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I often get asked "What can I do to stay motivated" and being a good trainer that really wants to help change peoples lives for the better, the answer is never easy.
What is real motivation?
To get great results in this field, whether your goal is to start a diet, losing weight off your stomach, gaining muscle or benching 300lbs the answer is always the same. You need to understand there has to be more to it than running a mile, curling a dumbbell or doing pushups. There has to be a certain level of love and dedication for what you are doing. Sure, a song or picture can motivate you to get through one workout, but that is not real motivation. Real long lasting motivation has to come from your soul; a great speaker once said if you do not believe in yourself 100%, who else will?
You need to find your own motivation to improve that one thing that will drive you forward no matter how hard it gets. Throughout my training career my motivation has always been the same, to inspire people to make their life better and show them that nothing is impossible.
My story
I have always believed everything happens for a reason, and my sickness for 7 years while seemingly hopeless and unfair to me at the time was no different. What left me at 120 pounds soaking wet began my journey to who I am today.
I know what it is like to feel weak, sick, and tired. To feel like your goal is impossible and no matter what you do, you do not seem to get any closer. I have spent weeks at a time in hospitals and had many surgeries and medication changes along the way. However, I also know what it feels like to overcome a struggle like that, to get up from falling and keep moving on. Remember even if you fall down 7 times, it is fine, just make sure you get up on the 8th.
And that truly is a great feeling, to overcome something you previously thought impossible. Always remember, no matter what you are going through, there will always be a way to get through it and prevail. I do not know every one of your goals outside of weight loss, however I can tell you this, if you find the true motivation you need to succeed, you will reach those goals. I may not know every struggle you are facing but if you find that motivation to not give up no matter how hard it gets, you will succeed.
Maybe you are trying to lose 10,20,30,50, or 200 pounds.
Maybe you are trying to quit an unhealthy habit such as smoking.
Maybe you are trying to improve your overall health, so one day you can run and play with your grandchildren.
Maybe you are trying to get in better shape to join the local police department or the military.
Maybe you are trying to improve for a sport or build muscle.
Maybe you are just trying to find the motivation to study for your career.
Or perhaps you are trying to overcome a sickness like I did.
If you believe that you can do it, you will do it
I am here to tell you, that you can do it. Just find that motivation you need to press on, to keep on going no matter what happens, and you will succeed. But there is something else you need to realize as well, the whole time you are working towards your goal, there always be people telling you that you can't to do it. People told me I would never reach 200lbs lean bodyweight after being sick so long, they told me I would never bench 300 lbs, but I did. Take all the negativity people point towards you and use it as extra fuel, every time they say you cannot accomplish your goal no matter what it may be, see it as an extra incentive to accomplish it.
When I was benching 125lbs and I told someone I would bench 300lbs one day , they told me no I wouldn't, I could never do that. That moment is when I knew my goal was high enough, for someone to be in total disbelief I will ever accomplish it. In addition, when I did accomplish it, it felt even better.
Remember you can do anything you set your mind to, and losing fat is not as hard as companies trying to sell you products present it. I am sure you have accomplished much harder tasks in life; all you need to do now is find your own personal motivation and press on.
Now that you know the primary form of motivation you will need to rely on to truly succeed long term, it is also important to note there is nothing wrong with short-term motivation boosters. I have included a list of tips below that will also help you raise your motivation and keep you on track.
5 Motivation Tips for success
Keep a Fitness Journal
Nothing will keep you motivated on a day to day basis like being able to look back at last months workout and see how much you have improved. Or to look back at last months measurements and see how many total inches you have lost. (HINT: Register now to get access to our free fitness journal)
Get Others Involved
Losing weight, like most ventures in life is best done with others, whether they are co-workers, friends, or your family.
Announce Your Goals
Informing your friends and family about your goals will help you push more to achieve them than keeping all your goals to yourself. As I mentioned in the last tip, getting others involved is always a positive thing in the end, however this way they do not have to join in, just tell them your goals and dates you should achieve them.
Avoid Negativity
As I said before, there will always be people who tell you that you cannot do something or that it is impossible. Either avoid these people or tell them you do not have time for their negativity and hopefully they will stop. Would you want a business partner who constantly talked about how your career will fail?
Listen to Uplifting Music and Read Positive Quotes
This may sound corny but listening to music and reading positive quotes has been shown in many studies to help individuals perform and stay on track better. You need to use every advantage you can to make sure you achieve your final goal and music always helps me get in the mood to do another hard workout.


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Check-ins with our professional staff will help keep you on track by providing you with the accountability needed to stay strong. When we think no one is watching we to tend revert back to our unhealthy habits. We all know how the old saying goes: when the cat's away, the mouse will play. Well, we are never away!
Support Groups
It is important to know that you are not alone on the journey to a healthier you. In addition to our trained staff, there have been many before you that have experienced some of the same struggles. Support groups offer a platform where we can bounce ideas off of each other as well as provide accountability.
Personal Nutrition Counseling
Our goal here at Shamba is to provide simple to understand and easy to follow professionally structured personal nutrition programs. We were not all created equal as far as the calorie is concerned, so the cookie cutter approach to diet does not work.
Nutrition Seminars
We believe that knowledge is power and that is why as part of the Shamba community you will have access to our informative and comprehensive nutrition and fitness seminars. In these seminars our trained staff will cover many different topics related to health and wellness. We then like to close out the seminar with an extended Q&A time. We have found this is where some of our best work is done.
EMAIL: email@example.com
ADDRESS: 1633 Monrovia Ave, Costa Mesa, CA 92627

subset: commoncrawl


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Thy – a small area in the western part of Jutland. Despite the size, it's the birthplace of many young, talented musicians. These young, talented musicians recently decided to do something quite innovative: Starting up a platform, from where the music from Thy can be spread out to the rest of the country – the platform is called 'Thy Music Collective'.
Yesterday they launched their brand new website, where you can read the latest news regarding concerts or releases, and you can read the profiles of the bands involved. And why not go ahead and mention a few of them:
Quick Quick Obey, Artificial Brothers, Mont Oliver and The Divers.
The bands involved are really different from each other, in style and such, but they all share the vision of passing on the musical heritage to younger generations – to make sure, that the musical scene in Thy keeps on growing. It's all about sharing know how and helping out your friends, even though you don't exactly play the same kind of music.
First step on the way is the release of their first mixtape, 'Sounds from up North #01' – where you can find a song from all the bands in the collective. The story of this collective is definitely worth mentioning to our readers, and their new mixtape is highly recommendable. Make sure you follow these guys on Facebook as well!


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Thollem McDonas and Rob Mazurek met for the rst time in January 2016 in Marfa, Texas to record and perform a concert for the closing of "Marfa Loops Shouts and Hollers," an exhibition of visual works by Mazurek. The recording, scheduled for release in April 2017 on New York record label Relative Pitch Records, offers listeners a front row seat at this electric rst encounter. This duo reaches out into the desert for endless possibilities. The results are coherent and deliver a constant driving force that urges the collaboration to continue into uncharted territories. (from the label)


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Hikaru no Go Episode 1 English Dubbed
You are going to Watch Hikaru no Go Episode 1 English dubbed online free episodes with HQ / high quality. Stream Anime Hikaru no Go Episode 1 Online English dub Eternal Rivals Young Hikaru Shindo is obsessed with money, so when his parents cut off his allowance, he decides to compensate by finding some of his grandpa's old things and selling them. He finds a Go board which is possessed by an ancient spirit named Fujiwara-no-Sai. Sai ends up possessing Hikaru and traveling with him, but he's disappointed when Hikaru refuses to play Go. Eventually Hikaru agrees to play Go, but his first opponent is the son of the national champion, Akira Toya. Will he be able to defeat this powerful prodigy?
Hikaru no GoHikaru no Go Episode 2 English DubbedReport broken/missing video


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BNP Paribas See Pound Sterling Decline Until First Half of 2018
- Written by Joaquin Monfort
- Subscribe to our Newsletter
- This copy is for personal, non-commercial use only. Reproduction of any content for commercial purposes is subject to our usage terms and conditions, please email the editor at his address directly for clarification.
UK economic growth in 2018 is tipped to slow at a faster rate than economists and policy makers at the Bank of England expect; and this surprise will have material implications for the value of Pound Sterling.
New research from BNP Paribas - France's second largest bank - has confirmed to clients that they see the value of Pound Sterling declining to a low which will be reached in the first-half of 2018 as UK economic growth underwhelms against current expectations.
"We expect growth in the UK to slow materially more than the Bank of England projects. It forecasts 1.6% growth for 2018, we expect growth to slow to 1.0%," says BNP Paribas FX Strategist Sam Lynton-Brown.
The Bank of England on November 2 lifted UK interest rates while also revealing an updated set of economic forecasts covering expected levels of growth and inflation.
The Pound fell in response to the event after the Bank's Monetary Policy Committee
removed the line that rates may need to rise by more than the market is pricing in and reiterated any further tightening would be limited and gradual.
"The BoE itself is basing its economic forecasts on an assumption of two further rate hikes over the next three years, which is an extremely gradual path for rates," says Lynton-Brown.
The Pound has since recovered some lost ground against both the Euro and US Dollar suggesting that the market agrees that two further interest rate rises are indeed likely - it is this assumption that two more interest rate rises are coming that is keeping Sterling supported.
Lose this assumption, and the Pound will likely fall.
Indeed, BNP Paribas reckon the Bank of England's growth forecasts will prove too optimistic and interest rates will likely be retained at current levels for an extended period of time, as lower interest rates make borrowing more affordable and keep the interest repayments on loans manageable.
Interest rates, and interest rate expectations, have a significant impact on currencies as higher interest rates attract more inflows of foreign capital as global investors are drawn to the promise of higher returns.
Increased inflows mean greater demand for the currency, thus raising its value.
As the probability of another rate rise dwindles due to poor growth, as in the BNP Paribas scenario, the Pound will therefore probably fall.
BNP Baribas' economists expect growth in the UK to slow materially more than the BoE projects. "We expect growth to slow to 1%. As growth slows, we anticipate that the pricing which remains in the market for further BoE rate hikes will be unwound and in sympathy GBP should continue to weaken," says Lynton-Brown.
"Evidence that the economy is slowing more than the BoE expects would be a catalyst for further GBP weakness," says Lynton-Brown. "We, therefore, maintain our bearish GBPUSD view, targeting a move to 1.25 over the next 6 months," says the strategist."
Above: Adding to the bearish setup on Sterling is positioning which shows investors have room to enter substantial bets against the Pound.
BNP Paribas' GBP Forecasts
The Pound is expected to weaken into 2018 but we note the low-point for the currency is seen around the end of the first quarter 2018.
The Pound-to-dollar exchange rate is forecast to trade at 1.26 by year-end, 1.25 by the of March 2018, 1.29 by end of June 2018 and 1.40 by end-2018.
The Pound-to-Euro exchange rate is forecast to trade at 1.10 by end-2017, 1.09 by March 2018, 1.11 by mid-2017 and 1.14 by end-2018.
Get up to 5% more foreign exchange by using a specialist provider by getting closer to the real market rate and avoid the gaping spreads charged by your bank for international payments. Learn more here.
Or will the Pound be Heading in the Opposite Direction?
BNP Paribas are clearly bearish on Sterling over the medium-term, but readers of Pound Sterling Live will be aware that there are optimistic viewpoints regarding the Pound's outlook to consider.
And of course, the discussion on Sterling's future rests not just with the Bank of England, but with the progress of Brexit negotiations.
There already appears a much greater chance of a transition period before Brexit-proper, which will give negotiators more time to renegotiate a new trade relationship and avoid a cliff-edge to WTO tariffs.
Such an outcome would likely protect the economy from a brexit shock and keep growth rates relatively robust, indeed analysts at Capital Economics expect the UK economy to remain surprisingly resilient.
"We continue to think that the markets are underestimating how quickly rates will rise in the UK," says John Higgins, chief markets economist at Capital Economics. "As the economy weathers the uncertainty over Brexit well."
Rather than expecting the BoE to backtrack on its two expected rate hikes in 2018 and 2019, Higgins actually sees the BoE raising rates much more than it currently projects, with three hikes in 2018 alone, taking the interest rates to 1.25%.
"Only one further 25bp increase is discounted in the overnight indexed swap (OIS) market between now and the end of 2018, whereas we anticipate that there will be three – taking Bank Rate to 1.25%," says Higgins.
Such a steep upwards trajectory for interest rates is likely to result in a rise in Sterling exchange rates.
Higgins thinks the Pound will rise the most against the Euro, against which he forecasts to rise to 1.23 by the end of 2018 whilst the Pound will only rise to 1.35 with upside in GBP/USD being capped by a robust Dollar.


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Members: $40.00 · Non-Members: $45.00
register online
Join The Clay Studio and New Liberty Distillery for a spirited tasting and mixology workshop! Mingle in our galleries and enjoy some libations from New Liberty while learning to make a superb craft cocktail that you can make at home. Ticket price includes a handmade cocktail tumbler by ceramic artist Melissa Mytty that you will get to use during the event and keep afterwards.


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We just got back from a week at the beach. It was pretty nearly perfect. Joel's parents came along too, and we had such a fun time! From the boys 'surf-boarding' to late night walks on the beach, to eating as much good food as we could fit into one week....well, it was great! Sometimes you just need time to take a deep breath, relax a little and spend some time having fun together as a family!
But I think the Curtis family is refreshed and ready to face this fall with resolve, joy, gratitude, and a 'let's get it done' attitude! We have a lot happening over the next couple of months. I've got three kiddos home-schooling now, Joel's busiest time at work is August-December, we're trying to get a small group up and running at our house, and of course we're still working on all of the foster care/adoption paperwork, as well as hopefully getting a home study scheduled sometime in the near future. It's going to be a busy fall!
But the thought of everything that lays ahead excites me. I'm looking forward to finally getting into a solid school/chore/meal planning routine again. The excitement of everything that lays ahead with our adoption excites me as well.....who is this little one God will bring into our family? And when? When you're pregnant and expecting a biological child, you know that in nine months at approximately this date, a baby will join your family. The 'unknown' of this whole adoption process has added quite a bit of excitement to it for me!
Love this sparkly photo! Just two of my favorite guys in the entire universe :)


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SAN DIEGO — When Colin Kaepernick arrived at Qualcomm Stadium on Thursday evening, U.S. Navy veteran J.D. McCallum was ready — with a protest sign calling out San Francisco 49ers quarterback for sitting out the national anthem.
The sign read: "COLIN, RESPECT OR LEAVE WHAT US VETERANS FOUGHT FOR."
Mccallum, a Chargers fan from Palm Springs, explained on camera to Breitbart News why he found it important to be at this game where military service members were to be honored — and where Kaepernick continued his protest against the anthem.
"I want to support our troops, me and my fellow veterans," Mccallum told Breitbart News. Kaepernick, he said, was "disrespecting our flag and everything that we fought for."
Kaepernick, who wears the #7 jersey, has been refusing to stand for the Star-Spangled Banner before football games to protest officer-involved shootings of black Americans, in solidarity with the Black Lives Matter movement.
Ahead of Thursday night's football game, earlier photographs of Kaepernick were found showing him in practice wearing his socks depicting police officers as pigs.
Mccallum told Breitbart News that he had never displayed a protest sign before coming to this Chargers-49ers game, but said that it was that important to him this nigh,t given Kaepernick's "disrespect." His daughter brought him all the way from Palm Springs to attend this game, and she was with him at the game. Friends at the senior center helped him make the sign that he brought to the game.
All current and former members of the military were asked to stand during the second quarter of the Chargers-49ers game, and were honored for their service amidst the 47,407 people in attendance.
During halftime, six veterans of the Vietnam War were specifically honored. The lights went out in the stadium, a flag was unfurled over a portion of the middle of the field, and fans held up cell phone lights.
Kaepernick took to Instagram last July in response to the Alton Sterling shooting in Louisiana, posting the inflammatory words, "This is what lynchings look like in 2016!"
Last Sunday, the quarterback told reporters he will continue to sit: "When there's significant change and I feel like that flag represents what it's supposed to represent, this country is representing people the way that it's supposed to, I'll stand."
He added:
People are dying in vain because this country isn't holding their end of the bargain up, as far as giving freedom and justice, liberty to everybody. That's something that's not happening. I've seen videos, I've seen circumstances where men and women that have been in the military have come back and been treated unjustly by the country they have fought for, and have been murdered by the country they fought for, on our land. That's not right.
NFL executives, former fans, Kaepernick's own birth mother, former 49ers football star Jerry Rice, and many others have criticized the football player's protest
Kaepernick said last Sunday that he has plans to engage in more activism: "There are things that I have in the works right now that I'm working on to put together in the future and have come to fruition soon." He also had harsh words for both major party presidential candidates.
When asked, Kaepernick couldn't point to a specific issue that he wanted to see change on to mark a "success."
In the second half of Thursday night's game ,Kaepernick did remain standing for God Bless America, and clapped as it concluded.
Follow Michelle Moons on Twitter @MichelleDiana


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Cocoa Tales: Episode Zero
I'm in a bar. It's...chilled. I'm resting my elbows against the cold, highly polished wood with my face in my hands when he walks over to me, his lips barely visible beneath his moustache. "Another one?" he asks and I nod, not lifting my head from my hands.
"You look like you just lost someone," he states as he fills my glass with my beer of choice. A domestic beer, but not one of the lousy ones.
Removing my hands from my tear-stained face, I draw a deep breath through my nose. "I lost," I state, "my muse."
"No kidding," he replies. I watch the foam slowly climb to the top of the glass. With the skill of a lifelong tender of bars, he stops at just the right moment spilling only the slightest amount of beer and sets the glass in front of me. "You mean you lost your girl," he asks through the dancing moustache, "or do you mean..."
"I mean," I say, lifting the glass to my lips, "I lost my muse. My actual, Zeus-bred muse."
"Wow," he replies, his eyebrows raised. "Impressive that you actually had a muse."
I shrug. "I suppose."
"I mean, aren't there only, like, a half a dozen of them?"
I shake my head. "A common misconception," I reply. "People think there's only seven muses. There are actually seven types of muses. Main types for arts and science and business and stuff. Then there are subtypes for the various types of arts like writing and music and painting. Science has its own, so does business. All fields where creative arts are useful. There's even a muse for accounting."
"Yeah, but they generally cause more problems than they solve."
He nods, says, "So there's thousands of them."
"Hundreds of thousands of 'em," I say. "If not millions. Mine found me when I was a kid. She stuck around for about twenty years or so. And now," I take a deep breath, "and now she's gone."
"Well, it sounds like quite a story," the bartender says, glancing around his bar. "Care to tell it?"
"Friend, if I could do that, I wouldn't need a muse."
I'm only a little dizzy as I walk by an ATM with graffiti on the side. A chunk of the plastic has broken off where someone has attempted to break into it in the night. Not important. This ATM will never come up again. I bump into a light post, off, as it is the middle of the day. Insignificant detail, I think, this could just as easily be night. It could be cloudy. It could be rain, it could be snow. I pass a homeless man with a faded denim jacket and an overturned empty bucket he's using as a drum and I say to him, "It could be hail."
"It is hell," he replies as I drop a quarter in his hat.
All the details, they flood in as I walk toward my apartment, but only one detail is significant: the apartment will be empty. The birds circling above the theater with the vertical sign reading "Cascade" are not important to me right now, but I see them all the same. Birds are meaningless, but there they are, all the same. The bar across the street with the clover on the glass has nothing to do with my life, but there it is.
This other world is filled with insignificant details that enter my mind and are gone mere seconds later.
I miss my world. In my world sights and sounds and smells and tastes are all important, are all germane to the world around them. Every word uttered, every punctuation punctuated has meaning, has been rehearsed, has been revised, has been perfected, has been divined.
There is nothing perfect about this world I live in, this chaos, this cacophony, this...hail.
I turn quickly into my empty apartment and lean on the door to shut it. I shut my eyes, and then with some force of will I convince myself to open them and scan our apartment. It remains the same, but for one missing muse.
She took nothing with her when she left because there was nothing to take. Muses conjure their own clothes from thin air using magic I can't begin to understand. Muses don't need to eat. They don't age, they don't sleep. They simply exist to inspire.
Seems my inspiration has run out.
All because of a cat.
A cat named Cocoa.


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Urgent safety warning regarding the da Vinci
FDA said in a Dec. 3 notice on its website. The stalling may result in a sudden "catch-up" if the surgeon pushes through the resistance, the agency said.
Out of more than 55,000 operations completed with the affected instruments, "there has been one reported instance of interrupted motion resulting in an imprecise cut, along with two additional instances of perceived resistance," the company said in the statement dated Nov. 19. "No patient complications were reported in association with these three instances."
In October, the company sent an "urgent medical device correction" letter to users warning of potential problems with metal coating on a lamp that may not be compatible with the control board.
This--of course--affected the company's stock prices.
More details of recent da Vinci complications can be read here and here.
You can also read this paper, systematically overviewing da Vinci errors.
You can also read this paper, systematically overviewing da Vinci errors.


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- Home
- News & Events
- Events
- Past events
- SWIFT Business Forum Romania 2015
SWIFT Business Forum Romania 2015
Report of event
The forum has become an important fixture in the yearly agenda of the Romanian banking industry.
The 6th edition of SWIFT Business Forum Romania, organized by the Romanian Banking Association and SWIFT, took place on 28 October 2015 in Bucharest. The event, which has established itself as a platform for information sharing, networking and collaboration for the Romanian banking industry, brought together 120 representatives of the financial banking community, regulators, market infrastructures, corporate customers and SWIFT, to discuss the most challenging issues facing the industry. Topics on the agenda for the day were the future of standards, SWIFT's 2020 strategy, solutions to address the financial crime compliance challenges, the latest trends in the banking and financial industry, opportunities brought by technology evolution and the current status of projects run by the Romanian community.
Other SWIFT events
SWIFT Insights
- Discover the latest trends in financial services
- Keep up with our news updates
- Read thought-provoking industry reports
- Explore global events and webinars


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Charleston City Market
188 Meeting Street
Charleston, SC 29401
--> Charleston's historic City Market has the largest handmade market in the Southeast! Find us here from March to December Friday and Saturday nights from 6:30 to 10:30pm for the all local artisan market. During the summer months the night market happens on Thursdays as well. Follow our instagram page @peachykeencreations for live updates on where and when we will be at the market!
217E Lucas St
Mt Pleasant, SC 29464
—>Charmed is a whimsical gift store in the beautiful courtyard of the Historic Commons of Mount Pleasant. Here you can find spiritual books, healing crystals, garden and home decor. Beautifully brought to you by intuitive owner Jennifer Miller who offer sessions by appointment at the space.
Eucalyptus Wellness
280 W Coleman Blvd Suite E
Mt Pleasant, SC 29464
—>Eucalyptus Wellness and Elixir Bar is a locally owned holistic health store that carries oils, herbs, cbd, supplements and gifts. The Elixir Bar at Eucalyptus offers a range of smoothies, bowls juices, and snacks made fresh to order.
Plum Natural Market
213 Oak Street Extension
Forest City, NC 28043
—> Plum Natural Market is an organic and natural food store offering high quality, humane groceries, herbs, supplements, cosmetics, gifts and more! Stop by for a selenite wand and to find out how their knowledgable staff can help you find what you're looking for.
Still Soul Studio
579 King Street
Charleston, SC 29403
—> Practice meditation, explore healing sound baths, learn aromatherapy and so much more at Charleston's first meditation studio! Still Soul Studio is a space dedicated to your relaxation and peace of mind. Visit their website for a full schedule of transformative classes!
Cornerstone Minerals
539 King Street
Charleston, SC 29401
--> A gallery of nature's art! Cornerstone Minerals retails a diverse selection of incredible, high quality gems and healing stones, small and large. Shop our collection of specimen pendants behind the glass bar at their King Street location.
We love collaborating with like minded businesses! Email owner Margot Keen at email@example.com for more information.


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Blockchain Gains a Foothold on Connecticut Campuses/
Blockchain is soon to arrive on Connecticut's college campuses, with new initiatives imminent at Southern Connecticut State University, University of Saint Joseph, and the University of Connecticut's Stamford campus. A six-week boot camp for individuals who would like to widen their computer programming skills to include Blockchain – a cutting-edge form of encryption technology – has been developed at Southern Connecticut State University in New Haven. The SCSU Blockchain Academy launches on January 23 and runs though March 6.
Blockchain refers to the technology behind the development of secure digital databases that are accessible to the public, but cannot be altered by anyone other than the person posting the data. It is a shared, distributed ledger that improves the process of tracking and recording a transaction. Blockchain can be used for a variety of purposes, including financial transactions, supply chain management, luxury goods or anything of value. Bitcoin and other cryptocurrencies use this technology.
"Southern intends to become a leader in educating people about the 'Internet of Value,' which is the fastest growing market the world has ever seen," said Colleen Bielitz, SCSU associate vice president for strategic initiatives and outreach. A promotional video posted by Southern (below) has already been seen more than one thousand times.
"Blockchain is going to be increasingly important to businesses, and during the next decade is expected to have a major impact on the economy and the world. The goal of this academy is to grow the community of decentralized application developers and to make New Haven a hub for Blockchain technology and innovation as companies look to take advantage of this growing market."
The University of Saint Joseph (USJ) announced last week that it has developed the Greater Hartford area's first two-part certification program for future blockchain technologist, in collaboration with DappDevs, which is also collaborating with Southern and UConn.
President Rhona Free, Ph.D., remarked, "With this certificate program, USJ continues its commitment to providing educational programs aligned to our regional economy. The Greater Hartford community will benefit from this newly-created training program that offers skill development and career advancement in blockchain application development."
The USJ pre-certificate program geared toward faculty, current college students, and college graduates in the Greater Hartford region, begins on Feb. 2, 2019, and runs over four weeks as one three-hour evening session per week. The full certification program is a six-week session that runs from March 5-April 11, as two three-hour sessions per week.
UConn's Connecticut Information Technology Institute (CITI) is sponsoring the creation of a blockchain chapter in Stamford in order to facilitate the development of an education-based micro community designed to connect decentralized application developers. This community, in hand with Stamford's established financial enterprises, will play a key role in further establishing Connecticut as a USA crypto capital, according to the university's website. UConn is offering a two-day Blockchain Development course, with its partners, DappDevs and the Werth Institute.
UConn's first-ever blockchain symposium was held in Stamford in August. The conference drew top scholars and Ph.D. students Stanford, Princeton, Virginia Tech, and from 10 nations, including England, Israel, Switzerland, China and Norway. State-run news agencies from Vietnam and China also covered the two-day event, called "Blockchain Technology & Organizations Research Symposium."
These initiatives reflect that blockchain is increasingly taking academia by storm, not only in Connecticut but across the nation. This past summer Columbia University and Stanford University both launched blockchain research centers, following in the footsteps of the Massachusetts Institute of Technology's Digital Currency Initiative, which launched as part of the MIT Media Lab in 2015; MIT was among the first institutions to create such a program, according to industry publication Inside Higher Ed.
The Center for Blockchain Research at Stanford University launched in June. Miami University launches a course in blockchain technology for undergraduates in the Spring 2019 semester. Montclair State University's center for continuing and professional education recently spearheaded the launch of three professional blockchain certificates -- one covering the basics, one for developers and one focusing on applications of blockchain in the financial sector.


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An American in Paris
|Performance/s: December 5 – 30
|Show Time/s: Varies
|Description: A regional premiere! Named Best Musical of the year by both the Drama League and the Outer Critics Circle and the winner of four Tony Awards, An American in Paris is the hit new musical guaranteed to sweep you off your feet—and into the arms of a story you'll never forget.
Inspired by the Academy Award-winning film and featuring the music of George and Ira Gershwin, An American in Paris is the story of World War II veteran Jerry Mulligan, who, hoping to build a new life, chooses newly-liberated Paris as the place to make a name for himself as a painter. But Jerry's life becomes complicated when he meets Lise, a young Parisian shop girl with her own secret - and realizes he is not her only suitor. Songs include "I Got Rhythm," "Liza," "'S Wonderful," "But Not for Me," "Stairway to Paradise" as well as beautiful romantic music including "An American In Paris."
This stunning combination of classic music, timeless story and gorgeous dance results in the spectacular musical perfect for the whole family!
|Suited for: All Ages
| Additional Details: Single tickets are now available. Subscription packages may be purchased online or by calling the box office.
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Key Points
The administration of third-party FMT capsules early after allogeneic HCT is feasible and appears safe.
FMT is associated with early expansion of microbiome diversity in transplant recipients.
Visual Abstract
We hypothesized that third-party fecal microbiota transplantation (FMT) may restore intestinal microbiome diversity after allogeneic hematopoietic cell transplantation (allo-HCT). In this open-label single-group pilot study, 18 subjects were enrolled before allo-HCT and planned to receive third-party FMT capsules. FMT capsules were administered no later than 4 weeks after neutrophil engraftment, and antibiotics were not allowed within 48 hours before FMT. Five patients did not receive FMT because of the development of early acute gastrointestinal (GI) graft-versus-host disease (GVHD) before FMT (n = 3), persistent HCT-associated GI toxicity (n = 1), or patient decision (n = 1). Thirteen patients received FMT at a median of 27 days (range, 19-45 days) after HCT. Participants were able to swallow and tolerate all FMT capsules, meeting the primary study endpoint of feasibility. FMT was tolerated well, with 1 treatment-related significant adverse event (abdominal pain). Two patients subsequently developed acute GI GVHD, with 1 patient also having concurrent bacteremia. No additional cases of bacteremia occurred. Median follow-up for survivors is 15 months (range, 13-20 months). The Kaplan-Meier estimates for 12-month overall survival and progression-free survival after FMT were 85% (95% confidence interval, 51%-96%) and 85% (95% confidence interval, 51%-96%), respectively. There was 1 nonrelapse death resulting from acute GI GVHD (12-month nonrelapse mortality, 8%; 95% confidence interval, 0%-30%). Analysis of stool composition and urine 3-indoxyl sulfate concentration indicated improvement in intestinal microbiome diversity after FMT that was associated with expansion of stool-donor taxa. These results indicate that empiric third-party FMT after allo-HCT appears to be feasible, safe, and associated with expansion of recipient microbiome diversity. This trial was registered at www.clinicaltrials.gov as #NCT02733744.
The role of the intestinal microbiota and its potential influence on clinical outcomes for patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) has been investigated in recent years.1⇓-3 Multiple factors contribute to significantly reduced microbiota diversity in patients undergoing allo-HCT, including previous and peri-HCT use of antibiotics, administration of chemotherapy and/or radiation, and altered nutritional patterns. Analyses of fecal specimens taken from recipients of allo-HCT around the time of engraftment have shown that reduced intestinal microbiome diversity is associated with significantly worse survival outcomes, and that changes in microbiota composition may influence important clinical outcomes such as acute graft-versus-host disease (GVHD) and disease relapse.4⇓-6 Although these associations between microbiome diversity and clinically important outcomes after allo-HCT do not demonstrate causality, they provide data to support clinical evaluation as to whether these relationships can be modified to influence outcomes for patients.
We hypothesize that approaches to restore a patient's microbiome diversity after HCT may improve outcomes after HCT. Although such approaches to restoring microbiome diversity are still investigational, fecal microbiota transplantation (FMT) from a healthy individual carries promise, as initial studies have shown this approach to be a remarkably effective therapy for recurrent Clostridium difficile infection, for which loss of microbiome diversity is an important predisposing factor.7 Early approaches to FMT for C difficile colitis administered liquid fecal inocula by invasive methods such as nasogastric intubation or endoscopy.8,9 A novel approach to FMT administration is through third-party frozen, encapsulated inoculum, which can be delivered by the oral route.10,11 In this pilot study, we investigated whether empiric third-party frozen FMT capsules would be safe and feasible after allo-HCT, and would be able to restore recipient microbiome diversity.
This study was approved by the Institutional Review Board at the Dana-Farber Harvard Cancer Center and conducted under IND 16857 (Holder: E. Hohmann). The study was conducted at the Massachusetts General Hospital Cancer Center. Written informed consent was obtained from all subjects. This trial was registered at ClinicalTrials.gov (NCT02733744). Patients were between the ages of 18 and 75 years and undergoing a first allo-HCT. Eligible conditioning regimens were myeloablative or the combination of fludarabine with melphalan (100-140 mg/m2). Any GVHD prophylaxis regimen was allowed at the discretion of the treating physician. Donors were 8/8 HLA-matched related or unrelated, or haploidentical. Stem cell sources were peripheral blood precursor cells or bone marrow grafts. Patients with a history of inflammatory bowel disease, delayed gastric emptying syndrome, or active gastrointestinal infection were excluded from the trial. In addition, patients who developed acute GI GVHD after HCT and before FMT administration were withdrawn from the trial out of concerns for safety. The decision to use prophylactic antibiotics during the peri-HCT period was at the discretion of the treating physician.
FMT capsule preparation
FMT donors were healthy, nonpregnant adults between the ages of 18 and 50 years. Donors had a normal body mass index (19-25 kg/m2) and did not take any medications on a regular basis; oral contraceptives were allowed. Volunteers were excluded for any significant medical history, employment as a healthcare worker, travel outside the United States, or use of antibiotics in the preceding 6 months. Candidates passed the American Association of Blood Banks donor questionnaire, physical examination, and general laboratory screening tests. Screening tests performed on donor blood and stool are listed in supplemental Table 1. All tests were within normal ranges or negative for all infectious screening tests (including cytomegalovirus), and the specified virologic screens were repeated after donation before samples were used. A fecal suspension was prepared in normal saline without preservatives, using a commercial blender in ambient air, and sequentially sieved to remove particulates. The final slurry was concentrated by centrifugation and resuspended in saline at one-tenth the volume of the initial sample, with 20% glycerol added as a bacterial cryoprotectant. The final fecal microbial solution was pipetted into size 0 capsules (650 μL) that were closed and then secondarily sealed in size 00 capsules (DR Capsules; Capsugel, Greenwood, SC). Capsules were stored frozen at −80°C (−112°F). Capsules were transported to the clinic or bedside on dry ice. Thirty capsules contained the microbial content of a median 38.6 g of feces (range, 24-56.7 g). In this study, FMT capsules were generated from 2 individual FMT donors, with patients receiving capsules from a single donor.
FMT capsule administration and specimen collection
The study schema is shown in Figure 1. FMT was administered no later than 4 weeks after neutrophil engraftment, and antibiotics were not allowed in the 48 hours before FMT. Patients were given a single standard dose of oral FMT, based on our published work for treatment of recurrent C difficile colitis, which is 15 capsules per day for 2 consecutive days, for a total of 30 capsules.9⇓-11 The capsules were administered each day at an outpatient clinic visit. Participants fasted for 4 hours before and 1 hour after capsule intake. Patients had up to 4 hours to swallow the capsules. Capsules could not be crushed, chewed, or dissolved. Stool and urine samples were collected before HCT, 1 week post-HCT, and at 5 points after the FMT administration (1 week, 1 month, 2 months, 6 months, and 12 months). Urine specimens were aliquoted in cryogenic vials and stored at −80°C until time of sample analysis. For bacterial analysis of stool specimens, 95% ethanol solution was added to stool samples in a 1:1 wt/vol ratio and mixed and stored at −80°C until sequencing analysis.
Analysis of urinary 3-IS
Analysis of the tryptophan metabolite 3-indoxyl sulfate (3-IS) was performed by reverse-phase liquid chromatography-electrospray ionization-tandem mass spectrometry in negative ion multiple reaction monitoring mode, as previously described.12,13 Obtained concentration values were corrected to urinary creatinine.
Analysis of stool specimens
Genomic 16S ribosomal sequencing was performed on stool specimens, as previously described.5,14 Briefly, genomic bacterial DNA was extracted from fecal specimens, and the 16S ribosomal-RNA V4-V5 variable region was amplified and sequenced on the Illumina MiSeq platform.4,5 VSEARCH was used for analyzing nucleotide sequences.15 Paired-end reads were merged, de-replicated, and sorted by length and size. For analyses of bacterial origin, sequences were error-corrected and chimera-filtered, using the UNOISE algorithm (http://www.biorxiv.org/content/early/2016/10/15/081257) to generate a preliminary list of operational taxonomic units (OTUs). For analyses of Clostridiales abundance and diversity as measured by inverse Simpson diversity index, an internally developed closed-reference OTU reference was used to classify sequences, and taxonomy was assigned in QIIME,16 using the Mothur method17 and the August 2013 release of the Greengenes reference taxonomy.18 An OTU table was generated using VSEARCH, and UniFrac19 distances between samples were determined with QIIME. For assessment of the inverse Simpson diversity score, sample sequences were first rarefied at a number below the sample, with the least number of sequences (n = 1152) using QIIME. All sequencing files and our internal OTU reference will be made available in the European Nucleotide Archive.
Data collection and management
Study data were collected and managed using REDCap electronic data capture tools hosted by Partners HealthCare Research Computing, Enterprise Research Infrastructure & Services group. REDCap is a secure, web-based application designed to support data capture for research studies.20
Subset analysis and comparison cohort with patients not receiving FMT
An exploratory subset analysis was performed to identify a group of patients that may benefit most from FMT after HCT based on exposure to broad-spectrum antibiotics. As this was a pilot study primarily aimed at establishing feasibility and safety of FMT in allogeneic HCT recipients, no control group was incorporated into the study design. In an exploratory analysis of the association of FMT with changes in microbiome diversity in this subgroup compared with what occurs in the absence of FMT, a comparison cohort of patients who did not receive FMT was retrospectively assembled. The patients in this comparison cohort were treated at Memorial Sloan Kettering Cancer Center or Duke University Medical Center and had stool specimens collected after allo-HCT as part of observational studies. The selection of patients for this cohort was based on broad-spectrum antibiotic exposure during HCT hospitalization, as well as availability of stool samples for sequencing analysis. Stool specimens from patients in the comparison cohort were analyzed according to the same methods listed here.
Statistical methods
This was an open-label, single-arm, pilot study evaluating FMT administered after allogeneic HCT to 13 adult patients. The primary endpoint of the study was feasibility, which was evaluated by the proportion of patients who were eligible for FMT administration and who were able to swallow 15 or more capsules (of 30). FMT was considered feasible if this proportion was 80% or higher and not feasible if it was 50% or lower. Secondary endpoints included cumulative incidence of bloodstream infections, C difficile colitis, and acute GVHD, as well as estimates for nonrelapse mortality, progression-free survival, and overall survival (OS). Progression-free survival and OS were estimated using the Kaplan-Meier method. Progression-free survival was calculated from the date of FMT administration to disease progression or death from any cause. Patients who were alive without relapse or progression were censored at the time of last clinical evaluation. OS was calculated from the date of FMT administration to death or censored at last clinical evaluation. The cumulative incidence of nonrelapse mortality was estimated with relapse as a competing risk. Comparisons of microbiome parameters (urinary 3-IS, Clostridiales abundance, inverse Simpson diversity index, UniFrac distance) were performed using the Mann-Whitney U test.
Patient characteristics
Eighteen patients were enrolled on the study before admission for HCT. Five patients did not receive FMT because of the development of early acute GI GVHD before FMT (n = 3), patient withdrawal of consent before HCT (n = 1), and prolonged chemotherapy-associated gastrointestinal toxicity (n = 1; Figure 2). Baseline patient and transplant characteristics of the 13 patients who received FMT are shown in Table 1. The median age was 63 years (range, 26-71 years). Of those given FMT, 7 were female and 6 were male. The most common underlying diagnoses were acute myeloid leukemia (n = 4), myelodysplastic syndrome (n = 3), and non-Hodgkin lymphoma (n = 3). Donors included matched unrelated (n = 9), matched related (n = 2), and haploidentical (n = 2). Twelve patients received peripheral blood precursor cells, and 1 patient received a bone marrow graft. Ten patients received reduced-toxicity conditioning with fludarabine and melphalan, and 3 received conventional myeloablative regimens. GVHD prophylaxis regimens included tacrolimus/sirolimus (n = 9), tacrolimus/methotrexate (n = 2), and posttransplant cyclophosphamide with tacrolimus/mycophenolate mofetil for the 2 haploidentical transplants. Antibiotic exposures beginning at the time of HCT hospitalization through day +60 are summarized in supplemental Table 2.
Safety and toxicity
Fourteen patients were deemed eligible for evaluation of the feasibility endpoint: the 13 patients who received FMT and the single patient with prolonged chemotherapy-related gastrointestinal toxicity. All thirteen patients who received FMT capsules were able to swallow all 30 capsules (15 capsules/day for 2 consecutive days). Patients swallowed the daily allotment of capsules within 30 minutes. Thus, the primary endpoint of the study was met, as 13 (93%) of 14 patients eligible to receive FMT were able to take 15 or more of 30 capsules. There was only 1 serious treatment-related adverse event (grade 3 abdominal pain), and this resolved within 24 hours of capsule administration. There was no treatment-related nausea, vomiting, or diarrhea reported.
Clinical outcomes
Clinical outcomes are summarized in Table 2. FMT capsules were administered at a median of 27 days (range, 19-45 days) after HCT. Median follow-up for survivors is 15 months (range, 13-20 months). Two patients developed grade 3-4 acute GI GVHD subsequent to FMT. One case of severe GI GVHD occurred 20 days after FMT in a patient who had to prematurely discontinue tacrolimus after developing posterior reversible encephalopathy syndrome. The patient also developed Klebsiella pneumoniae bacteremia and sepsis, with subsequent multiorgan failure. In the second, skin manifestations of GVHD were noted 7 days after FMT, with the onset of GI involvement weeks later. There were no additional cases of bacteremia after FMT. There was 1 case of C difficile colitis observed after FMT. Six patients have developed moderate-severe chronic GVHD. The Kaplan-Meier estimates for 12-month OS and progression-free survival after FMT were 85% (95% confidence interval, 51%-96%) and 85% (95% confidence interval, 51%-96%), respectively. There was 1 nonrelapse death, which was a result of acute GI GVHD (12-month nonrelapse mortality, 8%; 95% confidence interval, 0%-30%).
Correlative analysis of serial stool and urine specimens
Low urinary concentrations of 3-IS after HCT are indicative of significant and clinically relevant intestinal microbiota disruption.13 A significant decrease in the median urinary 3-IS level was noted when comparing the pre-HCT with the post-HCT/pre-FMT specimen (34.59 umol/mmol creatinine vs 4.36; P ≤ .0001; Figure 3). Furthermore, there were significant increases in 3-IS in the urinary specimens collected 1 week (4.36 vs 36.57; P = .0006) and 1 month (4.36 vs 40.89; P = .001) after FMT when compared with the post-HCT/pre-FMT specimen.
There was no statistically significant change in the intestinal microbiome α-diversity between the pre-HCT specimens and the post-HCT/pre-FMT or post-FMT specimens, as measured by the inverse Simpson index (Figure 4A). A significant decrease in Clostridiales abundance was observed when comparing the pre-HCT with the post-HCT/pre-FMT stool specimen, which corrected after FMT (Figure 4B). UniFrac distance analysis showed a more similar microbiome in patients when compared with their FMT donor after the administration of FMT than before FMT (Figure 4C). To assess engraftment of the FMT product, OTU origins were classified as being initially identified in the FMT donor sample only, in the patient pre-FMT samples only, both, or neither. Expansion of FMT donor-only OTUs was clearly observed in recipients after administration of FMT (Figure 4D).
Subset analysis and comparison cohort with patients not receiving FMT
According to the known association between antibiotic exposure and reduced microbiome diversity,21 we identified 8 patients who both received broad-spectrum antibiotics (not including ciprofloxacin prophylaxis) during HCT hospitalization before FMT and, thus, likely experienced an initial microbiota injury, and did not receive broad-spectrum antibiotics after FMT, which we hypothesized would increase the likelihood of durable engraftment of the FMT. This subset of patients experienced more significant increases in microbiome diversity, as measured by urinary 3-IS, inverse Simpson index, Clostridiales abundance, and shorter UniFrac distance from the FMT donor (Figure 5). For a comparison cohort, we identified 32 patients from 2 other institutions who received broad-spectrum antibiotic exposure during their HCT hospitalization and had available 16S-sequenced stool samples, but who did not receive an FMT. As the median time of FMT administration was 27 days after HCT (range, 19-45 days), we chose stool samples collected at points days 25-40 and days 50-70 after HCT for the control cohort to compare with the 1-week and 1-month post-FMT samples. In this unplanned post hoc analysis, patients who received FMT on this study had significantly improved intestinal microbiome diversity, as measured by the inverse Simpson index (Figure 6).
This pilot study is the first to explore the empiric administration of frozen third-party oral FMT capsules to patients early after allo-HCT to reconstitute microbiome diversity. We found that third-party FMT was safe and feasible when given in the period immediately after neutrophil engraftment. The primary endpoint of the study, feasibility of oral FMT early after allo-HCT, was met. We also found the approach to be safe, as patients experienced minimal toxicity and a low incidence of infectious complications. We did not observe transmission of infectious organisms from FMT capsules. There was a single case of bacteremia after administration of FMT, which occurred in the setting of active GI GVHD. We are encouraged by the safety and feasibility demonstrated, as there are multiple advantages to oral third-party FMT capsules, including noninvasive administration, centralized screening of donors and preparation of an FMT product, and the ability to treat many patients from a few healthy donors. This formulation and route of administration are perhaps more readily scaled up to multicenter studies than a liquid FMT preparation collected freshly and delivered via nasogastric intubation, enema, or endoscopically.
Our results also represent the first outside validation of urinary 3-IS, a tryptophan-derived metabolite produced by commensal bacteria, as a biomarker for microbiome diversity in allo-HCT patients. The patients in this study exhibited an expected decrease in microbial diversity while undergoing HCT, as predicted by the biomarker urinary 3-IS concentration, although this change was not statistically significant when assessed directly by 16S sequencing and the inverse Simpson index. The reason for this may be that urinary 3-IS concentration and stool 16S-based diversity measurements each detect different, and perhaps overlapping, patterns of microbiota injury. The administration of FMT in this study was associated with maintenance or recovery of intestinal microbiome diversity, as indicated by urinary 3-IS levels and 16S ribosomal sequencing of stool specimens, which could be observed as early as 1 week after FMT. Furthermore, there was clear expansion of donor-specific OTUs, suggesting that the recovery of microbiome diversity was directly attributable to the FMT. Previous studies have identified Clostridiales as a commensal anaerobe with an important role in intestinal homeostasis, and its loss during allo-HCT has been associated with increased transplant-related mortality.4,22 The increase in Clostridiales abundance after FMT is consistent with the other measures of microbiome health. We also retrospectively identified a subset of patients in this study who received broad-spectrum antibiotics during HCT hospitalization who appear to have attained the largest gains in terms of microbiome diversity after FMT. When compared with a post hoc cohort of allo-HCT patients from other institutions with similar antibiotic exposures but who did receive FMT, patients who received FMT had significantly improved intestinal microbiome diversity. Clearly, these comparisons must be interpreted with caution, given the differences between institutional clinical practices and the limitations of retrospective analyses. Nevertheless, taken together with the expansion of donor-specific taxa we observed, these results are consistent with the notion that the improvements in microbiome diversity in this study can be, in part, attributed to the FMT.
The loss of intestinal microbial diversity has recently been associated with adverse outcomes in recipients after allo-HCT. Reduced diversity of the intestinal microbiome within the first 7 days after neutrophil engraftment, as measured by 16S rRNA sequencing and defined by the inverse Simpson index, has been correlated with significantly worse survival outcomes (OS at 3 years was 36%, 60%, and 67% for low-, intermediate-, and high-diversity groups, respectively (P = .019).4 Similarly, low levels of urinary 3-IS in the first 10 days after allo-HCT have been associated with higher transplant-related mortality (P = .017) and worse OS (P = .05), with the majority of TRM being related to acute GI GVHD (86.4%; P < .001).13 Subsequent studies have explored associations between the intestinal microbiome with acute GVHD and disease relapse. One analysis showed that increased bacterial diversity after allo-HCT was associated with reduced acute GVHD-related mortality, and that increased amounts of bacteria specifically belonging to the genus Blautia were associated with reduced acute GVHD mortality.5 In a second study, acute GVHD was associated with lower α diversity of stool microbiota, with the presence of oral Actinobacteria and oral Firmicutes in stool at neutrophil recovery after allo-HCT being positively correlated with subsequent acute GVHD.23 Finally, a link between disease relapse after allo-HCT and the changes in the amount of specific bacteria in the intestinal flora has been demonstrated, notably with higher Eubacterium limosum abundance being associated with a decreased risk for relapse.6
It remains unknown whether interventions designed to modify the microbiome can affect clinical HCT outcomes, but numerous initial investigations are underway. Early administration of broad-spectrum antibiotic therapy is associated with significantly altered microbiota (reflected by suppression of urinary 3-IS levels), higher TRM, and worse OS when compared with patients with late or no antibiotic exposure.13,21 It has been hypothesized that commensal anaerobic organisms, such as Clostridiales, help maintain and restore microbiota diversity, and that the use of anaerobe-sparing antibiotics may benefit patients.21,24 Indeed, multiple prospective clinical trials are evaluating the effect of choice of antibiotic prophylaxis or empiric therapy for neutropenic fever on the intestinal microbiome during allo-HCT (NCT02641236, NCT03078010). In addition, the use of certain prebiotics and probiotics are being explored as possible approaches to prevent microbiota dysbiosis.25 Murine models have identified microbiome-derived metabolites, which may mitigate GI toxicity and GVHD, although clinical investigations in humans have not yet been reported.26,27 An ongoing pilot study is investigating the administration of fructooligosaccharides, a prebiotic with known ability to alter butyrate-producing bacteria,28 to patients undergoing allo-HCT (NCT02805075). In addition, there is a planned randomized clinical trial to study the role of Lactobacillus in preventing acute GI GVHD in pediatric recipients of HCT (NCT03057054). Exposure to the hospital environment may also have an effect on the intestinal microbiome, and it has been recently shown that patients who received care after transplant at home had similar outcomes to matched hospital controls, with a noted lower incidence of grade 2-4 acute GVHD.29 An ongoing study will evaluate changes in the intestinal microbiota for patients who receive HCT at home, as compared with those treated in the clinic or hospital (NCT01725022).
Previous investigations of FMT in HCT recipients have focused mainly on the treatment of antibiotic-resistant bacteria and C difficile infection.30⇓⇓-33 A prospective single-center study in patients with blood disorders, which included HCT recipients, suggested that FMT can eradicate antibiotic-resistant bacteria from the GI tract of recipients.34 A randomized trial of empiric autologous FMT to prevent C difficile infection in allo-HCT recipients is now ongoing (NCT02269150). Interestingly, 2 recent preliminary reports have suggested a possible role for FMT as treatment of steroid-refractory acute GI GVHD.35,36 These interventional studies, as well as the associations of low intestinal microbial diversity with the risk for infectious complications, acute GVHD, and TRM, suggest that microbiome restoration early after allo-HCT may be of benefit. Here, we show that frozen third-party FMT capsules allow for an easily accessible, noninvasive approach that is well tolerated in the early post-HCT period and can potentially hasten the recovery of microbiome diversity.
Limitations of this study include primarily the small sample size. A pilot safety and feasibility study was necessary, given that participants were receiving donor live bacteria in the immediate post-HCT period. This design inherently limits our ability to draw any conclusions about whether microbial manipulation by FMT directly influenced patient outcomes, as that requires a larger study with incorporation of a proper control group. In addition, given safety concerns about the risk for FMT-related bacteremia, we excluded patients with acute GI GVHD, as active inflammation compromises the integrity of the intestinal barrier. Given our data associating FMT with restoration of microbial diversity, and preliminary reports of the therapeutic effect of FMT in patients with steroid-resistant aGVHD,35,36 additional studies should be designed to investigate the effect of FMT on clinical outcomes after allo-HCT, including acute GVHD and infectious complications.
Further prospective evaluations into the use of FMT in patients undergoing allogeneic HCT are needed to better understand its effects on the recipient microbiome and to better characterize its influence on clinical outcomes. Given the limited size of current clinical studies, microbiome diversity-associated correlative endpoints seem most appropriate. However, a larger prospective trial with a clinical primary endpoint will eventually be required to ultimately determine whether microbiome diversity manipulation can truly have an effect on patient outcomes after allo-HCT.
The authors thank the patient and donor volunteers.
This work was supported by the National Institutes of Health, National Institute of Allergy and Infectious Diseases (5K08AI110655) (M.K.M.), National Center for Advancing Translational Sciences (5KL2TR001115-03) (A.D.S.), National Heart, Lung, and Blood Institute (R01 HL124112 [R.R.J.] and 1R01HL123340-01A1), and National Cancer Institute (P01-CA023766 [M.R.M.v.d.B.] and P30 CA008748). This work also was supported by the Jose Carreras Leukaemia Foundation (E. Holler and G.L.), the Cancer Prevention and Research Institute of Texas Recruitment of Rising Stars (R.R.J.), The Lymphoma Foundation, The Susan and Peter Solomon Divisional Genomics Program, and the Parker Institute for Cancer Immunotherapy at Memorial Sloan Kettering Cancer Center.
Contribution: S.L., M.K.M., E. Hohmann, and Y.-B.C. designed the study; Z. DeFilipp, C.D.R., B.V., M.E.K., M.S., J.B., B.R.D., A.E.-J., S.L.M., T.R.S., K.K.B., and Y.-B.C. recruited patients to the study and collected clinical data; J.M. and E. Hohmann prepared the FMT capsules; J.U.P., Z. Dagher, A.E.S., K.D., G.L., P.O., E. Holler, M.K.M., M.R.M.v.d.B., and R.R.J., contributed to the analysis of stool and urine specimens; J.U.P., A.D.S., T.E.D., J.A.M., Y.T., E.G.P., M.R.M.v.d.B., and R.R.J. contributed to the formation of the control cohort; Z. DeFilipp, S.L., E. Holler, M.K.M., E. Hohmann, R.R.J., and Y.-B.C. analyzed the data; Z. DeFilipp and Y.-B.C. wrote the manuscript; and all authors approved the final of the manuscript and submission of the manuscript.
Conflict-of-interest disclosure: E. Hohmann receives research support from Seres Therapeutics, Inc. J.U.P. holds patents with or receives royalties from Seres Therapeutics, Inc. R.R.J. is on the board of directors or an advisory committee for Seres Therapeutics, Inc., has consulted for Ziopharm Oncology, and holds patents with or receives royalties from Seres Therapeutics, Inc. M.R.M.v.d.B. is on the board of directors or an advisory committee for Seres Therapeutics, Inc. and holds patents with or receives royalties from Seres Therapeutics, Inc. E.G.P. is on the board of directors or an advisory committee for Seres Therapeutics, Inc. and holds patents with or receives royalties from Seres Therapeutics, Inc. The remaining authors declare no competing financial interests.
Correspondence: Yi-Bin Chen, Blood and Marrow Transplant Program Massachusetts General Hospital, 55 Fruit St, Yawkey 9E-9052, Boston, MA 02114; e-mail: ychen6{at}partners.org.
↵* R.R.J. and Y.-B.C. contributed equally to this study.
The full-text version of this article contains a data supplement.
- Submitted February 20, 2018.
- Accepted February 27, 2018.
- © 2018 by The American Society of Hematology


text:
A Survivor's Memories in His Own Voice
A year ago, I wrote an article for the Atlanta Jewish Times about a world without Holocaust survivors.
That piece began: "Norbert Friedman sits in a small, soundproof booth at Atlanta Interfaith Broadcasters' Midtown studio. As he has almost weekly for several months, the 92-year-old reads aloud from his memoir, 'Sun Rays at Midnight: One Man's Quest for the Meaning of Life, Before, During and After the Holocaust.' "
A year later, with the recording finished, Friedman bought lunch for the AIB staffers to express his appreciation for their help. The next challenge is arranging public access to this chronicle by a Polish Jew who survived 11 Nazi concentration and labor camps. (Full disclosure: As content manager for AIB, my wife helped facilitate the project.)
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Friedman rose from his wheelchair and in accented English told the gathering that he had prepared 18 pages of remarks, then laughed and said he would read only three. The years have not dulled his sense of humor.
"Thanks to the dedication of all involved, the promise given to those who could, to survive the catastrophe of mankind, fulfilling the pledge 'Do not let the world forget what happened to us' will be enhanced by legacy of a recorded spoken word. From the bottom of my heart, I thank you for that," Friedman said.
He also thanked "the impresario of the project," Judi Ayal, formerly of the William Breman Jewish Heritage Museum, "who convinced me of its feasibility" and monitored the reading from start to finish.
"Do not let the world forget." That is what the Jewish community does on Yom HaShoah, Holocaust Remembrance Day, which this year begins at sunset Wednesday, May 4, based on the Jewish calendar. In Atlanta, the Holocaust will be remembered in commemorations at 11 a.m. Sunday, May 1, at Greenwood Cemetery and at 3:30 p.m. Sunday, May 8, at the Besser Holocaust Memorial Garden at the Marcus Jewish Community Center.
The number of survivors continues to shrink. A year ago, there were 189,000 in Israel. A recent article pegged their average age at 87 years old. In the United States, last year's estimate of 130,000 is expected to be reduced by half by 2020.
Amy Neuman, the program manager of Holocaust survivor services at Jewish Family & Career Services, said the arrival of survivors to be near family has kept steady a figure of about 250 in the Atlanta area.
One who recently passed away at age 91 had a unique connection to Friedman. As The Atlanta Journal-Constitution reported: "On a Tuesday morning in early June 1950, Maria Geitler Dziewinski opened the door to a familiar face she had not seen since leaving war-torn Europe. It was a friend from her hometown of Krakow, Poland."
That friend was Norbert Friedman. "We walked up a flight of stairs and knocked on the door," Friedman told the AJC. "The lady of the house opened the door, and when she saw me, she almost fainted, and so did I. It was Maria Dziewinski."
Friedman is a raconteur, and at lunch he smiled as he retold the reunion story. He believes in the power of memory, so he continues to write and continues to speak.
The U.S. Holocaust Memorial Museum has initiated an effort called History Unfolded, crowdsourcing public research of newspapers from 1933 to 1945 to learn what Americans knew about the Holocaust as it happened. What has been learned thus far is that more information was available to the American public than previously believed.
"The sad thing is that, given all that publicity, still the Holocaust happened," Sandi Auerbach of Somers, N.Y., a member of the museum and contributor to the project, told The Washington Post.
More important than decades-old newspaper articles are the memories of living witnesses. That is why Friedman wrote "Sun Rays at Midnight." That is why it he felt it important to record the memoir in his own voice.


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Host: Jim Fisher
Engineer: Amy Browne
Program Topic: Winter Recreation and Fitness
Key Discussion Points:
a) What is Teens to Trails hoping to accomplish?
b) What activities does the Bureau of Parks and Lands offer for getting outdoor's in the winter?
c) Why is it important to get outdoors in the winter?
d) What does it take to get young people to do outdoor physical activity in the winter?
Mike Leighton, Manager Northern Region Parks
Bureau of Parks and Lands
106 Hogan Road, Suite 7 Bangor, ME 04401
(207) 941-4014 email@example.com
Mckenzie Smith, Partnerships Coordinator Teens to Trails
98 Maine Street Brunswick ME 04011
( 207) 725-0800 firstname.lastname@example.com www.teenstotrails.org


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Last Night over 100 guests filled Max Black to the brim with fashionista fierceness as we launched not one but 5 European lingerie labels in Sydney. Beyond how beautiful and amazing our team, the guests, the performers and the fashion were – we felt the love and now we'd like to send a little back out into the world.
Such a successful night would not have been possible without the kindness, hard work and pure creativity of some brilliant people. Our heartfelt thanks go out to:
Bruce & Sonya at Max Black – for everything!
Shana Quinn – for the music
Robbi Frew – for everything media
Rosie Wells – back stage craziness
Kent Johnson – Sydney Street Fashion
Balder Skanstrom-Bo – Photog Extraordinaire
Our Naughty Bag partners:
Neil Duckett at Two Ducks
Sugar & Sas | Windsor Australia
The Models & Performers: Frankie Faux | Bella Louche | Memphis Mae
Our MC and super glam host: Angie Demaskau
And of course our new lingerie partners:
Tres Bonjour
Something Wicked
Fleur of England
Maison Close
The night would not have been possible without the efforts of these amazing individuals so click, search and support them please (we certainly will be).


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As Marc Berman of the NY Post reports, the famous Willis Reed tunnel has been knocked out by the Madison Square Garden transformation. The tunnel has been replaced with center court seats and the Knicks will now enter the arena through a corner tunnel. James Dolan wants to start a new tradition of the players entering the court through the Delta Sky360Club where elite season-ticket holders can view the players running out of the tunnel. As great as that sounds, it is sad to see the famous center court tunnel go as the Garden is the last arena to have the center court tunnel.
Above is a video remembering the Willis Reed game in which he played injured to lead the Knicks to the 1970 NBA Championship.Follow @tarmosino


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What to wear clothes in a cage: stylish ideas and combinations
In the new season, the designer Marc Jacobs made everyone re-think about the once-popular plaid print. In his spring / summer collection he has focused on cells that, in his opinion, will dominate the fashionable women outfits throughout the year.
Checkered print can be called a classic, however, despite the long history of this pattern, many ladies have not learned to combine it with other wardrobe items.
Modern versions of the cells can be absolutely any color. At the last shows in Paris models took to the catwalk in outfits with red, green, yellow and white print. It was not only decorated the main image, but also accessories – bags, shoes, earrings, etc.
On the wave of an emerging trend on the checkered clothing as soon as possible to figure out what to wear such clothes so that your image does not look stylish and appropriate in any situation.
What to wear with a plaid skirt
Plaid skirt – a win-win for the image of a business lady. This outfit suits tall and slender girls. Designers recommend to combine a plaid skirt with solid turtlenecks or blouses.
Mini skirt in a cage will diversify the image of young girls. Don't overdo it with the prints and choose as top a plain t-shirt or shirt. The top throw with a leather jacket or a classic jacket.
The importance of color cells. If it is the traditional black and white tones, and the top of the outfit should be cool shades. Select turtlenecks in white, black or gray. Looks great combination of plaid skirts with sweaters and sweaters with large viscous or pattern.
What to wear with plaid pants
Remember that plaid pants emphasize on the legs, so if you have a problem area or an imperfect shape, it is better to abandon this dress.
Plaid pants are not recommended to wear full ladies with type figure «pear». They will make the body more bulky, visually adding a sentiment in the waist area. If you are a a slender girl with narrow hips, then feel free to wear plaid pants.
In the new season, pantsuits in a cage. They combine perfectly with blouses, pullovers and tops.
Note the style of pants. It doesn't have to be classic straight model. The cage looks attractive in almost any form. For example, a checkered print stylish looks on the skinny pants. Combine them with monochrome t-shirts and t-shirts. As shoes, select sneakers, Hiking shoes or comfortable espadrilles.
Full girls with wide hips are advised to pay attention to the General styles of pants with cell muted shades. The ideal option is flared from the hip. Choose a model with large print, it will visually slim figure and make it more proportional.
Skinny girls should look to the pants with small cell, and fashionable women with type figure «triangle» – to the models with a print medium size.
Plaid pants in contrast to skirts, require additional print blouse or top. It can be embroidery in the form of flowers, arrangement of rhinestones, or beads. However, it is not necessary to flood the image with unnecessary details – 1-2 bright accents in the image will suffice.
What to wear with plaid shirt
Especially love the fashionistas in the new season are plaid shirts. It is an indispensable garment in the wardrobe in the country style or streetstyle. Remember that clothes in small cells can afford only skinny girls. Large print allows you to visually hide figure flaws, therefore it is indispensable for women with curvaceous.
If you combine the shirt with jeans and shoes in men's style, you get a real cowboy outfit, which the city will look gorgeous. In addition to this plaid shirt can be worn with shorts, skirt or pants. It is important that the bottom of the outfit was solid.
Under the shirt you can wear white top and bottom to tie in a knot or not buttoning at all. As shoes, select high boots, shoes or light sneakers.
It is important to buy a shirt to your size. In some situations, you can select the model one size larger, but not smaller. When selecting plaid clothes it's also worth considering the type of shape. Chubby girls fit the «male» styles, which combine with shorts, leggings or jeans.
A fitted and feminine shirt are able to emphasize the figure of the slender female. The owners of the type of figure «pear» recommended model with a cage of medium size, as too small of print visually enhances the top of the outfit.
Shades of plaid shirts and the rest of the image should be in harmony with each other. Models with black, blue and grey drawings are suitable for almost any clothes. To clothing specific and vibrant colors to match your clothes need to be more careful.
Cellular things perfectly combined with the accessories in ethnic style wooden beads and bangles with charms, stylish hats with a wide brim.
What to wear with a jacket in a cage
Jacket – an essential element of office style, but his choice should be approached very carefully. Choosing the wrong model, you can visually add to your figure a few unwanted pounds. But if you found your ideal model, it is possible to underline the advantages of your figure.
The classic version, which is suitable for almost all girls, is a jacket in the English cell. This outfit must be present in the wardrobe of just slim and tall ladies. Big women, sorry, this outfit is not recommended to wear at all.
Plaid coat – a bright element to any outfit, so combine it with a plain top and a fitted turtleneck with a high neck blouse or top. Looks good combination of the jacket with jeans of dark shades, a pencil skirt or dress-case with delicate hues.
Plaid clothing is often associated with sophisticated style and strict dress code. However, despite its uniqueness, the cage can look in different images differently. Indeed, this print was first used in school uniform, so-called tartan, but with the stylish cells appeared in the images of young girls as the main decoration casual and office looks.


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There is no denying it: There has been a sea of change in our cultural landscape - one that has left the church in a challenging position. But what if we chose to lead from hope rather than despair?
Join us for a day dedicated just to church leaders: ministers, elders, and their spouses. This event will be hosted at the Sunny Hills Church of Christ and led by: Joey Cope, Rick Gibson, Jeff Walling, and Mike Cope!
This is a free event.


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Long Beach, CA: captured content at client conference aboard old luxury liner, loving the maritime atmosphere (once worked on a cruise ship around Hawaiian Islands). Sadly we had bad weather, but a short break gave us the opportunity to capture this engaging time lapse. Possible establishing shot?
We worked New Year's Eve in the center of the world.one of the coldest nights in Times Square history.luckily had some warm time inside.but what a night//NYC a magical place.
Manhattanville School of Business
We love the energy at MSB, excited to work with them again.
Fill the Screen with Square Video
This a square format video, with "text on-screen" to help to reinforce messaging. We're excited about using new ways for effective storytelling.
When a hard working trucker invites you into his home...
to spend time filming his family. and tell their story of what it means to be a first-time homebuyer. Then receiving text from them... priceless.
Spanish Video Series
After filming a series of storytelling videos at PHMC's Richmond branch in California, postproduction was a challenge..but we overcame. Our Editor in NY set-up multiple "live edit sessions" w our Bilingual Producer in CA... we found a way! Hola mis amigos, Lo hicimos. Gracias a Dios por los 3 años de clases de español en la escuela secundaria lol
Happy Tartan Day
Yesterday had the opportunity to photograph Nicola Sturgeon, First Minister of Scotland... on National Tartan Day no less. It's celebrated on April 6th, the date on which the "Scottish Declaration of Independence" (Declaration of Arbroath) was signed in 1320.
4 Thumbs Up
On set last week filming green screen educational video series... in Spanish! We converted client's training room into a studio for the day, using our teleprompter and portable green screen set-up. Of course a group selfie at the end... yes, thumbs up... muchas gracias team!
Customer testimonials are considered one of the most effective content marketing tactics. This video combines testimonial clips from 3 REALTORS, for simple yet powerful messaging.
"We Bleed Red, White and Blue"
In this storytelling video Veterans Patty and Rico Rodriguez tell the story of how Platinum Home Mortgage changed their lives.


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Media i Casa Salinas
This page explains about the different devices in the house. Initially, then here's a list of all devices:
- Internet (5 mbit download, 1 mbit upload). Name (SSID): GRAN ALACANT TV CH - Password: alicante
- Big TV in the living room, with ChromeCast, PlayStation3 and radio-function (since some of the channels on the TV are radio-channels).
- Small TV in the master bedroom (with the same channels as the big TV).
- Computer speakers in the office downstairs.
- Two aircondition units. One in the master bedroom and one in the living room.
The internet provider is called Gran Alacant Tv and has an office 500 meter from the house. There is a 5 mbit download and a 1 mbit upload.
There is a loose connection in the PSU for the router (which is located under the TV). But if the lamps in the router are glowing, then there should be internet.
Wifi-name (SSID): GRAN ALACANT TV CH
Password: alicante
If you don't know what ChromeCast is, to explain in shortly, then it is a way you can view a video from your phone or your computer, on the device which the ChromeCast is connected to (the big TV, in the case for Casa Salinas). So you open the video and 'cast it' to the TV (instead of watching it on your phone). It sends the audio/sound as well. It's possible to cast Spotify as well. Here is a video about how ChromeCast works: https://www.youtube.com/watch?v=-dT93PcNgUw
To make it work, then you have to do the following:
1) Connect the device from which you want to cast the video, to the WiFi in the house (see the 'Internet'-section above).
2) Turn on the TV and click on 'Source' and pick either 'HDMi1' or 'HDMi2' (it will should a ChromeCast-screen, when you're on the right one). If non of the HDMi-inputs shows the ChromeCast-screen, then ensure that the ChromeCast is connected. It's on the back of the TV - a small round device. And it has a small lamp that is on, if the ChromeCast is on.
3) Then start playing the video you want to see. Remember, that only some services offers the ChromeCast-function. Services such as YouTube, Spotify, Netflix and HBO-Nordic offers the service. If you want to test if it works, then it is suggested that you try viewing a YouTube-video. The icon that you have to click on, looks like this:
When you click on that symbol, then you'll be prompted about: 'Which ChromeCast you want to cast to' - and then you'll have to choose: 'Casa Salinas ChromeCast'.
When that is done, then the video should be played on the TV.
Watch Netflix, HBO-Nordic or other such services in Spain.
We haven't experimented with this yet - but we have been told, that if you make a VPN to a provider, where you're account is from, then it's possible to play videos from that service. If you for instance have a danish Netflix-account that you want to use, then you'll need a danish IP-address, which you for instance can get using: https://vpn-byen.dk/ . After the VPN is established, then the Netflix can be used (in theory).
The 'low tech'-reason is, that when you go online, then you obtain in IP-address. This IP-address has a geographical paramater, so if you visit a website or use a service, then that website/service can see where in the world you are. So if you're trying to use a danish Netflix-account from Spain, then Netflix can see that someone from Spain is trying to watch something that they only are permitted to watch in Denmark. And therefore the request will be denied. This can in theory be bypassed using a VPN.
There is a PlayStation3 connected to the big TV.
Playing DVD's
It's possible to play DVD's from the PlayStation. The menu is control with the PlayStation-controller.
There are a couple of computer-speakers in the office on the ground level. They can be used as desired. Guests often connect their phone/laptop to them, to play music.
Aircondition UnitS
There are two remotes in the house, and both remotes works for both aircondition units.


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We humans might be data averse by nature – especially when presented with data in a spreadsheet (see Data Tip #1). But there is one type of data we can't get enough of: data about ourselves. So when visualizing data, consider how you can put your viewer/user/reader into the chart, graph, or map.
The Guardian cleverly places their reader squarely in the middle of this simple chart. First, they ask what the reader expects is the correct answer to a question concerning a news topic such as: "Out of every 100 prisoners in the United States, about how many do you think were born in a foreign country?" The reader gives her answer and then can compare her answer to that other others in her country and to the correct answer.
Try it yourself. Would these stats have engaged you nearly as much had The Guardian simply presented them in text form? Are you more likely to remember these stats tomorrow? Did you reflect on how on/off the mark you were? Did you consider why your answer differed from that of others?
See other data tips in this series for more information on how to effectively visualize and make good use of your organization's data.
Photo by Ashim D'Silva on Unsplash


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LAGOS, Nigeria — When the sun sets in Nigeria, candle flames dance against the darkness, flashlights bob down empty streets and thousands of diesel generators cough to life.
This nation has more than enough oil and natural gas to satisfy its energy needs, but its power grid is a wreck, reaching less than half the population even on a good day. To frustrated Nigerians, the initials of the state-run electricity provider, the Power Holding Company of Nigeria — stand more aptly for "Please Have Candles Nearby."
Nigerian President Goodluck Jonathan vowed Thursday to set things right by expanding, repairing and privatizing the system — a hugely important issue for the nation of 150 million, with presidential elections scheduled for early next year. He made the announcement in a luxury Lagos hotel powered around the clock by diesel generators.
The effort will require enormous investment. In a report released Thursday, Nigerian officials suggested that $100 billion "would represent a conservative estimate" to build new power plants and transmission lines over the next decade.
There haven't been improvements in Nigeria's electrical grid since the 1970s, and its population has almost tripled since then. Former President Olusegun Obasanjo, who governed from 1999-2007 and is a mentor to Jonathan, purportedly spent as much as $16 billion to revamp the power grid — to no visible effect.
Nigerians' cynicism about the situation is as dark as the streets are at night. A survey of businesses conducted by the nation's anti-graft agency found executives rated the national power company less trustworthy than even Nigeria's trigger-happy and bribe-prone federal police. Many of those surveyed said they feel obliged to bribe workers to repair power lines or provide electricity.
Employees of the state-run power company went on strike Wednesday over their salaries but returned to work Thursday. But even when workers man their stations, most of the country remains without power.
Some Nigerians steal what little electricity there is. Power poles look like tangled black yarn with illegally spliced lines running in every direction. Workers cut electricity during hard rain, over fears of transformers blowing or poles falling to the ground, their live wires killing passers-by. One such incident left at least 20 dead in February.
Many in Africa's most populous country remain skeptical of ever seeing steady electricity.
"Every day I pray to God ... to give us light," said Cecilia Akpan, a 55-year-old widow who sells cassava at night by candlelight in the capital.
Those who can afford it get by with diesel generators. Those powering office buildings can be the size of boxcars. In humble market stalls and homes, small generators provide enough electricity for a few light bulbs and a fan during humid nights.