Two years ago when I read online that Mey Icki announced to withdraw the only Turkish whisky in the market "Ankara" from circulation and stop it's production I felt extremely sad... It was an end of an era. Mey Icki is one of the new alcohol industry giants in Turkey and purchased the spirit department of government owned Tekel after it's privatization in 2004. Tekel which means literally monopoly in Turkish has been founded in 1925 right after the declaration of Turkish Republic as a result of the new nationalist economic movement taking alcohol, tobacco and gunpowder under state monopoly. The government was nationalizing almost everything to be able to gain the control of the natural resources of the country back from foreign companies, to pay huge foreign debts after decades of devastating wars and to start their own late industrial revolution. Import was not allowed for a long time to protect the new government owned and private companies from severe competition. Tekel stayed as the only alcohol producer in the country for a long time. So in years they came up with a massive line-up of alcoholic drinks to be able to answer all the different demands including their own whisky "Ankara" which they named after the new capital of Turkey.
In late 1970's I remember seeing occasionally a bottle of VAT 69, Johnnie Walker Red Label or Black & White at home brought by my father's colleagues secretly as a present from Europe but besides that Ankara was the only whisky I could purchase legally in the country and actually afford by myself in my early twenties and college years. It was dirt cheap... To be honest I always loved whisky but my obsessive interest is relatively new. For only a little more than two years I learn, taste, read, collect and write about it. Now when I think about Ankara I deeply regret that I didn't save a few bottles before it disappeared from the surface of the earth. I tried really hard last two years to find a bottle when I visited Turkey several times but I couldn't.
In a strange way there is also very limited documentation about the production of Ankara. It was printed "Malt Whisky" on the label but we know now that it wasn't a single malt. It is believed that the whisky was distilled from a mix of malted and unmalted barley and rice. It was aged in new made, lightly charred oak casks between three and five years. If I dig from my memory pretty hard and add on top what I read online from different whisky tasters I can combine some tasting notes to give you an idea about Ankara: Nose has sweet and dried fruits, raisins, dried plums. Very malty. Palate is a little harsh, young alcohol burns the tongue. Spiciness of unmalted barley is kind of nice, like Irish whiskey. Young and damp wood influence and hint of dried sweet apricots follow. Finish is pretty short and spicy. Overall it was one of the best price/value ratio whiskies I can think of. Very easy to drink... For me it was the whisky of my youth, brings back unforgettable years full with memories. For any other whisky enthusiast it was a steal and a fine collection item for around five bucks only.
Whoa. This was a great read! The history of Tekel / Mey Icki / Ankara - or rather, the hardships and the end of its history - are saddening, but the twist at the end is heartening. Wouldn't it be all the more heartening, if Virginia Distillery came up with an Ankara line that came from these stills?
Don't give up the search for a bottle of Ankara. A bottle so massed produced for so many years is bound to be still kicking around somewhere.


Yet again disrespect to a graveyard, memorial, etc. Enough is enough. It's the people against the vandals!
Yet again disrespect to a graveyard, memorial, etc.
Enough is enough. It's us the people against the vandals! We must all get a bill passed in the State House stating it's time to get serious: if you are caught disrespecting or vandalizing these hallowed grounds, you will be punished – not with fines but jail time. It's out of hand these acts of disrespect.
We the people need a law passed – a serious law! No probation, community service, etc. Under 18, youth detention center; over 18, jail. Governor Patrick and leaders on Beacon Hill, help!
We need a law passed now! Our loved ones, our troops. deserve respect. They earned it!


text:
Back You are here: Home Infallibles Fatimah az-Zahra The veil of Allah (S.W.T)
The veil of Allah (S.W.T)
From" Kitab al-Turf" of Sayed ibn Taoos quoting from Kitab al-Wassiyah of Shaikh Isa bin al-Mustafaad al-Zareer from Imam Kazim (A.S) from his Father (A.S):
"When Prophet Mohammad (P.B.U.H&H.P) was about to die, He called the companions and said: "Indeed the door of Fatima (S.A) is my door, and Her house is my house. So whoever disgraces it, has disgraced the veil/covering (Hijaab) of Allah (S.W.T)."
The narrator Isa then says, "Abu al-Hassan Imam Kazim (A.S) then cried for long and cut of rest of his speech and said, "By Allah (S.W.T) the veil of Allah (S.W.T) was disgraced, By Allah (S.W.T) the veil of Allah (S.W.T) was disgraced, By Allah (S.W.T) the veil of Allah (S.W.T) was disgraced, O My Mother (S.A)..."
[Source: Bihar al-Anwar, Vol. 22, Pg. 476-477]
Ref: Marefate AhleBait (A.S).com
Allah (S.W.T)
Prophet Muhammad (P.B.U.H&H.P)
Imam Kazim (A.S)
Fatima Zahra (S.A)
Story of Door

redpajama_set_name: RedPajamaCommonCrawl


text:
Eva Lesmes (Gijón, Asturias, 3 de agosto de 1961) es una directora de cine, realizadora de televisión y guionista de cine y televisión española.

Formación
Graduada en Dirección de cine y televisión en el American Film Institute (Los Ángeles). Formada en Interpretación y Dirección de actores con John Strasberg, Dominique de Faccio, William Layton y José Carlos Plaza, en Madrid y en el Lee Strasberg Theatre Institute de Los Ángeles. Diversos cursos de guion en UCLA, Los Ángeles, y seminario de Robert Mackee. Graduada en Dirección Cinematográfica en la escuela TAI de Madrid

Obtiene una beca para escritura del guion La Conversa de Indias del European Script Found, y también una Beca Fullbright de extensión de estudios artísticos en EE. UU. del Comité Conjunto de Cooperación Hispano-Norteamericano. Fue Invitada al V.I.P. (Visitor International Program) por la Embajada de los EE. UU.

Trayectoria Profesional

En cine ha trabajado como guionista y directora de:  El palo (2000), Pon un hombre en tu vida  (1996), Al borde (1986), Ejercicio para dos manos (1981), Diario de otoño (1981). También para la gran pantalla ha sido script en 10 largometrajes, entre los que figuran Angustia de Bigas Luna, y  Solar Babies, producida por Mel Brooks.  Además ha ejercido como ayudante de Dirección en Publicidad en las productoras Vector Albi y Tesauro Publicidad desde (1982 a 1988).

Ha dirigido series de televisión, entre ellas: Maitena: Estados alterados, serie basada en las tiras de Maitena para Cuatro Cabezas (2008-2010); El comisario para Tele 5 (2009), 4 capítulos de Ellas y el sexo débil , Boca Boca para Antena 3 (2006); 3 capítulos de Código fuego (2003);  primera temporada de Ana y los siete para TVE (2002); A las once en casa 34 capítulos para TVE (1998-1999); segunda temporada de La casa de los líos, 13 capítulos para Antena 3 (1997) y Delirios de amor en el capítulo "El escritor de los escritores"  TVE (1988).

Ha guionizado y dirigido, además, el telefilme La noche del escorpión para La Forta 2002.

Desde 1988 compagina su actividad profesional con la enseñanza. Ha participado en cursos organizados por la Consejería de Cultura de Asturias, Instituto Andaluz de la Mujer, Comunidad de Madrid, Unión de Actores, La avispa, TAI, La base, NIC, y ECAM. Desde 2005 dirige Central de cine un espacio dedicado a la formación avanzada de cine dónde dirige los talleres de Interpretación para la Cámara. En 2003 funda junto con Javier Gancedo Central de Guiones, agencia de desarrollo de proyectos audiovisuales de ficción. Central de guiones colabora con productoras como Drive, BRB, Oberón y con el CDA (Centre de Desenvolupament Audiovisual, I.C.I.C. ).

Han desarrollado guiones de cine como Un Franco, 14 pesetas, o de televisión como el piloto de Maitena: Estados alterados para Cuatro Cabezas o Serrallonga, la llegenda del bandoler para Oberón.

Es miembro de la Academia de las Ciencias y las Artes de Televisión de España y de la Academia de las Artes e Industrias Cinematográficas. Ayuda a la escritura de guiones de largometraje del Ministerio de Cultura 2005 a 1OO% Animal. Además es una de las socias fundadoras de CIMA (Asociación de mujeres cineastas y de medios audiovisuales).

En 1999 ganó el Premio Pilar Miró de la Academia de las Ciencias y las Artes de Televisión de España al mejor guion de películas para televisión por el filme A simple vista que fue adaptado de la novela L'aire de les castañes del escritor español Vicente García Oliva y que narraba la vida y asesinato del transformista Alberto Alonso Blanco (Rambal).

Filmografía como directora
Maldito lunes (2012) cortometraje
Maitena: Estados alterados (Serie TV)
El comisario (Serie TV)
Ellas y el sexo débil (Serie TV)
Código fuego (2003) (Serie TV)
La noche del escorpión (2002) (Telefilme)
Ana y los siete (Serie TV)
El palo (2001) (Largometraje)
A las once en casa (Serie TV)
La casa de los líos (Serie TV)
Pon un hombre en tu vida (1996) (Largometraje)
Delirios de amor (Serie TV)

Referencias

 IX Muestra Recent Spanish Cinema: El Mundo
 : La Voz de Asturias

Directores de cine de Asturias
Guionistas de cine de España
Directores y realizadores de televisión de España
Guionistas de televisión de España
Nacidos en Gijón
Directoras de cine de España
Mujeres guionistas de cine

redpajama_set_name: RedPajamaWikipedia


PORT HAWKESBURY, N.S. – Fifteen community groups in the Strait area have received funding from Nova Scotia Health Authority (NSHA) and the Department of Health and Wellness (DHW) for projects that support local health care priorities.
Grants from The Wellness Fund are awarded annually to non-profit organizations across the province working to improve health in their communities, based on priorities identified by community health boards. The Strait Richmond Community Health Board (CHB) hosted a cheque presentation celebration Tuesday, Feb. 5 in the Arts & Craft Room at the Porthawkesbury Civic Centre to recognize this year's local recipients.
Tamarac Education Centre is one of many schools at the Strait Regional Centre for Education. It offers both English and French immersion classes for Port Hawkesbury and surrounding communities.
"Active Healthy Living is our motto, so the regional educator for the Black Educators Association and I decided to add culture into promoting our motto," student support worker Sabrina Skinner said. "This opportunity will allow the students to try foods that they might have never tried before. If it's not something they like, then at least they had the opportunity to try it.
To learn more about the Wellness Fund program, please visit https://www.communityhealthboards.ns.ca/wellness-funds or contact community health board coordinator Dorothy Bennett at 902-867-4500 ext.4 272, or dorothy.bennett@nshealth.ca.


text:
Here's the 15 locations to get DublinBikes stations this year
April 19, 2017 Cian Ginty News 9
A 15-station expansion of DublinBikes focused on Grangegorman is set to get underway this summer and to be completed by the end of the year.
Here's the a draft set of locations provided by Dublin City Council — the new stations are the blue markers:
The number of bicycle docking stations is to increase from 101 to 116, while 100 extra bikes are to be added to the total number of bicycles which stands at around 1,580.
Of the draft 15 new stations, 9 will be located around Grangegorman, where the DIT campus is partly still under construction.
If all goes will, four of the stations will be located along or just off the North Circular Road, three or four will be on Grandegorman Lower / Upper, and two will be on the city side of the Phibsborough Road.
Another four stations will add to capacity in the area between Croke Park and Connelly Station:
And two stations will add to capacity on the southside near the Grand Canal:
In 2016 users of DublinBikes took 4.3m journeys and more than 18 million journeys since the launch in September 2009.
At the start of this year the scheme had 68,000 annual subscribers and its busiest day ever was on September 16 of last year with 18,041 journeys taken.
Since February 2017 yearly membership subscriptions increased from €20 to €25 to partly pay for the expansion and also aiming to fill in an amount which was to date paid from the city council's general budget.
Cian Ginty
I am editor of IrishCycle.com and have reported on and commented on cycling in Ireland for over a decade. My background is in journalism -- I have a BA in Journalism from DCU and HDip in Print Journalism from BCFE. I wrote about cycling for national newspapers, and then started CyclingInDublin.com for overflow stories. Later the website was re-branded to reflect a more national focus.
Citizen Wolf April 19, 2017 at 7:53 pm
What is this nonsense with Dub City Council having to cover any shortfall in revenue. This scheme should be recognized as a national strategic project. The cost savings in health, pollution, carbon emissions, well-being of citizens, congestion, collisions etc etc etc easily outweigh any costs of the project. How many billions go into motorway building and maintenance? A fraction of a percent of that would cover the entire Dublin bike scheme.
Here we go – yet more evidence why Dublin Bike Scheme should be funded by central government, as it will save the country tens of millions in health costs. http://eprints.gla.ac.uk/138376/7/138376.pdf
Joao Pegado April 20, 2017 at 2:59 pm
What about arbour hill and Stoney batter area? The area already deserve at least 2 bike stations since Public transportation in the area (from stoneybatter until phoenix park) is so poor that i believe a lot of residents will be thankful.
KG April 20, 2017 at 11:59 pm
Really disappointed that Stoneybatter, Arbour Hill, Oxmantown, Phoenix Park end of NCRd has been ignored again. The scheme is very much biased towards the south side of the Liffey.
Stephen Huggard April 21, 2017 at 12:40 am
Griffith College next please!
Alvar April 25, 2017 at 10:30 am
Incannot believe the triangle among Rialto, Saint Patricks and Harold cross is still not coveraged. Nor for Rathmines nor Ranelagh
Aoife July 6, 2017 at 7:04 am
Great scheme for everyone in the city. But huge gaps in the south west of the city nothing from Rialto, to Sourh Circular Road or Blackpits, New Market and South Liberties. The area is a large residential area with good bike lanes
booccinell August 19, 2017 at 7:36 pm
I can't believe there isn't new stations next to Griffith College on south Circular Road. Explanation ? :)
How Will Apps for Sharing Parking Spaces Affect the City? - Dublin Inquirer
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Opening tonight, July 24th at the Congregation Gallery in Hollywood, CA is a group show entitled "The Black Plague Art Show". Curated by Cam Rackam, this show has a very impressive lineup with new works from: Jason Soles, Buddy Nestor, Cam Rackam, Chris Peters, Christopher Conte, Dan Harding, Ian Ward, Sean Chappell, Terry Wolfinger, Vincent Castiglia, Lacey Bryant, Karl Persson, Nikko Hurtado, Larkin, and many more. Of course we all know the Black Plague to be one of the deadliest pandemics in human history, but one of the elements you will see in many of these works is the outfits the plague doctors would wear. It consisted of a wide brimmed hat (a signifier of being a doctor), a long black overcoat (to minimize exposure), a cane for examining and ushering people around, and most notable the bird's beak shaped mask. This mask worked similar to a gas mask, as impure air was thought to spread the disease. The mask had red eyepieces, thought to block the doctor from evil, and the beak would be filled with herbs or spices that would reduce the smell and again block impure air.
It's an outstanding show, and had me surprised quite a few times. Dan Harding's new piece "La Bella Morte Nera" (or The Beautiful Back Death), is so amazing, his work just keeps getting better. I also liked Jason Soles "Bell Jar Baby" and various masks. Lacey Bryant also has some great, illustrative pieces that really take the idea of the Black Plague as inspiration. "A Surprise for Mum" has the rats that helped spread the plague, and "Pocketful of Posies" is pretty creepy as well. Take a look at the preview images here, and then head over for the full show.


Description:Plants Vs Monsters is an online HTML5 game. You can play the game on smartphone and tablet (iPhone, iPad, Samsung, Android devices and windows iPhone). You can put it to your favorites. So it can be convenient for you to play later! Now you can also play more other similar games on Playhit.com. Enjoy!


The following principle is key to becoming a successful poker player. Without the proper money management skills, the best players in the world would go broke. For all you skim-readers, here are the basic rules of bankroll management for Texas Hold'em.
20 buyins for NL Hold'em.
300 big blinds for Limit Hold'em.
40 buyins for SnG Tournaments.
"Bankroll management" (sometimes abbreviated to BRM) is where you play at certain limits to avoid losing all of your bankroll due to bad runs of cards, which any poker player must expect from time to time.
This is called "playing within your bankroll". Subsequently, if you play at higher limits where there is too great a chance of losing all of your poker money, you are "playing out of your bankroll".
The reason why you should choose your limits carefully in poker is due to the variance. Variance is a term used to describe the "ups and downs" of poker where you fluctuate from having bad runs of cards to good runs of cards, resulting in varying profits and losses.
If you play poker for long enough there are going to be periods of time where you will consistently lose money, not because you are playing badly, but because the cards are not falling your way. This means that if you do not have enough money in your bankroll to absorb these big downswings, it is likely that you will lose it all.
Every player, irrespective of ability, will experience variance in their game. Bankroll management is in place to deal with this variance and allow you to continue playing without going broke.
So what limits should I be playing at?
Pot limit and no limit Hold'em.
If you are playing pot limit or no limit poker, the safe recommended size of your bankroll is 20 times the full buy-in of where you want to play. This means that if you want to have the best chance of making money at a $1/$2 game where the maximum buy-in is $200, you should have a bankroll of at least $4000.
Another way of applying bankroll management is by only putting a maximum 5% of your entire bankroll on the table at any one time, which works out the same as having 20 times the buy-in for the game.
If you like to play limit Holdem however, you should have 300 Big Bets as a minimum for the limit you wish to play at. Therefore to play $1/$2 limit Holdem, you should have a bankroll of at least $600.
It is recommended that you have a bankroll that will give you 40 buy-ins to the level of tournaments that you wish to play at. Therefore if you want to play at the $10+$1 Sit n Go's you should have a bankroll of $440.
Try the online bankroll calculator or the downloadable fergulator tool for recommendations on where to play based on the exact size of your bankroll.
The guidelines noted above are very general rules that should give you the best opportunity to make money from playing Texas Holdem poker without going broke. However there are going to be some exceptions and alterations depending on how and where you play.
Bankroll management for pro players.
If you intend on taking poker up as your main source of income, the bankroll you would require will be substantially larger than 20 full buy-ins for cash, or 40 buy-ins for tournaments. This is because your living expenses will constantly be taken out of your bankroll and so it has to have the ability to withstand the variance along with the costs of everyday life.
Professional players will require a far bigger bankroll than the guidelines set out in this article.
If you are constantly dipping into your bankroll to pay for bills and groceries, you may find that occasionally you will not be properly rolled for the limits you are playing at. Furthermore, there may well be times of emergency when you will need to take a big chunk out of your roll, and so it's good to have a little extra money behind you just in case.
Bankroll management at short-handed tables.
If you play at shorthanded tables, you may notice that there is greater variance than at full ring games. The fact that you will be involved in a greater number of pots per orbit and playing against your opponent's weaknesses more than to your cards strengths will result in greater fluctuations in wins and losses over short periods of time. This means that you may consider slightly increasing your bankroll up a few buy-ins if you want to withstand the variance of these games.
Style of play and variance.
Your playing style can also determine what limits you should play in relation to the size of your bankroll. If you are a tight player then you should expect to receive a slightly reduced variance to that of a loose player, therefore you may be able to afford to reduce the amount of buy-ins in your bankroll.
This is because tight players will often only enter pots with strong hands and regularly go to showdowns with winnings hands, thus reducing the chances of seeing big losses. Consequently, if you are a loose player and play a large number of pots, you may want to increase the size of your bankroll to absorb the extra variance you may receive.
Loose players who play a large percentage of hands will experience more variance than tight players who play a low percentage of hands.
Absorbing losses and moving on.
Good bankroll management helps you deal with the psychological impact that losses can have on your game. If you have a bankroll of 10 full buy-ins for a cash game at the $200 NL game and lose 4 buy ins, your bankroll would deplete from $2000 to $1200. Thanks to your small initial bankroll this looks like a big loss and may cause you to tighten up your game and play "scared poker" because you are afraid to lose more money.
Now if you had 20 full buy-ins for the $1/$2 game, your bankroll would change from $4000 to $3200. Immediately you can see that visually this does not look as bad as the loss in the first instance. Therefore you will feel more comfortable that you have the ability to win back the lost money without feeling the need to change your game.
Moving levels and taking shots.
There will be times when you have bad runs of cards and good runs of cards. At certain times your bankroll will be too small or too big for the limits you are playing at.
If your bankroll drops below 20 full buy-ins, then you should also drop down a level so that you are playing within your bankroll until you have built it back up enough to play at the next level.
If you have more than 20 buy ins for the limit above, then it makes sense to move up to that limit if you feel you can beat it. Just be sure to drop back down to the lower limit if you experience significant losses.
At some points in your poker career you may fancy moving up a level just to test it out and to see how well you do. This is called "taking a shot". There is no harm in trying this as long as you stick to good bankroll management for most of the time you play poker.
Be careful not to get carried away by big wins at the higher level because your bankroll may still be too small to support continued play there. A useful tactic that you can use when taking shots is to not buy in for the full amount at the next level up. This way you will not be risking too much of your bankroll in any one game and you are essentially still playing within your bankroll if you do not put more than 5% of it on the table.
You may be interested to read about how quickly you can move up the stakes in poker.
It should be noted that bankroll management is not going to help you win money if you are a losing poker player.


text:
Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003
Mary G Reynolds1,
Bach Huy Anh2,
Vu Hoang Thu3,
Joel M Montgomery1,
Daniel G Bausch1,4,
J Jina Shah1,
Susan Maloney1,
Katrin C Leitmeyer5,
Vu Quang Huy3,
Peter Horby6,
Aileen J Plant7 &
Timothy M Uyeki1
In March of 2003, an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in Northern Vietnam. This outbreak began when a traveler arriving from Hong Kong sought medical care at a small hospital (Hospital A) in Hanoi, initiating a serious and substantial transmission event within the hospital, and subsequent limited spread within the community.
We surveyed Hospital A personnel for exposure to the index patient and for symptoms of disease during the outbreak. Additionally, serum specimens were collected and assayed for antibody to SARS-associated coronavirus (SARS-CoV) antibody and job-specific attack rates were calculated. A nested case-control analysis was performed to assess risk factors for acquiring SARS-CoV infection.
One hundred and fifty-three of 193 (79.3%) clinical and non-clinical staff consented to participate. Excluding job categories with <3 workers, the highest SARS attack rates occurred among nurses who worked in the outpatient and inpatient general wards (57.1, 47.4%, respectively). Nurses assigned to the operating room/intensive care unit, experienced the lowest attack rates (7.1%) among all clinical staff. Serologic evidence of SARS-CoV infection was detected in 4 individuals, including 2 non-clinical workers, who had not previously been identified as SARS cases; none reported having had fever or cough. Entering the index patient's room and having seen (viewed) the patient were the behaviors associated with highest risk for infection by univariate analysis (odds ratios 20.0, 14.0; 95% confidence intervals 4.1–97.1, 3.6–55.3, respectively).
This study highlights job categories and activities associated with increased risk for SARS-CoV infection and demonstrates that a broad diversity of hospital workers may be vulnerable during an outbreak. These findings may help guide recommendations for the protection of vulnerable occupational groups and may have implications for other respiratory infections such as influenza.
A World Health Organization (WHO) medical officer consulting with physicians at a hospital in Hanoi, Vietnam provided one of the earliest descriptions of a respiratory illness that later became known as SARS. Suspicions were first raised in Vietnam when staff at a small private health care facility, Hospital A, in Hanoi began to fall ill after caring for a business traveler recently arrived from Hong Kong [1]. This individual had been admitted to Hospital A on February 26th (Figure 1), where he received care for 4 days in the general medical ward and 4 days in the intensive care unit. On March 5th, he was transferred to a facility in Hong Kong where he died one week later; he was subsequently confirmed to have SARS-associated coronavirus (SARS-CoV) infection. [2].
Epidemic curve of the SARS outbreak among Hospital A staff, Hanoi, 2003.
Enhanced infection control practices, cohorting of patients, and increased use of barrier protections were initiated on March 6th, after it was recognized that a severe respiratory illness was affecting several staff members. There were no negative pressure rooms at the hospital. N95 respirators, goggles, and face shields were made available to staff on March 12th [Uyeki, personal communication]. Transmission of SARS-CoV among staff, visitors, and patients of Hospital A, and their close contacts outside the hospital, ultimately resulted in 62 cases of SARS in Northern Vietnam. Ninety percent of the 62 cases and all of the deaths (n = 6) occurred among individuals who visited or worked at Hospital A, which was temporarily closed on March 18th, 2003.
Hospital A is a small (<60 bed) private facility in Hanoi, providing inpatient specialist, laboratory, and nursing services. At the time of the outbreak, in addition to Vietnamese staff, several expatriate nurses and physicians were employed, often as clinical specialists on short-term contract from France. This report describes SARS-CoV secondary attack rates among the cohort of hospital staff at Hospital A and presents the results of a nested case-control study designed to identify risk-factors for SARS-CoV transmission after admission of the index patient. The primary objectives were to ascertain the extent of SARS-CoV transmission among the clinical and non-clinical staff at the hospital and to determine the nature of the initial exposures to the index patient that resulted in a substantial transmission event.
Cohort study population and enrollment
We conducted a survey of symptoms and exposures among the cohort of workers at Hospital A, and a nested case-control study to assess risk factors for acquiring SARS-CoV infection after admission of the index case. For the latter study, only individuals who had worked at least one shift during the time the index patient was hospitalized were included (Figure 2).
Diagram representing criteria for selection of case and control subjects to evaluate risks for SARS-CoV infection stemming from hospital exposure to the Hanoi index patient. (*) SARS cases were confirmed by serologic testing, viral culture, or RT-PCR performed on specimens obtained from persons with clinically compatible illness. (†) Excluded as study cases were SARS cases among the staff who were unlikely to have contracted infection from the index case (i.e., illness onset after March 5th, 2003 or seroconversion > 18 days after last exposure to the index patient); included as study cases are those SARS cases among the staff who had illness onset on or before Mar 5th, or seroconversion within 18 days of last exposure to the index case. (‡) Included as study controls were non-cases demonstrated to be negative for SARS-CoV antibody at least 18 days after last exposure to the index case. Potential control subjects were excluded from the analysis if no serologic specimen was collected from them or if the specimen was collected too early to assess final outcome status from exposure to the index case (i.e., within 18 days of last exposure).
During the outbreak, in the final two days that the hospital was open (March 17–18, 2003), investigators obtained a comprehensive list of hospital employees and held meetings with individual units (i.e., security, nursing, etc.) to recruit study participants. Upon providing written consent, participants were asked to complete a short, self-administered questionnaire and to provide a serum specimen for determination of antibodies to SARS-CoV. Questionnaires were translated into Vietnamese and responses were back-translated into English. Information was collected regarding the participant's contact with the index patient during his stay in the hospital from February 26th (evening) to March 5th, as well as their symptoms from the time the index patient was admitted to the hospital until 10 days after he was transferred (~1.5 incubation periods [3–5]). Self-reported symptoms were checked against case investigation forms for 42 staff members. Participants were asked about whether they had ever engaged in a series of activities relating to exposure to the index patient. Questions were simplified in order to minimize translation errors, ensure that the activities would apply for multiple different staff job categories (e.g., nurse and security guard), and to facilitate self-administration.
All exposure variables were comprehensive for the period that the index patient was hospitalized at Hospital A. For example, did you enter the general ward, referred to whether or not the subject entered the general ward at least once at any time during the index patient's hospitalization. Variables were not all exclusive. For example subjects were asked whether they ever came within 1 meter of the index patient, and whether they ever did so without a mask (respirator). Further information pertaining to the number and duration of potential encounters was not requested due to time constraints and concerns about recall bias.
A physician who provided care for SARS patients at Hospital A throughout the outbreak (this physician resided temporarily at the hospital while the outbreak was ongoing) served as a proxy respondent for the staff who had died (n = 6) or were too ill (n = 1) to respond at the time of the survey. This physician had assisted WHO investigators in conducting the initial staff interviews in early March following recognition of respiratory illnesses among staff. Work shift schedules were available for 30.0% of the Hospital staff and were used to verify staff responses. The protocol was approved following expedited review by the hospital institutional review board and the Vietnamese Ministry of Health.
Laboratory confirmation of cases
Laboratory confirmation of SARS-CoV infection was performed at the Centers for Disease Control and Prevention (Atlanta, Georgia, USA) and was based either on detection of RNA from SARS-CoV in clinical specimens (via reverse transcriptase polymerase chain reaction assays, RT-PCR), or by serology, as previously described [2]. Case definitions and laboratory assays employed during the outbreak in Vietnam are described in detail elsewhere [2].
Nested case-control study
To determine which work-related activities may have been associated with contracting SARS-CoV infection after admission of the index case, a case-control study was performed. Inclusion and exclusion criteria for study cases and controls are outlined in Figure 2.
Study cases were defined as persons having: (i) the presence of SARS-CoV antibody in at least one serum specimen collected prior to March 24th; or (ii) for SARS cases confirmed by means other that serologic testing (i.e., viral culture or RT-PCR), illness onset on or before March 5th, the last day the index patient received care at Hospital A. SARS Co-V infections resulting from exposure to the index patient were presumed to have resulted in antibody conversion on or before March 24th (18 days after the index patient's discharge) based on a conservative estimated timeline that includes a 6 day incubation period plus a 12 day interval to seroconversion. The estimated 6 day incubation period is based on the observed median number of days from exposure to illness onset among persons in Vietnam who reported only a single potential exposure to a SARS patient (n = 28). The 12 day estimated interval to seroconversion is based on the observed median number of days from illness onset to SARS-CoV antibody seroconversion among cases in Vietnam for whom the date of seroconversion is known within 48 hours (n = 17). This time frame is expected to exclude individuals who contracted infection from someone other than the index, while capturing the majority of individuals who were infected during index case's hospitalization in Hanoi, including a proportion of those who could have been infected on the last day of exposure to the index patient. The timing of illness onset alone was insufficient as a case selection criterion for the case-control study as this information was unavailable for many study enrollees.
Controls were defined as individuals within the study cohort who (i) were never identified as SARS cases, (ii) worked at least one shift during the time the index patient was hospitalized, and (iii) did not exhibit evidence of SARS-CoV specific antibodies within at least 18 days after last exposure to the index case.
Exposure and demographic variables used for analyses were dichotomous categorical; unknown or missing data was rendered as a negative response. Non-parametric tests (Fisher's exact, Cochran's Chi-square) or odds ratios (OR) with 95% confidence intervals (CI) were used to assess differences between groups using negative responses as the referent. The threshold for statistical significance was established at a p-value < 0.05.
Advanced age (> 50 years) and underlying medical conditions were not significant correlates of case status in this outbreak [Uyeki, personal communication] and were therefore not included in the analysis. All statistical analyses were performed using SPSS version 11.0.1 (SPSS Inc., Chicago, IL).
Survey of hospital workers
A staff census prepared in February 2003, indicated that 193 individuals were employed at Hospital A at the time of the SARS outbreak. The distribution of personnel between clinical and non-clinical roles is shown in Table 1. Twenty-nine of the 36 SARS cases (81%) at Hospital A occurred among clinical personnel with direct patient care or ancillary clinical roles. Direct patient care activities included primary medical functions such as patient examination and diagnostic evaluation, performance of procedures, and conduct of ongoing care and monitoring. In addition, non-clinical personnel were affected as well, with 19% of cases (n = 7) occurring among housekeepers and other cleaning staff (n = 5), kitchen staff (n = 1), and receptionists (n = 1). Several of the affected housekeepers entered the index patient's room on the night he was admitted to clean vomitus and respiratory secretions from the floor and walls, and various kitchen staff entered his room to deliver meals or collect service trays. Figure 1 depicts the epidemiologic curve of SARS illness among Hospital A personnel.
Table 1 Hospital A staff by job category – SARS attack rates and serologic profiles, Hanoi, 2003.
Two peaks of illness onset among staff were evident, on March 4th, and 9 days later on the 13th (Figure 1). All but one of the non-clinical staff cases became ill during the first apparent wave of the outbreak, which encompassed the period the index patient was an inpatient at Hospital A. Housekeepers and certain members of the kitchen staff had access to the index patient's room(s) during his stay, for purposes of cleaning and meal delivery. Overall, observed attack rates were highest among personnel with direct patient care responsibilities. Notably, however, nursing staff at Hospital A who were assigned to the operating Room (Op.Rm.)/intensive care unit (ICU) had significantly lower attack rates (7.1, p < 0.006) than did nurses in other staffing categories. Though mid-wives might not be anticipated under normal circumstances to have had opportunities for direct contact with the index patient, several women who had had complicated deliveries were hospitalized in the inpatient ward or ICU during the index patient's stay; two briefly shared a room with him.
Staff enrollment
Overall, 79% of Hospital A staff completed the exposure and symptom questionnaire, and 64% contributed at least one serum specimen. The lowest rates of participation in the exposure and symptom survey occurred among physicians and ICU nurses staffing categories (58.6%, 57.1%, respectively), but in both instances participation increased to over 64% for the serosurvey (Table 1). Staff work schedules were used, where possible, to independently verify a worker's presence at Hospital A during the index patient's hospitalization. A comparison between staff work schedules and worker responses is shown in Table 2. In general, there were fewer non-clinical staff than clinical staff participants in the serosurvey, but overall, serosurvey participation met or exceeded 50% in all but five staffing categories, these being, 'kitchen', 'dental', 'laboratory', 'administration', and 'reception'.
Table 2 Comparison of survey responses and staff work schedules during the SARS index patient's hospitalization in Hanoi, Vietnam.
The questionnaire was completed by proxy for seven individuals who had died or were too ill to complete the questions at the time of survey administration. Removal of these respondents from the study pool did not substantively affect study findings (shown below), therefore these responses were included analyses as appropriate.
Symptomatic illness among Hospital A staff
Results of the survey regarding symptoms of illness experienced by study participants are summarized in Figure 3.
Subjective symptoms of illness reposted among staff at Hospital A (n = 27 SARS cases, n = 115 non-cases), Hanoi, 2003. The presence of an asterisk indicates that the symptom was significantly associated with SARS case status (p < 0.05, Fisher's exact, two-sided). (#) indicates sample sizes for cases and non-cases of 8, and 58 respectively.
Consistent with findings from a clinical study of SARS patients conducted in Vietnam [6], fever, fatigue, myalgia, chills, anorexia, headache, and cough were the most frequently reported symptoms experienced by SARS infected staff at Hospital A. These symptoms occurred in over half of SARS cases, and all occurred at levels significantly above those reported by employees without SARS-CoV infection. Dizziness, shortness of breath and vomiting were also reported at significantly higher frequencies among SARS cases than uninfected staff, but nevertheless were reported by = 40% of SARS cases. Only diarrhea, sore throat, and rash were not reported at higher frequencies among SARS cases than uninfected staff. The background occurrence of rash was low among all participants, but both sore throat and diarrhea occurred at appreciable background rates (19% and 20%, respectively) among staff not infected with SARS-CoV.
Serologic profiles of Hospital A employees
Of the 124 Hospital A staff who participated in the serosurvey, 36 (29%) had at least one serum specimen that tested positive for the presence of antibody to SARS-CoV antigen (Table 1). Four Hospital A staff members with confirmed SARS-CoV infection did not complete the questionnaire or participate in the serosurvey. All 32 confirmed SARS cases that did participate in the survey tested positive for the presence of antibody to SARS-CoV antigen. Four additional, previously unrecognized, seropositive individuals were identified as a consequence of the serosurvey. Thus, 4 of the 36 initially identified SARS cases during the outbreak did not have serological confirmation, and they were replaced by the 4 additional, previously unrecognized, seropositive individuals identified as a consequence of the serosurvey (n = 36).
These 4 newly identified seropositive individuals (2 general ward nurses, 1 laundry worker, and 1 receptionist) had mild illness and were not identified during the outbreak despite active surveillance conducted among staff at Hospital A. Among this group, the 2 General Ward nurses reported having had at least three symptoms associated with SARS illness in this outbreak (the first reported fatigue, headache, and shortness of breath; the second also reported headache along with myalgia, chills, dizziness, anorexia, and vomiting), but neither reported having experienced fever or cough, which were inclusion criteria in the WHO SARS case definition used at the time. Both nurses also reported experiencing diarrhea during the study period. However, diarrhea was common among all Hospital A workers (23% of all reporting workers) regardless of SARS case status. Neither the laundry worker nor the receptionist reported having experienced symptoms significantly associated with SARS illness in Vietnam, with the exception that the latter reported vomiting.
Twenty-two study cases and 45 controls were identified (Figure 2). (Confirmed SARS cases not included in the study were excluded on the basis of illness onset date, date of seroconversion, or insufficient information to classify.)
Nearly all activities associated with physical proximity to the index patient or to his hospital rooms were significantly associated with SARS-CoV infection by univariate analysis (Table 3). However, touching the index patient (with or without personal protective equipment in the form of gloves, gown, face mask) or speaking to him in his room, were not significantly associated with SARS-CoV infection. Having had a job that involved direct patient care or sanitation/kitchen duties was also not associated with SARS-CoV infection. Having a non-clinical staff position was nominally protective (O.R. = 0.2, p = 0.011) against SARS-CoV infection, as was having had an upper-respiratory infection ('head cold', O.R. = 0.2, p = 0.039) within the prior 6 months.
Table 3 Single variable analysis of risk factors for SARS Co-V infection among hospital staff cases and controls, Hanoi, 2003.
Multivariate analyses were not performed due to the limited size of the study population.
SARS has been documented, under certain circumstances, to be highly communicable in hospital settings. Attack rates among workers with direct patient care roles have been observed as high as 10.0 and 11.8% in Canada and Hong Kong, respectively [5, 7]. This study examined early events after the admission of a patient with SARS-CoV infection into a small hospital, at a time before the risks from unprotected exposure to SARS patients were fully appreciated. Our findings highlight the potential SARS transmission risks to hospital workers from potentially infectious surfaces and from proximity to a symptomatic patient.
During several other outbreaks, airborne transmission of SARS-CoV was suggested as an important route of transmission in hospitals and residential settings [8–10]. Our findings do not allow us to discriminate between potential transmission via large droplet versus dilute aerosols, although large scale transmission through a concentrated 'plume' of virus seems less likely here, as proximity to the index patient was nearly universal among those who were infected. These findings have important implications for worker protection, as many different categories of workers perform activities that may bring them into proximity with a SARS-CoV infected individual.
Overall, we found that hospital workers who had greatest opportunity for proximity to the index patient were clinical staff, and among clinical staff, those with direct patient care duties experienced the highest attack rates and death rates among all categories of Hospital A workers. When Hospital A closed during the SARS outbreak, a second hospital (Hospital B) was designated to care for suspect SARS cases. There were no SARS cases among staff at Hospital B, and a serosurvey conducted among workers at the facility revealed no inapparent or asymptomatic infections despite the presence of numerous confirmed SARS cases in the wards [1]. The reasons for the disparity in infection rates among staff between Hospitals A and B is unclear, but comparing outcomes between the two hospitals in general supports the importance of enhanced infection control measures, barrier protections, and patient isolation, as control measures within hospitals.
A previous study of clinical workers at Hospital A suggested that the proportion of doctors and nurses using masks as a precautionary measure increased significantly after the initiation of secondary cases and that the use of masks had a significant impact on diminishing SARS-CoV transmission [11]. The potential benefits of enhanced infection control practices and barrier protections are also in evidence when looking at differences among workers at Hospital A who provided direct patient care. Among nurses at Hospital A, those who administered clinical care to critically ill or post-operative patients (Op.Rm./ICU nurses) experienced the lowest attack rates among all nursing categories, and though few (3 of 8) reported having engaged in any of the activities identified as being associated with risk for SARS-CoV infection (Table 3), it is possible that the lower overall attack rate for this group of nurses reflects the fact that routine infection control precautions employed by Op.Rm./ICU to protect vulnerable patients in the ICU also provided these nurses with protection against exposure to SARS-CoV. Studies from other SARS outbreaks have shown that nurses charged with providing intensive care to patients experienced relatively fewer instances of SARS-CoV infection [5], unless assisting with a high risk procedure such as an endotrachael intubation [12, 13].
During the course of this study, four workers, none of whom had been previously identified as cases, were found to have been infected with SARS-CoV. None of the four reported having had cough or fever, but two complained of diarrhea and another had a sore throat. A similar study conducted among health care workers in Singapore, revealed serologic evidence of SARS-CoV infection in two workers (of 112 exposed individuals) who experienced only mild symptoms of illness [14]. Both of these individuals had had fever and multiple systemic or upper respiratory symptoms, but neither developed pneumonia. Together, these reports and observations suggest that SARS-CoV infection can manifest with relatively mild symptoms, which can be easily masked against a background of unrelated illnesses in the community. The epidemiologic significance of mild (or asymptomatic) infections remains unclear however, and in this instance it is not known whether any of the four serologically positive individuals without pneumonia transmitted SARS-CoV to their contacts.
There were several limitations to this study. The first is the small sample size employed for the nested case-control, which contributed to a general lack of precision in measures of effect (odds ratios), and precluded our ability to look for independent risk factors through multivariate analyses. In addition, because of the need to minimize the complexity of the questionnaire, we were unable to assess either the duration, or the intensity of potential exposures, both of which are likely to be important modifiers of absolute risk. However, our streamlined approach using generalized questions allowed us to rapidly survey a large fraction of the hospital worker population, rather than just medical professionals. Finally, there were several potential sources of bias in this study which could have affected our results and conclusions. Although we performed the study prior to closure of the hospital, while the staff were still actively engaged in the outbreak investigation, we failed to achieve full staff participation, particularly among physicians and certain categories of nurses. This could have introduced a selection bias favoring enrollment of persons with less opportunity for direct contact with the index patient. Similarly, we questioned individuals about their exposure to the index patient 13 days after he was transferred to Hong Kong, and used a proxy to complete exposure questionnaires for deceased individual. Either of these could have introduced non-systematic information (recall) bias to our findings. We attempted to minimize the influence of these potential sources of bias by using case investigation forms and physician notes to verify self-reported information when ever possible.
Many of the job-related activities identified in this study as potential risk factors for SARS-CoV infection, such as entering the patient's room, and touching a visibly contaminated surface relate to 'proximity' contacts and possibly fomite involvement. These types of contact are broadly applicable to many different job categories from receptionist to physician, implying that our concept of occupational categories at risk for nosocomial infection may need to be broadened to include many different kinds of workers without direct patient care duties [5, 7, 15, 16].
The outbreak of SARS in northern Vietnam investigated here serves as a tragic reminder of the profound impact that the introduction of a highly communicable, virulent pathogen can have on the relatively closed community of a small hospital. In such instances, very early events following introduction can be pivotal in determining the ultimate magnitude of the outbreak and the degree of spread within the hospital. Appropriate recognition of those at highest risk of exposure and illness in conjunction with rapid, accurate identification of potential cases at the earliest stages of illness, are vital to minimizing the extent of spread. The results of this investigation highlight the diversity of workers at risk for nosocomial exposures and contribute to our understanding of risk factors for SARS-CoV transmission, which may include being in proximity to an infected patient or touching a contaminated surface.
Le DH, Bloom SA, Nguyen QH, Maloney SA, Le QM, Leitmeyer KC, Bach HA, Reynolds MG, Montgomery JM, Comer JA, Horby PW, Plant AJ: Lack of SARS transmission among public hospital workers, Vietnam. Emerg Infect Dis. 2004, 10: 265-268.
Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, Tong S, Urbani C, Comer JA, Lim W, Rollin PE, Dowell SF, Ling AE, Humphrey CD, Shieh WJ, Guarner J, Paddock CD, Rota P, Fields B, DeRisi J, Yang JY, Cox N, Hughes JM, LeDuc JW, Bellini WJ, Anderson LJ: A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med. 2003, 348: 1953-1966. 10.1056/NEJMoa030781.
Donnelly CA, Ghani AC, Leung GM, Hedley AJ, Fraser C, Riley S, Abu-Raddad LJ, Ho LM, Thach TQ, Chau P, Chan KP, Lam TH, Tse LY, Tsang T, Liu SH, Kong JH, Lau EM, Ferguson NM, Anderson RM: Epidemiological determinants of spread of causal agent of severe acute respiratory syndrome in Hong Kong. Lancet. 2003, 361: 1761-1766. 10.1016/S0140-6736(03)13410-1.
Leung GM, Hedley AJ, Ho LM, Chau P, Wong IO, Thach TQ, Ghani AC, Donnelly CA, Fraser C, Riley S, Ferguson NM, Anderson RM, Tsang T, Leung PY, Wong V, Chan JC, Tsui E, Lo SV, Lam TH: The epidemiology of severe acute respiratory syndrome in the 2003 Hong Kong epidemic: an analysis of all 1755 patients. Ann Intern Med. 2004, 141: 662-673.
Varia M, Wilson S, Sarwal S, McGeer A, Gournis E, Galanis E, Henry B: Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada. CMAJ. 2003, 169: 285-292.
Vu HT, Leitmeyer KC, Le DH, Miller MJ, Nguyen QH, Uyeki TM, Reynolds MG, Aagesen J, Nicholson KG, Vu QH, Bach HA, Plan AJ: Clinical description of a completed outbreak of SARS in Vietnam, February-May 2003. Emerg Infect Dis. 2004, 10: 334-338.
Ip M, Chan PK, Lee N, Wu A, Ng TK, Chan L, Ng A, Kwan HM, Tsang L, Chu I, Cheung JL, Sung JJ, Tam JS: Seroprevalence of antibody to severe acute respiratory syndrome (SARS)-associated coronavirus among health care workers in SARS and non-SARS medical wards. Clin Infect Dis. 2004, 38: e116-e118. 10.1086/421019.
Booth TF, Kournikakis B, Bastien N, Ho J, Kobasa D, Stadnyk L, Li Y, Spence M, Paton S, Henry B, Mederski B, White D, Low DE, McGeer A, Simor A, Vearncombe M, Downey J, Jamieson FB, Tang P, Plummer F: Detection of Airborne Severe Acute Respiratory Syndrome (SARS) Coronavirus and Environmental Contamination in SARS Outbreak Units. J Infect Dis. 2005, 191: 1472-1477. 10.1086/429634.
Yu IT, Li Y, Wong TW, Tam W, Chan AT, Lee JH, Leung DY, Ho T: Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med. 2004, 350: 1731-1739. 10.1056/NEJMoa032867.
Yu IT, Wong TW, Chiu YL, Lee N, Li Y: Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients. Clin Infect Dis. 2005, 40: 1237-1243. 10.1086/428735.
Nishiura H, Kuratsuji T, Quy T, Phi NC, VAN BV, Ha LD, Long HT, Yanai H, Keicho N, Kirikae T, Sasazuki T, Anderson RM: RAPID AWARENESS AND TRANSMISSION OF SEVERE ACUTE RESPIRATORY SYNDROME IN HANOI FRENCH HOSPITAL, VIETNAM. Am J Trop Med Hyg. 2005, 73: 17-25.
Fowler RA, Guest CB, Lapinsky SE, Sibbald WJ, Louie M, Tang P, Simor AE, Stewart TE: Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med. 2004, 169: 1198-1202. 10.1164/rccm.200305-715OC.
Loeb M, McGeer A, Henry B, Ofner M, Rose D, Hlywka T, Levie J, McQueen J, Smith S, Moss L, Smith A, Green K, Walter SD: SARS among critical care nurses, Toronto. Emerg Infect Dis. 2004, 10: 251-255.
Ho KY, Singh KS, Habib AG, Ong BK, Lim TK, Ooi EE, Sil BK, Ling AE, Bai XL, Tambyah PA: Mild illness associated with severe acute respiratory syndrome coronavirus infection: lessons from a prospective seroepidemiologic study of health-care workers in a teaching hospital in Singapore. J Infect Dis. 2004, 189: 642-647. 10.1086/381558.
Ho AS, Sung JJ, Chan-Yeung M: An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong. Ann Intern Med. 2003, 139: 564-567.
Lau JT, Yang X, Leung PC, Chan L, Wong E, Fong C, Tsui HY: SARS in three categories of hospital workers, Hong Kong. Emerg Infect Dis. 2004, 10: 1399-1404.
We would like to acknowledge and thank the many individuals within the Ministry of Health, Socialist Republic of Vietnam for their assistance with this study, especially Dr. Trinh Quan Huan, Director, Department of Preventive Medicine. We must also thank the staff of the Hanoi French Hospital, and the WHO staff in Hanoi, in particular Roger Doran, and Pascale Brudon, the WHO Representative in Vietnam at the time of the outbreak. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agencies.
National Centers for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
Mary G Reynolds, Joel M Montgomery, Daniel G Bausch, J Jina Shah, Susan Maloney & Timothy M Uyeki
Department of Medicine, Hanoi Medical University, Hanoi, Vietnam
Bach Huy Anh
Department of Medicine, French Hospital, Hanoi, Vietnam
Vu Hoang Thu & Vu Quang Huy
Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, USA
Daniel G Bausch
Centre for Biological Safety, Robert Koch Institut, Berlin, Germany
Katrin C Leitmeyer
Southeast Asia Regional Office, World Health Organization, Hanoi, Vietnam
Division of Health Sciences, Curtin University of Technology, Australia
Aileen J Plant
Mary G Reynolds
Vu Hoang Thu
Joel M Montgomery
J Jina Shah
Susan Maloney
Vu Quang Huy
Timothy M Uyeki
Correspondence to Mary G Reynolds.
The author(s) declare that they have no competing interests.
All authors read and approved the final manuscript. MR participated in the design of the study performed the statistical analyses and drafted the manuscript; BA participated in the design and coordinated implementation of the study; VT participated in the implementation of the study; JM participated in data analyses and preparation of the manuscript; DB participated in design of the study and preparation of the manuscript; JS participated in implementation of the study; SM participated in design of the study; KL participated in implementation of the study; VH participated in collection and analysis of laboratory diagnostic specimens; PH participated in data analysis and manuscript preparation; AP participated in design of the study; TU participated in design and implementation of study and supervised manuscript preparation.
Mary G Reynolds, Bach Huy Anh contributed equally to this work.
Reynolds, M.G., Anh, B.H., Thu, V.H. et al. Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003. BMC Public Health 6, 207 (2006). https://doi.org/10.1186/1471-2458-6-207
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Alamosa News
Health-Updates
GFWC active in Alamosa and beyond
Honored during a recent Alamsoa City Council meeting with a proclamation was the GFWC Women's Citizenship Club of Alamosa recognizing the 129th anniversary of the organization.
ALAMOSA–The General Federation of Women's Clubs has a membership in the San Luis Valley that is alive and well. The Alamosa City Council recently recognized the GFWC Women's Citizenship Club of Alamosa with a proclamation about the organization's 129th anniversary.
Established in 1890, the GFWC has a long and rich history of philanthropy and activism. It also boasts names such as Clara Barton and Eleanor Roosevelt as previous members. The GFWC was also highly involved in the Women's Suffrage Movement. There are 3,200 GFWC clubs with 90,000, GFWC members, from all 50 states. The GFWC motto is "Unity in Diversity."
In Colorado, the GFWC has been at work since 1895 and was instrumental in the establishment of Mesa Verde National Park. There are 12 GFWC Colorado clubs that have a total of 261 members, continue to work in their communities. This work includes support for the arts, preservation of natural resources, advancement of education, promotion of healthy lifestyles, civic involvement, and working toward world peace and understanding. These initiatives are supported not only with monetary donations, but also with hands-on tangible projects to provide immediate impact.
Theresa Rudder of the GFWC Women's Citizenship Club noted that the impact of the GFWC has been seen worldwide. Through partnering with organizations such as UNICEF, Heifer International, the March of Dimes, and Shot at Life numerous lives have been impacted.
One of the most notable areas of focus for the GWFC has been the issue of domestic violence. The GFWC leadership worked with then Sen. Joe Biden on the passage of the Violence Against Women Act. In Alamosa, the club has supported the work of Tu Casa Inc. Recently; the Women's Citizenship Club donated 25 new purses filled with personal hygiene items to assist Tu Casa clients.
The work of GFWC both locally and internationally has had impacts that are both seen and unseen. However, there has been a commitment to "Living the Volunteer Spirit," from it's members that does not appear to be slowing down.
Inmate commits suicide
Pond hockey tournament underway in Creede
ALAMOSA–The General Federation of Women's Clubs has a membership in the San Luis Valley that is alive and well.
2205 State Ave. Alamosa CO 81101


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Clarinda Harriss
Clarinda Harriss: Gladly Would (she) Teach and Gladly Learn
November 11, 2016 October 4, 2016 amusingpoetLeave a comment
Dr. Sara deFord, my longtime teacher and mentor—with whom I eventually collaborated on two books—was a medievalist as well as a poet. While we Goucher undergrads were happily toiling our way through Chaucer's The Canterbury Tales in their original Middle English, she pointed out that the description of the Clerk would fit perfectly a contemporary T(eaching) A(ssistant) working toward a PhD. Teaching at Forest Park High School while I worked toward my grad degree, I understood the aptness of the quotation. From spending my first 14 years of my total of 40 at Towson U., I was struck by how similar the Teach Assistant and the Adjunct are, and how both are fit to a T by the Clerk.
The funny thing about being a TA or an adjunct is that how many of these homeless, rights-less fledgling profs love their work; their exhilaration, if they are lucky enough to feel it at all, can transfer powerfully to their students. Both Lynda and Frannie, now among my oldest friends, were my students at Forest Park High School (FPHS) over 50 years ago. I am firming up plans for my annual get-together with Lynda, and my offspring and I consider Frannie a member of the family. I believe they graduated from FPHS in 1964. From FPHS students I learned, among many other things, that teaching was my true calling. (More so, even, than writing.) And I think what I learned to love best about teaching was how much it taught me. I had much to learn.
Fast backward to a January day in 1961, a teacher's meeting day just prior to the start of the Spring semester. I had tacked up various cheerful pictures above the blackboards (they really were black and made of slate!) and written a quiz on the board (my mother, perhaps the wisest teacher I've ever known, said a daily quiz would give me a chance to "get myself together" before starting a lesson). I had put Mateus wine bottle empties with ivy in them on the wide, wide windowsills (we're talking about the gorgeous old FPHS here, complete with marble halls and 20-foot high art deco goddesses holding urns on either side of the antique elevators). And I stared down at the rows and rows of antique desks, wood and wrought iron combos nailed securely to the floor. Empty desks. They seemed Escher-like. Nightmarish. I panicked.
But the next day, when the desks were all occupied by students, I realized (to paraphrase Winnie the Pooh's Roo sipping from a medicine bottle), "This is what Clarinda likes!" Panic evaporated. Elation took over, though sometimes it kind of scared me to realize that, at 21, and THE TEACHER, I was the only so-called adult in the crowded room. As soon as the desks were peopled with, well, people, the back-and-forth, the teaching and learning in both directions, started.
My sense of "I can do this!" was greatly enhanced by Stanley Berdoff. I think that's his real name; he won't be mad at me if he reads this, I suspect. Stanley was not present on the first day. "Wait till Stanley gets here," students told me, snickering. Stanley was the resident bad-ass. He wasn't there the next day, either. On the third day, just as I was climbing via a desktop up onto the window sill to see if I could open a window (even with one of those long hooked poles I couldn't do it), Stanley, late of course, swaggered in. The class held its collective breath."You must be Stanley," I blurted. "Do you think you could give me a hand here?"
In an instant Stanley leapt onto the windowsill as onto a charger and took the pole, the lance, from my hand. He jousted with the window and won. "Hey, when you need me to do anything for you, I'm right here," said Stanlely Bad-Ass Berdoff, my shining knight. I like to recall that the class applauded, but I'm not sure that part really happened.
Then there was the enormous Vo-Tech class. Every semester I was assigned at least one of those: boys—no, young men—who were either deemed not smart enough for the Academic track or who actually chose to be in the Vocational track, taking wood shop and machine shop so they could go into the workforce right way. For obvious reasons, the guys in that track differed radically from one another in intelligence, motivation, you name it. That difference swiftly became apparent to me when I met ferociously intelligent Jimmy McCulloch (not quite his real name, for reasons which will become apparent).
Thirty copies of MACBETH had recently been delivered by dolly to my classroom, and forty-some eleventh grade vo-tech guys were struggling through it, many forced to share their copies. Mostly we read the play aloud and acted out the bloodiest or funniest scenes (vo-tech guys made brilliant witches). Fact is, Macbeth is perfectly attuned to almost-adult males, who understand masculine rivalry and also tend to be a bit sentimental; it wasn't unusual for a couple of the guys to get teary eyed when Macduff cries "All my pretty ones? All?"
One day Jimmy lingered at my desk after class.
"Miz Lott, how much longer are we going to be doing Macbeth?"
"Oh, Jimmy, I'm sorry we're going so slowly—you're probably getting bored– but we should be done by the end of the week."
"No, Miz Lott, it's just that my uncles need to know when I can get back to work, and I can't cut school while we're on Macbeth."
Jimmy was the scion of a family famous from Baltimore to Appalachia for its skill at parting out stolen cars.
Jimmy played Macbeth the rest of the week. And, when he was not too busy working with his uncles, he kept my moribund 1950 Morris Minor alive till the semester ended. Guilty secret: I never really liked Macbeth till then. Jimmy and his vo-tech cohorts taught me to love it.
Then there were the Basics. These were students deemed not smart enough to be in either the academic OR the vocational tracks. We were given guidelines for how to "cope" with them, and dumbed down rewrites of Macbeth (ditto Silas Marner, etc.) arrived unbidden to our classrooms for them to suffer through. A couple of other fledgling profs and I cruelly referred to the most challenged of these students as the Mopantew Kids. That's because on one quiz a "Basic" youth spelled "potato" "mopantew." Years later, as a direct result of teaching poetry at the university level, I noted that this "Basic" boy was close to being literate: unlike some of the poetry students, he understand syllables and the alternation of consonants with vowels and, most of all, accentuation. All somebody would've had to do was get him and others like him Hooked on Phonics. That was a lesson I learned too late.
As much as I learned from my high school students, both at Forest Park and at Towson High (where it was a student who told me that I had to read Dalton Trumbo and another who turned me on to Confederacy of Dunces), nothing can quite compare with what I learned from my "Editing the Literary Magazine" course at Towson University(TU), a class comprising the large staff of GRUB STREET, TU's prizewinning lit and arg mag. On one blue-and-gold September morning, a beloved colleague, Peggy Benner, rushed into my classroom and plunked her "vintage" black and white portable TV on the front table. Not I, but the Grub Street editor, Hilary Szygiel, sat at that table, leading the discussion of the most recent batch of submissions. And that is how Hilarie and I and the other 30-some staff members watched the second Twin Tower fall in real time. It freaks me out—in a marvelous say—to realize that all of us, when asked what we were doing on 9/11, would almost certainly say the same thing, and, unless I'm a total exception, recall feeling a sense of connection like to few we'd ever experienced. To this day I feel grateful that I was part of what I consider the most important aspect of teaching/learning in a classroom: a sense of community unique in our experience. The community of scholars and vo-tech guys and writers and, yes, Mopantew Kids. It transcends time. The Clerk is part of the community.
From Canterbury Tales: The Clerk
For he hadde geten hym yet no benefice,
Ne was so worldly for to have office.
For hym was levere have at his beddes heed
Twenty bookes, clad in blak or reed,
Of Aristotle and his philosophie,
Than robes riche, or fithele, or gay sautrie.
But al be that he was a philosophre,
Yet hadde he but litel gold in cofre;
But al that he myghte of his freendes hente,
On bookes and on lernynge he it spente,
And bisily gan for the soules preye
Of hem that yaf hym wherwith to scoleye.
Of studie took he moost cure and moost heede.Noght o word spak he moore than was neede, And that was seyd in forme and reverence, And short and quyk, and ful of hy sentence; Sownynge in moral vertu was his speche,310And gladly wolde he lerne, and gladly teche.
Clarinda Harriss is a professor emerita of English at Towson University. For more than four decades she has done several things dear to her heart, and continues to do them: publish BrickHouse Books, Inc., Maryland's oldest literary press, and worked with prison writers. Her most recent book, THE WHITE RAIL (Halfmoon Editions, Atlanta, GA) , is a collection of short fiction, not her "real" genre, poetry. She delights in her two children and five grandchildren.
Uncategorizedadjuncts, Canterbury Tales, Clarinda Harriss, Forest Park High School, TA, teaching assistants, Towson University
What You Wish For: Clarinda Harriss
January 8, 2016 January 8, 2016 amusingpoetLeave a comment
Sixty-some years ago I had to let go of my high school crush on Tom. We were both graduating, me heading up the road to Goucher and he taking off into the wild blue yonder (literally); besides, despite from his unabashed kindness to everybody (quite remarkable in a high school BMOC who was both an athlete and a schoolbook whiz), he had barely noticed me.
Actually I didn't let my crush go altogether. I always inquired about him when our various five- and ten-year reunions rolled around. Via alumni chatter I learned he was a pilot and later that he had a glamorous, globe-encompassing career in the airline industry. I held onto the idea of at least seeing him again someday, but I let him go again when, to my surprise, he showed up at a reunion—possibly our class's 30th—with his second wife She was so clever and so lovely (to this day I envy her nose) that I knew Tom was lost to me forever.
Then came the months-long preparations for our class's 55th reunion. The reunion dinner was to be held at my house, with close to 55 people in attendance. The pre-dinner months brought a frenzy of email. At one point I got utterly fed up with myriad Reply Alls about stuff that concerned only the sender and sendee. I pecked out a message: COULD WE PLEASE STOP HITTING REPLY ALL TO EVERYTHING? RE. THE CURRENT DISCUSSION, PLEASE JUST LOOK AT THE REPLY FROM TOM AND DO WHAT HE SUGGESTED. But of course that message required me to hit Reply All. So Tom was among the recipients.
To my huge surprise, he replied—to me only—that he was happy to re-make my acquaintance. In fact, he'd like to head up to Baltimore sometime soon. He had been holding onto the notion of revisiting the town he spent his youth in. Maybe dinner. . .?
Thus a long (time) story became short. When the reunion dinner actually took place, I was barbecuing for the multitudes on a fancy new outdoor grill, courtesy of Tom. Shortly thereafter he moved to Baltimore. Within the year I allowed as how it was pretty stupid of him to maintain a Baltimore apartment when he had so far spent a total of two nights there. My house had plenty of room. It was the "Old Manse" I'd lived in with my parents and grandmother when he and I met in high school: a perfect place for me to Live In Sin with someone who was quite literally the man of my dreams. He moved in.
Fast forward, but not very far. I enjoyed being with Tom. My friends and family did too. I liked developing routines, his running, my writing, our multi-family holiday seasons, discovering our favorite places to eat raw oysters. But it didn't take long for me to realize that something was very wrong. He was not a heavy drinker and he certainly didn't do drugs, but he had the sense of time (or rather the absence thereof) commonly associated with potheads. Not much sense of direction, either. Strange indeed for the ex-captain of an industry where space and time were of the essence. Pressed for specifics about his last couple of decades, I discovered that he could barely remember them. Such discoveries slammed me like a runaway truck. Especially because by this time I no longer had a crush on Tom. I loved him. And the feeling was mutual.
The first appointment at Johns Hopkins' memory loss clinic confirmed what had already dawned on me: Tom had Alzheimer's. Had? Has. Its grip on Tom was fairly light at first, but it is tightening, tightening. The Big A is not something that lets a person go It holds on as a cat holds onto a mouse, playing with it before killing it.
About six months ago I began keeping The Dementia Diary. I started it at the suggestion of a close friend. I'd too often emailed her screens-full of the latest losses of keys, glasses, wallet, the latest finding of the dirty laundry whirling in the dryer. Of all three pairs of lost glasses, crushed to smithereens. Of being asked a dozen times in as many minutes what we're doing an hour from now. Of his conflation of the TV remote with the phone. And losing them both. Of the time I freaked out and rolled myself up in the soft kitchen rug, screaming.
Luckily I had the D. Diary to turn to when I got home from an hour at a near-by restaurant lunching with some close women friends to find an ambulance and two police cars in front of the house. Tom had hit the "panic button" on our burglar alarm. Of course it was an accident—he'd been trying to make sure the alarm was off before opening the door for the UPS man—but I think he was, in fact, panicked. Like many people with Alzheimer's, he becomes agitated at the unusual, and the most unusual thing of all is for me to be somewhere else. Those afternoons with "the Ladies Who Lunch" are my once-a-month two hours away. I hold onto them for dear life, as for dear life he holds onto me.
And that is exactly why, though I need to let go of the idea of Tom and me having what could be described as a normal relationship any more, I hold onto him with love, and I do mean romantic love—not just for the charming boy he was when I got that first crush, but for the remarkable man he is now. He remains one of the sweetest, best-looking, most generous-spirited, smartest humans I've ever known, despite how hard it has become for him to put his ideas into words. Though his children say he used to be quite impatient, he never makes a fuss when I myself do something dumb, forget something important. I believe he would lay down his life for me.
I understand now why he seems so much more fearful than I am when police helicopters shine search lights into the yards of our leafy, lovely, crime-ridden neighborhood. I used to think it was simply because I'm used to this 'hood and he isn't. But no, it's because he feels he must protect me. I saw this in action last September at three AM when a cat burglar really did creep into our bedroom. Tom leapt for him, yelling threats, cussing like a sailor, and the robber ran like hell with Tom at his heels.
Tom has not let go of what makes him him. I hold him close.
Bio: Clarinda Harriss is a professor emerita of English at Towson University. For more than four decades she has done several things dear to her heart, and continues to do them: publish BrickHouse Books, Inc., Maryland's oldest literary press, and worked with prison writers. Her most recent book, THE WHITE RAIL (Halfmoon Editions, Atlanta, GA) , is a collection of short fiction, not her "real" genre, poetry. She delights in her two children and five grandchildren.
UncategorizedAlzheimer's, Brick House Books, Clarinda Harriss, hope, loss, Love, Poetry, publisher, The White Rail
" I couldn't stop reading Once You're Inside, your new poetry book. I experienced so many emotions. Frustration, Hope, Anger. Then respect for your courage going into this broken system." ~Brian England
Couldn't stop reading
" I am able to hear the environment of the prison building as I read one transcript after another of the despair, horror, and hope. There should be a Nobel prize for going into the dark with others who live there on a permanent basis, but then again, darkness is a state of mind. Thank you for your beautiful work, Ann." ~Patti Tronolone
The opportunity to be with other women, to engage in purposeful journaling, and to receive guidance from Ann enabled me to begin the next chapter of my life. Becky Salerno
"purposeful journaling....enabled me to begin next chapter in my life."
"In clear, everyday language, Ann Bracken shows us the power of words to redeem the worst sort of misery. "The Altar of Innocence" chronicles the ultimately triumphant journey of a sensitive child through the minefield of alcoholism and depression. Ann's beautiful spirit shines through in every poem." Barbara Quick, , author of Vivaldi's Virgins and A Golden Web
"triumphant journey of a sensitive child..."
Ann Bracken is an out-of-the-box thinker. She is called to shed light on the complex, universal issues of human nature, and she does it so creatively. Bev Hitchins
"an out-of-the-box thinker."
This poetry residency made the children love poetry in a new way. Ann's passion for poetry rubbed off on every student and helped them to be successful. Michele Barron, Teacher, Howard County Public Schools
"residency made children love poetry in a new way."
"It will be helpful for to others and enlightening. Bonnie A.
Book endorsement


With a dysfunctional home life, she spiralled downwards abusing drink and drugs with the inevitable impact on her life and education.
"When we got the phone call about my brother, we partly guessed it would happen. He wouldn't have been the greatest in school, he was in trouble with the guards, I just started taking the pot he was taking until I finally came to a stop and said this isn't a life I want for my kids, so I woke up one morning and told myself cop on and do something about it."
Through the grapevine Jodie heard about the Dillon's Cross Project based at the Glen Resource Centre in Mayfield on Cork's northside.
Set up in 1995, the project is an outreach programme of the Education Unit at Cork Prison providing support and education to the wives and partners of prisoners and ex-prisoners.
Eibhlín Davitt, who runs the project, says these are women who are often neglected and forgotten about - many of whom have endured a lifetime of serious dysfunction.
The project tries to help them overcome the negative impact of having their husband or partner in prison so that they can function for the good of themselves and their children - providing them with a routine, and equipping them with fundamental life skills.
"Having to manage the children on your own, you are effectively a lone parent but yet you are married or have a partner in prison. You see him once a week. The partner in prison is in a kind of prison bubble and they can't relate to what is happening at home," says Eibhlín.
"I had a woman once who said to me, I have a four-year-old who won't go to bed, and a 14-year-old who won't go to school and I have a partner in prison who can't relate to either of those problems because he has so many problems of his own. It is so difficult for people."
Mental ill-health, substance abuse and the reality that their children are at a greater risk of ending up in prison too, are among the many problems facing these women.
Edel Cunningham, the Head Teacher at the Education Unit at Cork Prison, which oversees the project says a recent survey of the English prison system found that over 60% of the sons of men who served time will end up in prison themselves.
It is in an effort to break this cycle of re-offending that this project offering support and education is so important, she says.
The project is acknowledged as a model of good practice, but it "survives on peanuts", according to Edel.
Every year, she says, is a struggle to balance the books with funding from the HSE, the Board of Governors at Cork Prison, the Sisters of Mercy, the Drug & Alcohol Task Force and the Educate & Training Board.
Edel has no doubt that the project could do an awful lot more if there was money for extra teaching hours and to enable them reach out to other projects, especially those supporting the children.
"Really what we are trying to do is prevent the next generation going down the same pathway," she says.
Over the past 24 years, Eibhlín says they have helped more than 300 local women to achieve academic success under a programme which has evolved over the years but now offers modules on maths, computers, personal development, sewing and cooking to levels 3 & 4 QQI (Fetac).
Next door, the sewing machines hum as students from 24 years of age to 62 work on their end-of-year projects.
Among them is the course's youngest student. The 23-year-old tells me she was terrified of the sewing machine when the teacher Mary first sat her down in front of it but now she is flying at it.
She proudly shows me the cushion she made with its love hearts and her two sons' initials.
Another student has made a sensory blanket for a child with special needs.
She is so glad to be doing the course. Everything taught here is practical, she says. It's good for the self confidence and for the company.
"Sometimes people have to let off steam. It's great for the head and the heart, great for everything, really."
Elsewhere in the prefab, Jodie is finishing her morning maths class and will soon be off to collect her children from school. She reflects on the changes the progamme has made to her life and her dreams for the future.
"Looking back a few years ago this would never have been me. I didn't really look towards the future, I dwelt in the past but since I started coming in here that's changed."
"It's the best thing I have ever done.
"I was talking to the boss this morning about going further to be a youth worker and she said once I've finished the years here they will all help me to go where I want to go."
Every success here is hard-earned and celebrated.
This year the project celebrated a first - a former student graduating with a Bachelor of Arts degree. Eibhlín said this was monumental for them. But so too was the woman who wrote her name in the roll book for the first time.
"That was just such an unbelievably joyous moment, we were literally dancing around the kitchen so that there are all different levels of success but the majority of people who go on to second or lower third level would go on to do hairdressing, child care or nurse's assistant."
Over tea and toast in the kitchen at lunch break, 32-year-old Margaret tells me she hopes to study English at UCC, having finished the programme on her second attempt.
She's a bit nervous but says she knows there will be support for her here.
She is the first person in her family to graduate from a course of any kind.
Margaret says her 12-year-old daughter is so proud of her and recalls that following her graduation last January, her little girl took her mum's graduation cap and picture into school on her Show & Tell Day to tell everybody that "her mam graduated and she is going into UCC now and she could be teaching one of us some day".
Looking around her as the women pack up for the day, Eibhlín remarks that despite all the angst and all the sad stories, there is a fantastic atmosphere and the girls are full of fun - they get a lot of attention, and they appreciate that.


Lent, in current times, is observed by many Protestants as well as Catholics. Obvious outward signs such as ashes on the forehead, fasting, abstinence from meat on Fridays have evolved into a deeper meaning of a time of reflection, sacrifice and conversion.
While listening to a Lenten CatholicMoments podcast last year, I heard a great list of 40 Lenten Resolutions. If you are like me and tend to stick with the same resolutions year after year, this list might open your eyes to the possibilities during this period of preparation. The list incoporates both the idea of self -sacrifice and positive sacrifice with adding extra spiritual time as a way to celebrate this time of preparation.
It got me thinking of what have been the best Lenten observations for my family over the years.
How are you choosing to observe Lent? What would be on your list of top Lenten Resolutions? Share with us in the comments section.


text:
Q: Dungeon Game Solution explanation The dungeon game is described as:
The demons had captured the princess (P) and imprisoned her
in the bottom-right corner of a dungeon. T
he dungeon consists of M x N rooms laid out in a 2D grid.
Our valiant knight (K) was initially positioned in the top-left room
and must fight his way through the dungeon to rescue the princess.
The knight has an initial health point represented by a positive integer.
If at any point his health point drops to 0 or below, he dies immediately.
Some of the rooms are guarded by demons,
so the knight loses health (negative integers) upon entering these rooms;
other rooms are either empty (0's) or contain magic orbs that increase the knight's health (positive integers).
In order to reach the princess as quickly as possible,
the knight decides to move only rightward or downward in each step.
Write a function to determine the knight's minimum initial health
so that he is able to rescue the princess.
For example, given the dungeon below, the initial health of
the knight must be at least 7 if he follows the optimal path RIGHT-> RIGHT -> DOWN -> DOWN.
Notes:
The knight's health has no upper bound.
Any room can contain threats or power-ups, even the first room the knight enters
and the bottom-right room where the princess is imprisoned.
Example:
dungeon = [[-2,  -3,  4],
           [-6, -15,  0],
           [10,  25, -6]]

Answer: 8
The code solution is:
def dungeonGame(dungeon):
    dp = [float("inf") for _ in dungeon[0]]
    dp[-1] = 1

    for i in reversed(range(len(dungeon))):
        dp[-1] = max(dp[-1] - dungeon[i][-1], 1)
        for j in reversed(range(len(dungeon[i]) - 1)):
            min_HP_on_exit = min(dp[j], dp[j + 1])
            dp[j] = max(min_HP_on_exit - dungeon[i][j], 1)

    return dp[0]

Can somebody explain how the solution above is working?  Why is the dp only len 3 with the provided example?  Is it because there are only 3 steps required, excluding start and finish rooms?  Why is it getting the minimum on the adjacent dp's and then the maximum?  Also how come it seems that the last column is not being taken into consideration since dungeon[i][j], where j only goes up to 1 (taking the given example matrix).  I know the solution is written well, just trying to understand how its taking all the path into consideration.

A: This algorithm works its way back from the bottom right, going left and then up, finding the optimal score for each step along the way. I recommend you execute the algorithm with pen and paper, writing down the current values of i, j and dp along the way. That should really clear things up.

(Start): No i and no j yet, dp = [inf inf 1]

You'll need at least 1 HP after reaching the bottom right in order to win.

(After entering the first loop): i=2, dp = [inf inf 7].

You need 7 health to survive the -6 of the bottom right square itself.

(After entering the inner loop): i=2, j=1, dp = [inf 1 7]

If you're in the bottom center square, the bare minimum 1 health is enough to survive that square's +25, and reach the adjacent square that requires at least 7. And so on.
This is the crucial line that chooses between going right (stored in the next element of the intermediate results, dp[j + 1]) or down, dp[j].
min_HP_on_exit = min(dp[j], dp[j + 1])

There are only three elements to the intermediate results because with the movement rules (only move right and down) and a dungeon with a diagonal of 3, there are only at most 3 places where you could be after any number of moves.
Every time the solver moves up a line, the last column is taken care of as a special case here:
dp[-1] = max(dp[-1] - dungeon[i][-1], 1)

Why? Well, it's different from the other columns in that you can't move right, only down.

redpajama_set_name: RedPajamaStackExchange


Netflix Adds Two Standup Specials from Louis C.K.
Louis C.K. has two new standup specials in the works at Netflix. The Wrap reports that the streaming network will debut the first standup special, titled 2017, on Tuesday, April 4th. 2017 was filmed at a performance in Washington DC, and the release date for C.K.'s second standup special has not yet been revealed. C.K. joins a long list of comedians with multiple Netflix specials in the works including Jerry Seinfeld, Dave Chappelle, and Chris Rock.