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October 6, 1991, Section 5, Page 8Buy Reprints
MANHATTAN has hundreds of hotels, but they tend to be expensive. Even hotels that say they are economically priced can easily cost $150 a night for a double room. And that's before little extras like room service, tips and taxes, which are currently 16 1/4 percent for rooms under $100 and 21 1/4 percent for rooms over $100, plus $2 a room.
But Manhattan is a big place, and it's still possible to get a room for two for less than $100 without checking into a youth hostel. You shouldn't set your sights too high, of course. Expect an elevator, a private bathroom and sturdy locks. Expect fresh sheets, clean towels and daily maid service. Room service is usually too much to ask for, though there should be vending machines and perhaps coin-operated washing machines. And if your room has recently been renovated, there may even be a bit of style.
I recently spent a night at four hotels aimed squarely at budget-minded visitors. Three were chosen because they are either new or recently renovated. And the fourth was selected because it's a legend. In each instance, I reserved a room several days in advance and never mentioned that I was writing an article. Broadway American Hotel
The new Broadway American Hotel, which opened in January, is a welcome arrival on the Upper West Side. The place is a study in budget chic. Headboards have oval cutouts displaying postcards of King Kong on the Empire State Building. (Visitors can keep the cards.) The lobby's sleek new ceiling also has big oval cutouts, with the original crenelated ceiling, nicely restored, peeking through.
These touches are particularly striking as the hotel, originally designed as a 1919 apartment building, was a dingy single room occupancy hotel for years. One caveat: 173 of its residents still live here, in rooms sprinkled among the hotel's 200 guest rooms. All doors are identical, though I assumed a room on my floor with two extra locks belonged to a permanent guest. Ear-splitting music emanated from that door as I carried up my bag; luckily, though, things got quieter when I was ready to go to sleep.
My sixth-floor $89 room was large, with simple gray speckle-paint walls, two big closets, new blue-gray carpeting and two narrow twin beds with pale blue spreads. The television stood on a cupboard that hid a mini-refrigerator. It was the perfect atmosphere for "I Love Lucy" reruns. There was an oval-topped bedside table but no desk, and two armless wooden chairs, not very comfortable. The simple, white-and-gray bathroom was spacious. Only 50 rooms have private baths. The rest share what range from baths with tiny stall showers to larger bathrooms with tubs, with one bathroom to three guest rooms, or 13 bathrooms to a floor.
The tired-looking kitchens on each floor -- no pots and pans are supplied -- seem the domain of the permanent residents (one refrigerator door was padlocked). Drinks and snacks cost $1 in vending machines throughout the building.
Broadway American Hotel, 2178 Broadway (at 77th Street), New York, N.Y. 10024; (800) 446-4556 or (212) 362-1100. Rates: double rooms with private bath, $89; $65 with shared bath. All guests must present a credit card on checking in. Herald Square Hotel
Not far from the Empire State Building (and Macy's) is the Herald Square Hotel, a neat, clean few-frills hotel, with a glamorous past. Built in 1893, this pink brick and limestone building was the original home of Life Magazine -- there's a century-old carving of Winged Life, a fetching little cupid, gazing down at the entryway. It's worth taking a minute to admire the handsome exterior, because once you're inside, historic details are few. The well-lighted lobby is functional and nothing more, with no place to sit (vending machines and lockers fill a room off to the side). But early Life photographs and covers, including illustrations by Charles Dana Gibson, a onetime resident, adorn the walls. And the atmosphere, with lots of talkative Europeans and South Americans, can be lively and fun.
Like its sister hotel, the modestly priced Washington Square Hotel, the 114-room Herald Square, renovated two years ago, is cleverly designed, with no wasted space. My compact sixth-floor room, $65 for one person, was long and extremely narrow, with pale pink walls and gray moldings. A cheery strip of classically patterned wallpaper lined the ceiling. The double bed, with a pastel patterned spread, stood beside a built-in bedside table. A cabinet holding the television was at the bed's foot. By it was a drawerless desk with a cane-back chair. The long, narrow bathroom had a fairly new tub with a sliding glass shower door. There were no free-standing lamps; instead, rather annoying fluorescent lights were built into the walls.
My tiny window looked onto another building, though much of the view was obliterated by the air-conditioner. But larger rooms, all identically furnished, are almost spacious. All have vintage Life covers on the walls.
Herald Square Hotel, 19 West 31st Street (between Broadway and Fifth Avenue), New York, N.Y. 10001; (800) 767-1888 or (212) 279-4017. Rates: double rooms with private baths, $55 (showers only), $70, $75 and $85. Journey's End
Journey's End Hotels is the slightly ominous name for a chain of Canadian-owned economy hotels found mainly in small towns throughout Canada and the United States. But in July 1990 the company opened a 189-room hotel, just off Fifth Avenue, in a new high-rise near the main branch of the New York Public Library. There are no notably New Yorkish details about the Journey's End hotel, which typifies the high end of the budget league. The big white lobby looks like an airline check-in area. The narrow mezzanine lounge, where complimentary coffee and muffins are served on weekends, is clean and comfortable and has lots of tropical-print sofas and chairs. But the place is clean and well-run, if a little preachy. A printed notice on my bathroom mirror requested that guests refrain from stealing the towels.
My 14th-floor room in the back, at a summer weekend rate of $115, looked straight onto several brick buildings. It was spacious but dark; I had to keep the lights on during the day. The queen-size bed had a green floral spread, a blond wood headboard and one bedside table. A lamp hung over a table with two upholstered chairs. The large, cream-colored bathroom had a molded plastic tub.
When I checked in I was handed a stack of take-out menus from nearby delis and Chinese restaurants. So I ordered a corned beef sandwich from Reubens.
Journey's End, 3 East 40th Street, New York, N.Y. 10016; (800) 668-4200 or (212) 447-1500. Rates: double rooms, $135.88, $88.88 on weekends. Hotel Chelsea
In its own way, the Hotel Chelsea is as famous as the Plaza. The roster of illustrious past residents at this downtown red-brick temple of bohemia includes the writers Thomas Wolfe, Dylan Thomas, Arthur Miller and Brendan Behan. Punk rocker Sid Vicious died here. And Edie Sedgwick, girl of the year in 1965, almost burned the place down. The Chelsea, which seems little changed since Edie's day, still has an intriguing atmosphere, if you like things a little scruffy and don't mind seriously outdated plumbing. It's about as far as you can get from spit and polish, but that's probably the point.
The highlight of my brief stay was a morning spent in the lobby, sipping coffee from a nearby deli. The much-painted walls are lined with an impressive collection of contemporary art, all painted or sculptured by onetime residents, including the painter Larry Rivers. And the parade of passing residents was enjoyable and varied, from old ladies in shorts and straw hats to slim young artists and actors. Everyone stopped to pet a big white dog gnawing a bone by a battered coffee table.
The elevator wasn't working very well, so I walked the four flights to my $85 room. It was roomy but very old, with painted white stucco walls and stained mouse-gray carpeting. An orange wool chair stood in a corner, next to a beat-up desk. The double bed, which didn't have a blanket, had pilly sheets and a pink floral spread that matched the curtains. An old black-and-white television stood on a pedestal. And a weary kitchenette, with gas stove, fridge and sink, was by the door. But the room got plenty of light and was oddly cheerful.
The old yellow tile bathroom, however, was ghastly. The vintage shower dripped continuously. And the toilet was a slow flush. The porter will pick up take-out orders from nearby restaurants.
Hotel Chelsea, 222 West 23d Street (at Seventh Avenue), New York, N.Y. 10011; (212) 243-3700. Rates: double rooms with private bath cost $85 to $145.


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Adenovirus, a DNA virus, was first isolated in the 1950s in adenoid tissue–derived cell cultures, hence the name. These primary cell cultures were often noted to spontaneously degenerate over time, and adenoviruses are now known to be a common cause of asymptomatic respiratory tract infection that produces in vitro cytolysis in these tissues.
An extremely hardy virus, adenovirus is ubiquitous in human and animal populations, survives long periods outside a host, and is endemic throughout the year. Possessing 52 serotypes, adenovirus is recognized as the etiologic agent of various diverse syndromes. It is transmitted via direct inoculation to the conjunctiva, a fecal-oral route, aerosolized droplets, or exposure to infected tissue or blood.
The virus is capable of infecting multiple organ systems; however, most infections are asymptomatic. Adenovirus is often cultured from the pharynx and stool of asymptomatic children, and most adults have measurable titers of anti-adenovirus antibodies, implying prior infection. Adenovirus is known to be oncogenic in rodents but not in humans.
Adenovirus has been associated with both sporadic and epidemic disease and, with regard to infections among military recruits, who were routinely immunized against types 4 and 7 from 1971 until the cessation of vaccine production in 1996. Adenovirus became a significant cause of economic cost and morbidity in this setting. A live oral vaccine against adenovirus types 4 and 7 was approved for use in this population by the US Food and Drug Administration (FDA) in 2011, and subsequent incidence of acute respiratory disease declined.
Of interest is the role of adenoviruses as vectors in vaccination and in gene therapy.[1, 2, 3] Adenoviruses can infect various cells, both proliferating and quiescent, and thus hold the promise of targeting many different tissues and diseased cell lines.
The genome of adenovirus is well known and can be modified with relative ease to induce lysis or cytotoxicity of a specified cell line without affecting others.
The virus itself can be engineered to remove its replicative capacity by removing essential genes. Additionally, specific genes can be inserted into the virus that then can repair defective metabolic, enzymatic, or synthetic pathways in the host. Suicide gene systems that convert nontoxic systemically delivered prodrugs to active chemotherapeutic agents have been delivered via adenoviral vectors directly into cancer cells. However, the greatest challenge in viral gene therapy, as might be expected, is the immune response to the viral vector itself.
The complex mechanisms by which viral vectors may be incorporated into gene therapy and the rapid growth in this field put further discussion beyond the scope of this text.
Adenovirus is a double-stranded DNA virus that measures 70-90 nm and that has an icosahedral capsid.
The site of entry generally determines the site of infection; respiratory tract infection infections result from droplet inhalation, while gastrointestinal tract involvement results from fecal-oral transmission. Upon infection with adenovirus, one of three different interactions with the cells may occur.
The first is lytic infection, which occurs when an adenovirus enters human epithelial cells and continues through an entire replication cycle, which results in cytolysis, cytokine production, and induction of host inflammatory response.
The second is chronic or latent infection, the exact mechanism of which is unknown, which frequently involves asymptomatic infection of lymphoid tissue.
Lastly, oncogenic transformation has been observed in rats. During oncogenesis, the replication cycle is truncated, and adenoviral DNA is then integrated into the host cell's DNA. Thereafter, adenovirus produces potent E1A proteins that immortalize primary rodent cells by altering cellular transcription, ultimately leading to deregulation of apoptosis and malignant transformation.
United States
Adenovirus is isolated most commonly in infants and children. An increased incidence of infection was found in military recruits until the introduction of an effective vaccine against serotype 4 (Ad4) and serotype 7 (Ad7) in 1971. The economy-driven cessation of vaccine production by its sole producer in 1996 resulted in re-emergence of outbreaks, with Ad4 predominating in 98% of cases. The reservoirs exist within the crowded training environment itself, and Ad4 has been detected on lockers, rifles, and bedding. Ad4 seropositivity of new recruits has been demonstrated to rise from 30% to almost 100%. Prolonged pharyngeal shedding and communal quarters contribute to outbreaks, with illness most commonly arising in weeks 3 to 5.
Lost productivity and interrupted military training prompted reinvestigation of vaccine production. Live oral adenovirus types 4 and 7 vaccine was approved by the FDA in 2011, significantly decreasing and the incidence of febrile respiratory illness. Notably, co-infection with non-vaccine strains (B1 and E) have developed following vaccination,[4] and surveillance for emerging non-vaccine strains is still needed.
In 2007, media attention following adenovirus outbreaks in the United States focused on serotype 14. The CDC's Morbidity and Mortality Weekly Review published an article entitled " Acute Respiratory Disease Associated with Adenovirus Serotype 14—Four States, 2006-2007."
Severe morbidity and mortality associated with adenovirus infections are rare in immunocompetent hosts. Uncommon complications that increase the risk of mortality include meningoencephalitis and pneumonitis.
Severe adenovirus infections have been reported in immunocompromised patients, such as transplant patients and those with inherited and acquired immunodeficiency states. Mortality rates associated with adenovirus infections among pediatric and adult transplant recipients have varied from 6%-70%.[5]
Morbidity and deaths due to pronounced host inflammatory responses have occurred in past gene vector trials.
As with polio vaccines, live adenovirus vaccines in the 1950s became contaminated with simian virus 40 (SV40), with resulting concern that this virus caused various cancers. After subsequent long-term follow-up, some studies have found a moderate association between SV40 and human cancers as a transforming virus, while some other studies have reported no such findings.[6, 7]
No racial predilection has been described.
Adenovirus urinary tract infections are more common in males. The prevalence of other syndromes does not appear to be affected by the sex of the individual.
Adenovirus infection typically affects children from infancy to school age, but children of any age may be affected, including neonates. Young adults in any setting of close quarters and stress may be affected, as in the case of military trainees.
The prognosis of adenovirus infection is generally good in immunocompetent hosts, but mortality rates may be as high as 70% in immunocompromised individuals.
Frequent hand hygiene with soap and water or sanitizers that specify coverage of adenoviruses and avoidance of towel and pillow sharing among household contacts of patients with conjunctivitis is helpful.
Hygienic measures in children are difficult to enforce, but they should be taught regardless.
Patients should be advised of the contagiousness and possible long-term ocular sequelae of ophthalmologic disease.
Because the manifestations of adenovirus infections are protean, the major syndromes are discussed separately. The major syndromes covered in this article include (1) acute respiratory disease (ARD), (2) pharyngoconjunctival fever, (3) epidemic keratoconjunctivitis, (4) acute hemorrhagic cystitis, (5) gastroenteritis, and (5) adenoviral infections in immunocompromised hosts.
Given the range of manifestations, the varying levels and effects of immunosuppressive therapies, and rapid advances in molecular methods of detection, a comprehensive review of adenovirus infection in the immunosuppressed host is beyond the scope of this article. The reader is encouraged to review the literature for more detail regarding infection in specific settings.
As with many other viral syndromes, ARD is more common in spring and winter months. Approximately half of adenovirus respiratory infections do not cause symptoms. Adenoviruses account for 10% of all childhood lower respiratory tract infections.
The contagiousness of adenovirus is facilitated by very high levels of viral particles (100,000-1,000,000/mL) in the sputum or oral secretions of infected adults. Additionally, adults who lack antibody may be infected by the inhalation of as few as 5 virions in droplet nuclei.
Fever, rhinorrhea, cough, and sore throat, usually lasting 3-5 days, are typical symptoms of adenoviral ARD. Causes of sore throat may include pharyngitis, adenoiditis, or tonsillitis. Tonsillitis and otitis media were reported in up to 60% and 30%, respectively in a series of young children with serotype 4 predominance. Prolonged fevers, leukocytosis, and elevations in C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also noted in over half of cases, suggesting potential for confusion of this viral syndrome with bacterial infections.[8]
Lower respiratory tract infections, including tracheobronchitis, bronchiolitis, and pneumonia, may mimic respiratory syncytial virus infection or influenza. Notably, conjunctivitis in the presence of bronchitis suggests adenoviral infection.
Fatal pneumonia is uncommon but is more likely in neonates and has been associated with serotypes 3, 7, 14, 21, and 30.[9]
Encephalitis, hepatitis, and myocarditis are uncommon.
From the 1950s to 1971 (prevaccine era), adenoviruses accounted for significant acute disease in 70% of military recruits. Adenovirus serotypes 4 and 7 were primarily involved. A live enteric-coated oral vaccine against these serotypes was introduced in 1971 and reduced adenovirus-related respiratory illness by more than 95% in recruits and thus attenuated outbreaks. Vaccine production ceased in 1996 for economic reasons, and vaccination administration was limited to high-risk periods until supplies ran out in 1999. In 1997, a large epidemic of more than 500 cases associated with serotypes 3 and 7 occurred in US Navy recruits. Most recent analyses suggest that serotype 4 has caused most military outbreaks since 1999, with the exception of Ad14. Outbreaks in basic trainees declined with the reintroduction of live oral enteric-coated adenovirus vaccine against types 4 and 7.[10, 11]
Adenovirus serotype 14
Ad14, referred to as the "super cold" in the media, has caused rare outbreaks of ARD since 1955.
Between May 2006 and June 2007, 141 cases of Ad14 infection were reported in clusters in New York, Oregon, Texas, and Washington. Almost 40% of affected persons were hospitalized, almost half in intensive care, with a 5% overall mortality rate. The cases in Texas involved military trainees at Lackland Air Force Base, and subsequent cases were reported at Lackland, three other Texas military bases, and one eye culture in a civilian unassociated with the military. Adenovirus may be isolated from children with whooping cough syndrome in the presence or absence of Bordetella pertussis infection; however, whether adenovirus is an etiologic cause of the syndrome remains unclear.[12, 13]
This syndrome most often affects school-aged children. Contagious in nature, sporadic outbreaks of adenovirus infection occur in small groups, especially summer camps in the setting of an inadequately chlorinated water source such as a pool or lake. Interestingly, water sample cultures are often not confirmatory. Spread occurs via the respiratory route and contact with ocular secretions during the acute illness.
The classic presentation is characterized by fever, sore throat, coryza, and red eyes. Upper respiratory tract symptoms may precede ocular findings or may be absent.
Acute conjunctivitis may occur with or without pharyngitis or a respiratory syndrome. Encephalitis may occur but is rare.
Conjunctivitis usually begins in one eye and then spreads to the other, although both eyes may be affected simultaneously. Severe pain is atypical, but mild pain or discomfort, tearing, pruritus, and morning crusting are common.
It usually is self-limited to 5 days (incubation period is 5 days).
Uncommonly, an exanthem or diarrhea may occur.
This is highly contagious, with approximately 10% transmission in household contacts via hands and fomites. Transmission has also been associated with instrumentation, industrial trauma (shipyard workers [ie, shipyard eye], welders, airborne particles), contaminated ophthalmic solutions, and the hands of health care workers.[14] Corneal trauma facilitates infection.
After an 8-day incubation period, an insidious onset of unilateral red eye occurs, spreading to involve both eyes. Patients have photophobia, tearing, and pain (indicating corneal involvement). Children may have fever and lymphadenopathy.
Malaise and headache are reported.
Inflammation may persist for weeks, and residual scarring and visual impairment may occur.
Acute hemorrhagic cystitis usually affects children aged 5-15 years but may also affect immunosuppressed adults (eg, from kidney or bone marrow transplantation, AIDS). Boys are affected more often than girls.
Dysuria, frequency, and grossly bloody urine are reported. Hematuria is self-limited to 3 days, and other symptoms resolve later. Symptoms may be more prolonged in hematopoietic stem cell recipients.
Nephritis has occurred in recipients of hematopoietic stem cell transplants and is associated with fever, hematuria, and flank pain.[15, 16]
Enteric adenovirus infection is a common cause of infantile diarrhea in the daycare setting, but less common than rotavirus infection and, in some settings, less common than infection with astroviruses. It can also affect adults; in addition, a nosocomial outbreak in a hematology unit has been reported.[17] Adenoviruses replicate readily in the human intestine and may be cultured from asymptomatic individuals; thus, their presence in the setting of a diarrheal syndrome may be incidental.
Many serotypes are fastidious in culture. Serotypes 40 and 41 had been termed "noncultivatable." However, they have been cultured in the setting of diarrheal syndromes using newer cell lines. Monoclonal antibody assays, enzyme-linked immunosorbent assay, and electron microscopy support the association of these strains with enteric disease. However, one cannot assume that enteric disease is limited to these strains. In fact, various serotypes of adenovirus have been associated with infectious diarrheal syndromes in recipients of hematopoietic stem cell transplants.
Fever and watery diarrhea are usually limited to 1-2 weeks.
Mesenteric adenitis and intussusception have been associated with nonenteric adenovirus serotypes (ie, types 1, 2, 3, 5, 6). Approximately 40% of infants with intussusception have positive findings from cultures of stool or mesenteric lymph nodes for nonenteric serotypes, and most have no evidence of infection with enteric strains (ie, 40, 41). The role of adenovirus in this setting is unclear. Mesenteric lymphadenitis or hyperirritable small bowel associated with nonenteric adenoviral infection has been postulated to lead to intussusception. However, most patients with intussusception have no evidence of adenoviral infection (based on culture, serology, or histopathologic viral inclusion findings); thus, intussusception may be related to multiple etiologies.
Adenovirus is known to cause disease during the posttransplantation period in patients who have received hematopoietic stem cell transplants. Risk factors for adenovirus disease include allogeneic stem cell transplantation, T-cell depletion and nonmyeloablative conditioning regimens such as high-dose alemtuzumab (Campath) antibody therapy, lymphopenia, young age, and graft versus host disease. Prolonged neutropenia or immunosuppression also enhances the risk of adenoviral infections. Manifestations may vary but include hemorrhagic cystitis/nephritis, pneumonitis, hepatitis/liver failure, and gastroenteritis, particularly during the acute posttransplantation period prior to engraftment. In one series, nephritis was associated with acute renal failure in more than 90% of patients. Adenovirus should be considered in patients with a fever, hematuria, flank pain, and worsening renal function.[18, 5]
Uncommonly, T-cell immunodeficiency related to HIV infection has been associated with adenoviral infections, particularly in infants and children infected with HIV. Pneumonitis and hemorrhagic cystitis are cited most often. Cholecystitis, severe hepatitis, and liver failure have been reported.[19]
Immunosuppression in recipients of solid organ transplants has also been associated with the above syndromes, as has diffuse adenoviral infection of the allograft itself. Both allograft loss and recovery have been reported.[18] Adenoviral infection following pediatric lung transplantation has been reported.[20]
Importantly, note that a prior history of adenoviral infection in a patient with recovered immunocompetence may herald recurrence when the patient again becomes immunosuppressed. A high level of suspicion for adenovirus is warranted in these cases.
Pulmonary infiltrates are often diffuse and reticulonodular, but they may be lobar.
Hematuria may occur in the setting of nephritis or hemorrhagic cystitis.
Abnormal transaminase levels, which may be dramatic, may indicate adenoviral hepatitis.
Diarrhea may indicate adenoviral gastroenteritis.
Acute respiratory disease
Exudative pharyngitis and conjunctivitis may be seen.
Pulmonary rhonchi and rales may be found on auscultation.
Fever, coryza, pharyngitis (may be exudative), follicles in bulbar, and/or palpebral conjunctivae (typically mild granular appearance) may be observed.
Cervical lymphadenopathy may be seen.
Preauricular lymphadenopathy (ie, Parinaud syndrome), with small lymph nodes palpable just anterior to the ear is not common; however, its presence in the setting of a viral conjunctivitis is very suggestive of adenovirus infection.
Severe follicular keratoconjunctivitis has been reported (conjunctiva may be granular). Hemorrhagic conjunctivitis develops in some cases.
Palpebral edema is a finding.
Preauricular lymphadenopathy is not common but is a pathognomonic finding with adenovirus infection.
Visual haziness or impairment resulting from keratitis or corneal involvement may develop and may persist for months to years.
No significant features are described in the setting of hemorrhagic cystitis, other than evidence of blood in the urine. Fever is generally absent.
Flank pain and fever are seen in nephritis.
Patients with severe gastroenteritis may have signs of dehydration.
Features include dyspnea, dry cough, pulmonary rhonchi and rales, grossly bloody urine, and diarrhea.
Meningoencephalitis rarely occurs, usually in association with pneumonia. No pathognomonic features distinguish adenovirus aseptic meningitis or meningoencephalitis from other causes.
Immunosuppression in the host permits more severe manifestations. Pediatric liver transplantation, AIDS, and hematopoietic stem cell transplantation have been associated with protean adenovirus infections.
Adenovirus is stable in routine viral transport medium, including specimens of nasopharyngeal, rectal, and corneal secretions; urine; and unfixed biopsy tissue. Detection is enhanced if specimens are collected early in the clinical course and promptly shipped cold or frozen to the appropriate laboratory. Many adenovirus serotypes can be isolated in cell culture lines commonly used in diagnostic virology laboratories; a few, such as types 40 and 41, fail to grow. Primary human embryonic kidney cells support growth of many fastidious adenovirus serotypes, but their additional cost may be prohibitive in some settings. Other cell lines may not support the growth of ocular strains well, may be less sensitive, or may not be maintainable to support slower-growing strains.
Seroreactivity to adenovirus is common. By age 4 years, approximately half of all children have positive adenovirus titers. As a result, serology is less useful in the acute clinical setting. If a serologic diagnosis is pursued, serum should be obtained as early as possible in the clinical course, followed by a second titer 2-4 weeks later. A 4-fold rise in acute titers to convalescent titers is diagnostic.
Indirect immunofluorescence assays may be used for direct examination of tissue specimens.
Polymerase chain reaction (PCR) is being used with high specificity on various specimens (eg, respiratory, tissue, urine, blood) to identify adenovirus.[5, 21]
Serotyping is generally in the domain of epidemiology and research and is not typically used in clinical practice. However, as specific syndromes are associated with specific serotypes, tests can be performed in a reference laboratory.
Certain serotypes of enteric adenovirus have been seen in stool specimens using electron microscopy, but they have been difficult to isolate in routine tissue culture. These types have been referred to as noncultivatable enteric adenoviruses. Adenovirus has been identified using electron microscopy and immunohistochemistry techniques. The isolation of enteric adenovirus infection in recipients of small bowel transplants in whom allograft damage is a risk may warrant stool cultures or biopsy.
The following laboratory studies are suggested in the given syndromes, both to diagnose adenoviral infections and to evaluate for other diagnoses in the differential diagnoses of each syndrome.
Acute respiratory disease
Nasopharyngeal swab for culture of respiratory viruses (eg, influenza virus, adenovirus, respiratory syncytial virus, rhinovirus) is suggested.
Consider Monospot assay for Epstein-Barr virus.
Consider rapid group A Streptococcus throat swab and culture.
Pharyngoconjunctival fever
Nasopharyngeal swab for culture of respiratory viruses (eg, influenza virus, adenovirus) is suggested.
Consider Monospot assay.
Consider rapid group A Streptococcus throat swab and culture.
Epidemic keratoconjunctivitis
Viral and bacterial swab cultures of conjunctival secretions and scrapings are suggested.
Acute hemorrhagic cystitis or nephritis
Urinalysis and cultures for bacterial and viral pathogens are suggested.
Consider stool Wright stain; ova and parasites examination; culture for bacterial enteric pathogens; assays for norovirus, rotavirus, and Cyclospora; and Clostridium difficile toxin assay.
Plain radiography or CT scanning demonstrates typically diffuse and reticulonodular infiltrates. High-resolution CT scanning may show "crazy-paving" patterns in immunocompromised patients.[22] Occasionally, findings are lobar.
Liver ultrasonography may be helpful to exclude obstructive causes of transaminitis or hyperbilirubinemia.
Renal ultrasonography is helpful to exclude obstructive causes of renal insufficiency or renal swelling that may indicate infection.
Urine cytology should be considered to exclude other causes if hemorrhagic cystitis does not resolve within 5 days.
Biopsy may be considered in the setting of pneumonia, hepatitis, nephritis, enteritis, or other suspected end-organ involvement in immunocompromised patients, particularly in transplant recipients.
Obliterative bronchiolitis is seen; viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted. The intranuclear inclusions during late infection are surrounded by a clear halo, which may obstruct visualization of the nuclear membrane, resulting in a smudged appearance. These "smudged" cells are classically seen in adenovirus infection.
Denudation of the gastrointestinal mucosa with edema may be seen. Also, acute and chronic inflammatory infiltrate involving the full thickness of the bowel wall may be noted. Viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted within infected cells.
Viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted within infected cells.
Viral intranuclear and intracytoplasmic inclusions with positive immunohistochemical staining specific for adenovirus are noted within infected cells. Tubular epithelium is typically involved until late; extension may occur thereafter to the Bowman capsule and the glomerulus.
Currently, specific therapy for adenovirus infection, other than supportive and symptomatic treatment, remains a matter of debate. Fortunately, most infections are self-limited in the setting of a normal immune response and do not warrant specific therapy.
In immunocompromised patients, several drugs, such as cidofovir, ribavirin, ganciclovir, and vidarabine, have been used to treat adenovirus infections. Most of these agents are virostatic, may induce drug resistance, and have significant risks of toxicities, as well as risks to healthcare staff, depending on mode of delivery (eg, aerosolized ribavirin).
Adenovirus viremia is not uncommon among solid organ transplant recipients, and most cases appear to be self-limited and without sequelae.[23] In cases involving severe disease, such as adenoviral pneumonia after lung transplantation, cidofovir has been used successfully.[24]
The management and prevention of severe adenovirus-related disease in hematologic stem cell transplantation (HSCT) is of particular importance and continues to evolve. There are as yet no evidence-based guidelines for or against specific antiviral therapies in this setting. Reduction of immunosuppression is not always feasible during the first 100 days post-transplantation, during which the risk is highest.
The increasing use of unrelated donors and umbilical cord blood often requires increasing use of T-cell–depleted transplants to prevent acute graft-versus-host disease. Risk of mortality due to reactivated viruses is proportional to the degree of HLA-mismatch between donor and recipient and time to T-cell reconstitution. T-cell–depleted grafts, delayed engraftment, and high levels of viremia are major risk factors for adenoviral disease after HSCT. Engraftment or reconstitution of T-cell–specific immunity is vital to recovery from pulmonary or disseminated infection, regardless of antiviral therapy.[25] In one study involving children who underwent hematopoietic stem cell transplantation, all patients who died of adenoviral infection lacked specific T cells against adenovirus.[25] Rapid transfer of donor-derived, virus-specific memory T cells offers substantial promise in controlling severe disease with low adverse effects in those with intolerance or nonresponse to antivirals. Indeed, banking of donor-derived and third-party–derived virus-specific T cells is being explored for use in HSCT and can provide broad defense against multiple endemic viruses.[26, 27, 28, 29]
Some benefit of both ribavirin and cidofovir has been documented in case series, as demonstrated by decreased viremia and concomitant clinical improvement with antiviral therapy.[30, 31, 32, 33] Intravenous cidofovir treatment resulted in complete clinical resolution in 56 of 57 pediatric HSCT recipients, in whom the virus became undetectable without dose-limited nephrotoxicity.[34] Intravenous immunoglobulin (IVIG) has also been used in conjunction with antivirals.[35, 36]
A significant advance in antiviral therapy, brincidofovir is a lipid conjugate of cidofovir that may be given orally and demonstrates potent activity against adenovirus. While diarrhea may be significant, it appears to have significantly reduced bone marrow or renal toxicity in clinical studies with limited numbers of patients in an expanded access program. No significant resistance to brincidofovir has been observed. Preventive treatment and therapy initiated early into viremia after HSCT appears to reduce viral burden, severe disease, and overall mortality.[37, 38, 39]
Consultation with an ophthalmologist should be sought in the follow-up care of persons with keratoconjunctivitis, preferably early, but particularly if they develop corneal opacities.
If hemorrhagic cystitis does not resolve within 5 days, consider noninfectious etiologies and consultation with a urologist or nephrologist, as appropriate.
Immunosuppressed patients may present with various adenoviral syndromes, ranging from afebrile hemorrhagic cystitis to fulminant disseminated disease (followed by shock and death). Consultation with an infectious disease specialist is helpful in this setting.
After a 12-year hiatus, the FDA approved a live oral vaccine against adenovirus types 4 and 7 in 2011. It is indicated for use only by the US Department of Defense for military recruits entering basic training. No commercial vaccine is currently approved for public use.
Vaccination has been limited to military use because of the increased risk of clinically significant disease and potential for hospitalization. In 1971, the administration of live enteric-coated adenovirus vaccine (serotypes 4 and 7) was begun, with notable effectiveness. When given orally, these serotypes induce effective humoral immunity without producing disease. Because of economic factors, vaccine production was ceased in 1996, and rates of ARD in the military rose significantly. A large outbreak of ARD (serotype 4; >1000 cases) between May and December 1997 reinforced the need for immunization.[40] A live oral enteric-coated vaccine against adenovirus types 4 and 7 was approved by the FDA in 2011 for use only by the US Department of Defense in new military recruits entering basic training.
Approximately 80% of current isolates remain serotypes 4 and 7. However, serotypes 3 and 21 also appear to cause significant disease and may be appropriate targets of future immunization.[41] Further, breakthrough infection may occur with nonvaccine strains in persons who have been immunized, and vaccination programs may promote emergence of new epidemic strains. Surveillance and modification of vaccine strains may become necessary over time.
Genotyping of serotype 4 strains during outbreaks has demonstrated stable populations that vary geographically by training site. This suggests that epidemics arise from an endemic environmental source rather than from new recruits, and prevention programs may further require effective environmental control.[10, 42]
Effective isolation procedures, handwashing, and sterilization of instruments can prevent nosocomial infection.[43]
Hospitalized patients with adenoviral conjunctivitis require contact precautions. Adenoviral pneumonia requires both droplet and contact precautions.
Health care workers with any adenoviral syndrome should be relieved of patient care duties and sent home until symptoms resolve. Health care workers should be educated to report to the employee health office if they develop symptoms that suggest conjunctivitis.
Strict hand hygiene should be emphasized, particularly in ophthalmologic care settings. Hand-sanitizing solutions containing 70% ethanol are effective against adenovirus. Careful attention to labeling is necessary to ensure coverage of adenovirus.
Elimination of environmental reservoirs and fomites includes proper disinfection of tonometry and ophthalmologic instruments according to local infection control and manufacturer guidelines. Proper use and monitoring of open, multiple-use ophthalmic solutions (and timely discarding of these) according to local infection control and manufacturer guidelines is essential.
Adequate chlorination of swimming pools may prevent waterborne outbreaks. Adenovirus is relatively hardy and survives long periods on surfaces and in fresh water. Like norovirus and rotavirus, adenovirus is resistant to many common disinfectants, but chlorine is virucidal at a concentration of 2 parts per million (ppm).
Most disease is self-limited, and reassurance suffices; however, patients with keratoconjunctivitis or significant respiratory disease may need a follow-up evaluation within 2 weeks to monitor resolution. Immunosuppression often warrants hospitalization.
Consultation with an ophthalmologist may be indicated in the setting of corneal opacities. In addition, if hemorrhagic cystitis does not resolve within 5 days, consider noninfectious etiologies as the cause and refer the patient to a urologist or nephrologist, as appropriate.
Patients with meningoencephalitis or severe respiratory disease, including pneumonia, or those who are immunosuppressed require hospitalization.
Patients with severe keratitis who are suggested to have bacterial superinfection may require hospitalization.
Hospitalized patients who are immunosuppressed and have suspected adenoviral disease may benefit from early transfer to centers experienced in the treatment of critically ill immunosuppressed patients because rapid decompensation may occur.
Medical therapy is not indicated in healthy hosts. However, adenoviral keratitis has been treated with early topical steroids to avoid loss of sight; refer to the available ophthalmologic literature for details on the management of adenoviral ophthalmologic infections.
Ribavirin and cidofovir therapy have been used with variable success in immunosuppressed hosts. Anecdotal evidence suggests success against adenoviral infection with combined intravenous ribavirin and pooled human intravenous immunoglobulin. Also anecdotally, intravesical cidofovir has been reported to be successful in persons with adenoviral hemorrhagic cystitis; the latter delivery method may obviate the systemic toxicity of this agent and warrants investigation.[44]
Weighing the severity of illness, the likelihood of response in a given setting, and the possibility of adverse events, decisions regarding treatment should be individualized at this time. Evidence-based standardized treatment guidelines currently are lacking, and consultation with an infectious diseases clinician is recommended.
These agents inhibit viral DNA and protein synthesis.
Inhibits viral replication by inhibiting DNA and RNA synthesis. Antiviral against RSV, influenza virus, herpes simplex virus, and hepatitis C virus. The latter requires adjunctive treatment with interferons.
The likelihood that most adenovirus infections in immunosuppressed hosts are disseminated warrants intravenous rather than inhalational therapy, including in the setting of adenoviral pneumonia.
Nucleotide analog that selectively inhibits viral DNA production in CMV and other herpes viruses. Indicated for CMV retinitis.
Decreases incidence of adenovirus outbreaks in military personnel.
Live oral vaccine that replicates in intestinal tract and induces immunity in persons with low or no preexisting neutralizing antibodies to adenoviruses types 4 and 7. Indicated for active immunization of military populations aged 17-50 y for prevention of febrile acute respiratory disease caused by adenovirus types 4 and 7.
What is the pathophysiology of adenovirus infections?
Which patient groups have the highest prevalence of adenovirus infections?
What is the mortality and morbidity associated with adenovirus infections?
What is the racial predilection of adenovirus infections?
What is the sexual predilection of adenovirus infections?
How does the prevalence of adenovirus infections vary by age?
What is the prognosis of adenovirus infections?
What is included in patient education about adenovirus infections?
What are the major syndromes caused by adenovirus infections?
Which clinical history findings are characteristic of adenovirus-related acute respiratory disease (ARD)?
What is adenovirus serotype 14 (AD14) infection?
Which clinical history findings are characteristic of adenovirus-related pharyngoconjunctival fever?
Which clinical history findings are characteristic of adenovirus-related epidemic keratoconjunctivitis?
Which clinical history findings are characteristic of adenovirus-related acute hemorrhagic cystitis?
Which clinical history findings are characteristic of adenovirus-related gastroenteritis?
Which clinical history findings are characteristic of adenoviral infections in immunocompromised hosts?
What are the signs and symptoms of adenovirus?
Which physical findings are characteristic of adenovirus-related acute respiratory disease (ARD)?
Which physical findings are characteristic of adenovirus-related pharyngoconjunctival fever?
Which physical findings are characteristic of adenovirus-related epidemic keratoconjunctivitis?
Which physical findings are characteristic of adenovirus-related acute hemorrhagic cystitis/nephritis?
Which physical findings are characteristic of adenovirus-related gastroenteritis?
Which physical findings are characteristic of adenoviral infections in immunocompromised hosts?
What are the possible complications of adenovirus infections?
What are the differential diagnoses for Adenovirus?
What is the role of polymerase chain reaction (PCR) relative to adenovirus infections?
What is the role of serotyping in the diagnosis of adenovirus infections?
What is the role of viral cultures in the diagnosis of adenovirus infections?
What is the role of serology in the diagnosis of adenovirus infections?
What is the role of antigen testing in the diagnosis of adenovirus infections?
What is the role of syndrome-specific testing in the evaluation of adenoviral infections?
What is the role of lab testing in the diagnosis of adenovirus-related acute respiratory disease (ARD)?
What is the role of lab testing in the diagnosis of adenovirus-related pharyngoconjunctival fever?
What is the role of lab testing in the diagnosis of adenovirus-related epidemic keratoconjunctivitis?
What is the role of lab testing in the diagnosis of adenovirus-related acute hemorrhagic cystitis or nephritis?
What is the role of lab testing in the diagnosis of adenovirus-related gastroenteritis?
What is the role of imaging studies in the diagnosis of adenovirus-related pneumonia?
What is the role of liver ultrasonography in the diagnosis of adenovirus infections?
What is the role of renal ultrasonography in the diagnosis of adenovirus infections?
What is the role of urine cytology in the diagnosis of adenovirus infections?
What is the role of biopsy in the diagnosis of adenovirus infections?
Which histologic findings are characteristic of adenovirus-related pneumonia?
Which histologic findings are characteristic of adenovirus-related enteritis?
Which histologic findings are characteristic of adenovirus-related hepatitis?
Which histologic findings are characteristic of adenovirus-related nephritis?
How are adenovirus infections treated?
How are adenovirus infections treated following hematopoietic stem cell transplantation (HSCT)?
Which specialist consultations are beneficial to patients with adenovirus infections?
What is the role of vaccination in the prevention of adenovirus infections?
How are nosocomial adenovirus infections prevented?
How are waterborne adenovirus infections prevented?
What is included in the long-term monitoring of patients with adenovirus infections?
When is inpatient care indicated for the treatment for adenovirus infections?
When is transfer of patients with adenovirus infection indicated?
Which medications are used in the treatment of adenovirus infections?
Which medications in the drug class Vaccines are used in the treatment of Adenovirus?
Which medications in the drug class Antivirals are used in the treatment of Adenovirus?


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Sophie Raworth Biography
Nationality: British
Famous: Journalists British Women
Age: 51 Years, 51 Year Old Females
Sun Sign: Taurus
Also Known As: Sophie Jane Raworth
Born in: Redhill
Famous as: Journalist
Height: 5'9" (175 cm), 5'9" Females
Spouse/Ex-: Richard Winter (m. 2003)
siblings: Kate Raworth
children: Ella Rose Winter, Georgia Winter, Oliver Winter
Recommended For You
Sophie Jane Raworth is an accomplished English journalist, presenter, and newsreader. She is known for her work with the 'British Broadcasting Corporation' (BBC) for over 2 decades. She joined the 'BBC' in the early 1990s and initially worked at regional levels. She was a news reporter for 'Greater Manchester Radio' and a 'BBC Regions' correspondent in Brussels. She was launched on national TV as a co-presenter of 'Breakfast News' on 'BBC One.' She also worked as a presenter of various 'BBC' shows, such as 'Breakfast,' 'BBC Six O'Clock News,' 'Watchdog Daily,' 'Watchdog Test House,' and 'Crimewatch Roadshow.' She has been the main presenter of 'BBC News at One' and 'Watchdog.' She has presented many 'BBC' specials, such as 'Our Monarchy – the Next 50 Years' and the 'Queen's Golden Jubilee.' She has appeared on 'BBC' shows such as 'Tomorrow's World' and 'What Not to Wear.' She featured on 'The Andrew Marr Show' in Andrew Marr's absence. She currently anchors 'BBC News at One' on Tuesdays, Wednesdays, and Fridays and features regularly on 'BBC News at Six.' She also appears on 'BBC News at Ten' occasionally. She has received an 'Award of Doctor of Arts honoris causa' from 'City, University of London.'
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- Sophie Jane Raworth was born on May 15, 1968, in Redhill, Surrey, England, to Richard Raworth, a businessman, and Jenny Raworth, a florist. She was raised in the affluent suburban area of Twickenham in southwest London, England. She grew up with her sister, Kate.She attended an independent all-girls school named 'Putney High School' in Putney, London, and then an independent day school for girls named 'St. Paul's Girls' School' in Brook Green, Hammersmith, West London.She attended the 'University of Manchester' and studied French and German there, before spending a year teaching English to teenagers in Toulouse, France. Following this, she enrolled at 'City, University of London,' from where she completed a postgraduate course in broadcasting and journalism.Continue Reading BelowYou May LikeRecommended Lists:
Recommended Lists:Career
- In 1992, Sophie became a news reporter of the 'BBC' local radio station 'BBC Radio Manchester,' marking the beginning of her long journey with the 'BBC' network. In April 1994, she started working as a 'BBC Regions' correspondent in Brussels. She joined 'BBC's regional TV news service 'BBC Look North' in Leeds in May 1995.She stepped into national TV in 1997, with the 'BBC One' show 'Breakfast News.' She co-presented the show with Justin Webb and then with John Nicolson. The program was re-launched as 'BBC Breakfast' on October 2, 2000. The first show was hosted by Sophie and Jeremy Bowen. This daily British breakfast show that airs on 'BBC One' and 'BBC News' includes a mix of news related to sports, business, weather, and other areas. Sophie was one of the main presenters of the show between 2000 and 2002, initially presenting alongside Jeremy Bowen and then with Dermot Murnaghan.Meanwhile, between 1999 and 2000, she presented the 'BBC' TV series 'Tomorrow's World' that focused on new developments in science and technology. She also featured in entertainment programs such as the quiz show 'Judgemental' and 'Dream Lives' in the early 2000s.In January 2003, she began presenting 'BBC Six O'Clock News' alongside George Alagiah. She appeared on the 'BBC' makeover reality TV show 'What Not to Wear' in 2004. Style advisors Trinny Woodall and Susannah Constantine gave her a makeover on the show.She worked with 'BBC Six O'Clock News' till October 2005. Following this, she went on a maternity leave. She resumed her career as the main presenter of 'BBC News at One' in June 2006. That year, she was part of the TV coverage of the 'Children's Party at the Palace.'After taking a hiatus for her third pregnancy in early 2008, Sophie made a comeback with the 'Bank Holiday' edition of 'BBC News at One,' 'BBC News at Ten,' and 'BBC News at Six,' on August 25, 2008.Since early 2009, Sophie appears as the main relief presenter on 'BBC News at Six' and as a regular relief presenter on 'BBC News at Ten.' She covers for the main presenters during their absence. She has also covered for Andrew Marr during his absence on 'The Andrew Marr Show' in 2013 and occasionally presents relief shifts on 'BBC News.' She has presented many 'BBC' specials, such as 'Our Monarchy – the Next 50 Years' and the coverage of the 'Queen's Golden Jubilee.' She also played a cameo role in the British TV sitcom 'My Hero.'She and Justin Rowlatt presented the 'BBC' program 'The Trouble with Working Women' in May 2009. That year, she was one of the main presenters of 'Crimewatch' on 'BBC One,' co-presenting with Rav Wilding.Sophie presented the 'BBC' program 'Watchdog Daily' in 2012. She guest-presented the program 'Crimewatch' that year. In February 2016, she replaced Kirsty Young to take over as the temporary main anchor of the program and presented its first three shows of 2016. She made a cameo appearance as herself in the 2013 blockbuster action–thriller 'A Good Day to Die Hard,' the fifth instalment in the 'Die Hard' film series, starring Bruce Willis.An 'Award of Doctor of Arts honoris causa' was bestowed on her by 'City, University of London' on July 16, 2013.She presented the 'BBC' TV series 'Watchdog Test House' that aired from March 10, 2014, to March 20, 2015. In September 2015, she replaced Anne Robinson and became one of the main presenters of the 'BBC One' consumer investigative journalism program 'Watchdog.'In 2018, she presented a documentary named 'RAF 100: Into the Blue in 2018,' celebrating the 100th anniversary of the 'Royal Air Force.' The documentary had her tracing the story of her grandfather, Cpt. Edwin Raworth, who was one of the first pilots of the aerial warfare force of the UK that was formed toward the end of World War I.Recommended Lists:
Recommended Lists:Family & Personal Life
- Sophie dated her friend Richard Winter for a year. Richard, a property company director, proposed to her on her birthday in the beautiful town of Amalfi in Italy. The two got married on December 13, 2003, at a local church in London. They are blessed with two daughters, Georgia and Ella Rose, and a son, Oliver. Sophie lives with her husband and three children in London.On October 5, 2008, she ran the world's largest half marathon, the 'Great North Run.' She completed the 'London Marathon' on April 17, 2011, even after she collapsed 2 miles from the finish line. All six 'World Marathon Majors' were completed by her by 2017. She also completed the 6-day, 251 km ultramarathon, the 'Marathon Des Sables,' in April 2018. The marathon is held every year in southern Morocco, in the Sahara Desert, and covers a distance of around six regular marathons.In 2017, Sophie's earnings as a 'BBC' presenter were reported to be around £150,000–£199,999. Sophie has earned a decent count of followers on social-media platforms such as 'Twitter' and 'Instagram.' Her 'Twitter' account, 'sophieraworth,' has already earned over 82 thousand followers. Her 'Instagram' account has earned more than 16 thousand followers.Translate Wiki to Spanish, French, Hindi, Portuguese
How To CiteArticle Title- Sophie Raworth BiographyAuthor- Editors, TheFamousPeople.comWebsite- TheFamousPeople.comURL- https://www.thefamouspeople.com/profiles/sophie-raworth-43353.phpLast Updated- January 03, 2019
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MacLaurin Communication and Media is capitalising on the cable and
satellite industry boom with a raft of new account wins - worth a total
of pounds 120,000 in fees.
UK Gold and UK Living, Irish station Tara TV and US import The Weather
Channel have all signed up with the agency in the last two weeks. MCM
beat four others to win the PR business for archive satellite and cable
station UK Gold and its sister lifestyle channel UK Living. The
channel's marketers are keen to steal a march on Granada Sky
Broadcasting's autumn launch of eight new channels.
MCM is formulating a national newspaper and media trade press campaign
for UK Gold to run alongside its nostalgic 1970s-style ad campaign.
United International Holdings Programming, owners of Tara TV which is
aimed at England's Irish community, has also signed up MCM ready for a
late summer launch.
The campaign is designed to get cable operators to take on the station,
which boasts pounds 120 million worth of programming from Ireland's
state-owned TV company RTE.
MCM's third assignment is a broadsheet and trade press push for the UK
launch of 24-hour station The Weather Channel - one of the five most
popular channels in the US.
'I see cable as a major growth area for the PR industry,' said MCM
managing director Brian MacLaurin.


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Wedding Photography Packages
Sycamore Package
Half day wedding package
A choice of cover, from bride or groom preparations through to your ceremony, or your ceremony through your first dance. Includes a personal online gallery and shop to buy any extras.
Willow Package
Full day wedding package
Full day from bride or groom preparations to the first dance. Includes an engagement shoot, a framed 12" x 16" print with a choice of frame finishes and a personal online gallery with an online shop.
Oak Package
Luxury wedding package
Everything that's in the Willow Package, plus a stunning, professionally designed 10" x 10" wedding album with a choice of an engraved wood and leather cover or fabric, holding up to 60 photos of your choice.
Optional extras
Second Photographer
Having a second photographer for the day can be so beneficial. It's perfect if you want both sets of preparations covered plus you get that second point of view during the ceremony. There are also more opportunities for those candid shots of you and your guests whilst I'm with you for your portrait session, away from everyone, or doing group photos.
Only available with the Willow or Oak Packages
Engagement Shoot or couple shoot
A great way to capture the fun in your relationship. We'll go to an outdoor location of your choice and spend a couple of hours taking photos you'll treasure. We'll have some fun along the way and we'll capture the essence of you as a couple. Afterwards you'll have access to the final photos through a personal online gallery where you can purchase the photos as downloads, prints or wall art.
Boudoir Shoot
Do you want to give your husband or wife to be a cheeky gift on the morning of your wedding? Maybe you just want to celebrate your body... We'll do this shoot in the comfort of your own home (so maybe make sure no one will be home!)
After the shoot you'll have access to the final images in a private online gallery, where you can purchase photos as prints, downloads or wall art.
Commercial Work
From head shots to styled product shoots, every business is different. Contact me to have a chat about your needs.
07835 936 885


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2020 is almost here! Have you thought about your resolutions yet? We've put together a list of our favorite 10 Family Resolutions for the New Year. Family resolutions are a fantastic way to help springboard your family into the new year!
1. Develop a weekly ritual and stick with it.
Make it a point to make dinner every night together as a family and clean up as a team! Your family's weekly rituals can fun to, designate a movie night each week and watch some of the classics from your childhood. Pro tip: a popcorn station and sundae bar are great additions to any movie night!
2. Take a day off from school and work to spend the day together.
It seems like our weekends are more busy than our work and school weeks. With birthday parties, sporting events and family outings, I feel like I just need a break from weekend! Take a day off once in awhile to play hooky with the family. Go do something completely out your family's routine and spend the day together. Maybe you can wait for report cards to come out and after a hectic time at work, play hooky and take the whole family to an amusement park!
3. Take more time to say hello and goodbye every day.
This is one of my favorite, I think we could all take a few extra minutes each day to actually giving your loved ones a warm greeting and farewell each day. As you leave in the morning, don't just rush out with a quick wave, take a moment to actually give a warm hug, a kiss and a heartfelt "I love you".
4. Make a plan to volunteer on a routine basis.
Get together as a family to write down some different ways you want to give back to your community and then figure out how to make it happen.
5. Start a family exercise routine.
Establish some health goals for the whole family, create plan and then make it a routine. You don't have to go out and sign up for a gym membership, there's plenty of really fun ways to get out and get fit. You could start a neighborhood kid ball league once a week. Or you could make it a routine to go out and hike a new trail every Saturday, rain or shine!
6. Eat healthier.
Just like working out, set some goals, make a plan and create a routine. My pro tip is to plan ahead of time and prep as much as you can. Try to make it fun by dividing up the work among the whole family and creating challenges, like trying to cook one new dish a week.
7. No technology Tuesday!
Pick one day of the week and make it a point to not use any technology once everyone gets home. Instead of catching up on TV shows, sit around the table and play a game with the family or maybe go out for a walk. The activities are endless, just no technology. If that's a bit to daring, you could start small with making a strict rule of no technology while eating dinner.
8. Stop texting and driving.
Seriously. We all know the dangers, but yet millions of people still do it.
9. Take steps to become more eco-friendly as a family.
Get your children involved in recycling, teach them to always turn off the water while they brush their teeth, and make sure everyone flips off the lights when they leave a room.
10. Make an emergency plan.
Depending on where you live, an earthquake, hurricane, tornado, or any other natural disaster could happen at any moment, so make sure your family is prepared. Sit down as a family to discuss the possible outcomes, come up with a plan of action and practice it! Being prepared and knowing what to do in case of an emergency is half the battle.


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- Catalogs
- Security - Protective Equipment >
- Access control >
- Biometric reader
Biometric readers
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2N® ACCESS UNIT FINGERPRINT READER An IP access control unit equipped with fingerprint reader. Thanks to its optical sensor, it provides maximum security, high reliability, and rapid fingerprint reading ...
... fingerprints. It provides fast, forensic quality fingerprint capturing. The enrolled fingerprint images comply with U.S. strict biometric standards: the FBI IAFIS IQS Appendix F. Auto-capture function and real-time NIST ...
MorphoWave Compact Delivering frictionless access everywhere To protect their premises, organizations need access control solutions that are thorough, dependable and do not slow people down. IDEMIA relied on its patented, touchless ...
Fully integrated fingerprint card reader/controller The S610f is a fully integrated biometric and access control card reader that is used to secure restricted areas that require an additional ...
... fast process, improving both, the user experience and the integrity of system data capture. Smart card readers and biometric fingerprint readers both eliminate and reduce costs associated ...
MA300 is a biometric access control terminal with an integrated proximity reader and Bluetooth communication. MA300-BT, one of the innovative biometric fingerprint readers ...
Important step for passengersProviding advanced services for the integration of biometrics will be an important step for passenger identification at certain touch points.Our biometric solution integrates ...
... tasks. The Grabba Fingerprint reader is based on Morpho's proprietary optical technology and biometric algorithms, which are both known worldwide for their high levels of accuracy and performance. The ...
... functionalities and quality assurance criteria needed for a flawless capture of biographic/biometric data and document authentication, capable of enrolling multimodal biometrics (face, iris and fingerprint). ...
... images and rolled fingerprints within a second. From border management to voters registration or law enforcement - a complete biometric solution.
DERMALOG Identification Systems
Biometric recognition devices are a reliable and economical means of enhancing and upgrading the effectiveness of an access control system. They can be used to provide an additional check on a persons credentials, or ...
Standalone biometric solution for 500 users Card + fingerprint operation and CNIL Declaration of Conformity + Standalone biometric reader – touchscreen display – MIFARE® reader + ...
Vauban Systems
... of the owner.The operation of the "Biometric on Card" is as follows:The user checks his card on the reader. The reader extracts the biometric information from the card.The ...
... algorithm to keep your data accurate and secure.Operational in a variety of harsh environments the ievo ultimate reader is the flagship fingerprint reader from ievo Ltd. With a standard range of up to ...
I-Evo Ltd
Biometric Terminal – Networkable (WiFi) or Standalone, 500dpi Optical Sensor Supports EM/Mifare Cards, Wiegand In/Out, RS485, 1000 Fingerprints, IP65, i-Unis Android & iPhone App for Remote Control of the Access Control ...
The all in one stainless steel face recognition Facetower includes a 10' eye catcher monitor, overview camera for height measurement and gate surveillance, Adomo® with the face detail camera, counterfeit detection and NIR illumination.
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A Rooster in a Hen House
January 29, 2016
Kaz'O'zah Art firmly believes in the empowerment and support of women. Women are often required to juggle raising children as well as earning a living, and in many countries, all over the world, they are paid less than their male colleagues. Eighty percent of Kaz'O'zah Art's artisans are women, and in our 7 person administrative team, there is only one man. This does not mean we do not support or work with men however! We would like to introduce you to Fidèle Mafasho, the lone male in our administrative team.
Fidèle grew up in Bujumbura, but attended university overseas. In 2013, he graduated from the Symbiosis International University in India with a degree in Business Administration and Information Technology. After graduating Fidèle decided to return to his home country to begin work.
A few weeks after he arrived a friend introduced him to Kaz'O'zah Art executive director, Ange Muyubira, and the rest, as they say is history! At the time Kaz'O'zah Art was growing quickly and in need of someone to take control of the financial department. Fidèle was the perfect fit!
When asked about being the only male on the Kaz'O'zah Art administrative staff, Fidèle replied "It was very different at first to work with only women, but I have learned so much from them, especially when it comes to making decisions. A client will walk in to the shop unsure what they want; watching the others has taught me how our intuition can be crucial in helping our clients to decide on a design that best suits them."
Fidèle is crucial in controlling the finances of both Kaz'O'zah Art and the non-profit wing, Kaz'O'zah Keza, as well as managing government reporting and taxation.
But it is not all facts and figures for Fidèle. He also ensures there is a good atmosphere at Kaz'O'zah Art with his up-beat attitude and infectious laugh. Fidèle is always there with advice and direction for his fellow staff members and he is an important member of the Kaz'O'zah Art family.


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10 Must-Sees in D.C.
First things first, I am a total history buff, so I absolutely loved visiting Washington D.C. for the first time. I, of course, did not have enough time to see everything (I think that would take a lifetime to soak in everything D.C. has to offer), but I am still in awe of the things I was blessed with experiencing, so I thought I would pass on the things I believe to be must-sees for your first trip to D.C.
1. Try to plan your trip around D.C.'s cherry blossom trees.
Washington D.C. is famous for their beautiful cherry blossoms and they are surely guaranteed to bless your trip with calendar-worthy pictures. They bloom in the spring in March or April and last about a week; however, if you miss it, D.C. is still sure to give you Instagram-level selfies and stories.
2. The National Mall at Sunset
There is nothing like seeing the Lincoln Memorial reflecting across the pool at sunset and walking around it to see the National Monument reflecting back on the other side; however, I do suggest going on a weekday night to avoid some of the crowds.
3. The Newseum
If you adore your freedom of speech, press, religion, or assembly you must go to the Newseum. If you remember or have heard of 9/11, The Berlin Wall, Stonewall, or some very infamous FBI cases, go the Newseum. If you appreciate journalism and the fight to keep the public informed, then please do yourself a favor and go to the Newseum. It will be well worth the trip and there is so much to see your ticket is good to two consecutive days for just $25.
4. See a play in Ford's Theatre
Watch a musical or play in the very theater President Lincoln was assassinated in. The feeling is surreal and surly something you will never forget. Arrive early to walk through a museum preserving the memory of the infamous death and see the gun with your own eyes.
5. Take a trolley ride down to King Street.
With delicious food, live entertainment, and a strong sense of community you will fall in love with this little piece of town! It is just on the water's edge of the Potomac River and sure to delight!
6. Guided tour of the Nation's State Capital Building
Request a guided tour with your local House Representative or Senator to experience the State Capital Building in a more intimate way with an intern who works there and is privy to special stories and quirks you would never notice without them. Ask them about the Ghost Cat Prints.
You can also request a tour of the White House from the same representative but do it well in advance because slots fill up quick!
7. Get an official Library Card at Jefferson's Library of Congress
Literally, every inch of this building is decorated and absolutely stunning and you will be amazed regardless if you get a library card or not, but trust me, you will want to. A library card gets you access to the Library of Congress's famous Reading Room. It is free to get the card and only takes about ten minutes total, but ten minutes to try you luck at finding "The President's Book" from National Treasure: Book of Secrets? Yes please! Not a reader? That is just fine; simply revel in the fact that you are in an exclusive part of the Nation's capital that not many people experience.
8. Enjoy a meal in the oldest tavern in D.C.
Old Ebbitt Grille is a decadent restaurant with incredible food and a warm, historical ambiance. It is the perfect way to dine out in D.C., and while it might be a little pricy, the food is well worth it and the waitstaff are delightful. Splurge a little, it will be worth it!
9. Visit the Nation's archives.
In the National Archive Building, reside America's most treasured documents: The Declaration of Independence, the Bill of Rights, and the Constitution of the United States of America itself. Come and witness vital pieces of our history and national identity.
10. Visit the Jefferson Memorial at water's edge.
This breathtaking monument is well worth the stop, especially if you go while the cherry blossoms are in full bloom. Take a paddle boat out on the calm water and see the memorial and pieces of the National Mall from a unique view.
Whatever you do in D.C., will be phenomenal, so make this trip your own! Read up on what you would like to see and experience because there is so much more to do than what is on this little list. Please, go out and explore! Experience the world and learn an appreciation for culture, history, and different people.


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Background: Ms. Ribeiro comes from a colorful cultural background. Her father immigrated to the United States from Mexico in 1966and her mother is a first generation American, whose family immigrated to the United States from Hong Kong in 1944.
License: Irina Ribeiro is a member of the State Bar of Californiaand Oregon.
Education: Ms. Ribeiro obtained her Juris Doctor in San Diego, at the California Western School of Law. Prior to law school, she attended the University of California, Santa Cruz, where she obtained a Bachelor of Arts in Literatureand Legal Studies.
Experience: Ms. Ribeiro has successfully represented employers in complex business immigration matters. Similarly, she has reunited families living in different countriesand helped individuals to obtain legal status in the U.S. Prior to practicing immigration law, Ms. Ribeiro represented financial institutionsand related entities at a large business litigation firm where she gained invaluable courtroom experience.
Approach: Ms. Ribeiro's approach to the practice of law is good workand communication. Immigrating to the U.S. is difficultand confusing. The smallest mistake can result in delay, denial, or deportation. Constant communication between attorneyand client is the key to alleviating stressand avoiding error. Good work is a natural product of a healthy client-attorney relationship.
Philanthropy: Ms. Ribeiro is a strong animal rights advocate. She works with rescue groups throughout California to rescueand rehabilitate abusedand abandoned animals in danger of being euthanized.
Atty. Irina patiently listened to my situation and asked me appropriate questions pertaining to my problem. Not only that, while she needed to confirm something with her colleagues she ended the call and upon confirmation, she called me back with her answers. She operates at a very high level of professionalism and with very high work ethics. I would definitely seek her Guidance for future needs of legal advice.– Avik G.
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I will definitely go back to her if I have other questions in future.– Angela W.
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Irina is great, she helped me and my wife answering all our questions promptly. I also appreciate how she really is protective with ideas and questions. Highly recommended.– Felipe C.
I Victor Mundenda personally have found Ms Irina Ribeiro as an outstanding Immigration Attorney. She is down to earthand takes eachand every case at easy with patience. She is intelligent, humbleand clientele oriented attorney. Right now, she is working on my case (H1B application)and has impressed my employer including myself the way she is uniquely handling my case. She is a perfect attorney that one can rely on.– Victor Mundenda
Fast response. Professionaland caring.– Cynthia T.
Irina has been extremely helpful. Not only has she been honest about the options available to meand my family, but she has been patientand understanding in every aspect of the case. She's not about finding the quickand easy way, she's about finding the best way.– Gricelda R.
Irina helped me with EB-1 visa processand she is extremely good at what she does. The E-B1 process took nearly a year – including a 3 month preparation period. Irina really went aboveand beyond to help me with my case,and was there with me every step of the way. My case was especially complicatedand difficult because I am a theatre artist with a short period of working experience. Art does not appeal to the government easily so she needed to gather a huge amount of information to prove my value.
I just received notification from homeland security that my petition had been approved. I highly recommend Irina to anyone who is looking for immigration help.– Yusuke S.
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The service provided by Warren Law Firmand especially by attorney Irina Ribeiro is the best. I started doing only a consultation, but impressed with the excellent level of serviceand deep knowledge of the lawyer I hired to attend my case. I think communication, interaction, proactivityand high level of staff knowledge qualify this company as one of the market's best in my opinion.– Paulo R.
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I really like Irina. She is very nice, professionaland helpful!– Jin J.


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Our annual giving campaign "One Girl, One Day"
October 30, 2018
Our new 72-hour annual giving campaign "One Girl, One Day" was a huge success! We created this campaign to fall on October 11, The International Day of the Girl Child. We couldn't think of a better day to celebrate our 80 plus girls and raise money for them to attend a portion of our 7-week residential camp. With our girls coming from 33 different towns in NH we were certainly blessed with a wide variety of sponsors that showed their support. Over the three-day campaign we had a goal set in mind of $25,000 and we blew it out of the water by raising over $40,000. The dinner cruise held on the M/S Mount Washington to launch the campaign was a great way to set sail. Our generous supporters showed up to help, we had sponsors on board, mentors, board members, circle staff, friends and most importantly we had Circle Girls giving back to the program that gives so much to them. It was great to see our girls in action by selling raffle tickets, handing out prizes, and also getting to introduce themselves and mingle, while a few of them shared some of their personal stories. The live auction held by Alex Ray of the Common Man was a lot of fun and exceeded our expectations. Dr. Dan O'Neill helped us raise even more money with a reverse auction by funding a girl for a day, a week or a session. We are still shocked by how many people stepped up to support our girls. It certainly takes a tribe to run an organization like Circle Program and we are blessed with a very supportive group of people. The donations continue to roll in on-line and we are filled with gratitude! Thank you to all who participated in this campaign, every little bit makes a difference.
Gratitude is the Attitude!
Beth Musto
Development and Marketing Coordinator


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China may be the only country in the world able to stamp out cryptocurrency while repurposing its underlying blockchain technology. Decentralization becomes centralized under this scenario, as private enterprises implement blockchain solutions in line with central government directives. It's a bit like the "socialist market economy." The key to success here is acceptance of seemingly contradictory principles, one of Beijing's specialties.
China's UnionPay is stepping up European expansion in a bid to capture business from Chinese outbound tourism and corporate travel. The Chinese payments giant has established a partnership with Barclay's, which processes almost half of the UK's credit and debit card transactions, that will allow 110,000 UK merchants to accept UnionPay beginning from the summer of 2019.
India's fintech sector has surged over the past few years, with deal value reaching $2 billion in 2018. India now has more than 2,000 fintech startups, compared to less than 750 in 2014. Most Indian fintech startups are in the payments and lending segments, a boon for the subcontinent's under-banked population. Given the importance of fintech to financial inclusion in India, Delhi is preparing to launch a regulatory sandbox that would ensure that the industry develops stably. In late March, Reserve Bank of India (RBI) governor Shaktikanta Das said that the RBI would publish the guidelines for the creation of a fintech regulatory sandbox in the next two months.
As one of Southeast Asia's preeminent markets, Indonesia offers strong opportunities for fintechs. With a population of 265 million, it is larger than Vietnam, Thailand, Malaysia, Myanmar and Cambodia combined. In 2018, the Indonesian economy expanded 5.18%, beating economists' forecasts.
One of the great ironies about China for multinational firms is that they feel they have to be there, but the gatekeeper doesn't always let them in. This paradigm is especially evident in the financial services sector, where foreign firms control less than 2% of the market 18 years after China entered the World Trade Organization and promised to dismantle trade and investment barriers.
Thailand's Securities and Exchange Commission (SEC) has approved the kingdom's first initial coin offering portal (ICO) and is expected to issue guidelines for securities token offerings (STO) applications in the near future. ICO portals are used primarily to conduct due diligence.
In a few short years, Japan has become one of the most crypto-friendly countries in the world, pushing ahead with plans to integrate distributed ledger technology into its financial system despite rising skepticism about virtual currency's future. Even massive hacks of its crypto exchanges haven't affected Japan's determination to become a crypto nation. The Japanese government has handled the skullduggery in stride, strengthening systemic security measures rather than resorting to draconian crackdowns.
In less than a decade, Alibaba and Tencent have built the world's foremost mobile internet ecosystem in China. Their success derives from both innovative business models and unflappable determination. To be sure, they arrived at the right time - the rise of smartphones - but good timing isn't enough to prevail in a market as cutthroat as China's. Of course, Alibaba and Tencent also haven't had to contend with foreign competition. Would they have been as successful without the Great Firewall?
Singapore is an ascendant digital finance hub, in 2018 attracting $365 million in fintech investment. That investment was double the amount raised a year earlier. Despite its small size, the city-state is still the No. 5 fintech market in APAC by funds raised.
Vietnam plans to roll out a pilot peer-to-peer (P2P) lending scheme to boost financial inclusion in one of Southeast Asia's fastest growing economies. The pilot program will permit P2P lending firms to serve as intermediaries between lenders and borrowers, but they will be restricted from fundraising activity.
In Asia, digital wallets are increasingly where the money is for ride-hailing companies. Once they have a critical mass of customers using their app for taxis, the companies launch a suite of financial services people can access from the convenience of their smartphones. Didi Chuxing is going this route in China, while Singapore-based Grab and Indonesia-based Go-Jek are launching digital wallets across Southeast Asia.
Paradoxes abound in the Chinese economy, as the long arm of the state regularly collides with resilient entrepreneurial activity. Nowhere is this more apparent than the fintech segment, where Beijing is repurposing technology designed to facilitate freewheeling financial activity as an instrument of state control. We would like to ask enigmatic Bitcoin founder Satoshi Nakamoto to comment - if only we knew how to get a hold of him.
Across Asia, there is a race to go cashless as financial digitalization accelerates. Financial services companies want to capture business from digital payment adoption, while regulators want to reduce costs by printing less paper money and minting fewer coins. Consumers want convenient payment options.
Singapore's Grab is rolling out a suite of digital financial services in a bid to become Southeast Asia's preeminent app. The services including micro-lending, micro-insurance and payments. Like China's ubiquitous messaging app WeChat has done, Grab wants to build an ecosystem where consumers can bank, order food and shop - not just chat and hail rides. Asean's large underbanked population makes it an attractive market for fintechs.
Virtual currency adoption looks set to accelerate in Taiwan as the island plans to establish a mechanism for security token offerings by mid-year. The move is in line with Taiwan's launch of a fintech regulatory sandbox that allows firms to experiment with novel business models but not fall afoul of existing regulations.


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Phase Behavior and Rheology of Colloids with Polymer-Mediated Attractions
Park, Na Young
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Mixtures of colloids and polymers are used in many industrial and commercial applications such as paints, consumer products, and drilling fluids. Addition of polymers to colloidal suspensions can cause attractions between the particles, such as depletion and bridging attractions. These attractions produce complex phase behavior and rheology of the final suspension. In addition to the attractions that arise, the properties of the polymer additives themselves – size, dispersity, charge/interaction with particle – likely also affect the final suspension behavior. In this work, we investigated the effects of these properties of the polymer additives to the phase behavior and rheology of the resulting suspensions. First, we explored the effect of polymer dispersity on the phase behavior of depletion mixtures by using unary and binary mixtures of uniform, small polymers as the depletant in a model colloidal suspension. We found that the phase behavior could be mostly collapsed, irrespective of polymer dispersity, if the polymer concentration was represented as a weighted sum of the two polymers' concentrations in a binary mixture. Then, a new model depletion mixture was developed for measuring stress-dependent rheological properties: shear thickening and first normal stress difference N1. Using this system, we measured the effects of polymer depletant size and dispersity on the rheology of a shear-thickening suspension. The presence of large polymers enhanced the shear thickening of the suspensions and changed the sign of N1 from negative to positive, compared to the nearly hard-sphere suspension. Finally, we explored the effect of polymer adsorption strength on the surface of the particles on the cluster formation and rheology of a model bridging mixture, based on the same model colloidal suspension as the depletion studies. This bridging mixture is a promising model system for future systematic comparisons of the effects of depletion and bridging attractions. The results of this work confirm the importance of studying the effects of the properties of the polymer additives themselves on the final behavior of model colloids with polymer-mediated attractions, and they suggest that this understanding can be used to tune properties of the resulting suspensions.