text: This is the accessible text file for GAO report number GAO-05-863T entitled 'Influenza Pandemic: Challenges in Preparedness and Response' which was released on June 30, 2005. This text file was formatted by the U.S. Government Accountability Office (GAO) to be accessible to users with visual impairments, as part of a longer term project to improve GAO products' accessibility. Every attempt has been made to maintain the structural and data integrity of the original printed product. Accessibility features, such as text descriptions of tables, consecutively numbered footnotes placed at the end of the file, and the text of agency comment letters, are provided but may not exactly duplicate the presentation or format of the printed version. The portable document format (PDF) file is an exact electronic replica of the printed version. We welcome your feedback. Please E-mail your comments regarding the contents or accessibility features of this document to firstname.lastname@example.com. This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be reproduced and distributed in its entirety without further permission from GAO. Because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. Testimony: Before the Committee on Government Reform, House of Representatives: United States Government Accountability Office: GAO: For Release on Delivery Expected at 10:00 a.m. EDT: Thursday, June 30, 2005: Influenza Pandemic: Challenges in Preparedness and Response: Statement of Marcia Crosse: Director, Health Care: GAO-05-863T: GAO Highlights: Highlights of GAO-05-863T, a testimony before the Committee on Government Reform, House of Representatives: Why GAO Did This Study: Shortages of influenza vaccine in the 2004–05 and previous influenza seasons and mounting concern about recent avian influenza activity in Asia have raised concern about the nation's preparedness to deal with a worldwide influenza epidemic, or influenza pandemic. Although the extent of such a pandemic cannot be predicted, according to the Centers for Disease Control and Prevention (CDC), an agency within the Department of Health and Human Services (HHS), it has been estimated that in the absence of any control measures such as vaccination or antiviral drugs, a "medium-level" influenza pandemic could kill up to 207,000 people in the United States, affect from 15 to 35 percent of the U.S. population, and generate associated costs ranging from $71 billion to $167 billion in the United States. GAO was asked to discuss the challenges the nation faces in responding to the threat of an influenza pandemic, including the lessons learned from previous annual influenza seasons that can be applied to its preparedness and overall ability to respond to a pandemic. This testimony is based on GAO reports and testimony issued since 2000 on influenza vaccine supply, pandemic planning, emergency preparedness, and emerging infectious diseases and on current work examining the influenza vaccine shortage in the United States for the 2004–05 influenza season. What GAO Found: The nation faces multiple challenges to prepare for and respond to an influenza pandemic. First, key questions about the federal role in purchasing and distributing vaccines during a pandemic remain, and clear guidance on potential priority groups is lacking in HHS's current draft of its pandemic preparedness plan. For example, the draft plan does not establish the actions the federal government would take to purchase or distribute vaccine during an influenza pandemic. In addition, as was highlighted in the nation's recent experience responding to the unexpected influenza vaccine shortage for the 2004–05 influenza season, clear communication of the nation's response plan will be a major challenge. During the 2004–05 influenza season, state health officials reported that mixed messages created confusion. For example, CDC advised vaccination for persons aged 65 and older, and at the same time a state advised vaccination for persons aged 50 and older. Further challenges include ensuring an adequate and timely supply of influenza vaccine and antiviral drugs, which can help prevent or mitigate the number of influenza-related deaths. Particularly given the length of time needed to produce vaccines, influenza vaccine may be unavailable or in short supply and might not be widely available during the initial states of a pandemic. Finally, the lack of sufficient hospital and health care workforce capacity to respond to an infectious disease outbreak may also affect response efforts during an influenza pandemic. Public health officials we spoke with said that a large-scale outbreak, such as an influenza pandemic, could strain the available capacity of hospitals by requiring entire hospital sections, along with their staff, to be used as isolation facilities. www.gao.gov/cgi-bin/getrpt?GAO-05-863T. To view the full product, including the scope and methodology, click on the link above. For more information, contact Marcia Crosse at (202) 512-7119. [End of section] Mr. Chairman and Members of the Committee: I am pleased to be here today as you discuss the nation's preparedness to respond to a worldwide influenza epidemic--known as a pandemic.[Footnote 1] Shortages of influenza vaccine in the 2004-05 and previous annual influenza seasons, as well as mounting concern about recent avian influenza activity in Asia, have raised concern about the nation's preparedness to deal with a pandemic. Pandemic influenza, which arises periodically but unpredictably from a major genetic change in the influenza virus, can lead to worldwide disease and death.[Footnote 2] Although the extent of the next pandemic cannot be predicted, modeling studies suggest that its effect in the United States could be severe. According to the Centers for Disease Control and Prevention (CDC), it has been estimated that in the absence of any control measures such as vaccination and drugs, a "medium-level" influenza pandemic in the United States could kill 89,000 to 207,000 people, affect from 15 to 35 percent of the U.S. population, and generate associated costs ranging from $71 billion to $167 billion. In the event of a pandemic, the nation will likely experience a vaccine shortage. The nation's experience responding to the unexpected shortage of annual influenza vaccine during the 2004-05 influenza season--in which public health officials sought to match available vaccine supply with demand--underscores the challenges that federal, state, and local entities would need to meet in the event of a pandemic. In addition, our recent work has highlighted other challenges in responding to pandemic influenza. You asked us to provide our perspective on the nation's preparedness for responding to an influenza pandemic, including the lessons learned from previous annual influenza seasons that would be applicable to pandemic preparedness. In this testimony, I will discuss challenges we identified related to (1) planning for the purchase and distribution of influenza vaccine, including defining priority groups to be vaccinated; (2) communicating information about the situation and the response plan clearly and effectively among health officials, providers, and the public; (3) ensuring an adequate supply of vaccine and antiviral drugs; and (4) addressing hospital and workforce capacity to respond to large- scale outbreaks of infectious disease, including pandemic influenza. My testimony today is based on reports and testimony on influenza vaccine supply, pandemic planning, emergency preparedness, and emerging infectious diseases that we have issued since October 2000[Footnote 3] and on a review in progress for this committee on actions taken and lessons learned at federal, state, and local levels to ensure that high- risk individuals had access to vaccine during the 2004-05 influenza vaccine shortage. Our prior work includes analysis of information provided by and interviews with officials in the Department of Health and Human Services (HHS), specifically from CDC, the Food and Drug Administration (FDA), and the National Vaccine Program Office. We also interviewed public health department officials, vaccine manufacturers, and vaccine distributors; surveyed physician group practices; and reviewed HHS's August 2004 draft Pandemic Influenza Preparedness and Response Plan. Since March 2005 we have reviewed documents and interviewed officials from HHS, CDC, and the National Vaccine Program Office; national organizations, including the Association of State and Territorial Health Officials; organizations that conduct mass immunization clinics; a major vaccine manufacturer; and a large purchaser of influenza vaccine. We also conducted site visits at a judgmental sample of states and localities.[Footnote 4] We conducted our work in accordance with generally accepted government auditing standards. CDC and the National Vaccine Program Office provided comments on the facts contained in this statement, and we made changes as appropriate. In summary, the nation faces multiple challenges to prepare for and respond to an influenza pandemic. First, key questions remain about the federal role in purchasing and distributing vaccines during a pandemic, and clear guidance on potential priority groups is lacking in HHS's current draft of its pandemic preparedness plan. In addition, as highlighted by the nation's recent experience responding to the unexpected influenza vaccine shortage for the 2004-05 influenza season, clear communication of the nation's response plan will be a major challenge. Further challenges include ensuring an adequate and timely supply of influenza vaccine and antiviral drugs, which can help prevent or mitigate the number of influenza-related deaths. Finally, the lack of sufficient hospital and health care workforce capacity to respond to an infectious disease outbreak may also affect response efforts during an influenza pandemic. Background: Influenza is more severe than some other viral respiratory infections, such as the common cold. Most people who contract influenza recover completely in 1 to 2 weeks, but some develop serious and potentially life-threatening medical complications, such as pneumonia. People aged 65 and older, people of any age with chronic medical conditions, children younger than 2 years, and pregnant women are generally more likely than others to develop severe complications from influenza. Vaccination is the primary method for preventing influenza and its more severe complications. Produced in a complex process that involves growing viruses in millions of fertilized chicken eggs, influenza vaccine is administered annually to provide protection against particular influenza strains expected to be prevalent that year. Experience has shown that vaccine production generally takes 6 or more months after a virus strain has been identified; vaccines for certain influenza strains have been difficult to mass-produce. After vaccination, it takes about 2 weeks for the body to produce the antibodies that protect against infection. According to CDC recommendations, the optimal time for vaccination is October through November, because the annual influenza season typically does not peak until January or February. Thus, in most years vaccination in December or later can still be beneficial. At present, two vaccine types are recommended for protection against influenza in the United States: an inactivated virus vaccine injected into muscle and a live virus vaccine administered as a nasal spray. The injectable vaccine--which represents the large majority of influenza vaccine administered in this country--can be used to immunize healthy individuals and those at highest risk for complications, including those with chronic illness and those aged 65 and older, but the nasal spray vaccine is currently approved for use only among healthy individuals aged 5 to 49 years who are not pregnant. Vaccine manufacture and purchase take place largely within the private sector: for the 2004-05 influenza season, two companies (one producing the injectable vaccine and one producing the nasal spray) manufactured vaccine for the U.S. market.[Footnote 5] Although vaccination is the primary strategy for protecting individuals who are at greatest risk of serious complications and death from influenza, antiviral drugs can also contribute to the treatment and prevention of influenza. Four antiviral drugs have been approved for treatment. If taken within 2 days after symptoms begin, these drugs can reduce symptoms and make someone with influenza less contagious to others. Three of the four antiviral drugs are also approved for prevention; according to CDC, they are about 70 to 90 percent effective for preventing illness in healthy adults. HHS has primary responsibility for coordinating the nation's response to public health emergencies. As part of its mission, the department has a role in the planning needed to prepare for and respond to an influenza pandemic. One action the department has taken is to develop a draft national pandemic influenza plan, titled Pandemic Influenza Preparedness and Response Plan, which was released in August 2004 for a 60-day comment period. Within HHS, CDC is the principal agency for protecting the nation's health and safety. CDC's activities include efforts to prevent and control diseases and to respond to public health emergencies. CDC and its Advisory Committee on Immunization Practices (ACIP) recommend which population groups should be targeted for vaccination each year and, when vaccine supply allows, recommends that any person who wishes to decrease his or her risk of influenza-like illness be vaccinated. FDA, another HHS agency, also plays a role in preparing for the annual influenza season and for a potential pandemic. FDA is responsible for ensuring that new vaccines and drugs are safe and effective. The agency also regulates and licenses vaccines and antiviral agents.[Footnote 6] HHS has limited authority to control vaccine production and distribution directly; influenza vaccine supply and marketing are largely in the hands of the private sector.[Footnote 7] Although the Public Health Service Act authorizes the Secretary of HHS to "take such action as may be appropriate" to respond to a public health emergency, as determined and declared by the Secretary, it is not clear whether or to what extent the Secretary could directly influence the manufacture or distribution of influenza vaccine to respond to an influenza pandemic.[Footnote 8] The appropriateness of the Secretary's response would depend on the nature of the public health emergency, for example on the available evidence relating to a pandemic. According to a senior HHS official involved in HHS emergency preparedness activities, manufacturers of vaccine for the U.S. market have agreed in principle to switch to production of pandemic influenza vaccine should the need arise and proper compensation and indemnification be provided; therefore, he said, it would probably be unnecessary for the federal government to nationalize vaccine production, although the federal government has the legal authority to do so if circumstances warrant it. For the 2004-05 influenza season, CDC estimated as late as September 2004 that about 100 million doses of vaccine would be available for the U.S. market.[Footnote 9] CDC and ACIP recommended vaccination for about 185 million people, including roughly 85 million people at high risk for complications.[Footnote 10] On October 5, 2004, however, one manufacturer announced that it could not provide its expected production of 46-48 million doses--roughly half of the U.S. supply of expected vaccine.[Footnote 11] Because a large proportion of vaccine produced by the other major manufacturer of injectable vaccine had already been shipped before October 5, 2004, about 25 million doses of injectable vaccine for high-risk individuals and others, and about 1 million doses of the nasal spray vaccine for healthy people, were available after the announcement to be distributed to Americans who wanted an influenza vaccination. Preparing for and responding to an influenza pandemic differ in several respects from preparing for and responding to a typical influenza season. For example, past influenza pandemics have affected healthy young adults who are not typically at high risk for complications associated with influenza, and a pandemic could result in an overwhelming burden of ill persons requiring hospitalization or outpatient medical care. In addition, the demand for vaccine may be greater in a pandemic. Planning for Purchase and Distribution of Vaccine and Defining Priority Groups: Challenges remain in planning for purchase and distribution of vaccine and defining priority groups in the event of a pandemic. HHS has not finalized planning for an influenza pandemic, leaving unanswered questions about the nation's ability to prepare for and respond to such an outbreak. For the past 5 years, we have been urging HHS to complete its pandemic influenza plan. The document remains in draft form, although federal officials said in June 2005 that an update of the plan is being completed and is expected to be available in summer 2005. Key questions about the federal role in purchasing and distributing vaccines during a pandemic remain, and clear guidance on potential groups that would likely have priority for vaccination is lacking in the current draft plan. One challenge is that the draft pandemic plan does not establish the actions the federal government would take to purchase or distribute vaccine during an influenza pandemic. Rather, it describes options for vaccine purchase and distribution, which include public-sector purchase of all pandemic influenza vaccine; a mixed public-private system where public-sector supply may be targeted to specific priority groups; and maintenance of the current largely private system. The draft plan does not specifically recommend any of these options. According to the draft plan, the federal government's role may change over the course of a pandemic, with greater federal involvement early, when vaccine is in short supply. Noting that several uncertainties make planning vaccination strategies difficult, the draft plan states that national, state, and local planning needs to address possible contingencies, so that appropriate strategies are in place for whichever situation arises. If public-sector vaccine purchase is an option, establishing the funding sources, authority, or processes to do so quickly may be needed. During the 2004-05 shortage, some state health officials reported problems with states' ability, with regard to both funding and the administrative process, to purchase influenza vaccine. For example, during the effort to redistribute vaccine to locations of greatest need, the state of Minnesota tried to sell its available vaccine to other states seeking additional vaccine for their high-risk populations. According to federal and state health officials, however, certain states lacked the funding or authority under state law to purchase the vaccine when Minnesota offered it. In response to problems encountered during the 2004-05 shortage, the Association of Immunization Managers proposed in 2005 that federal funds be set aside for emergency purchase of vaccine by public health agencies and that cost not be a barrier in acquiring vaccine to distribute to the public.[Footnote 12] Although an influenza pandemic may differ from an annual influenza season, experience during the 2004-05 shortage illustrates the importance of having a distribution plan in place ahead of time to prevent delays when timing is critical: * Collaborating with stakeholders to create a workable distribution plan is time consuming. After the October 5, 2004, announcement of the sharp reduction in influenza vaccine supply, CDC began working with the sole remaining manufacturer of injectable vaccine on plans to distribute this manufacturer's remaining supply to providers across the country. The plan had two phases and benefited from voluntary compliance by the manufacturer to share proprietary information to help identify geographic areas of greatest need for vaccine. The first phase, which began in October 2004, filled or partially filled orders from certain provider types, including state and local public health departments and long-term care facilities. The second phase, which began in November 2004, used a formula to apportion the remaining doses across the states according to each state's estimated percentage of the national unmet need. States could then allocate doses from their apportionment to providers and facilities, which would purchase the vaccine through a participating distributor. The state ordering process under the second phase continued through mid-January. Health officials in several states commented on the late availability of this vaccine; officials in one state, for example, remarked that the phase two vaccine was "too much, too late." * Identifying priority groups in local populations also takes time. Federal, state, and local officials need to have information on the population of the priority groups and the locations where they can be vaccinated to know how, where, and to whom to distribute vaccine in the event of an influenza pandemic. During the 2004-05 influenza season, federal officials developed a distribution plan to allocate a limited amount of vaccine, but the states also had to determine how much vaccine was needed and where to distribute it within their own borders. For example, state health officials in Florida did not know exactly how many high-risk individuals needed vaccination, so they surveyed long- term care facilities and private providers to estimate the amount of vaccine needed to cover high-risk populations. It took nearly a month for state officials to compile the results of the surveys, to decide how many doses needed to be distributed to local areas, and to receive and ship vaccine to the counties. * Distributing the vaccine to a state or locality is not the same as administering the vaccine to an individual. Once vaccine has been distributed to a state or local agency, individuals living in those areas still need to be vaccinated. Vaccinating a large number of people is challenging, particularly when demand exceeds available supply. For example, during the 2004-05 influenza season, many places giving vaccinations right after the shortage was announced were overwhelmed with individuals wanting to be vaccinated. Certain local public health departments in California, including the Santa Clara County Public Health Department, provided chairs and extra water for people waiting in long lines outdoors in warm weather. Fear of a more virulent pandemic influenza strain could exacerbate such scenarios. A number of states reported that they did not have the capacity to immunize large numbers of people and partnered with other organizations to increase their capacity. For example, in 2004-05, according to state health officials in Florida, county health departments, including those in Orange and Broward Counties, worked with a national home health organization to immunize high-risk individuals by holding mass immunization clinics and setting up clinics in providers' offices to help administer available vaccine quickly. Other locations, including the local health department in Portland, Maine, held lotteries for available vaccine; according to local health officials, however, administrative time was required to arrange and publicize the lottery. HHS's draft pandemic plan does not define priority groups for vaccination, although the plan states that HHS is developing an initial list of suggested priority groups and soliciting public comment on the list. The draft plan instructs the states to define priority groups for early vaccination and indicates that as information about virus severity becomes available, recommendations will be formulated at the national level. According to the plan, setting priorities will be iterative, tied to vaccine availability and the pandemic's progression. Without agreed-upon identification of potential priority groups in advance, however, problems can arise. During the 2004-05 season, for example, CDC and ACIP acted quickly on October 5, 2004, to narrow the priority groups for available vaccine, giving the narrowed groups equal importance.[Footnote 13] In some places, however, there was not enough available vaccine to cover everyone in these narrowed priority groups, so states set their own priorities among these groups. Maine, for example, excluded health care workers from the state's early priority groups because state officials estimated that there was not enough vaccine to cover everyone in CDC and ACIP's priority groups. Communicating Information about the Situation and Response Plan Clearly and Effectively: Another challenge in responding to a pandemic will be to clearly communicate information about the situation and the nation's response plans to public health officials, providers, and the public. Experience during the 2004-05 vaccine shortage illustrates the critical role communication plays when information about vaccine supply is unclear.[Footnote 14] * Communicating a consistent message and clearly explaining any apparent inconsistencies. In a pandemic, clear communication on who should be vaccinated will be important, particularly if the priority population differs from those targeted for annual influenza vaccination, or if the priority groups in one area of the country differ from those in others. During the 2004-05 influenza season, health officials in Minnesota reported that some confusion resulted when the state determined that vaccine was sufficient to meet demand among the state's narrower priority groups and made vaccine available to other groups, such as healthy individuals aged 50-64 years, earlier than recommended by CDC. Health officials in California reported a similar situation. State health officials pointed out that in mid- December, local radio stations in California were running two public service announcements--one from CDC advising those 65 and older to be vaccinated and one from the California Department of Health Services advising those 50 and older to be vaccinated. State officials emphasized that these mixed messages created confusion. * Communicating information from a primary source. Having a primary and timely source of information will be important in a pandemic. In the 2004-05 influenza season, individuals seeking vaccine could have found themselves in a communication loop that provided no answers. For example, CDC advised people seeking influenza vaccine to contact their local public health department; in some cases however, individuals calling the local public health department would be told to call their primary care provider, and when they called their primary care provider, they would be told to call their local public health department. This lack of a reliable source of information led to confusion and possibly to high-risk individuals' giving up and not receiving the protection of an annual influenza vaccination.[Footnote 15] * Recognizing that different communication mechanisms are important and require resources. Another challenge in communicating plans in the event of a pandemic will be to ensure that the communication mechanisms used reach all affected populations. During the 2004-05 influenza season, public health officials reported the importance of different methods of communication. For example, officials from the Seattle-King County Public Health Department in Washington State reported that it was important to have a hotline as well as information posted on a Web site, because some seniors calling Seattle-King County's hotline reported that they did not have access to the Internet. According to state and local health officials, however, maintaining these communication mechanisms took time and strained personnel resources. In Minnesota, for example, to supplement state employees, the state health department asked public health nursing students to volunteer to staff the state's influenza vaccine hotline. * Educating health care providers and the public about all available vaccines. For the 2004-05 season, approximately 3 million doses of nasal spray vaccine were ultimately available for vaccinating healthy individuals aged 5-49 years who were not pregnant, including some individuals (such as health care workers in this age group and household contacts of children younger than 6 months) in the priority groups defined by CDC and ACIP, yet some of these individuals were reluctant to use this vaccine because they feared that the live virus in the nasal spray could be transmitted to others. State health officials in Maine, for example, reported that the state purchased about 1,500 doses of the nasal spray vaccine for their emergency medical service personnel and health care workers, yet administered only 500 doses. Ensuring Supply of Influenza Vaccine and Antiviral Drugs: Challenges in ensuring an adequate and timely supply of influenza vaccine and antiviral drugs--which can help prevent or mitigate the number of influenza-related deaths until an pandemic influenza vaccine becomes available--may be exacerbated during an influenza pandemic. Particularly given the time needed to produce vaccines, influenza vaccine may be unavailable or in short supply and may not be widely available during the initial stages of a pandemic. According to CDC, maintaining an abundant annual influenza vaccine supply is critically important for protecting the public's health and improving our preparedness for an influenza pandemic. The shortages of influenza vaccine in 2004-05 and previous seasons have highlighted the fragility of the influenza vaccine market and the need for its expansion and stabilization. In its budget request for fiscal year 2006, CDC reports that it plans to take steps to ensure an expanded influenza vaccine supply. The agency's fiscal year 2006 budget request includes $30 million for CDC to enter into guaranteed-purchase contracts with vaccine manufacturers to ensure the production of bulk monovalent influenza vaccine. If supplies fall short, this bulk product can be turned into a finished trivalent influenza vaccine product for annual distribution.[Footnote 16] If supplies are sufficient, the bulk vaccine can be held until the following year's influenza season and developed into finished vaccines if the bulk products maintain their potency and the circulating strains remain the same. According to CDC, this guarantee will help expand the influenza market by providing an incentive to manufacturers to expand capacity and possibly encourage additional manufacturers to enter the market. In addition, CDC's fiscal year 2006 budget request includes an increase of $20 million to support influenza vaccine purchase activities.[Footnote 17] In the event of a pandemic, before a vaccine is available or during a period of limited vaccine supply, use of antiviral drugs could have a significant effect. Antiviral drugs can be used against all strains of pandemic influenza and, because they can be manufactured and stored before they are needed, could be available both to prevent illness and, if administered within 48 hours after symptoms begin, to treat it. Like vaccine, antiviral drugs take several months to produce from raw materials, and according to one antiviral drug manufacturer, the lead time needed to scale up production capacity and build stockpiles may make it difficult to meet any large-scale, unanticipated demand immediately. HHS' National Vaccine Program Office also reported that in a pandemic, the manufacturing capacity and supply of antiviral drugs is likely to be less than the global demand. For these reasons, the National Vaccine Program Office reported that analysis is under way to determine optimal strategies for antiviral drug use when supplies are suboptimal; the office also noted that antiviral drugs have been included in the national stockpile. HHS has purchased more than 7 million doses of antiviral drugs for the national stockpile. Nevertheless, this stockpile is limited, and it is unclear how much will be available in the event of a pandemic, given existing production capacity. Moreover, some influenza virus strains can become resistant to one or more of the four approved influenza antiviral drugs, and thus the drugs may not always work. For example, the avian influenza virus strain (H5N1) identified in human patients in Asia in 2004 and 2005 has been resistant to two of four existing antiviral drugs. Hospital and Workforce Capacity to Respond to Large-Scale Infectious Disease Outbreaks: The lack of sufficient hospital and workforce capacity is another challenge that may affect response efforts during an influenza pandemic. The lack of sufficient capacity could be more severe during an influenza pandemic compared with other natural disasters, such as a tornado or hurricane, or with an intentional release of a bioterrorist agent because it is likely that a pandemic would result in widespread and sustained effects. Public health officials we spoke with said that a large-scale outbreak, such as an influenza pandemic, could strain the available capacity of hospitals by requiring entire hospital sections, along with their staff, to be used as isolation facilities. In addition, most states lack surge capacity--the ability to respond to the large influx of patients that occurs during a public health emergency. For example, few states reported having the capacity to evaluate, diagnose, and treat 500 or more patients involved in a single incident. In addition, few states reported having the capacity to rapidly establish clinics to immunize or treat large numbers of patients. Moreover, shortages in the health care workforce could occur during an influenza pandemic because higher disease rates could result in high rates of absenteeism among workers who are likely to be at increased risk of exposure and illness or who may need to care for ill family members. Concluding Observations: Important challenges remain in the nation's preparedness and response should an influenza pandemic occur in the United States. As we learned in the 2004-05 influenza season, when vaccine supply, relative to demand, is limited, planning and effective communication are critical to ensure timely delivery of vaccine to those who need it. HHS's current draft plan lacks some key information for planning our nation's response to a pandemic. It is important for the federal government and the states to work through critical issues--such as how vaccine will be purchased, distributed, and administered; which population groups are likely to have priority for vaccination; what communication strategies are most effective; and how to address issues related to vaccine and antiviral supply and hospital and workforce capacity--before we are in a time of crisis. Although HHS contends that agency flexibility is needed during a pandemic, until key federal decisions are made, public health officials at all levels may find it difficult to plan for an influenza pandemic, and the timeliness and adequacy of response efforts may be compromised. Mr. Chairman, this concludes my prepared statement. I would be happy to respond to any questions you or other Members of the Committee may have at this time. [End of section] GAO Contact and Staff Acknowledgments: For further information about this testimony, please contact Marcia Crosse at (202) 512-7119. Jennifer Major, Nick Larson, Gay Hee Lee, Kim Yamane, George Bogart, and Ellen W. Chu made key contributions to this statement. [End of section] Related GAO Products: Influenza Pandemic: Challenges Remain in Preparedness. GAO-05-760T. Washington, D.C.: May 26, 2005. Flu Vaccine: Recent Supply Shortages Underscore Ongoing Challenges. GAO- 05-177T. Washington, D.C.: November 18, 2004. Emerging Infectious Diseases: Review of State and Federal Disease Surveillance Efforts. GAO-04-877. Washington, D.C.: September 30, 2004. Infectious Disease Preparedness: Federal Challenges in Responding to Influenza Outbreaks. GAO-04-1100T. Washington, D.C.: September 28, 2004. Emerging Infectious Diseases: Asian SARS Outbreak Challenged International and National Responses. GAO-04-564. Washington, D.C.: April 28, 2004. Public Health Preparedness: Response Capacity Improving, but Much Remains to Be Accomplished. GAO-04-458T. Washington, D.C.: February 12, 2004. Infectious Diseases: Gaps Remain in Surveillance Capabilities of State and Local Agencies. GAO-03-1176T. Washington, D.C.: September 24, 2003. Severe Acute Respiratory Syndrome: Established Infectious Disease Control Measures Helped Contain Spread, but a Large-Scale Resurgence May Pose Challenges. GAO-03-1058T. Washington, D.C.: July 30, 2003. SARS Outbreak: Improvements to Public Health Capacity Are Needed for Responding to Bioterrorism and Emerging Infectious Diseases. GAO-03- 769T. Washington, D.C.: May 7, 2003. Infectious Disease Outbreaks: Bioterrorism Preparedness Efforts Have Improved Public Health Response Capacity, but Gaps Remain. GAO-03-654T. Washington, D.C.: April 9, 2003. Bioterrorism: Preparedness Varied across State and Local Jurisdictions. GAO-03-373. Washington, D.C.: April 7, 2003. Global Health: Challenges in Improving Infectious Disease Surveillance Systems. GAO-01-722. Washington, D.C.: August 31, 2001. Flu Vaccine: Steps Are Needed to Better Prepare for Possible Future Shortages. GAO-01-786T. Washington, D.C.: May 30, 2001. Flu Vaccine: Supply Problems Heighten Need to Ensure Access for High- Risk People. GAO-01-624. Washington, D.C.: May 15, 2001. Influenza Pandemic: Plan Needed for Federal and State Response. GAO-01- 4. Washington, D.C.: October 27, 2000. West Nile Virus Outbreak: Lessons for Public Health Preparedness. GAO/HEHS-00-180. Washington, D.C.: September 11, 2000. Global Health: Framework for Infectious Disease Surveillance. GAO/NSIAD- 00-205R. Washington, D.C.: July 20, 2000. FOOTNOTES [1] An influenza pandemic is defined by the emergence of a novel influenza virus, to which much or all of the population is susceptible, that is readily transmitted person to person, and causes outbreaks in multiple countries. [2] Influenza pandemics can have successive "waves" of disease and last for up to 3 years. Three pandemics occurred in the 20th century: the "Spanish influenza" of 1918, which killed about 500,000 people in the United States; the "Asian influenza" of 1957, which killed about 70,000 people in the United States; and the "Hong Kong influenza" of 1968, which killed about 34,000 people in the United States. [3] See "Related GAO Products" at the end of this testimony for a list of our earlier work related to infectious diseases, influenza vaccine supply, and pandemic planning. [4] The states included California, Florida, Maine, Minnesota, and Washington, and the localities included San Diego and San Francisco, California; Miami-Dade County, Florida; Portland, Maine; Stearns County, Minnesota; and Seattle-King County, Washington. We selected these states and localities on the basis of geography, population size, and state vaccination success rates. [5] HHS also located and purchased about 1.5 million doses of vaccine from manufacturers not licensed in the United States. Although this vaccine could be made available to be administered under special protocols, according to HHS officials, none of the vaccine was used in the 2004-05 influenza season. [6] In addition, FDA develops influenza reference strains and reagents and makes them available to manufacturers for vaccine development and evaluation. [7] Under the Federal Food, Drug, and Cosmetic Act, FDA ensures compliance with good manufacturing practice. FDA has limited authority to prohibit the resale of prescription drugs, including influenza vaccine, that have been purchased by health care entities such as public or private hospitals. This authority would not extend to resale of the vaccine for emergency medical reasons. The term "health care entity" does not include wholesale distributors. [8] According to the act, to declare a public health emergency, the Secretary must determine that (1) a disease or disorder presents a public health emergency or (2) a public health emergency, including significant outbreaks of infectious disease or bioterrorist attacks, otherwise exists. Public Health Service Act § 319 (current version at 42 U.S.C. § 247d). [9] See Centers for Disease Control and Prevention, "Supplemental Recommendations about Timing of Influenza Vaccination, 2004-05 Season," Morbidity and Mortality Weekly Report, vol. 53, no. 37 (2004): 878-879. [10] Not everyone in target populations receives a vaccination each year. See Centers for Disease Control and Prevention, "Prevention and Control of Influenza Recommendations of the Advisory Committee on Immunization Practices (ACIP)," Morbidity and Mortality Weekly Report, vol. 53, no. RR-06 (2004): 1-40. [11] The license for this manufacturer, with production facilities in Liverpool, England, was temporarily suspended by British regulatory authorities. [12] The Association of Immunization Managers is an organization that represents 64 state, territorial, and urban-area immunization programs funded by CDC. [13] On October 5, 2004, CDC, in coordination with ACIP, issued interim recommendations for influenza vaccination during the 2004-05 season that took precedence over earlier recommendations. The season's priority groups for vaccination with injectable influenza vaccine were considered to be of equal importance. They included all children aged 6- 23 months, adults aged 65 years and older, persons aged 2-64 years with underlying chronic medical conditions, all women who would be pregnant during the influenza season, residents of nursing homes and long-term care facilities, children aged 6 months-18 years on chronic aspirin therapy, health care workers involved in direct patient care, and out- of-home caregivers and household contacts of children younger than 6 months. See Centers for Disease Control and Prevention, "Interim Influenza Vaccination Recommendations, 2004-05 Influenza Season," Morbidity and Mortality Weekly Report, vol. 53, no. 39 (2004): 923-924. [14] According to CDC officials, as part of preparations for the 2005- 06 influenza season, the agency is preparing communication strategies with appropriate messages to respond to the fluctuations in supply and demand anticipated throughout the season. CDC has developed the communication plan but has not released the plan, as it is in the clearance process. [15] According to data collected during December 1-11, 2004, on self- reported vaccination during September 1 through November 30, 2004, among adults in priority groups who had not yet received influenza vaccine, about 23 percent reported that they attempted to obtain vaccination but could not. See Centers for Disease Control and Prevention, "Estimated Influenza Vaccination Coverage among Adults and Children--United States, September 1-November 30, 2004," Morbidity and Mortality Weekly Report, vol. 53, no. 49 (2004): 1147-1150. [16] Monovalent influenza vaccine protects against a single strain of influenza; trivalent influenza vaccine protects against three strains of influenza. [17] The $20 million increase is for CDC's Immunization Grant Program that provides vaccines for children, adolescents, and adults who present primarily at local health departments but are not eligible for CDC's Vaccines for Children program.


text:
Award-winning, dream-protecting author
A Total Eclipse of the Art
with John W. Howell
So Many Buns . . So Little Coffee
A few of my random thoughts from my journey
The Writer
Flash fiction, short stories, songs, poetry and musings from Botswana
Random Ramblings and Reviews from Trent P. McDonald
A Sanctuary for Enlightenment and Peace through Poetry and Inspirational Thoughts as we go through Life
Tips, tricks and tutorials for writers and authors
Mental Health & Self-care Advocacy
Delicious and easy gluten, dairy and nut free recipes
Reflections on Life through poetry, essays and photos
Creative Exploration in Words and Pictures
Fiction from Photos
A Journey into My World
Speech Language Pathologist, Writer, Blogger -- musings, anecdotes, stories, quotes, life lessons and growth
Recipes from the Past
Life's ups and downs, a personal journey.
God, Sant Kirpal Singh Ji, Dr. Harbhajan Singh, Biji Surinder Kaur, Kirpal Sagar, Unity of Man, Spirituality, Love, Compassion, Peace, Non-Violence, Right Understanding, Consciousness, Togetherness, Religions, Mind, Maya, Poems, Aphorism, Digital Art
Every day, I write a unique story for you to share and enjoy.
My streams of thought meet here
Dr. Rex .... Blogging for change.
a little bit of breeze and a little bit of salt
Photos, art - and a little bit of LIT.
Something that caught the lens of the Photographic Staff
Embrace Joy
FLASHES of inspiration. SHORT deliberations. STORIES for all.
Guitarist / Songwriter / Blogger
Louise Jensen - Writer - www.louisejensen.co.uk
Female empowerment | Inspiring women to success
Luxuriating in the Arts
Photos of my world and other stuff I hope you will enjoy too. Photos taken with Canon PowershotSX60HS Photos can be purchased.
Life, Love, Adventure & Magic
Never get lost in the Sauce
Art Inspiring Magic by Carolina Russo
Fashion Fitness Travel
househusband, bucketlister, storyteller
To remind you about the goodness and greatness within yourself and others.
A Poet's Place | Wolff Poetry Literary Magazine is Publishing Poetry Submitted by Published & Emerging Writers,
Food, Travel & Lifestyle
discover a magical world
The truth is in here
Random thoughts and images, some serious, some humorous, some pointless
Exploring fictional worlds in a flash
A writer's journey

subset: commoncrawl


text:
NETGEAR for
There's always something good on TV with NeoTV Streaming Players. NETGEAR gives you a variety of streaming players to choose from for the TV experience you want.
Get NeoTV and get a doorway into maximum media. Don't worry about what to watch. NeoTV streaming players help you find what you love with powerful media search. It's all yours – movies, TV, music and more…
NeoTV raises the IQ of your TV with a full curriculum of Internet-accessed entertainment. Just connect and enjoy – no computer needed.
The combination of filters you have selected has not produced any results. Please adjust your selection.
Add to compare


text:
- Just Released
- Sale Bestsellers
- Graduation Day
- Mother's Day
- Gifts for Him
- Gifts for Her
- New & Bestselling Fiction
- Father's Day
- Bargains
- Christian Book Award Nominees
- Bible Study Resources
- Wedding & Marriage
- VeggieTales
- Dove Awards Winners
- Keep Kids Safe Online
- Bulk Discounts on Books & Bibles
Featured 50% Off Fiction
Seven years ago, Moriyah was taken captive in Jericho and branded with the mark of the Canaanite gods. Now the Israelites are experiencing peace in their new land, but Moriyah has yet to find her own peace. Because of the shameful mark on her face, she hides behind her veil at all times and the disdain of the townspeople keeps her from socializing. And marriage prospects were out of the question . . . until now.Her father has found someone to marry her, and she hopes to use her love of cooking to impress the man and his motherless sons. But when things go horribly wrong, Moriyah is forced to flee. Seeking safety at one of the newly-established Levitical cities of refuge, she is wildly unprepared for the dangers she will face, and the enemies--and unexpected allies--she will encounter on her way.
Nilda Carlson has been trying to save enough money to go to America for months, so when a letter arrives, with an offer to pay her passage, she jumps at the chance. Her younger brother Ivar accompanies her, and they are thrilled to join older brother Rune and his family in the northern forests of Minnesota.But America is not everything Nilda imagined. A terrifying experience in a lumber camp shakes Nilda's confidence and trust in men, but a job helping a young widow raise her children and run her farm gives her a chance to build her own life. When she meets Fritz, the children's schoolteacher, she is initially unimpressed and uninterested. His kindness and passion for learning begin to win her over, but how can she sacrifice her dreams for the future for a man she's still not sure of?
After a harrowing experience with an obsessed patient, oncology nurse practitioner Leigh Weston needed a change. She thought she'd left her troubles behind when she moved home to Carrington, North Carolina, and took a job in the emergency department of the local hospital. But when someone tampers with her brakes, she fears the past has chased her into the present. She reaches out to her high school friend turned homicide investigator, Ryan Parker, for help.Ryan finds satisfaction in his career, but his favorite way to use his skills is as a volunteer underwater investigator with the Carrington County Sheriff's Office dive team. When the body of a wealthy businessman is discovered in Lake Porter, the investigation uncovers a possible serial killer--one with a terrifying connection to Leigh Weston and deadly implications for them all. Dive into the depths of fear with an exciting new voice in romantic suspense. Award-winning author Lynn H. Blackburn grabs readers by the throat and doesn't let go until the final heart-pounding page.
Seeking peace and safety after a hard childhood, Leah marries Judah, a strong and gentle man, and for the first time in her life Leah believes she can rest easily. But the land is ruled by Antiochus IV, descended from one of Alexander the Great's generals, and when he issues a decree that all Jews are to conform to Syrian laws upon pain of death, devout Jews risk everything to follow the law of Moses.Judah's father resists the decree, igniting a war that will cost him his life. But before dying, he commands his son to pick up his sword and continue the fight--or bear responsibility for the obliteration of the land of Judah. Leah, who wants nothing but peace, struggles with her husband's decision--what kind of God would destroy the peace she has sought for so long? The miraculous story of the courageous Maccabees is told through the eyes of Judah's wife, who learns that love requires courage . . . and sacrifice.
In an effort to get her security consulting business off the ground, Kelsey Allen has been spending a lot of time up in the air, rappelling down buildings and climbing through windows to show business owners their vulnerabilities to thieves. When she is hired to pose as a conservator at the Pink Palace Museum in order to test their security weaknesses after some artifacts go missing, she's ecstatic. But when her investigative focus turns from theft to murder, Kelsey knows she's out of her league--and possibly in the cross hairs. When blast-from-the-past Detective Brad Hollister is called in to investigate, Kelsey may find that he's the biggest security threat yet . . . to her heart.
Crackling with romantic tension and laced with intrigue, this suspenseful story from award-winning author Patricia Bradley will keep readers guessing--and looking over their shoulders.
When Aurelie Harcourt's father dies in debtor's prison, he leaves her just two things: his wealthy family, whom she has never met, and his famous pen name, Nathaniel Droll. Her new family greets her with apathy and even resentment. Only the quiet houseguest, Silas Rotherham, welcomes her company.
When Aurelie decides to complete her father's unfinished serial novel, writing the family into the story as unflattering characters, she must keep her identity as Nathaniel Droll hidden while searching for the truth about her mother's disappearance--and perhaps even her father's death.
Author Joanna Davidson Politano's stunning debut set in Victorian England will delight readers with its highly original plot, lush setting, vibrant characters, and reluctant romance.
Willa Forsythe is both a violin prodigy and top-notch thief, which makes her the perfect choice for a crucial task at the outset of World War I--to steal a cypher from a famous violinist currently in Wales.Lukas De Wilde has enjoyed the life of fame he's won--until now, when being recognized nearly gets him killed. Everyone wants the key to his father's work as a cryptologist. And Lukas fears that his mother and sister, who have vanished in the wake of the German invasion of Belgium, will pay the price. The only light he finds is meeting the intriguing Willa Forsythe. But danger presses in from every side, and Willa knows what Lukas doesn't--that she must betray him and find that cypher, or her own family will pay the price as surely as his has.
Hope Harbor police chief Lexie Graham has plenty on her plate raising her son alone and dealing with a sudden rash of petty theft and vandalism in her coastal Oregon hometown. As a result, she has zero time for extracurricular activities--including romance. Ex-con Adam Stone isn't looking for love either--but how ironic is it that the first woman to catch his eye is a police chief? Yet wishing for things that can never be is foolish.
Nevertheless, when Lexie enlists Adam's help to keep a young man from falling into a life of crime, sparks begin to fly. And as they work together, it soon becomes apparent that God may have a different--and better--future planned for them than either could imagine.
Lauded by "Library Journal "as "a master at character development," Irene Hannon welcomes readers back to this charming Oregon seaside village where hearts heal--and love blooms.


text:
Week 7 : Houston Texans 43, Ravens 13
What happened: In a showdown between the only two leading teams in the AFC, the Texans overwhelmed the Ravens in every way. After an early Ravens field goal, the Texans rattled off 29 consecutive points to end the first half. Quarterback Matt Schaub threw for two touchdowns and Arian Foster (pictured) ran for two against a beleaguered Ravens defense. Flacco, meanwhile, got nothing going in one of the worst performances of his career. Star of the game: You can take your pick from a variety of Texans, from Schaub to Foster to Andre Johnson. Even in a losing effort, Suggs deserves mention as well. He was the best Raven on the field and his one-sack, four-tackle performance capped a remarkable 5 1/2 month recovery from a torn Achilles. Turning point: The most appropriate answer probably was when the Ravens got off the bus. However, short of that, Texans cornerback Johnathan Joseph stepped in front of Torrey Smith and intercepted a Flacco pass that was deflected by J.J. Watt, returning it 52 yards for a touchdown. That made the score 16-3 and the rout was on. Key stats: Flacco was just 7-for-20 and had a 4.2 quarterback rating in the first half. He averaged only 2.6 yards per completion. The Ravens were out-gained 420-176. They also lost the time of possession battle, 38:16 to 21:44. The Ravens went 4-for-16 on third and fourth down. Quote: "There's no sugarcoating it. Call a spade a spade. They whooped our [butt]," Suggs said.
Baltimore Sun photo by Kenneth K. Lam
Copyright © 2019, The Baltimore Sun, a Baltimore Sun Media Group publication | Place an Ad


text:
With rumors of a ceasefire to begin, the IDF has announced the death of Cpl. Yosef Partuk, 18, of Emanuel.
An IDF soldier, Cpl. Yosef Partuk, 18, of Emanuel was killed Tuesday morning in a mortar attack in the Eshkol Regional Council area, the IDF released for publication Tuesday evening. Partuk was posthumously promoted to corporal.
The announcement came on the heels of a Gaza rocket attack that lightly injured six people after striking an apartment building in the central city of Rishon Letzion.The upper floors of the building went up in flames, according to Channel 2.
Also Tuesday evening, a person was moderately to seriously wounded when a rocket fired from Gaza struck a building in Ashkelon.
If a ceasefire does begin will it bring an end to the daily rocket fire that comes from Gaza? Don't you believe it. It is an attempt on the part of Hamas (and Egypt) to rearm and rebuild their rocket facilities.
May Cpl. Partuk's death be the last one experienced by the IDF in this conflict.
Read the latest news at Monkey in the Middle


text:
fun to experiment with viscosity inking and some copper chine collee. Only 3 inches by 3 inches,
with lovely ragged edges. A close up shows how the ink is reacting with the edges and the copper leaf.
Is it my imagination or do the spare bits and pieces that we just muck about with often work better and are more interesting than the pieces we spend days working on?


text:
The Rust Belt town of Braddock just outside of Pittsburgh is the sort of blue-collar enclave where factories once gave residents the promise of lifelong jobs at good union wages — the kind of place where resilience and character were more highly valued than possessions or status.
It's that world that Braddock native Russell Baze has watched slip away in "Out of the Furnace," the searing new drama from writer-director Scott Cooper ("Crazy Heart") opening in theaters Wednesday. As played by Christian Bale, Russell is motivated by love and loyalty — a good man beset on all sides by turmoil. He is ceaselessly confronted by tragedy, yet he marshals his emotional reserves, even in the face of heartbreak.
"There's a stillness to the character, a stillness that's he's had to have his entire life," Bale said in a recent interview. "He's had to put a hold on his impulses in order to be the patriarch of the family and to take on those responsibilities without going and screaming his head off. There's no whining or complaining or wishing that it's going to change. That's stoicism, isn't it?"
Bale, by contrast, is largely recognized for his relentless intensity, his determination to follow his creative impulses down wild and unpredictable paths, his willingness to radically reshape his body to conform to each new role. He also has a reputation, owing mostly to one unfortunate and well documented on-set outburst, as a temperamental leading man, quick to anger with little patience for Hollywood glad-handing.
"He's one of these actors that I think has gotten better with success, which isn't always the case — not that he wasn't good before," said Willem Dafoe, who co-stars in "Out of the Furnace" and worked with Bale in 2000's "American Psycho." "He's quite serious and he's quite concentrated, and he doesn't seem to suffer fools, as we know."
But late last month in Santa Monica, sitting down at a conference table with a pressed juice for lunch, Bale, 39, seemed neither tortured artist, nor glowering ogre — just an actor with a self-deprecating sense of humor battling jet lag and a hectic schedule.
He'd flown in from Spain where he's filming Ridley Scott's biblical epic "Exodus" to take part in a whirlwind press tour for "Out of the Furnace," and he'd spent the better part of the morning locked in a sound booth re-recording dialogue for his second December release, David O. Russell's period caper "American Hustle."
That film, in which Bale plays gifted swindler Irving Rosenfeld, a chubby Bronx con man with a bad comb-over who finds himself unexpectedly mixed up in the Abscam sting operation that entrapped numerous East Coast politicians, was named the best picture of the year on Tuesday by the New York Film Critics Circle. It opens in limited release Dec. 13.
He arrived for an interview not yet having lost all of the 43 pounds he'd gained for his part in "Hustle." His hair stuck up at odd angles, and one of the buttons on his black dress shirt was missing.
"I don't know what's happened here, I look like bloody Fabio or something," Bale said.
Bale so rarely speaks with his own voice on screen that it's almost surprising to hear his Welsh inflection in conversation. Usually, he has some manner of American accent — the South Boston bray of former welterweight boxer Dicky Eklund in "The Fighter" (his previous collaboration with director Russell, for which Bale won his sole Oscar), the German-Texas hybrid of Dieter Dengler, the Vietnam prisoner of war in Werner Herzog's "Rescue Dawn," the Gotham growl of the Caped Crusader in Christopher Nolan's Batman trilogy.
The actor, who resides in Los Angeles with his wife and daughter, spent most of his childhood in the U.K., though his family moved around a great deal. He began performing when he was just 8 years old, and by the time he was 13, he'd begun to garner international acclaim with his role in Steven Spielberg's "Empire of the Sun."
He worked steadily afterward, though, it was arguably a pair of indie movies — "American Psycho" and "The Machinist" — that helped cement his reputation as a master chameleon. For the former, he sculpted his physique to six-pack abs perfection for the role of the murderous Patrick Bateman; for the latter, he lost 63 pounds to play an insomniac consumed by guilt, a man trapped, mentally and bodily, inside a waking nightmare.
"Taking a risk and doing something that could either be abysmal or really bloody good is the only way to approach it," Bale said. "You've got to take those chances. Otherwise you could have a very good, nice solid performance, but I personally will always feel like a bit of a chicken, like I played it safe, like I wanted people to pat me on the back, instead of really going for it, like yeah, right, we could really crash and burn here. Those are the exciting ones."
Bale read Cooper's screenplay for "Out of the Furnace" while he was shooting his final Batman film with Nolan, "The Dark Knight Rises," in Pittsburgh in 2011. The actor said he was struck by the richness of the characters in the thriller, which "in other hands could become a very cliched generic piece."
He found his thoughts returning time and again to the drama, which sees the elder Baze son drawn into the criminal underbelly of Appalachia after his troubled kid brother Rodney (Casey Affleck) runs afoul of a vicious thug named Harlan DeGroat (Woody Harrelson). Despite feeling exhausted after his turn in Batman's cape and cowl had come to an end, Bale agreed to star in the film.
"Out of the Furnace" shot for about a month on location in Braddock in 2012, with Bale and Cooper attempting to craft a dark drama that above all else felt natural. To that end, Cooper rarely called "Action" to launch the performers into a scene; instead he simply would say "Whenever you're ready" to cue the cast and crew.
"That was something I went to Scott and asked him for," Bale said. "Directors, they need to have their routines and some are very superstitious, so if you're throwing them off their rhythm by saying, 'Can you please not say, 'Action'?' you ignore it and you just deal with it. With Scott, I did speak with him and said, 'Do you feel the need? Then let's not do it.' There is that sense, the word itself, 'Action' [suggests] let's do a lot, let's do something that's really entertaining... It always feels very strange to me when you are having to pander to the camera."
Cooper and Bale forged a friendship during "Out of the Furnace" — the filmmaker points out that Bale gained some of his "American Hustle" weight at Cooper's dinner table. Cooper believes Bale's commitment to his roles is what makes him stand out.
"He brings spontaneity to the work," Cooper said of Bale. "He's very restrained, he's very subtle, he surprises you. He can say so much with his eyes. He's impossibly handsome, but he's really a character actor."
Bale concedes that he'd love to work again with Cooper and Russell, though for the time being, he's focused on portraying Moses for Scott in the film due at the end of next year. He'll also star in the next project from reclusive director Terrence Malick, "Knight of Cups," another planned 2014 release. And after that? Possibly a holiday.
"I do think it becomes important for sanity, quality of work, but also I think people get really bored," Bale said of taking a break. "Really how many films do you want to see with one actor in it? Please, give us a break for God's sake. Go away for a while, you know?"


text:
Job Seekers, Welcome to Mississippi State College of Veterinary Medicine Career Center
The job you tried to view is no longer active.
See similar jobs below or perform a new job search.
See similar jobs below or perform a new job search.
Sort By
2,826 'veterinarian OR STATECODE:"CT"' Jobs
wethersfield, Connecticut
Double A Veterinary Hospital
3 Weeks Ago
Beacon Falls, Connecticut
Beacon Falls Animal Hospital
1 Month Ago
Simsbury, Connecticut
Hopmeadow Animal Hospital
6 Days Ago
West Hartford, Connecticut
Connecticut Veterinary Center, the Pet E.R.
1 Month Ago
Shelton, Connecticut
Community Veterinary Partners
5 Days Ago
West Hartford, Connecticut
Veterinary Specialists of Connecticut
3 Weeks Ago
Windsor, Connecticut
New England Veterinary Care and Cancer Care
4 Weeks Ago
Vernon, Connecticut
Town & Country Veterinary Associates
2 Months Ago
Bantam, Connecticut
Bantam Lake Animal Hospital and Thomaston Veterinary Clinic
1 Week Ago
Ellington, Connecticut
Ellington Center Animal Clinic
1 Month Ago


text:
0 Members and 1 Lonely Barbarian are spying on this topic.
The opposite side of the world? Not something we ponder much around here. They say there are some islands to the east, but that's as far as we know. Just lots of water out there, I imagine.Imagine a lens. There are two sides to a lens. The Convex, a bulging surface of outward presence. And The Concave, the dark brother-side. A world threatening to close in on you from all around. Imagine this was your world. It might be. Do you want to live blind to The Concave? Can you? Will you brave the Bowl of Bliss? Yes, they say that ignorance is Bliss, but who are they? ...There are many beings living just out of sight. I know, I'm one of them. I've been to The Concave, and know some of its secrets. Na- No- Do not yell. You could not if you wanted to, but please don't try, There are things I've done, and things I will do, for you. I've bartered with The Ghouls of Undermarsh, danced with The Witches of The Starlite Coven, sold my soul to obtain ultimate power, and fought through the Fogs of Rigor to get it back. Still interested? I hope so, because The Greatest of Eyes has been waching you. Now, sleep well. Tomorrow will be an exhausting day.You can recall having a strange dream. It is vague. A man was in your bedroom. Something about lenses. Your bed is warm and extremely comfortable, which is odd because it's the middle of the cold season. You open your eyes, the world is bleary as you clear the caked-on crust of sleep. You feel panic, alarm, this isn't my house, you realize. It smells like burned flesh and something else. You're in a tomb or crypt of some sort. It is dark, but you can see. Flickering light, like many candles, surrounds you."Welcome, Scorch-born." Says a voice from beyond the ring of dancing flames, "Are you hungry? Or just confused? Let me fetch you some breakfast. Do not worry about disturbing the candles. Their purpose is fulfilled and there is nothing more for them to burn. I shall return"
Is the convex world only full of happiness and bright sunshine, rainbows and unicorns? Or is it more like the mundane world?
Is the concave world bathed in darkness and full of things which shy away from the light? Is it home to evil, bloodthirsty, light-hating creatures or do its denizens merely view the world differently.
Does understanding the mysteries of the concave world grant wizards more power on the convex world because they are familiar with the unseen powers of the cosmos or does being exposed to its mysteries drive them mad?
The FallenYou fell. It was a long fall. You're trying to remember where you fell from, but it seems like there was no starting point to your fall. All you can remember is the fall. Why isn't this more bothersome, you wonder? It is dark and slightly damp. You're pretty sure you broke your legs upon impact, but something isn't right. No pain. Is that normal? You reach down to move the stone fragments among your surely destroyed lower limbs... You find a serpentine tail. That is odd. Since when do I have a tail like a snake? With some effort, you find it just barely able to support you. After undulating what-used-to-be your chest muscles, now elongated, you find yourself able to move forward, only rarely having to catch your arm on the wall for stability. You look up. No light up there, must have been a long fall. The thought brings a chill to your spine that continues into your tail. You make your way towards a light, looks like there's an opening into twilight ahead. After emerging from an earthen mound, of which there appear to be numerous, you can get a better look at your new-found tail. It's not what you expected. It is bent like a knuckle up behind you, complete with what could only be a large fingernail. That's peculiar. There's a finger growing out of my torso. Surely that wasn't always like that. Or was it? You're not sure, you must have hit your head pretty hard because you obviously have some form of amnesia. The world is cold and alien, black and blue rock structures extend many yards into the air all over this craggy mountain. As you make your way down the cliff, you meet up with a well-worn path. Well, looks like I'm not the first one to come by, you think, and start to manipulate your "Finger" muscles into carrying you down the slope.The Fallen are a strange sort of being, seemingly native to The Concave, they literally "fall" into being. They never know from where they have fallen, or who they may have been before (if they even were before), and such things don't typically concern them. They appear mostly human, except for their rippling multiple-segmented abdomens, which is distinctly an oversized finger. They are always curious and seem to live to try new things, meet new people, and go to new places. They have a morbid obsession with fingernails, keeping the fingertips of their enemies as trinkets and being innately horrified by anyone purposely clipping their fingernails.
Page created in 0.715 seconds with 27 queries.


text:
UNIVERSITY PARK, Pa. -- The Penn State Smeal College of Business Alumni Society Board will present awards to six alumni and two students at the March 22 Alumni Society Board awards banquet. The awards recognize students and alumni for their extraordinary commitment to diversity and the mission of the college.
The awards and the 2013 recipients are:
Smeal Alumni Diversity Award – Heather A. James, 1992, accounting
Heather A. James, assistant sales manager, cosmetics for Macy's Inc., is an executive board member of the Penn State Alumni Association Council, where she is the immediate-past chair of the Diversity Committee. She is also a member of Penn State's Educational Equity Advisory Board.
The Smeal Alumni Diversity Award honors alumni who have demonstrated a commitment to the college's goal of being a diverse and mutually supportive community that provides a climate of sensitivity, open-mindedness and respect.
Smeal Outstanding Young Alumnus Award – Gerard Lam, 2000, management information systems
Gerard Lam is the chief technology officer and founder of SANpulse Technologies, an industry leader in the efforts to modernize, standardize, automate and revolutionize the storage area network industry.
The Smeal Outstanding Young Alumnus Award recognizes recent graduates for their career achievements and community service.
Smeal Outstanding Volunteer Award – Maria Nolan Zuccato, 1981, finance
Maria Nolan Zuccato, regional financial officer for Penn State Brandywine and Great Valley campuses, is vice president of the Smeal Business Club, Philadelphia chapter, and a member of the Penn State Women's Professional Network of Philadelphia and the Philadelphia Women's Board of the American Cancer Society.
The Smeal Outstanding Volunteer Award honors alumni who serve as a volunteer with the Smeal Alumni Society Board and who volunteer to assist the college in other capacities such as mentoring and recruiting.
Smeal Alumni Service Award – Bette Tobey Kozlowski, 1981, accounting
Bette Tobey Kozlowski is a director in university relations and campus recruiting for KPMG, focused on campus recruiting strategy for Pennsylvania and Virginia business units and national faculty relations strategy. She currently serves as the vice chairperson for the Teaching, Learning and Curriculum section of the American Accounting Association.
The Smeal Alumni Service Award honors alumni whose exceptional allegiance and involvement with Smeal has brought distinction to the college and the University.
Smeal Undergraduate Distinguished Achievement Award – Jason R. Reiman, 1993, business logistics
Jason R. Reiman, as vice president of global customer service, planning and logistics for The Hershey Co., is responsible for transportation, warehousing, import/export, customer supply chain management, customer service, and supply and demand planning. Reiman provides leadership to an integrated logistics and planning organization, focused on delivering reliable customer service, cost improvement and working capital management via finished goods inventory.
The Smeal Undergraduate Distinguished Achievement Award honors undergraduate alumni whose career achievements have brought distinction to themselves and the college, and whose commitments of time, talent or resources have been key to enhancing the prestige of the college.
Smeal Graduate Distinguished Achievement Award – Scott Asplundh, 1982, master of business administration
Scott Asplundh is the chief executive officer for Asplundh Tree Expert Co., headquartered in Willow Grove, Pa., with operations throughout the United States, Canada, Australia and New Zealand. The company employs approximately 25,000 people.
The Smeal Graduate Distinguished Achievement Award honors graduate alumni whose career achievements have brought distinction to themselves and the college, and whose commitments of time, talent or resources have been key to enhancing the prestige of the college.
Smeal Board Sponsorship Award – Marissa Presser, Class of 2013, marketing
Marissa Presser currently serves as the president and marketing career fair coordinator for the student-run Penn State Marketing Association and is also active in the Alpha Delta Pi Sorority. Previously, she was the president and director of faculty and alumni relations for the Smeal Student Society.
The Smeal Board Sponsorship Award honors outstanding Smeal graduating seniors who have demonstrated leadership in the college and outstanding scholarship.
Smeal Student Diversity Award – Anthony Lyon, Class of 2013, management
Anthony Lyon currently serves as president of Strengthening Tomorrow Requires Initiative & Vision Everyday (STRIVE), an organization dedicated to serving underprivileged communities through mentoring and community outreach. He is also a member of the National Association of Black Accountants and the Black Male Leadership Symposium.
The Smeal Student Diversity Award recognizes Smeal students for leadership in an individual group project that furthers diversity efforts at Smeal.


text:
WASHINGTON (Reuters) - U.S. President Barack Obama proposed on Tuesday to hike the minimum wage by more than 20 percent, invest $50 billion on crumbling roads and bridges and spend $15 billion on a construction jobs program in a bid to boost economic growth.
In his annual State of the Union address, Obama urged Congress to support his plan, which would include tax and education reforms that the administration believes would help attract manufacturers back to the United States.
The complete cost of the program would be offset by spending cuts and tax reforms that will be laid out in Obama's budget proposal in the weeks ahead, senior administration officials told reporters.
The minimum wage increase would lift incomes for 15 million Americans and be done in stages, the officials said, noting that an increasing number of corporate chief executives support such a move.
The officials said economic studies show increasing the minimum wage is effective at reducing poverty while reducing turnover costs for businesses.
Obama is also proposing to raise the tipped minimum wage - the wage for jobs whose compensation includes gratuities - and have it indexed for inflation, a move, the officials noted, that was supported by Obama's 2012 Republican presidential opponent, Mitt Romney.
As expected, Obama is announcing in the speech the start of free trade talks between the United States and the 27-nation European Union.
As part of his push to give Americans skills to be competitive in a global economy, Obama proposed a new program to create universal access to pre-school for all 4-year-olds.
Reporting by Roberta Rampton and Jeff Mason; Editing by Jim Loney


text:
Communication is key in any relationship, but sending your wife a spreadsheet detailing the times and ways she rebuffed your sexual advances may not be the best way to get your point across.
A 26-year-old man discovered that the hard way after sending his wife, also 26, an Excel spreadsheet covering a six-week period. The woman received the spreadsheet in an email, which she called "immature" and "inflammatory" as she drove to the airport to embark on a 10-day business trip and promptly posted it to the popular forum Reddit.
The spreadsheet had three headings: "Date," "Sex?" and Excuse."
Reasons for not having sex include: "I'm watching the show (Friends re-run)," "I feel sweaty and gross, I need a shower," "I might be getting sick," and "I'm too drunk and ate too much."
According to the spreadsheet, there were three occasions where the couple had sex over the six-week period.
The woman's post, which has since been locked and is now read-only, has attracted hundreds of comments and the story has been picked up by media and other websites. The photo of the spreadsheet has been viewed more than 1.5 million times.
Many commenters take sides, while others take the middle ground.
"For the sake of your sanity in dealing with clients for nine days reply back with an email. But a nice one. Even if his email was pretty lame, he is probably fearing that the past 7 weeks are not only temporary but a new way of things," wrote depb66.
"Husband in a crisis and emotional. Best to take the high road, acknowledge his concerns and try to diffuse the situation. Getting upset will just increase the drama. What he has done is childish. He needs to get the tantrum out of his system so they can take the next steps," wrote Altruizzy.
"He needs to understand that his ways of expressing his frustration are unacceptable, but then you both need to tackle this issue of intimacy together with open minds if you want to move past this," GoingAllTheJay chimed in.


text:
Dolphins tight end Dustin Keller will miss the entire season with a knee injury, but the team says all is not lost at the position.
The Dolphins have selected tight ends in each of the last three drafts, taking Charles Clay in the sixth round in 2011, Michael Egnew in the third round in 2012 and Dion Sims in the fourth round in 2013, and Dolphins offensive coordinator Mike Sherman says all three of them have practiced very well since Keller went down.
"The loss of Keller is disappointing because he was making so much progress even as a blocker, and then fitting into our offense," Sherman said, via Armando Salguero of the Miami Herald. "The other three guys have really done a nice job. Obviously, they have a lot on their shoulders now with the loss of Dustin, so they need to be able to pick up the slack there. I think the tight ends have really made a lot of improvement. I think [tight end coach] Dan Campbell is a tireless coach and stays after them and gets the best out of his players."
None of those three players can do everything Keller does. But the three of them together may contribute enough to lessen the blow of losing Keller for the season.


text:
BFenix's adventures on Hellius
BFenix is fairly new to the BrikVerse, joining it in early R. 2,010. His passion for ABS has recently reborn, his loyal minifigs saw the light of day once again, and this time, glorious and epic battles were to take place in their lives thanks to him.
Currently under the supreme command of MAOX, nominated Leader of the Metal Warriors and Protector of the Metal Realms, he seeks for more BrikVerse worshipers to wage war with and against so he will never let his inner child escape again.
BFenix hasn't got a religion in the BrikVerse, since he considers himself both worshiper of the Metal and Zordor, God of War. What he enjoys most is wumin, beer, metal, friends and war, often making illustrations of it. He greatly despises internet trolling, swearing to find a way to beat it for good. Once in a while, when he consumes enough Warhale (also created by him), he shows signs of awesome that end up has amazing ABS constructions and other... Recently, BFenix earned the place of God/Moderator of The Metal sub forum, granted to him by The Overlord.
BFenix proudly wielding RAGE
BFenix's first ideas when he started his doings through out the BrikVerse were the same as most conquerors: Glory and Bloodshed, yet with a wise temper when planning. Thus his first deed was to found the Mercenary Army Of EXtermination, managing to get into the "big fights" between the mightier star civilizations while making good use of the BrikVerse's constant need of weapon and troop supply. He honored the Zordorians' God of War, Zordor, with his victories and conquests. The new and ever growing empire was already one of the head fabricators and researchers of weaponry and destructive teknology, yet, with the coming of the The Immortal War, prosperity boomed! The young conqueror joined Warhead and the Immortal Empire since they both shared the same dream: to unleash upon the BrikVerse the greatest crusade it had ever seen.
Yet, after the Fall of FICO, something changed. The Metal Powers were calling... Since then, BFenix stepped down from the ongoing war and went on a great quest to find a planet called Hellius. The events that took place there altered not just BFenix's, but many others lives completely, and soon, the whole BrikVerse would feel the change as Ragnablok draws closer with every passing second...
Warhead's Warriors, Entry 8:
Armed with a highly accurate Bowcaster Energy Weapon, BFenix can prove deadly over distance. Strapped to his back, BFenix carries an assortment of close combat weapons such as the Broadsword and the Power Maul - not as deadly as the BanHammer, but you still wouldn't want to get in its way.


text:
they are simply tests that had negative results, lots of things can throw them off.
since only a few were allowed to respond on dolphins thread and theres still his thread that suggests Seahawk players have cheated I'd like to say this..
lets test everyone on the Dolphins squad and see what we come up with?
what do ya say about that?
and, that allegation hardly explains Seattle's 5 losses and the Dolphins 6, did every team the Fins lost to have players on "performance enhancing drugs" huge difference between performance enhancers and any one of the many other agents that can tip off a urine test, they are known as "false positives", sheesh, do some homework before you start accusing players of cheating, if anything was a "fail" it was the official calling a personal foul on Tannehil's int, EPIC


text:
David Nicholson was feeling bullish when I checked in with him late Tuesday afternoon. The Midtown Farmers Market, which he manages, had just squeaked into fifth place in national voting to crown the best farmers market in the country.
Not bad, considering nearly 5,000 markets are in the running.
Who cares if online voting (www.care2.com/farmersmarket) is mostly a clever gimmick to promote sustainable agriculture and bulk up e-mail lists? It's hard to not root for our spunky contender, which Star Tribune food writer Rick Nelson calls the Little Market That Could.
Now, it's the little market that just might.
"If we can hold our place, we'll be in good shape," Nicholson said of his current top-five status. "But we're still driving for first."
Voting ends in two weeks. The top spot carries a $5,000 prize (fifth place, $1,000). That's small potatoes if Powerball is your reference point, but a princely sum for a market of this scale, located in Minneapolis on a slab of concrete across from a strip mall off the Hiawatha light-rail line.
Needless to say, the setting isn't the selling point. People are. That would be people on both sides of nearly 75 booths overflowing with luscious home-grown produce, naturally raised meat, fresh-cut flowers, scones, baguettes and crepes, cheeses, coffee, nuts, herbs and pottery. The market also is one of the first in the nation to accept food stamps (EBT).
Located next to the Midtown YWCA at 2225 E. Lake St. in the parking lot of the former Anishinabe Academy School, the market opened in 2003 with other development around the Hiawatha line. Volunteers from seven south Minneapolis neighborhoods, led by the Corcoran Neighborhood Organization, came together to create a communal gathering place offering fresh food that has taken on a vibrant life of its own.
Stroll over on a Saturday (8 a.m. to 1 p.m.) or Tuesday (3:30 to 7:30 p.m.) and you'll run into bankers, chefs, a certain ubiquitous Minneapolis mayor, people straight out of central casting for "Woodstock," parents with strollers and front-packs, college students and Somali families sent over from Smiley's Clinic across the road for a fresh culinary experience.
"Some kids are trying fresh raspberries for the first time," Nicholson said.
Mike Mann, 60, and wife, Vicki, 58, have shopped the market all seven years. Its proximity to their Longfellow home got them there. Relationships keep them coming back.
"We go there to see our neighbors," said Mann, a local storyteller. "We spend all week with e-mail and iPhones, and then we humans need to spend some face-to-face time. This is a gathering place where we can do that."
Zachary Keilholz, 22, biked over on the Midtown Greenway on a recent Tuesday to buy pretty much everything he could stuff into his backpack: eggplant, cilantro, a dark-green, leafy vegetable ("not sure what it's called," he said), red bell peppers, tomatoes, squash, basil, chard. Total cost: $17.
"It's fantastic," said Keilholz, an architecture and urban studies major at the University of Minnesota. "I like the closeness. People have fun, like that guitar player."
Yes, the market has live music, too, story times, sheep-shearing, cooking demonstrations and informational booths on nutrition and bike safety. In the fall, shoppers throw a potluck for the vendors to thank them. No wonder sellers like Denny Havlicek of New Prague, Minn., come back year after year.
"I'm really appreciated at this one," he said, bagging a tray of his tiny sweet apples for a young woman as her husband bolted to the next booth to buy fresh basil.
Megan Easter, 25, is a new vendor this season. She and her fiance, Shawn Person, 30, sell "high-quality, sustainable coffee without the snobbery," under their Public Coffee House label. The market has grown a lot, she noted, "even in one season."
Nicholson hopes that growth continues. On everyone's mind, and no doubt driving the enthusiastic voting, is the possibility that the market will have to move. With Anishinabe relocating, Minneapolis Public Schools has signaled a desire to sell the property for possible housing and retail redevelopment. But Nicholson is confident that the market, which has brought more than $1 million to vendors since its inception, will return next year.
The smartest move, though, is to make the market a centerpiece of any developer's master plan. Fifth place or first, this is one of our city's gems.
Gail Rosenblum • 612-673-7350 • email@example.com


text:
The Dark Girl Dress'd In Blue part 06
Composer: Clifton, Harry
Medium: Lithograph
Date: 1863
Alfred Concanen and T W Lee worked together to produce many sheet music illustrations, Concanen was responsible for the figures and pictures and Lee generally worked on the lettering. Many songs were produced for Harry Clifton (1832-72). He was one of the great stars of the early years of the Music Hall. He wrote all his own words but 'borrowed' most of his tunes from old folk songs. Here he is wearing a riding outfit and holds a whip in his left hand. With his right hand he is raising his hat to a women in a blue dress. In the background is the 1862 Exhibition building.


text:
What makes or breaks a relationship today? From the privacy of their own bedrooms, ten couples offer frank, funny and often surprising insights into love, sex and marriage in AMERICANS IN BED. Featuring a rich cross-section of ages, ethnicities, religions and sexual orientations, the revealing and thoughtful special debuts MONDAY, AUG. 12 (9:00-10:30 p.m. ET/PT), exclusively on HBO, and wraps up this year's summer documentary film series.
Other HBO playdates: Aug. 12 (3:45 a.m.), 15 (2:00 a.m.) , 21 (midnight) and 27 (1:45 a.m.)
HBO2 playdate: Aug. 14 (8:00 p.m.)
The U.S. has one of the highest marriage rates in the developed world, as well as the third-highest rate of divorce, with as many as half of unions failing. Brimming with genuine emotion and honesty, AMERICANS IN BED spotlights some of the many reasons people come together - and grow apart.
Director Philippa Robinson conducts wide-ranging interviews with subjects who are filmed in the comfort of their own beds, asking probing questions about what people look for in a partner and how they know when they have found it. From a couple that has been together for 71 years to a pair of fresh-faced newlyweds, she encourages her subjects to open their hearts and minds as they share candid and touching insights into their relationships, underscoring the fact that no union is as simple as it seems on the surface.
Each couple gradually discloses intimate thoughts about the sometimes painfully private issues that affect every relationship, including passion, fidelity, family obligations, separation, conflict, negotiation and illness. As they talk about how they met and fell in love, some even surprise each other with feelings long held back, while others revisit old hurts as if they had happened yesterday.
Joe and Patty, in their 40s with three growing children, say that while physical attraction was a big part of what drew them together, sex is no longer the most important aspect of their relationship. By turns wistful and bawdy, they look forward to the day they have room in their lives for the spontaneity of the past.
After 71 years of marriage, Helen and Red are still together, though now in assisted living. They went on their first date when she was 16, but Red wasn't interested in an innocent teenager. Once his gallivanting days were over, he returned to his young sweetheart to settle down. The attraction between them is still apparent today. "He still makes me feel young," says Helen, adding that in seven decades, she's never turned him away in bed.
George and Farid took their relationship slowly, not allowing it to become physical until Farid felt sure of his younger boyfriend's commitment. Now, they have found unexpected happiness in marriage and parenthood, something neither dreamed they would ever be able to experience.
At first glance, Leon and Blanca seem mismatched. He stands 6'6'', while she is 4'10", but a passionate connection keeps them together through a roller-coaster relationship that has broken up 26 times in two years. Leon's commitment to a polyamorous lifestyle is a constant test for the monogamous Blanca. As he says, "When things are good, they are very, very good. When they are bad, they are horrid."
When Linda and Margie first met online, Linda was separated from her husband and Margie was still married, but their deep connection was undeniable to both. When Margie had to choose between her two lives, Linda gave her the space she needed, saying, "I want you to be happy, whether that's with me or without me."
Yasmin and Mohamed, a young Egyptian-American couple, have been married nine months. Both are all smiles as they discuss each other and their new relationship. After a courtship shaped by age-old custom and family strictures, they find a sweet thrill in the simple pleasures of married life. "This is my person now," says Mohamed. "I always wanted a person."
Fatima and Kevin came close to splitting when she discovered explicit texts on his phone, rupturing the trust they had so carefully built. Kevin says he wants to "do right" by his partner and their relationship as they work to restore what they once had, and Fatima is still "bursting" with love for Kevin.
After meeting Randy, a photographer, on the set of a music video, Julie, a musician, gave up touring to be at his side. Then his career began sending him away from their Manhattan home for long stretches, leaving her alone. Now, the sizzling physical bond between them is starting to suffer and they poignantly debate how to argue more productively, so that they can concentrate on having fun together.
AMERICANS IN BED was produced and directed by veteran documentary filmmaker Philippa Robinson, who is also a trained counselor and is currently completing her masters in psychotherapy. Her acclaimed documentary "The British in Bed" aired on the BBC as part of the long-running series "Wonderland."
For more information on the documentary, visit: Facebook: facebook.com/hbodocs; and Twitter: @HBODocs #AmericansInBed.
AMERICANS IN BED is a co-production with the BBC; produced and directed by Philippa Robinson; executive producers, Sheila Nevins for HBO and Jane Tranter for the BBC; senior producer, Lisa Heller; senior editor, Stuart Briggs; editor, Marc Davies; directors of photography, John Halliday and Wolfgang Held.


text:
Here's the other Essence that was found together with Underwater (in previous post). Which was why I was pretty convinced I found a purge box. Seriously, today's Essence looked a lot better in photos than in real life. Essentially I needed to twist my hand to hold it at certain angles before it'll look good.
Not worth the effort walking around like I broke my arm in a weird way.
Essence Chic Reloaded,
2 coats + HK Girl TC.


text:
CAPE CANAVERAL, Fla. — SpaceX is expected to attempt a third launching of the Falcon 9 rocket and six Orbcomm satellites late Sunday afternoon, but weather is a concern.
Showers and thunderstorms are expected and Air Force meteorologists predict a 20 percent chance of adequate weather. The launch window has been widened from the normal hour to 5:30 p.m. to 8:08 p.m.
Weather forced Saturday's launch to be canceled and fluctuating rocket tank pressures stopped Friday's attempt.