
Mon-Sun 10:00am-6:00pm
Lease luxury apartments in San Francisco, CA at Carmel Rincon Apartments.


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I've done both Hot Yoga and Vinyasa for over ten years. I cannot imagine one without the other. I was fortunate to acquire a taste for both – and they are acquired tastes. I enjoy warm rooms and hot rooms, never cold rooms – that's where I draw the line. Fortunately, Sunstone offers hot, warm and ambient classes! Here's some of my take-aways:
Hot Yoga: At Sunstone, it's hot, it's humid, it's QUIET. In a Hot Yoga class you spend the entire 60 or 90 minutes trying to silence the voices in your head/stilling your mind – some days are better than others. Work to your edge and be in the moment, that is the point, otherwise go home (not really, but you know what I mean). Realize giving 100% is different relative to the day, not what you think you can do or compared to yesterday – you'll be better off.
Sunstone's sequence of postures is brilliant, restorative, and healing for the bodies (emotional, physical, intellectual and spiritual). Unlike Vinyasa or Flow yoga, the Hot Yoga class provides a reset before each posture, which allows for a deliberate and strong set up for each posture, your body appreciates this. Hot Yoga at Sunstone is the same sequence every time, so you can allow the class to unfold in your muscle memory and then maybe a bit deeper (internal or external). *remember yoga is not nearly about what's on the outside but what's occurring on the inside (organs, joints, emotions, muscles, locks, nadis, compressions/expansions, positivity, bandhas – quite a bit to work with there. If you don't recognize some of these words, don't worry, they will be in a future blog).
By doing the same set of postures you may also gauge where you are in your practice, how far you've come from the very first day or since the last class you took. Keep a journal, give yourself credit for your journey, it's often easy to forget how hard certain postures were in the beginning. Trust me, they were harder than you remember, because you've gotten better. Hot Yoga is tremendously grounded and reliable. If this is your class of choice, this may say something about your character.
Nervous about the "hot" factor? 1. know that our class is not as hot as the Bikram classes you may have heard about. Ours are set to body temperature (98.6 degrees) and have added humidity, which makes them a bit more comfortable. 2. We'd encourage you to try our Hot Yoga Lite class which has all the same postures as a slightly more gentle pace in a warm, not hot, room.
Vinyasa Flow: Postures move from one to the next throughout the class.The constant movement is aligned with breath – a symphony of breath and action. At Sunstone, some Vinyasa classes are sequenced – Flow Yoga, Calm Flow and Hot Flow- but Power Flow postures are teacher-lead and thus fluctuate from class to class.
In these classes, you must maintain an open mind and a willingness to the abandon the knowledge of what posture may come next. Vinyasa is fleeting, as soon as you think you've got the hang of one posture, you are on to the next. This style is prominent in the fields of letting go, allowing, and accepting. The movement often sabotages your balance, while the sweat rolling down your arms onto your hands causes your downward facing dogs to slide and slip. The external body attempts to rule the internal body. All of your insides feel like they want to change places with your outsides.
You will be encouraged to breathe through all of these happenings. Often there is music to distract your mind, your thoughts simply can't compete with the groove. (Your body inherently loves to dance and hardly ever gets the opportunity, so it is content to keep the movement going.)
When both Hot Yoga and Vinyasa Flow are incorporated throughout your weekly practice, you will experience a balance. You will be able to keep your feet firmly on the ground but with a lightness of spirit that will not weigh you down!


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Here in the northern hemisphere, the days are getting brisker and the leaves are changing colors. So for this Throwback Thursday (#TBT), we've put together a slideshow full of fall imagery. Why not sit back, read up on some Coke history, and trade in your pumpkin spice latte for a refreshing
Coca-Cola this week?


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