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HIV indicates human immunodeficiency virus.
Differences were apparent across all age groups, but most pronounced in young adults between age 20 and 64 years, as reflected by the highest incidence rate ratios. The 67% higher severe sepsis rate in black patients was predominantly explained by a higher rate of infection hospitalizations. The y-axes, shown in blue, indicate the range of incidence from 0 to 80 per 1000 population. Class intervals include data for ages equal to the lower limit of each interval and up to but less than the upper limit.
The additional risk of developing organ dysfunction conditional on infection was small. Class intervals include data for ages equal to the lower limit of each interval and up to but less than the upper limit.
In contrast to whites, the majority of infections, severe sepsis cases, invasive pneumococcal infections, and deaths occurred in young black patients. For example, 74% of pneumococcal infections occurred in young black patients compared with 45% in young white patients younger than 65 years. Similarly, 49% vs 30% of severe sepsis cases, 74% vs 45% of invasive pneumococcal disease cases, and 36% vs 18% of infection related deaths occurred in black patients and white patients younger than 65 years, respectively. The gray line indicates 65 years of age.
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Mayr FB, Yende S, Linde-Zwirble WT, et al. Infection Rate and Acute Organ Dysfunction Risk as Explanations for Racial Differences in Severe Sepsis. JAMA. 2010;303(24):2495–2503. doi:10.1001/jama.2010.851
© 2019
Context Severe sepsis, defined as infection complicated by acute organ dysfunction, occurs more frequently and leads to more deaths in black than in white individuals. The optimal approach to minimize these disparities is unclear.
Objective To determine the extent to which higher severe sepsis rates in black than in white patients are due to higher infection rates or to a higher risk of acute organ dysfunction.
Design, Setting, and Participants Analysis of infection-related hospitalizations from the 2005 hospital discharge data of 7 US states and infection-related emergency department visits from the 2003-2007 National Hospital Ambulatory Care Survey.
Main Outcome Measure Age- and sex-standardized severe sepsis and infection hospitalization rates and the risk of acute organ dysfunction.
Results Of 8 661 227 non–childbirth-related discharges, 2 261 857 were associated with an infection, and of these, 381 787 (16.8%) had severe sepsis. Black patients had a 67% higher age- and sex-standardized severe sepsis rate than did white patients (9.4; 95% confidence interval [CI], 9.3-9.5 vs 5.6; 95% CI, 5.6-5.6 per 1000 population; P < .001) and 80% higher standardized mortality (1.8, 95% CI, 1.8-1.9 vs 1.0, 95% CI, 1.0-1.1 per 1000 population; P < .001). The higher severe sepsis rate was explained by both a higher infection rate in black patients (47.3; 95% CI, 47.1-47.4 vs 34.0; 95% CI, 33.9-34.0 per 1000 population; incidence rate ratio, 1.39; P < .001) and a higher risk of developing acute organ dysfunction (age- and sex-adjusted odds ratio [OR], 1.29; 95% CI, 1.27-1.30; P < .001). Differences in infection presented broadly across different sites and etiology of infection and for community- and hospital-acquired infections and occurred despite a lower likelihood of being admitted for infection from the emergency department (adjusted OR, 0.70; 95% CI, 0.64-0.76; P < .001). The higher risk of organ dysfunction persisted but was attenuated after adjusting for age, sex, comorbid conditions, poverty, and hospital effect (OR, 1.14; 95% CI, 1.13-1.16; P < .001). Racial disparities in infection and severe sepsis incidence and mortality rates were largest among younger adults (eg, the proportion of invasive pneumococcal disease occurring in adults < 65 years was 73.9% among black patients vs 44.5% among white patients, P < .001).
Conclusion Racial differences in severe sepsis are explained by both a higher infection rate and a higher risk of acute organ dysfunction in black than in white individuals.
Severe sepsis is a broad clinical syndrome defined as infection complicated by acute organ dysfunction.1 It affects more than 750 000 US residents each year, with a hospital mortality of 28%.2 Epidemiological studies consistently report a higher incidence of severe sepsis among black than white patients.3 However, it is not known whether these disparities occur because of differences in susceptibility to infection or in the risk of developing acute organ dysfunction once infection has occurred. This distinction is important for developing interventions to reduce disparities. For example, if racial differences in severe sepsis are largely due to differences in the incidence of infection, efforts to reduce disparities should focus on community-based interventions, such as vaccination. On the other hand, if disparities are largely due to differences in the incidence of organ dysfunction, improving the management of black patients hospitalized with severe infections will be necessary.
Therefore hospital discharge data from 7 states in the United States were analyzed to determine the extent to which previously reported differences in severe sepsis incidence were due to a higher infection rate or a higher risk of acute organ dysfunction. Because differences could be due to different admission thresholds, we also analyzed national emergency department data. Whether infection and severe sepsis rates between the 2 races differed by age and comorbid conditions was determined to identify subgroups most amenable to interventions. In particular, the implications of age-related racial differences on vaccination were explored, focusing on invasive pneumococcal disease, because pneumococcal pneumonia is the most common cause of severe sepsis, and pneumococcal vaccination is the largest adult vaccination program for bacterial sepsis.4,5
We conducted retrospective, population-based analyses of hospitalized patients from the 2005 state hospital discharge databases of 7 US states to compare racial differences in infection and severe sepsis–related hospitalizations. We determined population-level estimates of infection and severe sepsis hospitalizations using 2005 population estimates that were based on the 2000 US census. We analyzed data from each state (Arizona, Florida, Massachusetts, Maryland, New Jersey, New York, and Texas) because they are large and diverse, represent a significant proportion (25%) of the US population, and maintain high-quality hospital discharge data, including information on self-reported race (<2% of patients elected not to report their race). We limited all analyses to non-Hispanic white and black patients because our prior work showed similar incidence rates of severe sepsis in Hispanic and non-Hispanic whites.3
To account for confounding due to different admission thresholds, we compared hospital admission rates for patients who presented to the emergency departments (EDs) with infection in the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2003 to 2007. Details of the NHAMCS survey methodology are described elsewhere.6 Briefly, the NHAMCS uses a 4-stage probability sample design to collect a nationally representative sample of ED visits in noninstitutional general and short-stay hospitals and excludes federal, military, and Veterans Affairs hospitals. Patient race is reported by hospital staff or obtained from medical records and is missing in approximately 12% of visits.
In hospital discharge data, we identified hospitalizations for or complicated by bacterial and fungal infections based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (eAppendix 1 and eTable 1). We used previously validated criteria to define severe sepsis as documented infection plus acute organ dysfunction.2 Consistent with severe sepsis entry criteria in prospective clinical studies,7 mechanical ventilation had to be listed for a patient to be assigned respiratory organ dysfunction. We also compared risk of acute organ dysfunction in the subset of patients with septicemia, as described previously.8
We used ICD-9-CM codes in primary and secondary diagnosis fields and Charlson criteria to identify presence of comorbid conditions.9 We excluded patients with human immunodeficiency virus (HIV) because compared with the general population, patients with HIV have higher infection rates and are more likely to develop severe sepsis. Furthermore, previous studies have shown that the prevalence of HIV varies by race.10,11 We used the same ICD-9-CM codes used for analyses of the hospital discharge data (eTable 1) to identify ED visits for bacterial or fungal infections in the NHAMCS data set.
Using hospital discharge data, we determined racial differences in age, sex, and comorbidities for patients hospitalized with severe sepsis and infection using χ2 and t tests, as appropriate. We categorized frequency counts of hospitalizations and deaths due to severe sepsis, infections, and invasive pneumococcal disease in 5-year age increments.12 Unless otherwise stated, all rates reported are age and sex standardized.
We compared age- and sex-standardized population-based incidence rates of severe sepsis hospitalizations between the 2 races. We then estimated whether differences in severe sepsis incidence were explained by differences in incidence of infection-related hospitalizations and the risk of developing acute organ dysfunction, conditional on occurrence of an infection.
To compare differences in infection-related hospitalizations, we performed our primary analyses on all patients who were hospitalized for infection or whose hospitalization was complicated by an infection. Recognizing potential limitations of administrative data, we also conducted several sensitivity analyses to assess the robustness of our findings. First, because it is difficult with hospital discharge data to determine whether infection was present at admission or not, we used New York state data (which includes present-at-admission indicators for all diagnosis fields) to compare rates of infection at admission by race. Second, in the entire data set, we repeated our analyses for different sites and types of infection. Third, because less severe infections may be missed due to differences in access to care and different thresholds for hospital admission, we determined racial differences in postoperative infection rates which are less likely to be influenced by these factors. We assessed the risk of developing postoperative infections after common surgical procedures,13 including appendectomy, coronary artery bypass graft (CABG) surgery, carotid endarterectomy, colon resection, extremity bypass surgery, lower extremity joint replacement, hysterectomy, and lung resection using random-effects logistic regression. A list of the ICD-9-CM codes for these procedures and postoperative infection is provided online (eTable 2).
We adjusted for age, sex, Charlson score, poverty, and hospital effect to compare the risk of hospital-acquired infection. We additionally accounted for confounding due to different hospital admission thresholds by comparing admission rates for infection-related ED visits between the 2 races using NHAMCS data. Finally, to ensure that higher rates of infection or severe sepsis in black patients were not simply because black patients were more likely to receive care at hospitals that reported higher infection rates, we compared the distribution of each race across all hospitals stratified by their reported infection rate.
We estimated age- and sex-adjusted population-based risks of severe sepsis. We then constructed serial random-effects logistic regression models on all infected patients to assess the risk of severe sepsis conditional on infection, adjusting for age, sex, poverty (proportion of white individuals below poverty as a measure of zip code–level economic privation),3 and comorbidity. We built models measuring comorbidity by the Charlson score and then by presence or absence of diabetes and chronic kidney disease, because these chronic diseases were more common among black patients. Each of these models was adjusted for clustering of patients by race at hospitals (hospital effect) and varying proportions of black patients by center using the decomposition method.14,15 These models yield 2 odds ratios (ORs), the within-hospital OR, which measures the association between race and severe sepsis risk conditional on being admitted to the same center, and the across-hospitals OR, which reflects the risk of severe sepsis across hospitals with varying proportions of black patients. Unless otherwise stated, we report the within-hospital ORs.
We explored the implications of age-related racial differences in infection-related hospitalizations on current guidelines for pneumococcal vaccination by estimating the proportion of patients hospitalized with invasive pneumococcal disease who would not be targeted by current vaccination guidelines. Vaccination is currently recommended to high-risk adults. High-risk adults include all persons aged 65 years or older, and younger persons who smoke or have chronic diseases. We did not include smoking status as a risk factor because reliable data about smoking history was not available.16
Database management and calculation of descriptive statistics were performed using Visual FoxPro and Excel (Microsoft Corporation, Redmond, Washington) and regression analyses were performed using Stata version 10.1 (Stata Corp, College Station, Texas). Racial distribution curves across hospitals ranked by overall infection rate were compared by Kolmogorov-Smirnov test. There was a greater than 90% power to detect a 0.5% difference in severe sepsis risk between the 2 races assuming 2-sided tests and an α of .05. The study was reviewed and exempted by the University of Pittsburgh institutional review board.
Of 8 661 227 non–childbirth-related hospitalizations, 2 261 857 (26.1%) infection-related hospitalizations were identified. Of these, 381 787 (16.8%) hospitalizations were also associated with acute organ dysfunction, and thus classified as severe sepsis (Figure 1). Among those hospitalized with infection and severe sepsis, respiratory infections were most common and occurred in a third of all cases (Table 1). Other common infections were genitourinary, abdominal, wound, and soft tissue infections, and bacteremia of unknown source. The distribution of type of infection was similar between the 2 races.
Table 1 compares characteristics of patients hospitalized with infections and severe sepsis. Among patients hospitalized with infections, black patients were younger than white patients (51.6 vs 63.1 years, P < .001). Small differences were observed in the overall burden of comorbid conditions (41.4% of black patients and 42.2% of white patients had at least 1 comorbid condition, P < .001). However, larger differences in the burden of certain comorbid conditions were noted. For example, 23.6% of black patients had diabetes and 3.5% had chronic kidney disease, whereas 17.8% of white patients had diabetes and 2.6% had chronic kidney disease (P < .001 for both comparisons). Pulmonary disease was more prevalent in white (10.5%) than in black patients (5.2%; P < .001). The higher prevalence of chronic kidney disease and diabetes persisted when analyses were stratified by occurrence of severe sepsis and was seen in patients older and younger than 65 years (Table 2).
Similarly, among those with severe sepsis, black patients were a mean 62.0 years vs white patients who were a mean 70.3 years (P < .001). Again, the overall burden of comorbid conditions was similar in both groups. However, the prevalence of certain comorbidities varied by race, similar to the pattern observed in patients with infections (Table 1 and Table 2).
Black patients had a 67% higher severe sepsis hospitalization rate than did white patients (9.4; 95% confidence interval [CI], 9.3-9.5 vs 5.6; 95% CI, 5.6-5.6 per 1000 population; incidence rate ratio, 1.67, P < .001; incidence rate ratios across different age groups: 1.40-2.05, Figure 2). The difference in severe sepsis hospitalization rate was partly explained by a higher infection hospitalization rate (47.3; 95% CI, 47.1-47.4 vs 34.0; 95% CI, 33.9-34.0 per 1000 population; incidence rate ratio, 1.39; P < .001, incidence rate ratios across different age groups were 1.09 to 1.65, Figure 2). Black patients also had a higher hospitalization rate for septicemia (8.0; 95% CI, 7.9-8.1 vs 3.9; 95% CI, 3.9-4.0; P < .001).
Black patients consistently had higher infection-related hospitalization rates than did white patients both when using New York state data to analyze infections present at admission (38.4; 95% CI, 38.1-38.6 vs 28.2; 95% CI, 28.1-28.3 per 1000; incidence rate ratio, 1.36; P < .001) and when stratifying all infections in the entire data set by site (respiratory, septicemia, genitourinary, abdominal and wound and soft tissue) and type of infection (Table 3). An etiologic classification was available in approximately 25% of cases. Among all patients with infections, black patients had higher rates of Gram-positive and Gram-negative infections (Table 3).
Postoperative infections were most frequent after colon resection (4.9%), extremity bypass (2.3%), CABG (1.5%) and appendectomy (1.3%), while infection incidence rates after carotid endarterectomy, lower-extremity joint replacement, hysterectomy, and lung resection surgery were less than 1%. Compared with white patients (unadjusted OR,: 1.35; 95% CI, 1.26-1.45; P < .001), black patients were more likely to develop postoperative infections after these surgeries (adjusted OR, 1.27; 95% CI, 1.15-1.42; P < .001).
Higher hospital infection rates among black patients were not because they were more likely to be admitted with an infection. Indeed, the admission threshold for patients presenting to an ED with infection was higher for black than white patients (Table 4; age- and sex-adjusted OR of hospitalization among all patients who presented to the ED with an infection from 2003-2007 was 0.70, 95% CI, 0.64-0.76; P < .001). Similarly, higher infection rates were not because black patients were more likely to receive care at hospitals with higher recorded infection rates than white patients (P = .68).
Conditional on an infection diagnosis, black patients across all age groups had a higher risk of developing acute organ dysfunction (age- and sex-adjusted OR, 1.29; 95% CI, 1.27-1.30; P < .001; Figure 3). Similarly, black patients with septicemia had a higher risk of organ dysfunction than white patients (age- and sex-adjusted OR, 1.38; 95% CI, 1.36-1.41; P < .001). Of the 381 787 patients hospitalized with severe sepsis, 296 552 (77.7%) had single organ dysfunction. Common organ dysfunctions were renal, respiratory, and cardiovascular failure. Seventy-eight percent of white patients had single organ dysfunction vs 76.0% of black patients (P < .001; Table 5). Blacks more frequently had renal (46.6% vs 43.8%, P < .001) and respiratory failure (34.4% vs 30.5%; P < .001) than white patients, while cardiovascular failure was more frequent in whites (25.5% vs 22.9%, P < .001).
The higher risk of organ dysfunction among black patients persisted, although attenuated, when adjustment for poverty and hospital effect were included (OR, 1.15; 95% CI, 1.14-1.17). This attenuation was due in part because organ dysfunction was a more frequent complication of infection at hospitals that treated greater proportions of black patients (adjusted OR across hospitals, 1.15; 95% CI, 1.11-1.20; P < .001 for every 20% increase in proportion of black patients). Further inclusion of comorbidity, measured either by Charlson score (OR, 1.14; 95% CI, 1.13-1.16) or by preexisting kidney disease and diabetes (OR, 1.17; 95% CI, 1.15-1.18) yielded similar within-hospital odds of organ dysfunction among black patients.
Mortality was higher among black than white patients hospitalized for infection and severe sepsis (age- and sex-adjusted OR, 1.23, 95% CI, 1.21-1.25 for black patients and 1.11; 95% CI, 1.08-1.14 for white patients; both P < .001). Furthermore, infection and severe sepsis mortality rates were 1.5-fold and 1.8-fold higher in black than in white patients (2.6; 95% CI, 2.6-2.7 vs 1.7; 95% CI, 1.7-1.7 per 1000 population and 1.8; 95% CI, 1.8-1.9 vs 1.0; 95% CI, 1.0-1.1 per 1000 population).
Racial differences in infection-related hospitalizations were especially pronounced in those between the ages of 20 and 64 years, as illustrated by the highest incidence rate ratios in these age groups (range of incidence rate ratios, 1.7-2.0, Figure 2). Of black patients with infection-related hospitalizations, 266 734 (66.6%) occurred among those younger than 65 years, whereas 815 096 white patients (43.8%) were younger than 65 years (Figure 4). The higher proportion of infections persisted among black patients compared with white patients in this age group when we stratified analyses by site of infection (62.2% vs 33.8% for respiratory, 65.4% vs 42.3% for genitourinary, and 77.8% vs 61.3% for abdominal infections, respectively, all P < .001).
Similar to infection-related hospitalizations, a different distribution of severe sepsis cases across different age groups persisted between the 2 races (Figure 4). For example, 49.4% of severe sepsis cases involving black patients occurred among those younger than age 65 years.), whereas 69.7% of white patients with severe sepsis were 65 years and older. Infection- and severe sepsis-related deaths also affected more black than white patients younger than 65 years (Figure 4; 36% vs 18% of all infection-related deaths; 39% vs 22% of severe sepsis, respectively; all P < .001). Based on age- and sex-adjusted rates, young black patients were twice as likely to die of severe sepsis as young white patients (5.9; 95% CI, 5.7-6.0 vs 2.8; 95% CI, 2.8-2.9 per 10 000 population, incidence rate ratio, 2.1; P < .001).
Black patients had higher invasive pneumococcal disease hospitalization rates than did whites (22.3, 95% CI, 21.2-23.3 vs 17.1; 95% CI, 16.8-17.5 per 100 000 population; incidence rate ratio, 1.30; P < .001). Similarly 73.9% of invasive pneumococcal infections occurred in black patients younger than 65 years, whereas 44.5% occurred among white patients in this age group (P < .001, Figure 4). One in 4 pneumococcal infections occurred in black patients aged 18 to 65 years who had no underlying comorbidities and therefore would not have received pneumococcal vaccination based on current guidelines (23.6% in black patients vs 13.9% in white patients, P < .001). Invasive pneumococcal disease deaths substantially affected young black vs white patients younger than 65 years (57% vs 28%; P < .001).
In this large retrospective cohort study, we showed that the higher severe sepsis rates reported previously in black patients are explained by a higher likelihood of being hospitalized with infection and a higher risk of developing acute organ dysfunction. This finding was observed for both community- and hospital-acquired infections, consistent across different sites and etiologies of infection, and occurred despite the finding that black patients were less likely to be admitted when presenting to an ED with an infection. Thus, community-acquired interventions, such as vaccination and improved management of chronic diseases, and better management of those hospitalized with an infection to prevent organ dysfunction, are necessary to reduce disparities in severe sepsis.
The underlying mechanisms of racial disparities in infection and severe sepsis are poorly understood. A combination of differences in chronic disease burden, particularly subclinical disease, social and environmental factors, and genetic predisposition causing differences in the host immune response to infection likely contribute to the observed differences in infection and severe sepsis-related hospitalization rates.17-19 A higher prevalence of chronic kidney disease and diabetes was observed among black patients hospitalized for infection. Prior studies suggest that these conditions are more common among black patients in the US population.20,21 These differences may partly explain higher infection-related hospitalization rates among black patients, and better management of these conditions may reduce disparities. However, the higher infection rates were observed in those who did not report comorbidities, and these differences were observed as early as age 20 years. Furthermore, the differences in comorbidities did not explain higher risk of organ dysfunction among those hospitalized for infection. Differences in host immune response may explain these differences, as shown by recent studies suggesting polymorphisms in key proteins involved in the host response to infection may increase the susceptibility to severe infections and septic shock among people of African descent.19,22
The age-related differences in infection-related hospitalizations between the 2 races in our study occurred because black patients had more infections at a younger age, and they have lower life expectancy, therefore, leading to fewer elderly black individuals in the population.23 These findings have important public health implications for current vaccination guidelines. The number of cases of invasive pneumococcal disease missed by current vaccination guidelines was estimated to illustrate the implications of age differences in the incidence of infection-related hospitalizations and showed that 25% of invasive pneumococcal disease cases would be missed in blacks. Hence, earlier vaccination for black people, similar to the recommendation for earlier pneumococcal vaccination in Alaskan Natives and American Indians, should be considered to reduce disparities.24
Prior studies suggest that the quality of care for community-acquired pneumonia is lower at hospitals that treat larger proportions of blacks.15 A higher risk of organ dysfunction was observed at hospitals that provided care to larger proportion of black patients. These differences were independent of differences in demographic characteristics, poverty, and comorbidities. Thus, strategies that narrow quality gaps across hospitals in the care of infection and acute organ dysfunction could reduce racial disparities in severe sepsis. However, even after adjusting for differences across hospitals and baseline patient characteristics, black patients still had a residual increased risk of developing organ dysfunction and the mechanism for this finding is unclear.
Major strengths of this study are the large sample size and that the findings can be generalized to a large portion of the US population. In addition, several sensitivity analyses were conducted to account for potential confounders. Results were independent of sex, robust across different sources and etiologies of infections, and persisted after adjusting for poverty level. The analysis of national ED data suggests that the results may underestimate the difference in infection rates because black patients presenting to an ED with an infection are less likely to be admitted. Also excluded was the possibility that higher infection rates among black patients were simply because they were cared for more often at hospitals that report higher infection rates. The finding of higher infection rates among black patients persisted when restricted to analysis of patients with septicemia, to patients with infections present on admission, and to patients developing postoperative infections.
This study has important limitations. First, ICD-9-CM codes may not accurately identify infection and severe sepsis cases. The ICD-9-CM codes may underestimate certain infections25 and may overestimate severe sepsis cases by including those cases for which organ dysfunction preceded infection. However, coding errors are unlikely to differ by race within hospitals. In addition, this and other studies showed that the number of severe sepsis cases was similar when identified by ICD-9-CM codes and by prospective clinical data collection performed by trained data collectors.2,8 Second, social determinants such as household size, income, and educational status have been shown to be associated with infection burden in children and adults.26,27 Other social conditions such as smoking status, alcohol consumption, and nutritional status may also contribute to higher infection and severe sepsis rates among blacks. The influence of these factors was not determined because they are not coded reliably in administrative data sets.
In conclusion, higher severe sepsis rates among black patients are explained by both higher infection-related hospitalization rates and a higher risk of acute organ dysfunction. Reducing these racial disparities will require community-based interventions, such as vaccination, improved management of chronic diseases, and hospital-based interventions targeted especially to hospitals that serve large proportions of black patients. Current guidelines for pneumococcal vaccination, one of the largest and most effective strategies to prevent severe sepsis, do not target up to 25% of cases among blacks.
Corresponding Author: Sachin Yende, MD, MS, CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, 642A Scaife Hall, 3550 Terrace St, Pittsburgh, PA 15261 (email@example.com).
Author Contributions: Drs Mayr and Yende had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Mayr, Yende, Linde-Zwirble, Barnato, Angus
Acquisition of data: Linde-Zwirble
Analysis and interpretation of data: Mayr, Yende, Linde-Zwirble, Peck-Palmer, Barnato, Weissfeld, Angus
Drafting of the manuscript: Mayr, Yende
Critical revision of the manuscript for important intellectual content: Linde-Zwirble, Peck-Palmer, Barnato, Weissfeld, Angus
Statistical analysis: Mayr, Yende, Weissfeld
Obtained funding: Yende, Angus.
Study supervision: Linde-Zwirble, Barnato, Angus.
Financial Disclosures: None reported.
Funding/Support: Dr Mayr was supported by grant T32 HL007820-10, and Dr Yende was supported by grant K23GM083215 both from the National Institutes of Health.
Role of the Sponsor: The funding agencies had no role in the design and conduct of the study, collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.
Disclaimer: Dr Angus, contributing editor to JAMA, had no role in the evaluation of or decision to publish this article.
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Excellent point about this relatively undiscussed benefit of backpacking. It is pertinent not only at the personal level but also at the national policy level to get funding for trails and wilderness protection as part of a national "war on obesity".
However, I do question the point about hiking poles contributing to a net daily increase in calorie expenditure. The flaw is seen in the link to the Nordic walking article claiming 40% increase in calorie expenditure and documenting the 150 vs. 180 heart rate. What was not mentioned was the difference in time it took the guy to go up the hill with/without poles.
It's the same reason why walking and running consume about the same number of calories over the same distance covered. Yes, running consumes calories faster but you get there sooner.
Thus, any component of pole-usage energy that contributes to forward headway will NOT increase net calorie expenditure at the end of the day. That is to say, if two people agree on reaching a given destination (as is typically the case) and one uses poles and the other does not, there should be little difference in their caloric output by the time they reach their destination that is attributable to pole usage. Only "additional" usage such as carrying the weight of the poles in the first place or energy spent in balancing or swinging at spider webs will contribute to a net caloric output. Unless . . . pole usage contributes to people actually covering more miles.
But wait, there's more. It may be that pole usage (or the component that contributes to forward motion, anyway) actually reduces caloric output. It has been stated that to accomplish a given work output that it is more efficient to use multiple muscle groups at a lower exertion level than to use fewer muscle groups closer to the limit of their output. Thus using arms in addition to legs may be more calorie efficient and thereby reduce one's calorie deficit.
In conclusion, a great article making a vital point about weight control and also about the value of poles. I just think the link between poles and caloric expenditure is more complex than commonly realized and the impact of pole usage on caloric expenditure is not yet clear.

subset: commoncrawl


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sanddbox wrote:Don't diss scientology. L Ron Hubbard is fucking brilliant. He came up with the easiest way to make money without having to work much.
Goatboy wrote:sanddbox wrote:Don't diss scientology. L Ron Hubbard is fucking brilliant. He came up with the easiest way to make money without having to work much.
Scientology is as much a religion as Microsoft is.
sanddbox wrote:That's not my point. My point is that L Ron saw how he could use religion to exploit people, and pulled it off.
People are retarded; they'll believe anything.
Spectre557 wrote:Possumdude, have any further thoughts on this? I'd like to see your point of view on my last few points.
Charlieace wrote:you sound eerily close to my religion. i guess i consider myself christian, but i haven't been to church in years. i also had a wild thought. if heaven is what we make it, why can't god be?
i'm also prepared to accept any religion. if i die and see allah staring at me, i'll accept it. if i die and see buddha sitting on his fat ass smiling like always, because he's a genuis and always happy, i'll accept it. i've almost converted to buddhism. i have even considered athiesm, but then denied the fact.
i've also been wanting to say this: i think god made science do all the work, and he intervenes from time to time. i also think i'm the only live person in this universe, and everyone else is just here but not functioning like i do, BUT! but everyone else has their own universe, which is a parallel universe, and everything is synchronized. so if it punched someone (which i constantly do), it happens in my universe and their universe (i can punch a trillion to the 10000 power miles!). and if something becomes unsychronized, it screws with the time-space continium and causes a time paradox. it seems to fit, and is incredibly bizzare, but i think its how god made it. so call me a crackpot.
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Minecraft Club - Woodcroft Library
Fri, Dec 15, 2017, 3:30 PM
Fri, Dec 15, 2017, 3:30 PM
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Minecraft Club runs Tuesdays and Fridays after school.
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This post is based on a book review I recently wrote on The Mathematics of Life, by Ian Stewart. A final version of the review will appear in a future issue of SIGACT News. Please feel free to download a pdf version of the full preprint, or just read an abbreviated version of it here, in blog format.
Ian Stewart is one of the premier popularizers of mathematics. He has written over twenty books about math for lay audiences. He has also co-authored science fiction, and books on the science of science fiction (three books on "the science of discworld"). In his newest effort, The Mathematics of Life, Stewart focuses his talents on the mathematics of biology, and the result is superb. In an easy, flowing read, with dozens of diagrams and scholarly footnotes — but without a single formula — he introduces the reader to a wide range of interactions between mathematicians and biologists. I heartily recommend this book.
Turing's morphogenesis in the modern day
The Mathematics of Life contains 19 chapters. Chapter 8, "The Book of Life," focuses on the Human Genome Project, and algorithmic challenges of DNA sequencing. However, as this possibly the area most familiar to SIGACT News readers, I will only mention it briefly, and, instead, focus on chapters that introduced me to areas of mathematical biology I had not previously encountered.
Perhaps the most direct connection to (the roots of) theoretical computer science comes in Chapter 13, "Spots and Stripes," where Stewart considers Alan Turing's famous paper, The Chemical Basis of Morphogenesis, and sketches the development of biological thought about animal markings since Turing's groundbreaking proposal. As Stewart says:
For half a century, mathematical biologists have built on Turing's ideas. His specific model, and the biological theory of pattern-formation that motivated it, turns out to be too simple to explain many details of animal markings, but it captures many important features in a simple context, and points the way to models that are biologically realistic.
Turing proposed "reaction-diffusion" equations to model the creation of patterns on animals during embryonic development. As noted by Stewart, Hans Meinhardt, in The Algorithmic Beauty of Seashells, has shown that the patterns on many seashells match the predictions of variations of Turing's equations. The mathematician James Murray extended Turing's ideas with wave systems, and proved the following theorem: a spotted animal can have a striped tail, but a striped animal cannot have a spotted tail. Intuitively, this is because "the smaller diameter of the tail leaves less room for stripes to become unstable, whereas this instability is more likely on the larger-diameter body."
Teaser for full review
In the pdf I also discuss Stewart's presentation of evolutionary game theory to model biological evolution, and the use of high-dimensional geometry to model the self-assembly of chemical virus coats. Beyond that, there is much more great material in Stewart's book that I did not mention at all. The prose style is friendly and clear throughout, without talking down to the reader.
I consider this to be an excellent introduction to the mathematics of biology, for both amateurs and professionals. Seasoned researchers are likely to learn "teasers" about areas unfamiliar to them, and smart people "afraid of math" can read the book and enjoy the material. Highly recommended. I will conclude this review with the same words Stewart used to conclude the book:
Instead of isolated clusters of scientists, obsessed with their own narrow specialty, today's scientific frontiers increasingly require teams of people with diverse, complementary interests. Science is changing from a collection of villages to a worldwide community. And if the story of mathematical biology shows anything, it is that interconnected communities can achieve things that are impossible for their individual members.
Welcome to the global ecosystem of tomorrow's science.
Ian Stewart (2011). The Mathematics of Life Book: ISBN 0465022383


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MORE than 800 people have responded to plans for the £100m redevelopment of West Way shopping centre in Botley, Oxford.
While some have urged developers Doric Properties to overhaul the centre, a majority of 87 per cent have objected to the proposals. Oxford West and Abingdon MP Nicola Blackwood lent her voice in opposition to the development, urging Vale of White Horse District Council to reject the application in an eight-page letter.
Doric wants to knock down West Way shopping centre, Elms Parade shops, Field House sheltered housing and the empty Elms Court office block.
It wants to build an extended shopping and cinema complex, including a hotel and gym.
ALMOST 90 per cent of people who responded to plans to demolish and rebuild Oxford's West Way shopping centre have objected.
Of the 827 who had their say on Doric Properties' £100m scheme to bulldoze Elms Parade and build a six-screen Cineworld cinema, supermarket, hotel and 525 student flats, 722 people (87 per cent) said it shouldn't go ahead.
And just 20 people (two per cent) thought the development should go ahead.
The remaining comments were either neutral, missing data, repeats or not yet processed.
Last night, co-chairman of the West Way Community Concern group, Chris Church, said they were delighted with such a "huge response".
He said: "We hoped for 300 objections...once again local people have responded way beyond our expectations.
"The Vale of White Horse District Council needs to recognise the huge level of opposition, and the lack of any significant local support."
Doric wants to demolish the empty shops, derelict Elms Court office block, West Way shopping centre, Botley Library, Seacourt Hall, Field House sheltered housing, the Botley Baptist Church, and the vicarage to St Peter and St Paul's Church.
Residents have called the plans an "overdevelopment" of the site and called for it to be scaled down.
Poplar Road resident Ruth Ashwell, 55, has lived in Botley for 20 years.
The mum-of-one said: "The development is far too big and doesn't take into account local people's opinions, it's an overdevelopment.
"It is creating a district centre but we need a local shopping centre."
Doric co-director Simon Hillcox said: "We recognise that there has been an organised campaign for submitting objections, however we remain encouraged by the supportive comments we do receive through other means such as on our Facebook page and in the comments section of the Oxford Mail.
"Now that the consultation period is coming to a close, we will be considering the feedback received by the council in detail before deciding how to respond. Encouragingly, all the responses from statutory consultees received to date raise no objections to the application."
MP for Oxford West and Abingdon Nicola Blackwood opposed the plans in an eight-page letter to the Vale.
She wrote: "This is clearly a popular and well-loved part of Botley, which residents regard as a central hub of the local community. It has also been apparent in recent years that some of the existing West Way buildings are a little tired and in need of repair, so like many residents I would agree it would benefit from new investment.
"However any development must work with and for the residents of Botley and I believe that this proposal as submitted does not achieve that."
Darren Smith, who lives by the Southern Bypass: "The West Way Centre is in dire need of redevelopment and Doric's plans are exactly what the area needs."
Poplar Road resident James Hodgkins: "I am glad that these plans are finally in place to turn Botley into the best part of Oxford to live."
Lime Road resident Lisa Probert: "We do not need what is effectively an out-of-town shopping and leisure complex in such a residential area."
Hids Copse Road resident Harriet Bretherton: "There is no way that the existing roads will be able to cope with the envisaged increase in traffic – 30,000 movements."


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06 June 2007 22:45
Small Arms Premium Content Now Available on Xbox LIVE Arcade
A remote village has been razed to the ground today, following sightings of a wild band of barbarians. Gastronaut Studios has claimed responsibility, citing premium downloadable content and a free Title Update for Xbox LIVE Arcade title Small Arms as the cause of the violence. Sources at the scene have said that players will be able to download two playable characters, two distinctive battlefields, and access two unique achievements from Xbox LIVE Marketplace, all for 250 Microsoft points. The update and new content have been launched already.
1 (1 marks)


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After a years-long process, Shawnee Regional Airport has been designated a Foreign Trade Zone Magnet site.
After a years-long process, Shawnee Regional Airport has been designated a Foreign Trade Zone Magnet site.
City commission voted to approve the application in 2008, and the application was filed in fall 2009.
The airport being designated as a magnet site is beneficial for any Shawnee businesses that do imports.
Typically imports will go to a port and be inspected by Customs. Upon arrival, the purchaser of the goods is expected to pay various fees, which can total thousands of dollars.
However, the benefit of a foreign trade zone allows the products to skip Customs and come to the foreign trade zone site before paying the tariffs.
Matthew Weaver, director of marketing and business development at Trade Zone 106 in Oklahoma City, explained that there are two ends of the spectrum for a foreign trade zone regarding the tariffs.
One end is a deferral of the tariff, meaning the purchaser is allowed to pay a portion of the overall tariff as he sells the imported items, Weaver said.
Elimination is when two imported products, such as toner and printer cartridges are combined in the United States. When this happens, the product is considered American-made and the purchaser is no longer required to pay any tariff on it, he added.
"It really helps you manage your business," Weaver said. "It's a pretty awesome tool."
The added benefit of the airport being a magnet site is that multiple Shawnee businesses can take advantage of the tariff benefits through the airport. Whereas typically each business would otherwise have to become it's own foreign trade zone to take advantage of the tax benefits, Weaver added.
Assistant Airport Manager Rex Hennen said he is pleased Shawnee received the designation.
"The main thing is it expands our ability to attract new business," Hennen said.


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I had the privilege and honor to "team teach" the importance of "cursive" writing for students of all ages and backgrounds.
I had the privilege and honor to "team teach" the importance of "cursive" writing for students of all ages and backgrounds. The group of participants was the Kansas Chapter of the International Graphoanalysis Society (KIGAS) which is really a group of people dedicated to all aspects of handwriting.
We usually talk about the personality aspects of handwriting but with the lack of interest in cursive writing in our society we find it necessary to try to reintroduce the importance of "cursive" writing. It seemed silly to me to be teaching our group about this subject because we were basically preaching to the choir.
How could we talk for six hours about this very simple subject and keep it interesting for the participants? Curtis Wilson (a fellow handwriting specialist) and I discussed it at great length and decided to have a dialogue back and forth and with the group. It worked out really well!
We shared with the group that 45 states have discontinued "cursive" writing in their school curriculum. We also discussed that when you type on a keyboard there is no real sense of accomplishment among students that is truly their own. Kids identify with what they produce in writings and drawings.
Art is very important and the use of "cursive" writing encourages the student to explore their creative side. Cursive handwriting encourages the mind to connect with the brain and puts thoughts in a connected fluid manner. It also encourages hand-eye coordination and the use of fine motor skills.
These skills are useful and necessary for mechanical engineers, surgeons, carpenters, mechanics, musicians, and artists of all kinds. Fine motor skills are very important….what better way to learn than by using "cursive" writing?
Cursive handwriting enables students to remember their lessons more than if they were using the keyboard system or printing. This was researched by Karin Harman James from Indiana.
Iris Hatfield from Louisville, Ky., sites 50 reasons to learn cursive, some of which I would like you to think about.
Cursive improves the neural connections in the brain. Writing cursive increases the ability to read cursive. Many high school students cannot read cursive. They are cursively illiterate in their own language.
With "cursive" writing there is improved continuity and fluidity of written communication. This involves connecting letters, which has been shown to increase both speed of writing and attention span during writing. This increases continuity and fluidity in writing, which in turn encourages greater amounts of writing.
Cursive helps students to learn easier because printing is more difficult due to the frequent stop and start motion when forming letters. In addition, some printed letters look similar and are easily reversed, like the 'b' and 'd', which is often confusing to children. This is of particular value to children with learning challenges like Dyslexia and A.D.D.
Cursive writing improves reading and spelling ability. When printing, some children write so erratically that it is difficult to determine where one word ends and another begins. Cursive on the other hand, requires children to write from left to right so that the letters will join in proper sequence; therefore, it is easier to read. It also aids with spelling through the connectivity of the letters.
These are just some of the reasons to consider pertaining to cursive writing. We realize that the technology world is important but we should never forget the importance of the written word…the handwritten word. What teacher or parent or grandparent would not appreciate a handwritten thank you note or a letter?
Handwritten notes and letters are almost extinct and a lost art. Let's revive this art before it is gone forever! We as parents and grandparents and even friends can teach penmanship…the lost art and bring some continuity back into the fragmented printing world.
Sanda Foote is a handwriting specialist/examiner from Superior, Neb. Her website can be found at www.writefacts.com.


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Hawken-Dazs wrote:To those saying "if only he was two inches taller..."
he wouldn't be as elusive in running if he was taller. His height is a blessing in disguise.
Also, he does a great job selling the fake handoff because of his height. Those are key plays that have stretched the field in numerous drives.
Yeah, I'm starting to think that any liabilities due to his height are offset by other benefits.
Game and match.


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|2010-05-20, 07:43
|Link #143
Join Date: Sep 2009
i dnot really know y there makeing a live action monster movie cause i dont think its to good of a show and if i had to guess id say this will be like blood the last vampire and dragonball evolution not as good as it should be
|2010-05-20, 12:38
|Link #144
Join Date: Dec 2005
Location: Central Texas
Age: 34
|2010-05-21, 00:21
|Link #146
start thinkin bout clones
or at least a agent will tell their client that. they will go down the list of movies like this that failed and if you are starting out directing, could be a career killer if its so bad, its the butt of jokes from 2012-2020.
look at who directed battlefield earth, i still dont think that guy gets offered jobs
|2010-06-08, 16:49
|Link #148
I'm not a tumor
Join Date: Jul 2009
Location: In the dreams of beautiful women
Age: 26
cmon they practically look like twins!
Spoiler for MANGA!:
And now he can be a credible candidate because of his little stint in prince of persia.
Last edited by Hellychan; 2010-06-08 at 16:50. Reason: Added spoiler tag!
|2010-06-09, 22:48
|Link #149
Junior Member
Join Date: Oct 2009
im usually a lurker...
But the people saying that the characters are in no way asian/japanese because they have big eyes are, frankly, being racist and stereotyping.
Asians do not all have tiny eyes.....
And last i checked white people do not have enormous eyes either...
Asians tend to have different shaped eyelids and brow structures, not eye size. No body in real life has eyes that as big as the characters in bleach. Bottom line all the characters are not meant to look realistic. Artists haven't drawn realistically since the invention of cartoons; it's called art style, an artistic touch, abstract style, etc.
If you know anything about the history of cartoons, you would know there have always been "default" character faces. By that i mean plain looking faces with unproportioned eyes, they do this because its hard to make emotion show on a 2d character without extra large eyes. They draw like this in japan as well, but even more extremely. Problem with this is that some caucasians think that "default" face has to be white because in american cartoons other races(especially asians) are drawn stereotypically. It's sad that even in this day and age some people simply cannot accept the concept of art style and would rather stick to their stereotypical views of people.
And no not all Japanese people wish they look white. Just like in America there is a minority that are especially interested in the opposite culture, its not every body. Common stereotypes for caucasions in japan and other asian countries are that they are all hook nosed, blond, or fat. We know this isn't always true, but there are a portion of asians that believe this. Just like how there is a portion of whites who think all asians have tiny eyes.
Rant over.
The general rule is that all characters in Japanese anime are japanese, unless stated otherwise (in words or blatantly obvious allusions). Just like how in western comics/cartoons where characters should be assumed caucasian unless stated otherwise. Batman has looked asian to me all my life, but i know he's white because of context.
Last edited by Kyo Seki; 2010-06-10 at 01:12.
|2010-06-14, 17:41
|Link #151
Join Date: Aug 2008
I don't have high hopes for this movie although I am very interested when it comes to actors and the story.
Hollywood already prooved they can't transform japanese gold to American gold.
Just look how they (literally) screwed up the Godzilla-movie.
All they had to do there was to make 1 (or 2) cgi monster(s), some crappy story and mimic some abilities - and voilà!
|2010-06-18, 22:36
|Link #152
Loving Romeo X Juliet
Join Date: Jul 2007
Location: City of Angels
The moment they start walking/running on air it is over for me.... I know there is a lot of walking/fighting in mid air in Bleach but the manga can pull it off cause it looks like they are actually standing on something..... but when it comes to live action, actors simply can't avoid the fact that their feet are dangling in mid air and they have nothing to stand on therefore their movements look horribly fake and awkward.... kinda like a puppet.
The solution I propose to them Hollywood directors and Asian film makers is to use green-screen on the floor too, that way the actors are standing on something and the running/fighting in mid air sequences won't look so odd...
|2010-06-19, 17:09
|Link #153
Join Date: Dec 2005
Location: Central Texas
Age: 34
|2010-06-19, 17:27
|Link #154
Loving Romeo X Juliet
Join Date: Jul 2007
Location: City of Angels
In all 3 movies there is people fighting in mid air and green screen is used but in those fighting sequences they suspend the actors with wires and so their feet are dangling in mid air so those fighting sequences look very odd. If they would only use green screen on the floor those fighting sequences would be way WAY better...
I outta visit these "directors" and special effects people to show them how to use a dam green screen for mid-air-fights properly ....
|2010-06-20, 17:52
|Link #155
Senior Member
Join Date: Apr 2009
Location: In your mom's pants
The only movie I saw of the above 3 is Crouching Tiger Hidden Dragon and I thought all the mid air scenes looked fantastic, the characters weren't supposed to be standing in mid air, they were jumping through it. Why would the ruin those scenes by adding more cgi?
|2010-06-20, 20:28
|Link #156
Loving Romeo X Juliet
Join Date: Jul 2007
Location: City of Angels
Yeah CG is not the best solution but a green-screen-floor is. This is what I am talking about:
See: 0:24; 2:28.... she goes from one bamboo branch to another but there is only air in between... she acts as tho as if she is walking/running on air but that part comes across very odd because there is obviously nothing beneath her feet to stand on, the parts where they jump and walk on water also look odd... My solution would have been to make her land on one branch and then use momentum to propel herself to the next branch without the "wobbly feet" action in between
This is where anime comes on top, check this ichigo vs Grimy fight in mid air so u'll see what I am talking about:
Watch > 0:44 ... he is in mid air yet it seems like he is standing on something. This makes the scene look way cooler and the effect can be easily replicated using a green-screen-floor.
BUT the best example comes at 2:27... where Grimmy is showing off with his Bruce-lee moves (in mid air). Imagine an actor trying to do the same but being suspended with cables instead of standing on a green screen floor... the poor actor would look (and feel) like a puppet.
The scene at 7:44 where Grimmy and Tousen "walk in mid air" back into hueco mundo through that garganta could also be closely replicated without the use of cables or CG ...again using a green screen floor...(except for the garganta thing)
Don't get me wrong tho... there are impossible things that Anime can pull off and Live action movies just can't ( CG for those instances perhaps?) but still ... the green screen floor could be used to make those mid air fighting sequences look more natural and put an end to that "wobbly feet" syndrome I keep seeing in certain Martial Arts-themed movies.
Last edited by CuXe; 2010-06-20 at 20:42.
|2010-06-20, 20:43
|Link #157
Senior Member
Join Date: Apr 2009
Location: In your mom's pants
You just had to link the dub didn't you?
I don't see what you are complaining about, at 0:24 she is running on the tree branches and the water parts look good to me. I don't really disagree with you about the green floors perhaps being something to consider for the Bleach movie, I just think you should take CTHD of that list.
|2010-06-20, 20:56
|Link #158
Loving Romeo X Juliet
Join Date: Jul 2007
Location: City of Angels
Let me put it this way...Naruto .... there is a lot of tree-hugging ... I mean tree jumping scenes in that anime... how would u feel if you saw the anime characters moving their feet (just like the actors in live action movies) when they jumped from tree branch to tree branch? I would look very odd... thats what I am referring to in all those movies..... I know that is not a deal breaker for lots of people but I would rather watch CG than wobbly feet.
I am not a Matrix freak but.. u know, the fighting sequences in mid air (Neo v Smith) were pretty dam good and that was mostly CG... ...
|2010-06-22, 01:51
|Link #159
Join Date: Jul 2009
Location: Texas
|2010-06-22, 05:07
|Link #160
Join Date: Dec 2005
Location: Central Texas
Age: 34
It may not be perfect, but that didn't stop CTHD to win a shit ton of awards. They know what they're doing, it's just you don't like the style.
copy pasta time:
Wire fu is an element of Hong Kong action cinema. It is a combination of two terms: "wire work" and "kung fu". Wire fu is used to describe a sub-genre of Kung-Fu movies where the stuntmen skill is augmented with the use of wires and pulleys, as well as other techniques, in many cases to perform stunts and give the illusion of super-human ability.
Also...good CG doesn't come cheap...
Though American made and doesn't use wire-fu, Ninja Assassin was sweet
Last edited by Mr. DJ; 2010-06-22 at 05:35.
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Peter Robinson
- Email: pbrobinson AT gmail DOT com
Peter Robinson works on Fedora in his spare time. His day job is an Infrastructure Engineer working for a global telecommunications company within their European Enterprise Hosting division. His time on Fedora is spent mostly within Fedora Mini where he is joint lead with sdz maintaining Moblin and Sugar and generally bothering people when their package deps bloat too much. He's also maintains and co-maintains a few packages here and there both related to the Fedora Mini projects as well as random stuff that interests him.
Generally he just works on anything that happens to look vaguely interesting, mostly in the small portable device side of things, or things that help make his day job easier.


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Fat Mike from the band NOFX just learned a very important lesson: You can't piss where you play ... and expect to be invited back.
TMZ has learned the rocker has officially been banned from Emo's Annex in Texas where he recently pulled that whole "you think you're drinking tequila but it's actually my urine" stunt.
A rep for Emo's tells us "Emo's does not condone Fat Mike's actions, and we do not encourage or condone any acts of stupidity that Fat Mike may perform."
Think before you drink.
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Kuznetsov's 'Tavatuy' Rallies to Take The Lead in Scarlino
5 May 2017
Scarlino, Italy (May 5, 2017) - Opening day of the second Melges 32 World League event hosted by Marina di Scarlino featured three spectacular races with Pavel Kuznetsov's Tavatuy from Russia taking the early lead.
Kuznetsov's crew, which includes tactician Evgeny Neugodnikov, was undoubtedly THE team to beat today. Their daily performance resulted in a 1-4-2 scoreline with the breeze swinging between 240 and 260 degrees with about 10 knots of breeze. This ultimately gave the overall lead, but also immediately set a very precious margin between themselves and the pursuers.
Seated second overall with a total of 14 points is Fritz Homann's Wilma maintaining all top-five finishes with Nico Celon on tactics. Current Melges 32 World League leader Matteo Balestrero aboard Giogi with Daniele Cassinari as tactician is in third, confirming him as one of the fastest boats in the fleet.
Rounding out the top five, in fourth and fifth respectively are Edoardo Pavesio's FRA MARTINA, and Edoardo Lupi/Massimo Pessina on Torpyone.
Daily highlights include the all-Corinthian crew of Francesco Graziani on Vitamina winning the second race of the day with Kilian Holzapfel on Homanit Junior coming second. International Class President Giangiacomo Serena di Lapigio's G-SPOT took the bullet in Race Three.
The forecast for Day Two in Scarlino predicts more intense wind conditions, where Kuznetsov will try to re-engage the fleet and defend his lead. But, just behind him will be a much more heated battle. With the Melges 32 fleet competition at a very high level, centimeters can make all the difference between who gets on the podium versus who goes home empty handed — it's the best ingredients for spectacular Melges World League!
The Melges World League, European Division counts on the valuable support of: Helly Hansen as the official clothing sponsor with its Melges World League Race Loft dedicated to both sailors and all fans of the sport of sailing. Garmin Marine is the official timekeeper, and Lavazza keeps the Melges World League fully fueled with the Italian taste of its signature coffee. Toremar shares Melges' DNA in which binds it to the sea. All official photo and video images are from the creative and driven talents of Barracuda Communication.
As with all Melges 32 events around the world, racing updates will be posted online at the Official Melges 32 Facebook Page. Tune in for the latest racing information, results, video interviews, and photos. Race reports, press releases and photos will be available online each day post-racing at melges32.com.
TOP FIVE RESULTS (PRELIMINARY - After Three Races)
1.) Pavel Kuznetsov/Evgeny Neugodnikov, Tavatuy; 1-4-2 = 7
2.) Fritz Homann/Michele Paoletti, Wilma; 5-5-4 = 14
3.) Matteo Balestrero/Daniele Cassinari, Giogi; 3-6-6 = 15
4.) Edoardo Pavesio/Manuel Weiller Vidal, FRA MARTINA; 9-8-3 = 20
5.) Edoardo Lupi-Massimo Pessina/Lorenzo Bressani, Torpyone; 2-10-9 = 21
View Full Results
Official Yachtscoring Event Website
Photo Gallery - Barracuda Communications
TOP FIVE RESULTS (2017 Melges 32 World League - After One Event)
1.) Matteo Balestrero, Giogi = 20 pts.
2.) Andrea Lacorte, Vitamina Amerikana = 19 pts.
3.) Giangiacomo Serena di Lapigio, G-SPOT = 18 pts.
4.) Edoardo Pavesio, FRA MARTINA = 17 pts.
5.) Lasse Petterson, Pippa; 16 pts.
Melges 32 on Facebook
Melges 32 on Twitter
Melges 32 on Instagram
Melges 32 on YouTube


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PORTSMOUTH — Temple Israel at 200 State St. will host a guest speaker on Middle East issues at 12 p.m. on Sunday Nov. 18.
The Greater Seacoast UJA is pleased to present Gil Tamary, Washington Bureau Chief of Israel's Channel 10 News, will speak on "Israel, Iran — Post U.S. Presidential Election." The public is welcome.
Tamary is known by virtually every Israeli as a top news reporter. He has worked for Israel Broadcasting Authority, Israel Public Radio, and as anchor and chief editor of "Good Morning Israel."
Tamary covers a wide range of Middle East issues from the U.S. and conducts exclusive interviews with many dignitaries and political figures, including presidents, secretaries of state, the head of the World Bank and others.
His reporting has spanned from the Camp David Accords in 2000 where he conducted an exclusive interview with President Clinton and Secretary of State Albright, the 9/11 story and the Iraq war. During the Bush administration, Tamary had exclusive interviews with President Bush, Secretary of State Condoleezza Rice, Secretary of Defense Donald Rumsfeld and many more.
Covering President Obama's election, Tamary interviewed (then) Sen. Barack Obama about his future policy toward Israel and the Middle East.
During his career, Tamary interviewed many of Israel's Prime Ministers including Benjamin Netanyahu, Ehud Barak, Ehud Olmert, Ariel Sharon and Israel's president, Shimon Peres.
In 2006, Tamary made media history when he trapped Iran's President Mahmoud Ahmadinejad into answering a question he posed at a United Nations news conference. It is historic because it became the only time the Iranian strongman "who doesn't recognize Israel's right to exist" has ever spoken to an Israeli journalist.
Another memorable moment was the exclusive interview Tamary conducted with the first Israeli astronaut, Ilan Ramon, during the Columbia mission to space. Ramon told Tamary, just days before the tragedy of the Columbia, how excited he was to see the tiny country of Israel from space. It was the only TV interview Ramon gave on board the Columbia Shuttle while in space.
On the lighter side, Tamary has interviewed many of Hollywood's hottest stars, among them John Travolta, Cameron Diaz, Tina Fey, Brad Pitt and Angelina Jolie.
Also known for his reporting on the Israeli economy, Tamary used to serve as international editor of Forbes — Israel magazine, and economic editor for Israel TV and the IDF radio and has a writer for "Globes," Israel's number one business newspaper.
Tamary has a bachelor's degree with distinction, in economics and management, and an master of business degree, both from Tel Aviv University.
Back in Israel Tamary was the anchorman and chief editor of the popular morning news show "Good Morning Israel."
Temple Israel-Portsmouth to host guest speaker on Middle East issues
PORTSMOUTH — Temple Israel at 200 State St. will host a guest speaker on Middle East issues at 12 p.m. on Sunday Nov. 18.


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Setup your application's code
If you are using Visual Studio 2017, simply open the Package Manager Console (View -> Other Windows -> Package Manager Console), and install the package:
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Install-Package Auth0.OidcClient.Android
For iOS:
Install-Package Auth0.OidcClient.iOS
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- With the project loaded in Visual Studio for Mac, Ctrl+click (or right click) on the Packages folder of the project in the Solution Pad, and select Add Packages...
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Auth0.OidcClient.iOSdepending on your platform.
- Tick the checkbox next to the package to select it, and click the Add Package button
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5009 51 St., Lloydminster, AB, Canada, T9V 0N9
Phone: (780) 875-6101 Fax: (780) 871-0852
Supports Green Practices
"Supports Green Initiatives" designates a hotel's participation in an optional environmental program that includes the use of energy-efficient lighting, guestroom towel/linen re-use, and on-premise recycling. "Supports Green Initiatives" does not represent an official certification of any kind.
Join free while you book
There is no catch. Join for free, and get access to exclusive perks!
Access to exclusive promotions and low, member-only pricing
10 points per dollar that add up fast... for free nights, gift cards or your dream getaway
Instant extra rewards for your weekday travel
Exclusive flexible rate for Choice Privileges members when you book direct at ChoiceHotels.ca or through the Choice Hotels Mobile App. Valid at most International and U.S. Choice Hotels locations. Must be or become a Choice Privileges member prior to making the booking. Discount rate is non-transferable or redeemable for cash, cannot be used for future stays or existing reservations and may not be combined with other promotions, offers or discounts. Unless otherwise stated, quoted rates are per room, per night, based on single/double occupancy and do not include taxes, gratuities or incidental charges. Early departure fees, deposit and cancellation restrictions may apply and will vary by hotel. Not valid at vacation rental properties.
Welcome to the Econo Lodge, a Lloydminster hotel near Barr Colony Heritage Cultural Centre
Lloydminster, Alberta's Econo Lodge® hotel is conveniently located near many area attractions including the Barr Colony Heritage Cultural Centre, Fuchs Wildlife Exhibit and the Border City Petting Zoo.
Sandy Beach Regional Park is just a short drive away, offering guests a choice of outdoor activities: swimming, picnicking, hiking, biking, boating, golf and more. RC's Rib & Steakhouse and Cocktail Lounge is a relaxing place to unwind with a delicious meal or refreshing drink after a day of business or leisure. Shopping and entertainment options are available nearby.
All guest rooms at this Econo Lodge hotel are designed to make guests feel at home, with features including flat-screen televisions, microwaves, coffee makers, desks and cable television. Some rooms offer ironing equipment. Copy and fax services are available for business travellers and ample onsite parking is provided.
Guests of this Lloydminster, Alberta hotel enjoy high-value amenities including:
Check-In Time: 15:00 Check-Out Time: 11:00 Guest Rooms: 40


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Since late 2011, the U.S. government has been touting an "Asia pivot" concept. This suggests that American defense, political and economic policy is undergoing a refocus towards the East, following decades of engagement in central Asia.
The plan to increase from 50% to 60% the proportion of the U.S. Navy's fleet deployed in the Pacific has yet to be achieved. At the time of the initial announcement, more than 50% were in the Pacific already; the 60% figure will not be reached until 2020. Plans to garrison 2,500 U.S. Marines in Darwin are still proceeding, but those numbers are unlikely to be met until at least 2016, with, thus far, only several hundred troops rotating through the northern Australian city for training. A proposed growth to the size of U.S. forces based in the Philippines is still awaiting host government approval.
"The Obama administration's pivot doesn't really exist," argued the Cato Institute's research fellow in defense and homeland security, Benjamin H. Friedman, in an article published by China-U.S. Focus last November. Nevertheless, some increases in force presence and the potential to expand regional force projection have taken place.
The first littoral combat ship (LCS), the USS Freedom, began a 10-month deployment to Singapore in April 2013; in November, the ship delivered aid to the Philippines following typhoon Haiyan. A second LCS is expected to rotate into the region this year, for a deployment that may last up to 16 months.
The U.S. Navy announced last month that the aircraft carrier USS Ronald Reagan will replace the USS George Washington as flagship of the 7th Fleet forward-deployed naval force, based at Yokosuka, Japan. George Washington, which is 11 years older than Ronald Reagan, is due to undergo its mid-life refueling complex overhaul and will sail to Newport News, Virginia. The Navy's statement announcing the redeployment notes that: "The security environment in the Indo-Asia-Pacific requires that the U.S. Navy station the most capable ships forward." No date has yet been disclosed for the rotation.
While it is tempting to see China's expanding military as the key challenge prompting renewed American focus on the region, commanders highlight North Korea as their main source of concern. Speaking to media from the destroyer USS Spruance in Singapore last month, the U.S. Pacific Fleet commander, Admiral Harry B. Harris, Jr., described North Korea as the USA's "number one security concern" in the region.
"I am concerned as a commander for the provocations that come from North Korea," he said. "I don't understand them, I don't understand their leadership, and I don't understand their intent."
Despite China's announcement of an air defense identification zone (ADIZ) covering the Japanese-administered Senkaky islands, which Harris described as "an unfortunate imposition" which "has not affected our military operations at all," the U.S. attitude towards China appears one of carefully calibrated politesse.
"We welcome, quite frankly, the growth of China as a military power in the Pacific," Harris said, noting that the Chinese will participate for the first time this year in RIMPAC – the biennial Rim of the Pacific maritime military exercise, which will involve forces from 23 nations and takes place in June near Hawaii.


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Seems everywhere I go now, I see bike culture. Don't think that's just cause I notice it as the publisher of Bike Hugger and a blogger. There's just more of it, like this women with a cruiser and her dog in a basket in Eatonville, WA.
I was there for the Keller Rohrback Road Race and took more photos like this
Prerace food
and FSA's Neutral Wheel Support
Wheels on top and in the car


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The 1992 Rose Bowl win over Michigan 34-14 which the Huskies won the national championship was a special moment in time, but KShell has an even better Washington Huskies bowl game moment to share. The 2010 Holiday bowl had the Huskies vs. the Nebraska Cornhuskers. Jake Locker vs. Taylor Martinez. The Huskies went from 0-12 to Holiday Bowl champs in just two years.
Moments In Time: 2010 Holiday Bowl – A Great day for UW Football
December 20, 2011 By
Washington vs. Nebraska – Week 3 Recap
September 18, 2011 By
Jason Green brings us a College football week 3 game recap on the Washington 38 vs. Nebraska 51 matchup…


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Jena McGregor on the FC Now blog asks an interesting question: Where are the cruise ships in the Gulf Coast disaster? She says:
- Maybe they've offered and I've missed it. Maybe it's geographically or physically impossible to make it happen. But an offer from a cruise ship company to take the folks in the Superdome out into the Gulf of Mexico for a few days sounds like both a way to get thousands of people out of the misery of that area and -- while I don't mean this opportunistically in any way -- a PR gold mine.
I'm guessing that it was a physical impossibility, what with a Category 5 storm in the area, to position ships nearby before or during the storm. And, as one commenter pointed out, they probably don't have "spare" ships hanging around. Then again, if they can be brought in to house Superbowl overflow, now that the storm has cleared, they might be able to do something to help. But it would cost them a fortune to take the ships out of general circulation and feed everyone for free.
Then again, I hear the Astrodome is taking in refugees, and my guess is that now we're just starting to see the waves of help arrive for those in hard-hit areas. I just hope that it lasts as long as people are going to need it—I'm hearing it could be anywhere from a month to a year before New Orleans is fully operational again, and the lack of info about Biloxi and other areas outside of NOLA is a worrisome.


text: A Quiet Passion Previous image Next image Zoom Previous thumbnail Next thumbnail 1 of 1 A Quiet Passion 2 For £10 DVD £5.99 Barcode: 5060238032377 Studio: Thunderbird ReleasingCertification:12Duration: 125minsFormat: DVDCategory: DramaReleased: 17th July 2017 Earn Pure Points: 599 A Quiet Passion Qty Add to basket Where can I use my points? International delivery available.Free UK delivery on orders over £10. Usually dispatched within 24 hours. Click & Collect Get it delivered to a store near you with FREE click and collect available on this product. HubBox Click and Collect Get it delivered to one of over 4,000 HubBox locations for just £1 extra (plus any delivery charges) Share: Twitter Pinterest Facebook Google+


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Edwin M. Thomas, 57, of Lakewood Ave., passed away August 27, 2012 at home. He was the beloved husband of Sharon M. (Jimenez) Thomas for 37 years.
A son of the late Edward and Judith (Johnson) Thomas, he was an Enlisted Member of the Rhode Island Army National Guard for 36 years retiring as Master Sergeant.
Edwin was the loving father of Michael E. Thomas, Rhode Island Army National Guard; and brother of Debra Thomas, Dean Thomas and the late Kim Thomas. He is also survived by many nieces and nephews.
His funeral will be held Friday at 9a.m. from the Thomas & Walter Quinn Funeral Home, 2435 Warwick Ave. with a Mass of Christian Burial at 10a.m. in St. Peter Church, Fair St., Warwick. Burial with military honors will be in Rhode Island Veterans' Cemetery, Exeter. Visiting hours Thursday 4-8 p.m.
In lieu of flowers, contributions to the American Cancer Society, 931 Jefferson Blvd., Suite 3004, Warwick, RI 02886 would be appreciated. For information and condolences: TheQuinnFuneralHome.com


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Anna O'Connell says
I'm a regular blood donor in memory of Robert Heinlien and now in support of a friend in remission with leukemia; the Red Cross vampires get a pint from me every 8 weeks. Because I'm O neg (universal donor type) they call to book an appointment as soon as I'm eligible to donate again. My next opportunity is late February.
Theophylact says
Gave my 114th pint the first week in January, so I'm not eligible until early March.My first blood donation was over 50 years ago at college. Shortly after that, my grandmother required 40 pints of blood as a result of surgery for colon cancer, and because of my donation in Massachusetts, the New York hospital didn't charge for the blood. Basically, I've been paying back (and forward) ever since, except for a hiatus when I lived in Canada.For a while, I gave platelets, but the double-needle process stopped working with my elderly veins, so I just give whole blood (O+)these days.
Melissa says
I'm sorry for your loss but glad the funeral service provided something positive emotionally. Donating blood is something I haven't done in a while. I'll have to look up my local blood drives.
The Ridger, FCD says
Unfortunately chemo renders you ineligible… but at least I used to
Cuttlefish says
Yeah, but see, Ridger, you have now upped the ante for anyone else looking for an excuse not to give, AND have raised the emotional guilt factor of the plea for donations: "I wasn't gonna give, but Ridger was, if it were not for chemo…damn, sign me up for another pint!"


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FRANKFURT (Reuters) - Siemens' new Chief Executive Joe Kaeser is returning more power to lower-level managers around the world with the aim of making the engineering group more nimble.
The company, Germany's second-biggest by market value, said in a statement on Thursday it was doing away with a level of regional management it calls "clusters", introduced by former chief executive Peter Loescher in 2008, to return to a flatter hierarchy and make it easier to take quick decisions.
"Eliminating the clusters will make Siemens more streamlined and closer to the markets," Siemens said as around 600 of its managers held an annual meeting in Berlin.
Kaeser, a 33-year company veteran, was named as CEO at the end of July after Siemens dumped Loescher four years before the end of his contract, following a series of profit warnings.
Now he has to find a way to whip into shape a lumbering conglomerate with 78 billion euros ($105 billion) of annual sales and products ranging from gas turbines to high-speed trains and ultrasound machines.
Under the new structure, managers in countries that are most important to Siemens in terms of business volume and growth prospects will report directly to the executive board members responsible for Siemens' four main businesses - Industry, Energy, Healthcare and Infrastructure & Cities.
These countries, which Siemens does not specify, account for more than 85 percent of revenue.
A German magazine earlier reported CEO Kaeser was also planning a major corporate revamp that would see him dismantle the Infrastructure & Cities (I&C;) division and review the other three main businesses.
I&C; was only just set up by Loescher in 2011. It bundles businesses making products ranging from security to power distribution systems and high-speed trains and generates an annual revenue of about 17.6 billion euros.
Manager Magazin cited sources as saying Siemens would shift I&C;'s businesses to other parts of the company.
It said Kaeser would announce concrete plans for the reorganization in the European spring of 2014, with any new structure to be implemented a year from now. Siemens declined to comment on the report.
The report seemed to contradict recent statements by Kaeser, who said earlier this month that there were no plans for further restructuring measures after the company's current 6 billion euro savings program ends next year.
Kaeser has vowed to put Siemens back on an "even keel" and end years of continual restructuring.
Since he took office on August 1, he has remained largely below the radar, but he has already started to assemble a team of managers to help him close the gap with more profitable rivals like Switzerland's ABB and U.S.-based General Electric.
Earlier this week, Siemens announced Kaeser was bringing back former Siemens manager Horst Kayser as his new head of strategy on November 1, around five years after he left Siemens to become CEO of German industrial robotics company Kuka.
($1 = 0.7412 euros)
(Fixes typographical error in first paragraph)
(Editing by David Evans)


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CAMBRIDGE, Mass. – Seven members of the MIT men's track and field team will be making the trip to the University of Wisconsin-La Crosse for the 2013 NCAA Division III Men's and Women's Outdoor Track and Field Championships. The Championships will commence this Thursday, May 23 and will run through Saturday, May 25.
The final U.S. Track & Field and Cross Country Coaches Association (USTFCCCA) poll was released at the same time as the NCAA qualifying list, revealing that MIT has moved up six spots from last week to rest in 19th.
First up for the Engineers is the 4x100 relay that will compete on Thursday afternoon, soon after the start of the meet. The relay, that is composed of junior Michael DuPlessis (Wantagh, N.Y.), freshman Michael Kaba (Jackson, N.J.), senior Josh Duncavage (Austin, Texas) and junior Tyler Singer-Clark (Falmouth, Mass.), is seeded 13th.
To close the first day, the 4x400 relay, made up of freshman States Lee (Charlotte, N.C.), Kaba, freshman Derek Barnes (Coto De Caza, Calif.) and Singer-Clark, will take the stage. The young relay, with three freshmen and a junior, is seeded in third place, just four seconds shy of first-place seeded University of Wisconsin-Eau Claire.
In addition to the two relays, four Engineers will also be competing in individual events. Singer-Clark is seeded sixth in the 200m and Lee squeezed into the 400m in 20th place. Senior Patrick Marx (Grand Rapids, Minn.) is 19th in the 800m, while Kaba holds the highest seeding of all MIT athletes, sitting in fifth place in the 400m Hurdles.
The Championships will commence on Thursday, May 23 at 2:00 p.m. with the Heptathlon and the 4x100 relay will take off soon after 4:00 p.m. MIT will be looking to improve on its performance from the 2012 NCAA Outdoor Championships, where it tied for 68th place.
Host website - http://www.uwlathletics.com/sports/2012/12/13/MTRACK_1213120030.aspx?id=122


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Updating Builder
Before You Begin: Make a Backup
It is highly recommended to take a full backup of your Builder powered site using BackupBuddy before upgrading.
Important Notes
- Ensure that you are not using Builder Theme - Core as your site's active theme. Otherwise, customizations and changes you might have done to Builder files will be lost during upgrade. You must always use a child theme of Builder as your site's active theme.
- Make sure that you have first upgraded any Builder-related plugins in use such as Style Manager, Builder SEO and Builder Blocks to their latest versions before attempting to upgrade Builder.
Manually Updating Builder Using the Easy Theme and Plugin Upgrades Plugin
The easiest way to upgrade Builder is by using the free Easy Theme and Plugin Upgrades plugin. Created by lead Builder developer Chris Jean, this plugin allows you to easily update themes (like Builder) and plugins without having to manually delete your current version of the theme or plugin before uploading a new version.
- Download, install and activate the Easy Theme and Plugin Upgrades plugin from the WordPress.org plugin repo.
- Log in to the iThemes Member Panel and download the latest version of your Builder theme file(s).
- Again from the WordPress dashboard of your site, navigate to Appearance >Themes. Click Install Themes, then Upload.
- Browse to and locate the zip file of the latest Builder that you downloaded from member panel. Change the Upgrade existing theme? setting to Yes and click Install Now button.
- Once the theme has been successfully installed, click Return to Themes page.
- From the themes page, make sure you are using a child theme or custom theme of Builder as your active theme.
- Continue to the Licensing Builder page of the Codex to license your Builder site.
Licensing Builder for Automatic Updates
Automatic updates are now included in Builder 5.0. Visit the Licensing Builder page for instructions on licensing Builder for automatic updates.
- Builder can also be upgraded by replacing the existing Builder directory with the one extracted from the latest zip file using a FTP client or cPanel file manager. The advantage of using Easy Theme and Plugin Upgrades plugin is that it takes a backup of whatever is being replaced.
- If you have made extensive customizations to your child theme, visit the Updating Custom Child Themes section first.
See also
- Updating Custom Child Themes
- Builder - Introduction
- Features
- Installation
- Updating Builder
- Licensing Builder
- Release Notes
- Plugins that Conflict with Builder
- Support Forum
- Frequently Asked Questions