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by Tom Utescher
Last Tuesday at Episcopal Academy the Springside Chestnut Hill Academy basketball team was like one of those old cartoon characters with a little angel on one shoulder and a devil on the other, encouraging contrasting responses to a dilemma.
In this case the devil and the angel might have been called "Old Lions" and "New Lions," as SCH gained an early lead and then faced a determined rally by the host Churchwomen during a nerve-wracking second half.
Back during the first round of Girls Inter-Ac League contests, when the Lions saw a second-half lead disappearing they usually lost their composure, and the game.
With junior guard Gianna Pownall back in the line-up for the full second round of Inter-Ac bouts (following a concussion early in game three of six in the first set), SCH responded much better in a crisis, taking defending champ Germantown Academy into overtime and then avenging losses to Penn Charter and Notre Dame.
The "Old Lions" held sway early in the second half last Friday, as SCH failed to score for more than 11 minutes and watched their 32-17 halftime margin dwindle away, then the "New Lions" emerged just in time to avoid a catastrophic collapse, keeping control of the ball and shooting seven-for-10 at the foul line in the last 90 seconds to salvage a 41-36 victory.
Episcopal, which tied the game at 34-all with two minutes to go, could've clinched the Inter-Ac title outright if it had beaten SCH and then come
back on Friday to knock off GA, which lost on Tuesday at Penn Charter and slipped to a league record of 9-2. Instead, the Churchwomen's record went from 8-2 at the start of the week to 8-4 with the loss to SCH on Tuesday and a subsequent setback dealt them by GA, which became the sole champion at 10-2.
Springside Chestnut Hill, which had been 2-4 after the first round of Inter-Ac play, topped Baldwin 48-19 last Wednesday to cap a six-game win streak and end the regular season back even at 13-13 overall. With a 7-5 league record, the Lions (13-13 overall) tied for fourth place with PC, which defeated Baldwin on Friday, 42-28.
On Tuesday at Episcopal the Churchwomen's center, Megan Quinn (a 6'2" junior who has made a verbal commitment to Villanova University), rang up a game-high 19 points, but the Lions managed to spread out her scoring, with no more than six points in any one quarter. SCH senior Michelle Boggs focused on defending in the paint, coming away with three points and five rebounds.
Episcopal was missing one of its two seniors, starting forward Sarah McKay, who had torn an ACL two weeks earlier. The Lions were still without injured junior reserve Maddi Hinchey, while sophomore Madi Sehn, the first forward off the bench for SCH, was home sick.
The visitors got plenty of perimeter offense from senior Sydni Epps, who scored all of her 12 points on four rainbow three-pointers during the first 11 minutes of the contest. That helped the Lions to a 19-10 lead at the end of the opening period, and a 24-14 advantage in the middle of the second frame.
A third senior, forward Elana Roadcloud, scored three times from the paint in the first round and added a fourth field goal to make it 26-16. In addition, Pownall went to the hoop aggressively at the close of the first half, netting six points to contribute to a 32-17 bulge at the break.
As the second half dawned, Episcopal addressed the defensive rebounding problems it had had before the interlude, and also threw a press at the Lions.
Early in the third quarter, two buckets by EA's Quinn were sandwiched around a third personal foul on SCH's Epps, who retired to the bench. Episcopal also had a starter in foul trouble, but the player the Churchwomen subbed in, promising freshman guard Leah Becker, scored on a baseline drive and then hit a three-pointer to make it a six-point game at the three-quarter mark, 32-26.
Flustered by the EA press and anxiously throwing up bricks at the basket, the Lions saw the Churchwomen draw within two points before SCH ended a drought of more than 11 minutes. Roadcloud finally got the scoreboard moving again with a 12-footer from the right side, and the tally was now 34-30. A turnover and then an errant shot on two possessions by the Lions led to transition baskets by the home team, which pulled even at 34-all on junior Kristen Hinckley's lay-up with 1:59 to go.
Epps fouled out of the game seven seconds later, but it was actually the Lions who were on the brink of the one-and-one bonus. At 1:33, Pownall made a pair of free throws to move the visitors ahead for good. The "New Lions" were emerging down the stretch, coping with ball pressure and getting some key defensive stops. Senior Alexis Giovinazzo and Roadcloud each sank one of two free throws, nudging the lead to 38-34 with 28 seconds remaining.
After a miss by the Churchwomen at the offensive end, another foul sent Pownall to the line and EA's Hubley off the floor with her fifth personal. The SCH junior hit the first of two on the double-bonus opportunity, but Episcopal got two points back as Quinn completed her total from the free throw line.
It was now 39-36, but under nine seconds remained. Fouled once more, Pownall swished her first shot and rattled in the second, putting the final score on the board.
A rescheduled rematch with Baldwin School (0-12 Inter-Ac) took place at Springside Chestnut Hill the following afternoon. Senior Day recognition was extended to Boggs, Epps, Giovinazzo, Roadcloud, and team manager C.C. Conver. The first three have made their college choices; it'll be basketball for Boggs at East Stroudsburg and Epps at Hofstra, while Giovinazzo plans to play softball at Muhlenberg College.
The game itself gave all the Lions' reserves ample opportunity to play against the struggling Bears. The count was 20-5 at the quarter, and it kept on climbing, bringing the regular season to a stress-free conclusion for Springside Chestnut Hill.


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Crunchy Cornmeal Cookies
1+1/2cup All purpose flour
1+1/2cup Yellow cornmeal
1cup Powdered sugar
1tbsp Vanilla extract
1/2tsp Baking powder
Preheat the oven to 350F, line a baking sheet over a baking tray, keep aside..In a large bowl, beat together the butter and the powdered sugar until they turns creamy, meanwhile mix the flour,baking powder and cornmeal together and keep aside..gradually add the flours,vanilla extract to the butter-sugar mixture and knead as soft dough, cover the dough with a lid and arrange in fridge for an hour...Make a small balls from the dough and arrange over the baking sheet with enough space..bake for 15-20minutes until they turns golden brown.
Cocoa powder - 2 tbsp
Butter - 1 tbsp
Milk - to knead the dough
Grated Coconut - 2 tbsp
Sugar - as per taste level
1.Powder the Marie biscuits, Add cocoa powder, milk and knead it to a smooth dough like chapathi dough. Keep aside.
2.Mix coconut , butter and sugar in a seperate bowl, the mixture should be sticky. Roll the coco dough to form small chapathis.
3.Now spread the coconut mixture over the chapathis and gently roll them to form cylinders and keep aside.
4.Refrigerate the rolls for about 30mins; Remove and cut them width wise . Serve it immediately as the rolls butter part tend to melt down.
All purpose flour: 1 tablespoon
Coconut milk: 1 ¼ cup
Water: ¼ cup
Salt: ¼ teaspoon
Egg: Half of one egg
Baking powder: ¼ tsp
Sugar: ¼ cup
Black Sesame seeds: 1 tablespoon
Oil for frying
Beat egg slightly in a small bowl
In bowl add rice flour, salt, baking powder, sugar, black sesame seeds, slightly beaten egg and coconut milk and water, mix everything until incorporated well. Batter should be similar to pan cake or dosa. Keep aside.
Heat oil in wok and put mold also in oil while heating. When oil is smoking hot, dip acchappam mold in the batter and again put in oil with batter. Acchapam begin to leave from mold as it starts cooking. If it not dot detach by itself from the mold, use a skewer to help to detach, and continue to cook them until it become crisp and slightly brown in color. Remove them using a skewer and drain extra oil in paper towel. When it completely cooled, store it in an air tight container.
MW Honey Lemon Pistachio Cookies
Fine Sugar : 1/2 cup
Butter/margarine : 1/4 cup (room temperature)
Water : 2 tblsp.
APF/all purpose flour : 2and 1/2 cup
Egg : 1 (beaten)Baking powder : 1 tsp.
Pistachio/almonds : 1/2 cup (chopped)
Lemon peel : 1/4 cup
Lemon extract: 1 tsp
* In a medium sized saucepan, combine honey, sugar, butter/margarine and water. Stirring constantly, cook over low heat until butter melts and sugar dissolves. Cool to room temperature.
* In a large bowl, blend flour, baking powder, pistachios and lemon peel.
* Stir beaten egg and lemon extract into cool honey mixture. Stir honey mixture into four mixture little by little and mix. Knead to make a soft pliable dough, not too hard. Cover with a plastic wrap and refrigerate the dough for 1 hour.
*Take out and divide the dough into 5-6 big balls. Take each ball and spread out to 1/4 inch thickness. Cut into your desired shapes with cookie cutter.
* Take a microwave safe container/plate, grease it a little or place them on a waxed paper on MW glass tray.
* Microwave on medium high for 4 minutes. (My MW power is 1250 watt-time depends on the power level of your MW)
* The cookies should be just firm when done. It will be crunchy when cooled down.
Coconut Oatmeal Cookies
Savithri's Spot
1/2 cup sweetened coconut
1/2 oats (quick cook)
1/8 tsp salt
1/2 tsp baking soda
3/4 cup butter
1/4 brown sugar
2 tbsp honey
Set oven to 350 degrees.
Combine the flour, coconut, oats and salt and baking soda together in a bowl.
Melt the butter in a pot on the stove and add the brown sugar and honey to it. Let it combine and then cool for 2 minutes before adding it to the dry ingredients.
I found the mixture a little dry when I made it so I added some water to it to help it combine better. Two to three tablespoons did the trick.
Roll out round balls (walnut size) and flatten on baking sheet and put in the oven for 11-13 minutes or until brown.
Eggless Almond-vanilla cookies
4 oz softened butter
2 oz ground almonds
1 level teaspoon bicarbonate of soda
½ teaspoon baking soda
1 teaspoon vanilla essence
3 tablespoons milk slightly warmed
3 oz golden brown sugar
1 tablespoon flour (for rolling and dusting.)
1. Cream together the softened butter and sugar till light and fluffy.
2. Add the vanilla essence and warmed milk. Mix thoroughly.
3. To the flour add the bicarbonate of soda and baking powder and sieve together.
4. Add the ground almonds to the sieved flour and mix together.
5. Gently fold in the flour and almond mixture to the creamed butter and sugar mixture.
6. Mix together to make a soft dough.
7. Wrap the dough in cling film and put in the fridge for 30 mins.
8. Heat the oven to 180 degrees centigrade.
9. After 30 minutes remove dough from fridge and divide into 4 parts.
10. Roll out each part onto a floured surface and cut out desired shaped cookies.
11. Transfer the cookies to a greased baking tray and cook in the oven for 7-8 minutes till lightly brown.
12. Remove from oven and cool on a cooling rack.
13. Repeat for remainder of dough.
Store cookies in an air tight jar or container.
Shortbread Cookies
My Culinary world
1 cup all-purpose flour
1/2 cup icing sugar
1/2 cup cornstarch
1/2tsp.vanilla extract
Sift four, cornstarch, sugar together and keep it aside. Cream butter, vanilla until light and fluffy, then add the sifted dry ingredients to butter in few batches; blend smooth with mixer until they are mixed well. Refrigerate dough 15 minutes. Preheat oven to 300F. Make 1'' balls, place then on ungreased cookie sheet; flatten lightly with fork. Chill the cookies for 5-10min., then bake for about 20-25min., or until slightly brown.
Chips Ahoy Style Cookies
1 tsp baking soda
1 tsp salt
1 cup light brown sugar
1cup granulated sugar
1 1/2 cup veg shortening
1 1/2 tsp vanilla extract
1 large egg white
2 tbs warm water
12 ounces semi sweet chocolate chips
Preheat oven to 325 degree F. Mix the flour and baking soda in
bowl and keep aside. With an electric mixer beat the two sugars and
shortening until creamy. To this add vanilla, salt and egg white. Add
the flour half cup at a time, adding a tbs of water, as necessary to mix
the flour. Mix in chocolate chips, roll into 2 inch balls and press down
with the palm of the hand to make flat. Bake 12 to 15 minutes or until
golden brown.
Vegan Chocolate Banana Cake
Madhuram's Eggless Cooking
Whole Wheat Pastry Flour 2 cups
Granulated Sugar (See Notes) 1 and 1/3 cup
Cocoa Powder 2/3 cup
Baking Soda, 1 and 1/2 teaspoon
Wet Ingredients:
Canola Oil 1/4 cup
Hot Water 1 and 1/2 cups
Vanilla Extract 1 teaspoon
Bananas, mashed or pureed 1 cup
1. Preheat the oven at 350F/180C. Spray a bundt pan with non stick cooking spray.
2. In a large bowl mix together the dry ingredients and keep it aside.
3. I pureed 2 small size bananas with little water to measure 1 cup of puree.
4. To the flour mixture add the canola oil, hot water and vanilla extract; mix well.
5. Now add the pureed bananas and blend thoroughly.
6. The cake batter is quite "water-y". Pour the batter in the prepared pan and bake for approximately from 45-60 minutes or until a toothpick inserted comes out clean. The original recipe mentions 55-60 minutes, but mine was done after 45 minutes itself.
7. At this stage I did see some cracks on the cake. Move the bundt pan to a cooling rack and let it cool for 10-20 minutes. Place a baking sheet on the pan and slowly invert the pan holding the sides of the sheet to remove the cake from the pan. Then carefully transfer the cake to the wiring rack and let it cool completely before you frost. I didn't frost mine.
My Notes:
1. The original recipe used all purpose flour but we did not realize that the cake was made with whole wheat pastry flour. The cake had a wonderful texture; moist but not sticky and not gritty. This can very well be a birthday cake; but I would use butter in that case.
2. You could also increase the quantity of sugar to 1 and 1/2 cups if you are not frosting this chocolate banana cake. You could also sprinkle some chocolate chips instead. Since I wanted to make a vegan cake I did not add any. I prefer mild sweetness so the 1 and 1/3 cup was perfect.
3. The cake was surely moist but I felt that it did not taste rich. The original recipe uses 1/2 cup of melted butter for the fat which I replaced with 1/4 cup canola oil and some mashed bananas. So I think we could use 1/4 cup of melted butter or margarine instead to give that richness. If you want to use entire 1/2 cup batter, you can reduce the quantity of mashed bananas to 3/4th cup.
4. The next time I try this recipe I'm going to use cooked beet puree instead of mashed bananas. I'm pretty sure that its going to be so good.
Spiced Eggless Sponge Cake with Carrots
100 grams salted butter, melted
1 tin condensed milk (I held just a bit back)
1/2 cup grated carrot
3/4 tspn baking powder
3/4 tspn cinnamon powder
3-4 cloves crushed
1/2 cup milk
chopped almonds to spread on batter
Pre-heat oven at 180c for about 10 minutes
Grate carrot and keep aside
Melt butter and mix well with 1 tin condensed milk
Add 3/4 teaspoon baking powder and mix again
Add 1 cup flour – little at a time to avoid lumps and milk simultaneously
Mix batter well and add the cinnamon powder and crushed cloves
Mix grated carrots and pour into a greased baking tin, spread chopped almonds on top
Bake for about 30 minutes at 180C depending on your oven.
Viennese Sachertorte
Devi' Blog
150 gms butter
150 gms icing sugar
few drops of vanilla essence
6 eggs, separated
125 gms all-purpose flour
1/4 teaspoon baking powder
1. Break the chocolate (150 gms) and melt it in a bowl placed over simmering water.
2. Beat the chocolate, butter, icing sugar, vanilla essence, and egg yolks until it combines well.
3. Sift the flour and baking powder and add it to the batter and mix well
4. Beat the egg whites and fold into the batter
5. Preheat the oven to 300 F, place the batter in the baking pan and bake for about 50-60 minutes, then take it out and allow to cool.
6. Melt the remaining chocolate placed in a bowl over simmering water and spread over cake and leave it to set for some time. The cake is ready.
Almond Pistachio Cookies with Saffron Icing
Veggi Fare
5 tbsp - sunflower oil
7 tbsp - low fat milk
6 tbsp - muscovado sugar / castor sugar
1/4 tsp - vanilla essence
1/4 cup - almonds, blanched and sliced thinly
1/4 cup - pistachio, coarsely powdered
1/4 tsp - bicarbonate of soda
a pinch of salt
Icing - 2 1/2 tbsp castor sugar, a few drops of warm milk and a few strands of saffron. (mix everything together)
1.Preheat the oven to 190 degree C and line a baking tray.
2.Mix together the oil, milk, sugar and vanilla essence in a bowl.
3.In another bowl, mix together the flour, almond slices pistachio, salt and bicaarbonate of soda.
4.Make a well in the centre of the flour mixture and add the liquid mixture and mix lightly with a wooden spoon. Do not overmix.
5.Scoop 1 tsp of the mixture and roll into balls. Place them on the lined baking tray, spaced well apart and flatten slightly.
6.Place the tray in the centre of the oven and bake for about 8-10 minutes or until a skewer inserted in the centre of a cookie, comes out clean.
7.Let the cookies cool in the tray for 5 minutes and then transfer them on a wire rack to cool completely.
8.Drizzle the icing on the cookies. Leave to set.
Mexican Wedding Cookies
Desi Soccer Mom
1/2 cup fine sugar
1 tsp vanilla extract
1 + 3/4 cups APF
1 cup almonds, (1/2cup ground fine and the other half coarse)
1/2 cup chocolate chips, chopped coarse
1/2 cup sweetened flake coconut (optional)
pinch of salt
1/2 tsp nutmeg
1/4 tsp dry ginger powder (optional)
1/2 tsp instant coffee powder (optional)
1/2 cup confectioner's sugar, for dusting
Cream the butter and sugar together till light and fluffy. Add the vanilla extract and beat some more.
In a separate bowl, combine all the dry ingredients thoroughly.
Gradually add to the whipped butter till well incorporated.
Wrap tightly in the shape of a log in a plastic wrap and refrigerate for an hour.
Preheat the oven to 325 degree F (180 degree C).
Cut one inch discs out of the log and roll into balls.
Place an inch apart on a parchment lined cookie sheet and bake for 8 - 10 minutes till the cookies are firm to touch.
Transfer to a wire rack to cool and after a minute dust the confectioner's sugar on top with the help of a small strainer.

subset: commoncrawl


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One of the first things that may come to mind when you think about creating a quilt from re-purposed fabric is using fabric from vintage sheets. A quick search on the internet and you will pull up many quilts made from vintage sheets. Today we will feature two very different quilts that both feature this fun and versatile re-purposed fabric. Read below as Jeni Baker and Jodie Bissig tell us more about using vintage sheets to create these quilts.
Featured Quilt 4a: Giant Vintage Star
The first of the two quilts is by Jeni Baker and it's called the Giant Vintage Star Quilt. Jeni blogs at In Color Order and you can find her on Flickr as well. She is a member of the Madison Modern Quilt Guild. Read on as Jeni answered a few question about this quilt.
Tell Us About Your Quilt
One night, I was poking around on Pinterest and was led to an article featuring barn quilts located in Adams County, Ohio. I had seen a barn quilt before in Holmes County, Ohio, but hadn't thought much about it. I was immediately inspired by these barn quilts, and started thinking about translating the concept into a quilt. I realize this is sort of backwards, as barn quilts are generally inspired by real quilts, so I suppose making this quilt completed the circle! This quilt is made up entirely of one giant quilt block. The block is generally known as the Starflower block, a block I was already familiar with and fond of. This seemed a perfect opportunity to dig into my vintage sheet stash. I ended up choosing a rainbow of colors in addition to a fun white patterned sheet for the background. It finishes off as a healthy throw quilt at 68″ square.
What Do You Love About Using Scraps or Re-purposed Fabrics?
It's a great feeling to create something beautiful from something that has been discarded. I definitely get that feeling working with vintage sheets. You're giving them a second chance to shine and become something useful. Plus, it's Eco-friendly! 🙂
Tell Us About Yourself and About You as a Quilter
I grew up in Ohio and am currently living in Wisconsin with my boyfriend and pet bunny George. I graduated with a degree in Marketing and Studio Art and am currently teaching sewing classes at a sewing lounge part time. Creating has always been an important part of my life, whether it be through sewing, photography or other crafts. I learned to sew about 10 years ago through trial and error and a bit of help from my Mom. I started quilting in late 2009 after moving into my first apartment, and have been hooked ever since. My favorite part of the quilting process is choosing the fabrics and colors.
Featured Quilt 4b: Vintage Neighborhood
The second quilt featured today is called Vintage Neighborhood by Jodie Bissig. Jodie blogs at Sew Handmade and you can find her on Flickr too. She is a member of her local quilt guild where last year she was the proud librarian. There isn't a local Modern Quilt Guild in her area, YET! Do we see President/Founder Jodie in her future? Read on as Jodie talks about making Vintage Neighborhood and her love of quilting.
Tell Us About Your Quilt
This 36″ square quilt was made using blocks from an online quilting bee with members from all over the U.S. This was the first time I ever participated in a group like this and I loved it. I requested "wonky house blocks" for my month and encouraged the ladies to be creative. This quilt includes three blocks I made myself and 6 blocks made by others in the group.
What Do You Love About Using Scraps or Re-purposed Fabrics?
I love vintage sheets for many reasons – first, the patterns and colors are so beautiful – I especially love the florals and prints that look like watercolors. I love how soft and well-worn the fabrics feel, without being 'worn out." And, lastly, I love the cost! A large vintage sheet costs only a few dollars at a thrift store and provides yards and yards of beautiful fabric.
Tell Us About Yourself and About You as a Quilter
I started quilting in 2007- I completed my first quilt just in time for my daughter's first birthday. Since then, I've made 49 quilts in between raising my babies and running a photography business. My husband and I are currently building a house and our plans definitely include a sewing room! I love to sew and there's nothing better that seeing my children peacefully sleeping under a quilt I have made for them.
Thanks Jeni and Jodie for sharing your beautiful vintage sheet quilts with us!


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Chikungunya virus (CHIKV) has caused multiple outbreaks in tropical and temperate areas worldwide, but the clinical and biological features of this disease are poorly described, particularly in Africa. We report a prospective study of clinical and biological features during an outbreak that occurred in Franceville, Gabon in 2010.
Methodology/Principal Findings
We collected, in suspect cases (individuals presenting with at least one of the following symptoms or signs: fever, arthralgias, myalgias, headaches, rash, fatigue, nausea, vomiting, diarrhea, bleeding, or jaundice), blood samples, demographic and clinical characteristics and outcome. Hematological and biochemical tests, blood smears for malaria parasites and quantitative PCR for CHIKV then dengue virus were performed. CHIKV+ patients with concomitant malaria and/or dengue were excluded from the study. From May to July 2010, data on 270 laboratory-confirmed CHIK patients were recorded. Fever and arthralgias were reported by respectively 85% and 90% of patients, while myalgias, rash and hemorrhage were noted in 73%, 42% and 2% of patients. The patients were grouped into 4 clinical categories depending on the existence of fever and/or joint pain. On this basis, mixed forms accounted for 78.5% of cases, arthralgic forms 12.6%, febrile forms 6.7% and unusual forms (without fever and arthralgias) 2.2%. No cases of organ failure or death were reported. Elevated liver enzyme and creatinine levels, anemia and lymphocytopenia were the predominant biological abnormalities, and lymphocytopenia was more severe in patients with high viral loads (p = 0.01).
Author Summary
Chikungunya fever (CHIK) is a disease caused by a virus transmitted to humans by infected mosquitos. The virus is responsible for multiple outbreaks in tropical and temperate areas worldwide, and is now a global concern. Clinical and biological features of the disease are poorly described, especially in Africa, where the disease is neglected because it is considered benign. During a recent CHIK outbreak that occurred in southeast Gabon, we prospectively studied clinical and biological features of 270 virologically confirmed cases. Fever and arthralgias were the predominant symptoms. Furthermore, variable and distinct clinical pictures including pure febrile, pure arthralgic and unusual forms (neither fever nor arthralgias) were detected. No severe forms or deaths were reported. These findings suggest that, during CHIK epidemics, some patients may not have classical symptoms (fever and arthralgias). Local surveillance is needed to detect any changes in the pathogenicity of this virus.
Citation: Nkoghe D, Kassa RF, Caron M, Grard G, Mombo I, Bikié B, et al. (2012) Clinical Forms of Chikungunya in Gabon, 2010. PLoS Negl Trop Dis 6(2): e1517. https://doi.org/10.1371/journal.pntd.0001517
Editor: Daniel G. Bausch, Tulane School of Public Health and Tropical Medicine, United States of America
Received: July 28, 2011; Accepted: December 22, 2011; Published: February 14, 2012
Copyright: © 2012 Nkoghe et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: CIRMF is supported by the Gabonese State, Total Gabon, and Ministère Français de la Coopération. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Chikungunya fever (CHIK) is a neglected tropical disease caused by the Chikungunya virus (CHIKV), an arthropod-borne virus belonging to the genus Alphavirus of the Togaviridae family. This virus is transmitted to humans via the bite of infected Aedes mosquitoes (Aedes aegypti, Aedes albopictus). The genome consists of a single positive strand of RNA that encodes four nonstructural proteins involved in virus replication and pathogenesis, and five structural proteins that compose the virion [1]. CHIKV is subdivided into three genotypes based on phylogenetic analyses. These genotypes, based on the gene sequences of an envelope protein (E1), are Asian, East/Central/South African (ECSA), and West African [2]–[6].
Over the past two decades, this virus has caused multiple outbreaks worldwide, particularly in tropical and subtropical areas. Since its initial isolation in Tanzania in 1953, sporadic cases and numerous outbreaks have been reported in Africa, India Ocean Islands, India, and even in Italy, a temperate region. CHIKV circulated in West and East Africa at low levels until 1999–2000, when an outbreak occurred in the Democratic Republic of the Congo (DRC) with around 50,000 cases [7]. From 2004, successive epidemics occurred, starting in Kenya with 13,500 cases and then spreading through the Indian Ocean region, including the Comoros Islands, Mauritius, Mayotte, La Réunion Island, Madagascar and the Seychelles [8]–[13]. On La Réunion Island alone, which has a population of 760,000 inhabitants, at least 266,000 cases were reported [14]. Thereafter, the epidemic arrived on the Indian subcontinent in 2006–2007 and caused more than 1.3 million cases [15]. Genetic analyses showed that the ECSA genotype was responsible for these outbreaks [8], [16]. Numerous cases were subsequently reported all over the world [17], directly associated with the return of tourists from India and affected India Ocean islands [2]. The first reported European outbreak occurred in two contiguous villages of northeastern Italy [18].
A unnoticed and retrospectively diagnosed large outbreak hit Cameroon in 2006 [19], then Gabon one year later, where a concomitant CHIKV/dengue virus- serotype 2 (DENV-2) epidemic raged in the northwest and north; 20,000 cases were recorded and Aedes albopictus was identified as the main vector [20]. Isolates from the 2007 Gabon outbreak belonged to the ECSA phylogroup and harbor the A226V mutation [6].
Thus, the virus has proven able to expand to novel ecological niches, together with the vector Aedes albopictus [21], [22]. Recently, autochthonous cases of dengue fever (DF) and CHIK were reported in southern France, where Aedes albopictus has also been detected, raising serious concerns [23].
CHIK, a word from the Bantu language, means "that which contorts or bends up" referring to the stooped posture that develops in infected patients due to severe joint pain and impaired walking ability.
The clinical manifestations of CHIK are now well described. The infection is characterized by three distinct forms: asymptomatic, classical and severe. The asymptomatic form is revealed by serology, in naïve populations. In its classical form, the illness appears as a "dengue-like" disease, sometimes being confused with DF, particularly in areas where the two viruses cocirculate [3], [22], [24]. After an incubation period of 3–7 days, symptoms start abruptly with acute fever, followed by severe and often debilitating polyarthralgias sometimes lasting months or years. Additional symptoms include a maculopapular rash, myalgias and headaches [3], [22], [24]. In La Reunion Island, severe forms were reported, mainly in patients with underlying medical conditions. These forms included neurological and cardiovascular disorders, acute hepatitis, skin diseases, and respiratory and renal failure. Miscarriages and neonatal infections were also reported, and some deaths were directly attributed to CHIKV [3], [14], [25], [26].
In previous studies, clinical and biological descriptions were mostly retrospective, and included a limited number of patients. Furthermore, except for the first known CHIKV outbreak in Tanganyika [27], most studies were conducted in Asia, the Indian Ocean Islands and Europe [18], [25], [28], [29], while none have concerned Africa, where multiple pathogens co-circulate [7], [19], [20], [30]–[32].
Here, we report the findings of a prospective, exhaustive clinical and biological study of 270 laboratory-confirmed cases during the simultaneous CHIKV/DENV outbreak which occurred in Gabon, a Central African country, in 2010 [33], focusing on the high clinical variability.
Materials and Methods
Outbreak area
A simultaneous CHIKV/DENV outbreak was reported in two provinces (Ogooue Lolo and Haut Ogooue) of southeast Gabon, from April to July 2010. This study took place in Franceville, the main town of Haut Ogooue province, located 512 km south-east from Libreville (capital of Gabon) (Figure 1). In Franceville, there are 4 healthcare capacities, including 2 public hospitals with a total of 170 beds. The Centre International de Recherches Medicales de Franceville (CIRMF), which includes a medical unit, is located in the heart of the city.
Ethical considerations
The CIRMF team partnered the Ministry of Health (MoH) response team during this outbreak. The investigations (epidemiological and clinical inquiries, blood sampling for laboratory confirmation) were thus considered as part of the public health response. According to the MoH's directives, written consent was not required due to emergency diagnosis. An oral consent was obtained for each patient during interviews. The study was approved by the Regional Health Director, including individual oral consent for blood sampling (Authorization n°189, Figure S1). The results were transmitted to patients and MoH.
Study population and clinical examination
The study was conducted in the field by two doctors who investigated cases in all healthcare facilities of Franceville, while free medical consultations were provided by another in the CIRMF medical unit.
At the time of this outbreak, all the hospitals were requested to sample suspected cases. The case definition adopted by the MoH included suspected and confirmed cases. Patients were suspected of having CHIK if they presented with at least one of the following symptoms or signs: fever (defined as a temperature ≥38°5, measured by a HCW), arthralgias, myalgias, headaches, rash, fatigue, nausea, vomiting, diarrhea, bleeding, or jaundice. A 'confirmed' case met the clinical case definition and was PCR-positive.
Patients with suspected CHIK who were identified by the CIRMF team were examined physically, then data were collected on a standardized questionnaire, including age, sex, residence, time of onset and intensity of symptoms, and location of arthralgias (Figure S2). Analgesics and non steroidal antiinflammatory drugs (paracetamol, ibuprofen) were provided to patients according to MoH recommendations. If necessary, patients were hospitalized, and the length of stay was transmitted to our team. Finally, clinical data on the disease course and outcome were collected during a 3-month period.
Blood collection and laboratory analyses
Blood samples were collected in two 7-ml EDTA Vacutainer tubes and one 7-ml dry tube (VWR International, France). The tubes were stored in the dark at +4°C until arrival at the laboratory.
Thick and thin blood films were stained with 20% Giemsa and examined for malaria parasites. Patients with positive test were excluded from the study. Hematological (Hematology Analyser ACT 10, Beckman Coulter) and biochemical (creatinine, AST, ALT) tests were performed (Automatic Analyser Hitachi model 902, Roche Diagnostics).
For molecular studies, RNA was extracted from 140 µL of plasma by using the QIAamp Viral RNA Mini Kit according to the manufacturer's recommended procedures (Qiagen, Courtaboeuf, France). cDNA was synthesized in a 9700 thermocycler (Applied Biosystems, Foster City, CA, USA), where 25 µL of extracted RNA was mixed with 25 µL of High Capacity cDNA kit (Applied Biosystems, Foster City, CA, USA). Finally, 5 µL of newly synthesized cDNA was used as template in 25 µL of TaqMan Universal PCR Master Mix and then, thermocycled in a 7500 Real-Time PCR system (Applied Biosystems).
RNA positive and negative controls were added in each run. The TaqMan PCR products were identified by curves using a 7500 system SDS software.
The quantitative PCR mix were run with 400 nM of each primer and 200 nM of probe. The E1 gene (208 bp) was targeted for the CHIKV detection (genome position, 10387–10595): CHIK-S (S = Sense): AAGCTYCGCGTCCTTTACCAAG; CHIK-R (R = Reverse): CCAAATTGTCCYGGTCTTCCT; CHIK-P (P = Probe): CCAATGTCYTCMGCCTGGACACCTTT [34]. For DENV detection, the 3′ UTR (107 bp) was targeted (genome position, 10590–10697): DENt-S (t = total, for the 4 serotypes): AGGACYAGAGGTTAGAGGAGA; DENt-R: CGYTCTGTGCCTGGAWTGAT; DENt-P: ACAGCATATTGACGCTGGGARAGACC [35]. The probes used for CHIKV, then for DENV assays were labeled with FAM-reporter and TAMRA-quencher (Applied Biosystems). Quantified RNA transcripts and cell-culture supernatants of CHIKV and DENV were used in 10-fold dilutions as standards for viral load (VL) determination. The VL was determined by comparison to a standard curve. This standard curve was obtained from standard RNA which was diluted at 10 in 10 times. Exponential regression was used to determine the CHIKV viral loads from the threshold cycle. The standard linearity minimum was <101 cDNA genome equivalents/mL. DENVs were typed as previously described [35].
Co-infected patients were excluded from this study.
Statistical analyses
Statistical analyses were performed using Epi Info software (6.04, Epiconcept). Results were expressed as averages (with their SD) and percentages (with their 95% confidence interval, CI). Student's t test was used to compare laboratory parameters (samples from 50 healthy volunteers recruited at the CIRMF medical unit, with sociodemographic characteristics similar to those of the study subjects, were selected as controls) and continuous clinical variables. For qualitative variables, the Chi square test or Fisher's exact test was used as appropriate. A p value <0.05 was considered to denote statistical significance.
Outbreak description
From May to July 2010, 2731 suspected cases were recorded in the two provinces, and 1208 cases (44.2%) were laboratory confirmed (Table 1). There were 1139 CHIKV+ cases (94.2%) in Haut Ogooue province. In all, 933/2063 (45.2%) cases were confirmed in Franceville, representing 81.9% of the confirmed cases in the province.
The first cases were confirmed on April 25 (week 17), the peak incidence was reached at weeks 21 and 22 (400 confirmed cases), and the outbreak ended at week 27 (Figure 2).
Study population
Of the 2063 suspected cases detected in Franceville, 408 (19.8%) were examined by the CIRMF medical team, of whom 289 were CHIKV+, 19 were co-infected (with 18 CHIKV+/DENV+ patients and 1 CHIKV+/DENV+/malaria+). So, 270 CHIKV+ (66.2%) were selected for the study (Figure 3). The 119 CHIKV- patients did not receive a diagnosis.
They represented 28.9% of all CHIKV+ patients in Franceville. They were distributed throughout the outbreak, with 99 (36.6%) patients included at the epidemic peak, in weeks 21 and 22 (Figure 2).
The M/F sex ratio of the study population was 0.85 and mean age was 30±16 years (range, 1–77). Fifty-six patients (20.7%) were under 16 years old, 70 (26.3%) 16–30 years old, 92 (34.1%) 31–45 years old, and 53 (18.9%) over 45 years old.
Clinical symptoms
CHIK patients consulted an average of 2 days (range, 0 to 18 days) after the onset of symptoms, 232 (85.9%) from day 0 to 3, 30 (11.1%) from day 4 to 7, and 8 (3%) after day 7. The mean duration of symptoms in the acute phase was 7 days (range, 1–24 days). Hospitalization was necessary for 42 patients (15.5%) with more pronounced manifestations, and the mean length of stay was 2.6 days (range, 1 to 6 days).
At the time of the initial consultation, 230 (85%) patients complained of fever, 246 (90.4%) had arthralgias, 197 (72.9%) myalgias and 194 (71.8%) headaches (Figure 4). They all described an abrupt onset of the illness.
Joint pain was mostly polyarticular, bilateral and symmetrical. On average, 7 joints per patient were affected. Among the 246 patients with arthralgias, 100 (40.7%) had fewer than 5 affected joints, and 146 (59.3%) had 5 or more affected joints. Arthralgias occurred in the large joints (shoulders, elbows, wrists, knees, ankles) in 242 (98.4%) patients, and in the lower limbs in 220 (89.4%) patients; the spine was affected in 146 (59.3%) patients. Incapacitation was noted in 158 (64.2%) patients (Table 2), and swelling of the elbows, wrists, knees or ankles was noted in one-quarter of these patients (Figure 5A).
A: Swelling of the ankles and feet in a 43-year-old woman. B: Resolutive maculopapular rash of the arms in a 41-year-old man. C: Bullous vesicles on the thigh of a 3-year-old child. D: Rash with edema of the face in a 16-year-old girl.
Myalgias mainly affected the forearms, arms, thighs and calves, and sometimes became increasingly incapacitating. No cases of myositis were seen. Headaches were beating or weighty, and were located in the frontal, parietal, retro-orbital or, rarely, occipital regions. Skin lesions were noted in 113 (41.8%) patients, in the form of macular or maculopapular exanthema (Figure 5B), morbiliform or bullous rash in a few children (Figure 5C), and was accompanied by pruritus in one-quarter of cases. A more aggressive form, with facial edema, was seen (Figure 5D). Peeling of the affected skin occurred a few days after. Digestive symptoms, consisting of abdominal pain, nausea, vomiting and diarrhea (87, 32%), were described, and mild bleeding of the nose and gums reported (6, 2.2%) in patients with normal platelet counts. Seizures occurred in 2 children (CSF was not sampled), who recovered without sequelae.
No complications or deaths were reported.
Distribution of clinical forms
The disease was classified in four forms according to the existence of fever and/or arthralgias (plus any additional symptoms), namely mixed (fever and arthralgias both present), pure febrile (fever without arthralgias), pure arthralgic (arthralgias without fever), and unusual (neither fever nor arthralgia).
The mixed form was found in 212 (78.5%) patients, the arthralgic form in 34 (12.6%), the febrile form in 18 (6.7%), and the unusual form in 6 (2.2%) (Figure 6A). Patients with the unusual form mainly had digestive symptoms (Table 3).
A: Distribution of the four clinical forms. B: Distribution of clinical forms according to the period of the outbreak.
The performance indicators of the "fever and arthralgia" combination were estimated in suspected patients (including PCR negative patients), taking into account the true positive (TP), true negative (TN), false positive (FP) and false negative (FN) results. Sensitivity was calculated as TP/(TP+FN), specificity as TN/(TN+FP), positive predictive value (PPV) as TP/(TP+FP) and negative predictive value (NPV) as TN/(FN+TN). The "fever and arthralgia" combination showed a sensitivity and specificity of respectively 73.1% and 41% for PCR positivity, and PPV and NPV of 78.5% and 34.4% (Table 4).
All four forms occurred throughout the outbreak, with a majority of patients in the mixed form between week 18 to 23 (Figure 6B).
There was no significant difference in the mean duration of symptoms (p = 0.33) across the 4 clinical forms. Hospitalization was necessary for 35 (16.5%) patients in the mixed form, 3 (8.8%) patients in the arthralgic form, 4 (2.2%) patients in the febrile form and none of the unusual form (p = 0.33), and there was no significant difference in the mean length of hospital stay (p = 0.16).
Biological parameters
Hematological and biochemical parameters were available for 224 patients. Mean counts of leukocytes (5243±1676/mm3, range 1900–11000/mm3) and platelets (233 089±81 750/mm3, range 52000–455000/mm3) did not differ from the controls. Nevertheless, anemia (mean hemoglobin 12.3±1.7 g/dl, range 8–17 g/dl), and lymphocytopenia (mean lymphocyte count 2228±216/mm3, range 184–7150/mm3) were significantly frequent in CHIKV+ patients (respective p values 0.0009 and <0.0001) than in the controls. Liver enzymes (AST and ALT) and creatinine levels were significantly higher (respective p values 0.03, 0.003 and <0.0001) in CHIKV+ patients than in controls (Table 5).
There was no significant difference in hemoglobin rate, leukocyte, lymphocyte, or platelet count, or biochemical parameters across the four clinical forms.
Viral load
A total of 123 patients were selected for viral load (VL) assay. The selection criteria included age, sex, site of consultation, area of residence, week of disease onset, and clinical form. Their characteristics were comparable to those of the initial sample.
The mean VL was 1.2×107 (range, 1–4.4×108). Fifty eight patients (47.2%) had low VL (<100 000 DNA copies per mL, Group 1), and 65 (52.8%) had high VL (≥100 000 DNA copies, Group 2). There was no difference in hemoglobin rate, leukocyte or platelet count or biochemical data between the two groups. However, lymphocytopenia was significantly more frequent (p = 0.01) in group 2 than in group 1. Moreover, there was no difference in symptoms, affected joints (large vs small), their location or intensity (Table 2).
There was no difference in VL according to the day of sampling or symptom onset (day 0 to 3, day 4 to 7, and after day 7). VL did not differ across the four clinical forms.
Outcome at month 3
Of the 270 CHIKV+ patients included in the study, 225 (83.3%) had completely recovered by day 30. The other 45 patients complained of persistence or relapse of fever (n = 6), arthralgias (n = 36; incapacitating arthragias were still present in 5 patients), myalgias (n = 11), headaches (n = 20), pruritus (n = 5) or fatigue (n = 10).
At day 90, 11 patients had persistent arthralgias. Among the 5 patients with incapacitating arthralgias, 4 recovered by day 90 and one was lost to follow-up. Three patients had headaches.
During a recent concomitant CHIKV/DENV outbreak which occurred in south-east Gabon, we conducted a prospective study in the most affected town, obtaining clinical and biological descriptions of 270 laboratory-confirmed cases of CHIK. We found variable clinical manifestations, including unusual forms.
This is the second large epidemic to be reported in Gabon, after the concurrent CHIKV/DENV-2 intrusion in 2007, in which 2 provinces and 7 towns were affected. International shipping was suspected of providing the portal of entry for both viruses [20]. Inside the country, the infection spread insidiously, along a north-west/south-east axis via the railway and roads, leading to a new outbreak in 2 provinces and 10 towns, 600 km distant and 3 years later. Identified in Gabon just before 2007, in an area where Aedes aegypti was previously predominant [36], Aedes albopictus was the main vector of the first outbreak [20], and the second. Given the rapid spread of this mosquito, even in temperate areas [18], gradual invasion of the entire country by these viruses is foreseeable.
This descriptive and prospective African study provides exhaustive clinical and biological data than previous outbreaks in the DRC, Republic of Congo, Cameroon and Gabon where descriptions were succinct [7], [19], [20], [37]. Available descriptions have also been made in patients from la Reunion Island [25], [26], notably, in a prospective study [38].
A large number of patients were enrolled in this study. They represented about one-third of all laboratory-confirmed cases, and were distributed throughout the outbreak period, following the global epidemic curve. This series is therefore largely representative of the epidemic, and is as large as two other studies which included respectively 157 and 274 patients [25], [38]. Other studies included less than 100 patients [28], [39], [40]. However, some patients with mild symptoms did not consult at the hospitals, and constituted the unique bias of recruitment. So, the number of enrolled patients is underestimated.
This study did not provided any information on asymptomatic because patients' recruitment occurred in the hospitals (individual with symptoms only). In a recent study, asymptomatic CHIKV infection was estimated at 28% [41]. With regard of the number of CHIKV negative cases, the circulation of other arboviruses during this epidemic cannot be ruled out. During the 2007 outbreak, DENV-2 was detected [20] and a fatal case of West Nile virus infection was diagnosed in Libreville [42]. Moreover, recent sero-epidemiological studies have suggested the circulation of DENV, West Nile and Rift Valley Fever viruses in rural populations [43]–[45].
We observed marked clinical variability. As previously described, fever and polyarthralgias were the most frequent manifestations, affecting nearly all the patients [3], [14], [22], [25], [38], [41]. They were found in respectively 85% and 90% of our patients, and were both present in three-quarters of cases. We found a weak association between the "fever and arthralgia" combination and PCR positivity, with a sensitivity and specificity of 73.1% and 41%, while in another recent study this combination had a diagnostic sensitivity of 84% and a specificity of 89% in an epidemic setting [41]. Differences in the case definition and the assay could explain this discrepancy.
In its classical form, CHIK is a painful febrile illness characterized by incapacitating arthralgias. Patients presenting with a bent gait due joint pain, mainly affecting the wrists and ankles, are easily recognizable. Incapacitating arthralgias are considered pathognomonic for the disease. When the symptoms are less severe, the clinical diagnosis becomes less clear-cut, and they may also be seen in other diseases such as malaria, DF and typhoid fever. To date, only the classical DF has been reported in Africa. To our knowledge, there is no comparative study of the two diseases. Complications such as dengue hemorrhagic fever and dengue with shock syndrome and persistent arthralgia following CHIK constitute the noteworthy differences. In our field experience, these diseases are clinically indistinguishable, and the problem of differential diagnosis may be compounded during concomitant CHIKV/DENV outbreaks in a malaria endemic area.
Pure febrile and arthalgic forms were also seen, adding to the clinical variability. The other symptoms were as frequent as in previous studies [14], [25], [38], [41]. Myalgias sometimes resulted in incapacity. Rashes were easily diagnosed in our darker-skinned population, and uncomplicated bullous lesions were also seen in children. The mechanism by which bleeding occurs despite normal platelet counts is unclear, but this classifies CHIK in the viral hemorrhagic fever group, in this area where ebolavirus and yellow fever virus also circulate.
We identified 2.2% of patients who had neither fever nor arthralgias. These unusual forms were evoked in the Reunion Island. This is their first description due to a strong clinical presumption of physicians and a less sensitive and specific case definition. Furthermore, no severe forms (requiring maintenance of vital function) and deaths as described in the Reunion Island [14], [26] were noted in Gabon. In a context of frequent self-medication, as in our study, many patients with unusual and non severe forms did not consult a health service, and some of those who did may have been misdiagnosed. So, the total number of cases, in this epidemic, and the proportion of unusual forms, are probably underestimated. Our findings imply that, during epidemic periods, clinicians should not focus solely on fever and arthralgias.
The four clinical forms were present throughout the outbreak period, suggesting that pathogenicity did not vary markedly.
We also observed rare relapses or persistence of arthralgias, as previously described [3], [14], [22]. The low rate of persisting arthralgia in our sampling contrasts with previous studies [46]–[48]. The little number of individuals followed up and the low mean age (at 30 years) of our sampling could explain it. In previous studies, the mean age of the population study was higher (at 50 years) and the incidence of persistent arthralgia was higher in older patients [46]–[48]. Immunonologic and genetic factors (anti CCP antibodies, antinuclear antibodies and HLA DR alleles) are associated with rheumatoid arthritis following Chikungunya fever [49]. Their absence in our patients could also explain low rate of persistent arthralgia.
In CHIKV infections, biological abnormalities are varied, transient and nonspecific, as in many other viral diseases [25], [38]. In our study, biological data from CHIKV+ patients were compared with those of healthy volunteers than CHIKV-, in order to avoid a bias in results interpretation. CHIKV- patients were considered as having another disease. Varied biological abnormalities were found. Anemia may have been due to parasitic coinfection (ankylostomiasis, ascariasis). Lymphocytopenia correlated with viremia, as recently described [38], and is probably due to excessive apoptosis with peripheral lymphocyte destruction. The increase in liver enzyme and creatinine levels may have been due to drug toxicity (particularly when ibuprofen and paracetamol are associated), muscle damage or even rhabdomyolysis. Finally, the disease severity did not correlate with VL in our study, contrary to a recent study in which the severity criteria were different [50]. Together, these findings imply that symptoms are not directly related to the virus but rather to the immune reaction.
Theoretically, PCR is the preferred method for detecting and quantifying CHIKV viral RNA, mainly during the first week after infection [4], [5]. The detection of the virus later than 7 days after symptom onset in 3% of our patients is surprising. It is conceivable that their initial symptoms were due to another disease such as malaria or dengue, before they contracted CHIKV.
The genotype of CHIV implicated in Gabonese and Cameroonian outbreaks belongs to the ESCA phylogroup and harbor the A226V mutation [20]. This mutation has also been found in samples from La Reunion Island which the genotype belongs to the Asian phylogroup. This mutation improves replication and transmission efficiency in Aedes albopictus mosquitoes [6]. To date, no genotype and no mutation have been found associated with specific clinical forms.
Finally, our study showed that this outbreak, as the first one, occurred during the rainy season and Aedes albopictus was the main vector, with an extension in other parts of the country. Globally, the clinical picture did not differ from Asian, European and Indian Ocean Islands studies. The acute phase and outcome seemed similar, as biological abnormalities and treatment efficacy. In the other hand, there were some noteworthy distinctive features: the mean duration of symptoms in the acute phase is long (7 days reaching to 24 days), relapses and persistent arthralgia were rare, there were no severe forms or deaths, and unusual forms were well described.
Epidemiological surveillance must continue in order to detect any change in the pathogenicity of CHIKV.
Supporting Information
Figure S1.
Research authorization.
Figure S2.
Standardized questionnaire.
Checklist S1.
Strobe checklist.
We thank Philippe Yaba, André Delicat, Philippe Engandja, Yvette Lekibi, Loumbangoye Germaine, Koné Martine and Mouyabi Victoire from Centre International de Recherches Médicales de Franceville (CIRMF), Gabon, for their technical assistance; Jean Baptiste Atsougou, Regional Health Director and his staff in Franceville for their help in the management of the outbreak.
Author Contributions
Conceived and designed the experiments: EML DN. Performed the experiments: DN RFK MC GG. Analyzed the data: DN RFK. Contributed reagents/materials/analysis tools: IM BB UB PB CP. Wrote the paper: DN.
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- 47. Larrieu S, Pouderoux N, Pistone T, Filleul L, Receveur MC, Sissoko D, et al. (2010) Factors associated with persistence of arthralgia among Chikungunya virus-infected travellers: report of 42 French cases. J Clin Virol 47: 85–8.
- 48. Sissoko D, Malvy D, Ezzedine K, Renault P, Moscetti F, Ledrans M, Pierre V (2009) Post-epidemic Chikungunya disease on Reunion Island: course of rheumatic manifestations and associated factors over a 15-month period. PLoS Negl Trop Dis 3: e389.
- 49. Bouquillard E, Combe B (2009) A report of 21 cases of rheumatoid arthritis following Chikungunya fever. A mean follow-up of two years. Joint Bone Spine 76: 654–7. Epub.
- 50. Ng LF, Chow A, Sun YJ, Kwek DJ, Lim PL, et al. (2009) IL-1beta, IL-6, and RANTES as biomarkers of Chikungunya severity. PLoS One 4: e4261.


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We looked to Hawaiʻi's vibrant culture of artisanal craftsmanship when designing the hand-braided leather straps on the Kāhiko—which simulate traditional rope braiding.
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text: Can Cattlemen Win Over Consumers? February 6, 2013 10:29 AM Tweet John Lundeen, senior director of market research for the National Cattlemen's Beef Association TAGS: Marketing, Overseas December 18, 2014 By Boyce Thompson AgWeb Email A survey of consumers makes one thing abundantly clear: The beef industry could do a better job of marketing its product. Beef producers want consumers to think that scientific advances make their food more affordable. But consumers think something else entirely: They worry about the impact of current beef production practices on the long-term health of their family. That's one of several examples of subjective dissonance between the beef industry and its end-users highlighted by John Lundeen, senior director of market research for the National Cattlemen's Beef Association, in a speech at today's 2013 Cattle Industry Conference. Lundeen took much of his data from the Consumer Beef Index, a semi-annual survey designed to spot consumer trends NCBA has conducted since 2007. Human health concerns Lundeen pointed to one survey of American consumers that showed that 37% of American consumers worry about the unintended long-term health effects of eating beef grown with today's scientifically advanced methods. Another 11% are concerned with the short-term impact. That adds up to nearly half the population. That said, that the industry is doing a good job convincing consumers that beef consumption is safe, Lundeen said. An NCBA survey conducted earlier this year found that three out of four Americans believe that beef positives outweigh the negatives. "This is a huge victory," he said, pointing to recent surveys that indicate the industry has "turned the corner" on concern over the E. coli virus. NCBA research shows that 47% of the U.S. population eats beef at least twice a week. Unfortunately, there's a new threat that lies on the horizon. "Now people, and the federal government, are starting to talk about salmonella," Lundeen said. While most people now believe that beef is healthy, many wonder "whether other sources of protein are even healthier," Lundeen said. The industry wants mothers to believe that beef is the perfect food for young children. "Really, they ask?" Surveys show that millennial parents prefer to feed chicken to their children under 10—74% prefer chicken, compared to 18% for beef. Their reasons range from "lower fat content" to "quicker to prepare." "We must win the hearts of the Millennials," Lundeen said. Animal health concerns While ranchers want consumers to think that all antibiotic use in animal agriculture is good, only half of American consumers are comfortable with their use, even if an animal is sick. Half of American consumers are OK with antibiotic use if an animal gets sick, 43% when prescribed by a vet. But only 29% agree with the proactive use of antibiotics to prevent disease. "We all need to be responsible about the use of antibiotics," Lundeen said. Most consumers have a negative impression of feedyards until they actually visit one, Lundeen said. "After you show people how the feedyards work, they like the way the industry does business," he said. "They are much more comfortable. They have assumed the worst." The same goes for cattle herding and feeding. Consumers are more likely to correlate pictures of feedlots, feedbunks and syringes with beef industry practices than pictures of cattle grazing in pastures. The industry could do a lot to change perceptions, Lundeen said, by showing pictures on the web and in brochures of cattle grazing and of people, not machines, feeding animals. Changes in dining habits In the meantime, major change has occurred in American dining habits. Two-thirds of dinner menus are decided on the same day, and consumers freeze half the steaks and two-thirds of the ground beef they buy. Defrosting ground beef may be enough of a hassle that it may be left out of that night's spaghetti sauce. Lundeen noted that work is under way to produce cuts of beef and packaging for ground beef that's easier to defrost or can be cooked frozen. With convenience such a big factor in deciding what's for dinner, frozen buffalo wings and chicken tenders become tempting options. "How do we put beef into what folks want to eat?" Lundeen asked, noting that hamburgers were the original solution to quick-cooking. Meatballs that can be pulled from the fridge and dropped in a sauce are another tempting, convenient option. Other solutions include thinner packing of ground beef that can be defrosted faster. The industry also has a challenge keeping up with changing demographic patterns. Lundeen's research, both empirical and through focus groups, shows that "thin cuts are a big deal" to Hispanic populations that know how to cook it properly. "Most people dry it out," he said. In taste tests, most consumers say that marbled steak tastes better. Yet many consumers today are looking for lean cuts. Lean ground beef with only 10% fat content "is a big deal. But we have all these steaks that are 90/10, some 95/5. It's a split market decision." Back to news


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of DNA
1. Prepare a sample of diluted DNA. The final volume should be 400 µL but the dilution ratio will vary from 1:100 to 1:400.
2. Turn on the spectrophotometer (and the UV bulb) for at least 15 minutes to allow it to warm up. When the machine is ready, set the wavelength for 260 nm.
3. Blank the spectrophotometer by using 400 µL of the same solvent used to dilute your DNA. You will need to fill both of the quartz cuvettes (these are very expensive so please be careful with them) with this solvent.
4. Empty the cuvette and put your diluted DNA sample in the cuvette.
5. Record the OD260.
6. The concentration of your original dsDNA stock solution can be determined using this formula:
OD260 x 50 µg/ mL x dilution ratio (e.g. 100 or 400) = concentration of DNA
7. Clean the cuvettes with distilled water and turn off the spec.
Note: For many years people thought you could judge the quality of DNA by measuring a 260:280 ratio. This has been shown to be incorrect if the DNA has been cleaned with phenol, since phenol also absorbs at 260 nm. We do not do this any more.
Lab Schedule Outlined
Lab Schedule In Context of Research Project
Molecular Biology Main Page
Course Materials
Biology Main Page


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Collegiate Academy
Henry Ford Early College
Henry Ford Early College-Advanced Manufacturing- Powered by Ford
Dearborn Center for Math, Science, and Technology (DCMST)
The Dearborn Center for Math, Science, & Technology was created by the Dearborn Public Schools in 2001 to provide a challenging program for high achieving, highly motivated students. Currently, our competitive admission process selects 90 students for enrollment in the 9th grade from all qualified 8th grade students. Acceptance is based on an evaluation process that considers middle school grades and standardized test scores. Students attend DCMST for a half-day with transportation provided to and from their home high school.
Michael Berry Career Center
Dearborn Magnet High School
Dual Enrollment
Through dual enrollment, eleventh and twelfth grade students are able to earn both high school and college credit at the same time. Many Dearborn students attend Henry Ford Community College gaining a head start on their college educations. There are limitations on course availability based on completion of high school courses as well as test scores. Contact: High School Counselor
Honors Classes
Honors classes are offered in Language Arts (9th and 10th grades), Geometry (9th grade), Algebra 2 (10th grade), Pre-Calculus (11th grade), Biology (9th grade), Chemistry (10th and 11th grades) and Physics (10th and 11th grades). These advanced high school classes are faster paced and more rigorous than non-honors classes. Enrollment is limited and is based on past grades, test scores, and teacher recommendation. Contact: High School Counselor/High School Principal
Advanced Placement
Advanced placement classes offer high school students university-level courses at their high schools or online through the Michigan Virtual High School. Enrollment is open to all students in the 11th and 12th grades. Students who take AP classes are encouraged to sit for the national AP exams in May of each year. Students achieving a passing score are awarded college credit by the college or university they attend after high school. Contact: High School Counselor
Work-Based Learning
Seniors who have a job may be able to earn high school elective credit for their work-based learning experience. Contact: High School Counselor/High School Principal
Reading/Writing, Mathematics, and Science Intervention Classes
Each high school offers additional support classes in math and reading/writing support during the school day to students who are performing substantially below grade level. This support class is in addition to students' regular language arts and/or math class and replaces an elective. Contact: High School Counselor or Math/Language Arts Coordinator
Summer School
Secondary summer school offers students another opportunity to catch up on lost credits as well as offering the possibility of taking additional classes during the regular school year. District-wide summer school location rotates each year between Dearborn High, Edsel Ford, and Fordson High School. Contact: High School Counselor/High School Graduation Intervention Specialist
ASAP Extended Day Program
We encourage students who fail classes to immediately make up the lost credit in this after school program. This is important for our goal of keeping students on track in order to graduate high school on-time. Students who have not failed classes may also choose to take classes in the extended day program in order to take additional classes during the regular school day. Classes are held at each of our high schools immediately after school. Contact: High School Graduation Intervention Specialist/Counselor/High School Principal
Credit by Examination (Test Out)
Early Start
Incoming ninth grade students who have been identified by their middle school as likely to have challenges in high school are recommended to participate in Early Start during the summer between eighth and ninth grades. Students spend 12 days during the summer working with the high school staff on study skills and previewing the ninth grade curriculum. Once the regular school year begins, these students are followed closely by their counselors. The counselors meet frequently with the students and communicate with their teachers to ensure success catching any problems encountered by the students at the earliest stage. Lunch meetings give students the opportunity to stay in constant contact with their counselors and the ninth grade lead teacher. This offers the strong support necessary for at-risk freshmen to adjust to high school. Contact: Ninth Grade Lead Teacher/High School Principal
Advanced Math
Seventh and eighth grade students who have demonstrated sufficient prior learning and readiness are placed in accelerated math classes. Pre-Algebra is offered in seventh grade and high school Algebra 1 is offered for high school credit in eighth grade. Contact: Middle School Principal or Secondary Math Coordinator.
Middle School World Languages
Depending on enrollment, Dearborn middle schools offer French, Arabic and Spanish classes in seventh and eighth grades. The eighth grade year-long class is offered for high school credit. Contact: Middle School Principal or Middle School Counselor
Middle School Math and Reading Support
Each Dearborn middle school offers additional math and reading support during the school day to students who are performing below grade level. This time is in addition to students' regular language arts and/or math class and replaces an elective. Contact: Middle School Principal or Secondary Math Coordinator.
Middle School Music
STEM (Science, Technology, Engineering & Math) Middle School


text: Market Strategy: Marketing Flexibility October 2, 2013 02:53 AM Tweet TAGS: Marketing, Overseas December 18, 2014 By Jerry Gulke Top Producer Market Strategy Columnist Email A cat-and-mouse scenario might be brewing. If end users develop a sense of urgency, prices could form a V-bottom. Whether it's one year out or three years, funding a flexible marketing strategy can be costly. Commercial firms have enhanced their hedge-to-arrive contracts to acquire ownership of the physical commodity, with some firms requiring delivery at a specific point in time as part of the agreement. For me, maintaining beneficial interest until I'm ready to dispose of my crops is a priority. Price outlook is the most rewarding, but it also requires more effort. I try to determine what has changed that could have a major impact on my decision. I expect to make mistakes, but I want the flexibility to modify decisions so small mistakes don't turn into big, costly ones. Weather has interrupted our ability to meet demand twice since 2008, making price outlook more difficult and marketing flexibility more important. Had these difficulties not occurred, our quick response to increase corn production by 15 million acres in 2007 might have slowed the process of land price appreciation, as well as lessened global expansion. The 93.5 million acres posted in 2007 produced 13 billion bushels, which was sufficient to meet demand and end the year with 1.5 billion bushels left over. Trend-line yields going forward would have allowed excess supplies to build while meeting the ethanol mandate, thus providing less competition for soybeans to meet the Chinese demand. Present Day: A year ago, technical topping action suggested a more aggressive attack for locking in 2013 and 2014 prices while maintaining flexibility of futures. Options were hardly a second thought due to the high cost. This summer's weather might have taken the top end off of expectations, but I think we were too low, and the corn market responded accordingly. Soybeans stocks are tighter, but it's doubtful buyers will want to spend $14 for all of North and South American production. A normal year would have left us with huge ending stocks for corn, wheat and likely more-than-adequate soybean stocks. Speculators saw this coming and moved out of commodities into more traditional investments, as they saw the ag sector as having topped. Phase Two. While selling out of the field worked the past two years, prices of corn fell to levels not seen for years in December futures. Excess supplies approaching 1.8 billion bushels is something many have not had to deal with for 10 years, but there is opportunity. The market puts a "carry" in the futures for old crop when supplies are in excess. Essentially the market pays the holder a "storage" premium, as the market cannot absorb all the production in the short run. Monthly carry charges are about 5¢ per month, suggesting the December/July spread is about 35¢, compared to an equivalent spread of about 19¢ in 2003. Given a good crop next year, that spread could earn another carry of 10¢ from July to September. A V-Bottom Possible: Not only are grain bins essentially empty going into harvest, but total on- and off-farm storage has increased nearly 3.5 billion bushels during the past eight years, offering another source of revenue for on-farm facilities. This also means farmers can put away the 2013 crop much faster than most commodity traders realize. Timing will be of the essence for end users who lack coverage. A cat-and-mouse-type scenario might be brewing. Should end users develop a sense of urgency, prices could stabilize, forming a V-bottom with a price rally toward the end of the year. Jerry Gulke farms in Illinois and North Dakota and is president of Gulke Group Inc., a market advisory firm with offices at the Chicago Board of Trade. For information, send an e-mail to firstname.lastname@example.com or call (707) 365-0601. Disclaimer: There is substantial risk of loss in trading futures or options, and each investor and trader must consider whether this is a suitable investment. There is no guarantee that the advice we give will result in profitable trades. Back to news


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Alby has a talent unlike any other owl – he's a skateboarding star!
Alby lives at the Folkestone Owl Sanctuary in Kent, England. Brian Maxted, who runs the sanctuary, often takes the owls to local shopping centers while seeking donations. One day while they were out a boy put his toy skateboard done and Alby jumped right on! Alby was pulled along while riding the skateboard and appears to have a great time.
Maxted bought Alby his own skateboard and now he has perfected his technique. Alby will swoop onto the board and use his momentum to glide forward. When the skateboard stops, he flies off and circles again for another ride!
Read more at The Telegraph.


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Joan Jett-Blakk and Babette, c.1993
Hosts of talkshow/performance series produced by Rick Jacobsen
Gelatin silver print
KIKI GALLERY COLLECTION A small gallery located in San Francisco's Mission District, the Kiki Gallery was a provocative, intelligent presence in the Bay Area art community from 1993 to 1995. Kiki's founder and director, Rick Jacobsen, shaped a lively program of exhibitions, readings, and performances by emerging artists. The confluence of innovative art, gay culture, and performance that was distinctive to Kiki had its antecedents in the mid-1950s projects of King Ubu Gallery and Six Gallery. In these pioneering artist-run spaces, Jack Spicer, Robert Duncan, Jess, Wally Hedrick, Jay De Feo, Allen Ginsberg, and others presented and supported one another's work. The same creative energies effloresced in the theatre of the Cockettes, in the conceptual art and performance movement of the 1970s, and in the rich history of alternative art spaces in the Bay Area. These energies had a brilliant, though brief, flowering at Kiki. The gallery became highly regarded for its director's imagination and fearlessness in presenting challenging new work.
Wayne Smith
Sick Joke, 1993
catalogue cover
KIKI GALLERY COLLECTION In its existence of only twenty-two months, Kiki was known for many memorable shows and events, beginning with the exhibitions Caca @ Kiki and ending with Piece: Nine Artists Consider Yoko Ono. The archives includes: exhibition catalogues (Sick Joke, Fresh Produce), publicity materials (Late Night with Joan Jett Blakk), performance stills (David E. Johnston's Gone Dollywood), original art (Keith Mayerson's Pinocchio the Big Fag), and snapshots of Rick Jacobsen with Jerome Caja's work installed for the exhibition Toilet Water, seen in the background.


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The Peak Oil Crisis: Waiting For Winter
By Tom Whipple
In the fourth quarter, worldwide demand for oil goes up by 2.5 million barrels per day over summer demand to keep the northern latitudes warm during the winter months. Given that we might have an unusually cold winter this year, the demand increase might be conservative.
The Chinese government recently announced their economy is going to grow another nine or ten percent this year. Maybe they have figured out how to grow without increasing their oil consumption. If they expect in keep this up, their oil imports should start increasing The US economy is still bouncing along fairly well with predictions of pretty good growth next year. More oil needed!
Although many of our flooded refineries are getting back into operation, about a million barrels per day of refining capacity has not yet recovered from the hurricanes. Two-thirds of our Gulf oil production is still shutdown and it's beginning to look as if government predictions that all will be well in the Gulf by Christmas are optimistic. In Iraq , the insurgents continue to blow up oil pipes at a steady pace and it is only a matter of time before they figure out how to shut down production completely. The shipments of refined gasoline to the US from our fellow International Energy Agency members will soon be drawing to a close. The first signs of serious inflation are beginning to stir.
Despite all this bullish-for-oil news however, prices have dropped some 15 percent since the Katrina peak of over $70 dollars. Wall Street oil traders and analysts are starting to tell financial reporters that the hurricane dislocations are over for a while and the good times may roll for a while longer. Indeed earlier this week the Dow flew up 170 points on the idea that our oil problems no longer look as bad as they did a few weeks ago.
Where did all this optimism come from? Is it justified? The root cause, of course, is that the securities industry is based on eternal optimism and growth. Few have grasped, or are willing to admit, how close we are to the final oil crisis of all time.
The more immediate reasons for the spectacular price drop in the price of oil, and the price at our gas pumps, seems to be the lack of more production-damaging hurricanes and the perception that we Americans have slowed our driving in response to "expensive" gasoline.
After two months in which one hurricane after another has threatened or actually wiped out Gulf oil production and refining, any news that this is not about to happen in the immediate future drives oil traders to sell and sell some more.
Another reason for the price drop, however, is the "demand destruction" (a fancy term for "it costs too much so I am not going to buy as much) said to be taking place in the United States .
Last week the Department of Energy reported US demand for petroleum products had dropped by 2.3 percent as compared to 2004. The American Petroleum Institute did DOE one better by announcing that demand during September had dropped by nearly 4 percent. This was backed up by a consumer survey in which 69 percent claimed to be driving less.
There you have it. Economic theory worked. Higher gas prices have finally driven Mr. and Mrs. America to slow down, ride a bus now and them, or to simply stay at home and watch TV. Supply and demand will soon be back into balance and the crisis will be over for a while. There is no doubt some are cutting back on their driving, but how much and will it last enough to bring supply and demand back into balance without sharply higher prices?
That the US 's hurricane-disrupted crude production fell to less than 4 million barrels per day during September — the lowest since 1943 — does not seem to bother anybody. Just for the record, this means we are currently importing or withdrawing from our strategic reserve some 80 percent of our daily oil consumption.
Why didn't we fall flat on our backs with much of our crude production and significant pieces of our refinery production still out of service in the last six weeks? The answer is, our fellow members in the International Energy Agency (IEA) are letting us have an additional 800,000 barrels of gasoline per day out of their reserves. Moreover it seems our domestic refineries are still deferring maintenance and are still cranking out gasoline rather than switching over to more heating oil production at the end of the summer driving season. It is this combination that has kept us going.
The IEA, however, has already voted to stop letting us have world reserves beyond what was voted immediately after Katrina and the advent of colder weather will quickly force a choice between driving and staying warm.
On top of all this, some commentators are voicing concern that instead of reporting an actual reduction in demand, the government is really measuring a reduction in refinery output which, given all the flooded refineries, should be completely obvious.
The replacement for reduced gasoline production comes from local storage tanks and increased imports of foreign gasoline. In the current hurricane-induced dislocations in much of the US oil industry, one would suspect it is difficult for the government to accurately track just what is going on.
All this is saying it may be a touch too early to start celebrating the end of $3 gasoline. Even if the Caribbean is through generating hurricanes for the year, the world's supply/demand balance is very tight. So fill up your tank while prices are low and hold off on that new SUV for a while. It looks like a long harsh winter ahead and Katrina's second shoe has yet to drop.


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Goldcut 424™ M42 Bandsaw Blades
Goldcut Bandsaw blades are manufactured with an added 4% chromium ensuring the ability to withstand high mechanical and dynamic stress. Precise tooth formation is assured by an automated milling process. Our sales team is available for technical recommendations for your specific application.


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(c) Pocumtuck Valley Memorial Association, Deerfield MA. All rights reserved.
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Most people, by the mid-1800s, purchased locally made soaps rather than made their own: the soap-making process was long, hot and filled with fumes. Soap had been commercially made in the American Colonies beginning in 1608. By the 1860s there were few soap manufacturers able to ship their goods much further than their home cities and few markets for their products, which were considered expensive luxuries. Commercial cakes of soap began to be distributed to wider networks beginning in the 1840s but most local stores continued making their own soap until around 1900. This flyer is for a soap that was made according to a very specific formula and uses the generic phrase "patent soap" to describe itself. Although the formula could have been printed entirely, without any handwritten sections, it provided a greater security for the vendor to give the crucial items at the point of sale. Soap made according to this method was sold at a store. It was stored in a single large block; individual chunks of soap were cut to the customer's order.
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Getzlaf misses Ducks' game against Canucks because of upper-body injuryNHL.com @NHLdotcom
ANAHEIM, Calif. - Anaheim Ducks captain and leading scorer Ryan Getzlaf has been scratched from Sunday night's game against the Vancouver Canucks because of an upper-body injury.
Getzlaf has 10 goals and 12 points through his first 18 games, helping Anaheim vault to the top of the NHL overall standings.
The 9-year veteran, one of only five players on the Ducks' roster who helped them win their first Stanley Cup in 2006-07, recorded his first career hat trick with three goals in the first period of Friday night's 6-2 victory over Buffalo.


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Landreo wrote:tractordad wrote:Still looking into making some of these carb plates, just need to find a good local source for steel.
I have a 1' long piece of 1/2 thick x 6" wide aluminum angle stock. I think that would work well and it would be easy to put in a vise and use. I'm just not sure how hard it would be to mill up.
Metal depot or Mcmaster-Carr, few bucks for some aluminum, literally 5 minutes with a drill and you are done.
The 1/2 inch thick aluminum will work, no need for a mill. Lap with some wet dry sandpaper on a table saw bed or on a piece of window glass until smooth.
Lay out the holes, drill, no need to tap the mounting holes, just drill and use some #10 screws to clamp the carb to the plate. Remember, you are bending pot metal not titanium. Use some washers for the #10 screws to raise the low areas to aid in bending the carb body.
Five minutes with a hand drill and done? I would like to see a video of that. I suspect you are overlooking the other areas that need to be clearanced.


text: Alison Jubilee Bailey was first introduced to miniature painting by a friend in 1996. This friend had an ill-considered painting area set up in front of his computer, so when Alison was learning the mysteries of "GW Flesh Wash" over "Dwarf Flesh," the resultant spillage that ruined the keyboard was practically inevitable. Alison did not have another opportunity to paint until mid 2003, not long after she started playing D&D and then Warhammer. This time, the first miniature she tried to paint was one of the Reaper dancing girls and not far into the process, she proposed the following question: "Why are there these lines all around the model? They're getting in the way." So began Alison's journey to discover better ways to paint. She has been painting professionally off and on since 2005. Alison goes by Jubilee on most forums, but may show up as ali.jubilee in a pinch. Her website can be found at Jubilant Creations read more


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We detailed the latest doomed initiative to legislate the sale of video games in New York last month, and the outcome was expected: yesterday, the bill was signed into law. The law is completely worthless, as it requires violent games to be labeled as such, even though they already are, and it also requires game systems to include parental lockouts, which they already do. Now that these things are law, the ratings are no longer voluntary.
Of course this law has absolutely no chance of standing, as the New York Civil Liberties Union has already said it will fight the law; hopefully, the ESA is already mounting a legal challenge as well. In California, the MPAA and RIAA ran to the gaming industry's defense when similar legislation was discussed; any group involved with entertainment media won't let a law like this stay on the books. Politicians are hungry, they won't be happy just controlling the sale of games, and no one wants to see their own business affected by new law.
The law will be struck down as unconstitutional, the taxpayers will end up paying a pretty penny for what everyone knew was a fool's errand, and we'll be reporting on another state trying this madness in a matter of weeks. Remember, wasting money, ignoring the Constitution, and giving citizens the check is worth it if you get a talking point for re-election.
The sheer number of bills that have been introduced to legislate game sales that have been struck down at the taxpayers' expense should be a hint that these laws are doomed... but politics isn't always about reality.