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Garyk Lee Style TV "Oh Christmas Wine Rack" Now Available Worldwide - Subscribe and Watch Today!
When We Dance the Music Dies
Urbanworld Film Festival 2019
"Becoming The Total Package" by Canada's Millionaire Matchmaker Aviva Reimer Now On Pre-Sale For .99 Cents
Gala: "Jewelry With A Mind and Attitude of its Own" "Fashion For Passion" by Eileen Shapiro
"Teachings of the Masters" — Guru Yogi Mohan
"Empire Experience" to Take Over The Mint LA, June 11
Steve Bluestein: "Memoir of a Nobody" by Eileen Shapiro
Doc Review: The Mayor of Comedy
SVTV – The Digital Media Platform Built for Strong Voices In The LGBTQ Community, Its Allies, Advocates, and Fans!
Artist/Designer Garyk Lee To Perform At The 3rd Annual "Lip Sync For A Cure" Benefit Show 1/26/19
The Mob Chats with Maz Jobrani
Beacon Publishing Group Releases "Kip Addotta: Confessions Of A Comedian" In Audiobook Format
CANADIAN HOWIE MANDEL AND ICM PARTNERS LEAD AN INVESTOR GROUP AND ACQUIRE THE GLOBAL COMEDY BRAND JUST FOR LAUGHS GROUP
Eric Anders sends Trumpism a message with new album "Eleven Nine"
Interview with Casandra Jewel
Interview: David Palmer: The Leo King by Eileen Shapiro
INFOLIST.com & Jeffrey R. Gund Red Carpet PRE COMIC-CON BASH Los Angeles July 11, 2019
Health & Fitness Tips & Tricks with Eugenia Kuzmina
The 6th Annual THE SOIRÉE during GRAMMY® Week
Celebrity Influencer Simonetta Lein Launches A Striking Video For Popular Fashion Brand Shein
The PondHawks Talk New Single "Afraid of Love," Music and More…by Eileen Shapiro
Mob Account
SVTV: "Stud Model Project: The Series" Grand Finale: A Summary of the Debut Season by Eileen Shapiro
Mob Team
Lifestyle, MobAngeles, Movies & Videos
"Stud Model Project: The Series", disrupts the labels in gender norms within the LGBTQ community. The mission of the series is to break barriers, and deconstruct the labels placed on the dominance within the LGBTQ community. Not only will you watch some of the sexiest stud models from around the country wearing the hottest fashions, as part of this groundbreaking reality show the cast of incredible models will share stories and reflect on their identities. A competition with self-reflection, advocacy, table talk and camaraderie, bringing meaningful moments that will educate and inspire viewers." This became the premise and inspiration of this never before conceived of hit series, aired via The SVTV Network, (Strong Voices Television Network).
We contacted the creator of this landmark television series Teresa Morcho and Sheri Johnson, the show's producer to try and gain some insight regarding season one of Stud Model Project and the Grand Finale scheduled to air August 31, on Atlanta's Black, Gay Pride Day.
The series had a revolutionary, cutting edge effect on today's television reality programming and all are excited about the outcome and the winner of SVTV's "Stud Model Project: The Series" first season.
Teresa, you must be very excited?
Teresa: It's been a long road, but a very exciting road. I am ready.
Do you know who the winner is?
Teresa: We do.
Now I don't suppose you would tell me even if I promised not to print it?
Teresa: I will not! You have to wait and see.
Somehow I knew you'd say that.
Teresa: I think it's going to take everyone by surprise.
Teresa, this being your first reality series and Sheri you as the producer of this unique series, what have each of you learned from the experience?
Teresa: It's one of those things where you are going into a class that someone has scheduled for you, and you think you know what it's about, but you have no idea. You just learn as you go along. And what I have learned is to definitely lean on your resources. We have a ton of resources from everyone. Everyone has their own strength even down to the models. Some of them have been on TV before, some of them have modeled before, some are artistic, some of them have been behind the camera. This is my first time doing it and I was a student in my own classroom. That's what it felt like. I just ate it all up. I just learned as much as I could and worked with the resources that I had available to me, and just had fun.
Very well put. Sheri what is your take on the series and how successful it has become?
Sheri: First I wanted to thank Teresa for her resilience as the creator of the show, from the time she pitched the show, we had met some years before, until the time the show came to fruition, I applaud her. This was one of our first reality shows that we have done to this scale. It was the largest production the network has had. I believe it paid off because the project was one of the top series on the network and again it was a learning experience. I came in running the production company, and running a television network for the LGBTQ community to tell our lives and our stories, and the show directly got into that. To see the finished product come to fruition…..I applaud the whole thing.
I understand the series was super successful judging from the comments and posts on social media, and everyone getting excited. So I'm wondering, will there be a next season?
Teresa: I'm going to leave that for Sheri. We've been talking about a season two but there is no final decision. We are talking about ideas for it. If it does come about the ideas that we have been talking about are going to be very exciting. I'm excited about it if it does happen, but we have talked about it for sure.
Sheri?
Sheri: We are looking for sponsors for the show. We have some exciting things coming up very soon. I believe in the show, I love the show, I love Teresa's mind, and we are trying to take the show to another level, like network television or other Digital platforms. So, we are in hope of getting sponsors for season two but again we have talked about seasons, and we just have to get the concept in front of the right people. It's about elevating the show, taking it to the next level, getting our story out, getting the LGBTQ Community out into the forefront.
Now the Grand Finale, the final episode of the season is not on the programs usual Thursday, so when can we look forward to seeing it?
Teresa: The season finale is going to air on Sunday August 31st, and the reason we are airing it that day is because we are inviting all of the models back during Atlanta Black Pride. They will all be in another mansion just like they were before, and they are hosting some events Pride weekend. So, we are just going ahead and bringing them in and having the show on a special day. That way we can announce the winner and celebrate together.
Do either of you want to comment on anything special regarding the show?
Teresa: One thing I will say is the show has created so much attention within the LGBTQ community period, the visibility within the trans and lesbian community is one where the momentum is so strong that this show came at the right time. It just created an environment that made people feel comfortable in their skin, with so many people having come forward about who they are, that it required me to open into a larger presence, not just pictures now. So I am talking to a publicist of the brand itself to branch it into an online community magazine type of thing which will actually give them some information that they can learn about mental health, assist in fitness, they can assist in things like that, that they don't see in regular magazines or regular articles that speak to them. So, a lot of resources are starting to come my way in order to branch this out and make it bigger for this community that has a lack of presence in media period. So I really appreciate SVTV for the platform to be able to bring it out to the masses. What this did is create a momentum that is unparalleled. I thank Sheri for that opportunity because it has given a voice to so many people that were voiceless for a long time.
Sheri: I would like to add that this was made possible by Ty Bif Studios out of Atlanta, the production company for the series. He's done a great job and a lot of this would not be possible if it wasn't for him.
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Single Review: Kyle Motsinger: "Love On Each Other"
Singer/Songwriter Kyle Motsinger Releases Highly Anticipated New Single "Love On Each Other"
Introducing Loretta Christiansenson by Eileen Shapiro
Will Buck releases "Thief in the Night"
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GEORGIE THE (FORMER) ABACO MANATEE RETURNS TO THE BERRY IS.
Last year I posted about Georgie, the young manatee that made Abaco her home for several months. Georgie was born in Spanish Wells. She and her mother Rita travelled to Nassau Harbour, where in April 2012 they were rescued from the multiple shipping hazards and released in Great Harbour Cay, Berry Is. Both were equipped with tags to monitor their movements. In June, the newly-weaned Georgie embarked on a big solo adventure by swimming to Abaco. Her tracking device showed that she called in at the Marls, before continuing right round the top of Abaco and down the east side, calling in at various Cays on the way. In all, her journey was some 200 miles long. She eventually settled down in the Cherokee and Casuarina area, and in a modest way became a lettuce-chomping celebrity.
"Georgie underwent a series of general health evaluations and was fed approximately 75 pounds of lettuce each day. She gained more than 200 pounds during the course of her care and weighed 569 pounds upon her recent release".
This entry was posted in Abaco, Abaco Wildlife, Bahamas (Abaco), Bahamas Conservation, Bahamas Manatees, Bahamas Marine Life, Conservation Abaco, Marine Life Abaco, Whales & Dolphins Abaco and tagged Abaco, Abaco Conservation, Abaco Manatees, Bahamas Manatees, Bahamas Marine Conservation, Berry Islands Manatees, BMMRO Abaco, Manatee Cherokee Abaco, Manatee Conservation, Manatee Facts, Manatee Georgie Abaco, Manatee Monitoring, Manatee Tagging, Manatee Video, Marine Conservation, Marine Life Abaco, Rita & Georgie Manatees, West Indian Manatee. Bookmark the permalink.
That's quite an intrusive tracking device RH – doesn't it get tangled up in stuff?


Remodeling & Design Build Contractor in Templeton | Gannage Constructrion, Inc.
Gannage Design & Construction is a design build construction company specializing in major remodels, home additions, kitchen remodels and decks. Unlike most general contractors, we only accept a handful of clients each year in order to maintain a superior level of communication and attention to detail. Design build is sometimes compared to the "master builder" approach, one of the oldest forms of construction procedure. As a design build company we are the single source of responsibility over the entire project. Superior communication, expert knowledge and attention to detail are our main goals in serving you.
Gannage Construction provides top knotch work at an honest price. Mikhails's attention to detail is unmatched and his commitment to the customers satisfaction, exemplary. You will never feel out of touch with your project as Gannage Construction keeps you up to date on the latest developments from start to finish. As a local business professional myself, I highly reccomend Gannage Construction for all your new construction or re-model projects no matter what size!
Mikhail Gannage and his crew did a fantastic kitchen renovation for me....on time and on budget! Cabinets refinished, island repaired, new granite countertop & back-splash, deep stainless sink & faucet, disposal, RO unit, hot tap, new recessed can lights and new appliances. The entire crew was polite, professional and dependable. Mikhail personally supervised every step of the project and kept me updated on plans as they evolved. I enthusiastically recommend Gannage Construction for anyone who wants quality work at a fair price.
Always fun starting a project with as much information as you can get. We worked with Aaron Gannage on design to come up with options and where to begin... Highly recommend taking this step first. Glad we found the right person to work with.
Mikhail and his crew remodeled and completely updated our home, adding a bathroom and laundry room and redesigning the interior space to be more beautiful and meet our functional needs. They were punctual, professional and stayed within the proposed budget. We highly recommend their work and would hire them again.


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Our experts work with educational institutions and investors in the educational field to provide counselling services to their schools, colleges, universities and educational projects. As providers of language learning services, we have participated in many educational reform projects, including the basic education endeavours undertaken in many countries.
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Get a total of approximately 80 Orange Jolly Ranchers and only the Orange ones. These little orange Jolly Ranchers taste AMAZING! But they are extremely hard to find! But you found them!
They are all individually sorted and so you only get the ones that you really want, the Orange Jolly Ranchers!
The reason that the Orange Jolly Ranchers are more expensive than the other flavors is that they are only released in limited quantities. They don't come out in the bulk packages like regular Jolly Ranchers so we have to sort through many bags in order to get the Orange. But at least you don't have to buy an entire package and throw out the other flavors that you don't like. They were discontinued for a while, so you might want to stock up! Thanks again for loving Orange Jolly Ranchers!
These Orange Jolly Ranchers are very hard to find in the retail market. wish the price was a little cheaper.
Good orange flavor, I don't like them as much as the lemon, but they are good!
As I Remember so long ago so hard to find retail almost impossible.
Click the button below to add the Orange Jolly Ranchers 80 pieces to your wish list.


The Derma9 Brush helps you to apply thin and even layers to the unique areas of your face. You will use less product and get better, longer-lasting results.
Using a brush is also more hygienic, as you avoid transferring bacteria and germs from your hands to your skin. Simply rinse the brush thoroughly with warm water after applying each mask!


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Misadventures é o quarto álbum de estúdio da banda de rock americana Pierce the Veil, lançado em 13 de maio de 2016. Produzido por Dan Korneff e a gravadora Fearless Records, foi gravado entre 2014 e 2015 em Nova Iorque.

Visão geral e produção
Quando questionado pela Rock Sound sobre o significado do nome do álbum, o vocalista Vic Fuentes contou que "Meio que representa nossas vidas pelos últimos anos que estávamos gravando este álbum. Todas os passos diferentes que foram tomados, os lugares diferentes que este nos levou. É uma daquelas coisas de quando você cria um plano e você sabe que as vezes as coisas não vão do jeito que você planejou. Meio que foi isso que aconteceu. Havia todos essas diferentes e inesperadas mudanças que apareceram no nosso caminho enquanto nós tentavamos encontrar o fim do álbum. É isso que o título representa."

Lançamento
Planos de um álbum a caminho foram inicialmente anunciados em 23 de dezembro de 2013 - a banda liberou uma atualização de feriado anunciando que eles lançariam um novo álbum em 2014 pela Fearless Records. Depois, em uma entrevista com a Alternative Press Vic Fuentes declarou que a banda estava visando adiar o lançamento para o começo de 2015. A razão pelo atraso na data de lançamento ocorreu pelas várias semanas gastas com a produção de duas músicas que a banda escreveu enquanto gravavam o novo álbum no estúdio.

Novamente, as ambições da banda pelo lançamento no começo de 2015 não se realizaram e o lançamento foi adiado para mais tarde, em 2016.
Em 18 de março de 2016, foi anunciado que o álbum seria lançado em 13 de maio pela Fearless Records, produzido por Dan Korneff.

Faixas

Membros
 Vic Fuentes - vocais, guitarra rítmica, teclado
 Tony Perry - guitarra solo
 Jaime Preciado - baixo, vocais de apoio
 Mike Fuentes - bateria

Paradas

Paradas semanais

Paradas anuais

Álbuns de post-hardcore
Álbuns de Pierce The Veil
Álbuns de 2016
Álbuns em língua inglesa

redpajama_set_name: RedPajamaWikipedia


text:
Bioterrorism and Surveillance for Infectious Diseases - Lessons from Poliovirus and Enteric Virus Surveillance | OMICS International
Journal of Bioterrorism & Biodefense
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Commentary Open Access
Bioterrorism and Surveillance for Infectious Diseases - Lessons from Poliovirus and Enteric Virus Surveillance
L M Shulman1,2*, Y Manor1, D Sofer1 and E Mendelson1,2
1Central Virology Laboratory, Public Health Services, Israel Ministry of Health Sheba Medical Center, Tel Hashomer, Israel 52621
2Dept. of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel, 69978
Lester M. Shulman
Central Virology Laboratory
Chaim Sheba Medical Center
Tel-Hashomer, 52621, Israel
Fax: +972-3-535-0436
Received Date: November 18, 2011; Accepted Date: February 05, 2012; Published Date: February 18, 2012
Citation: Shulman LM, Manor Y, Sofer D, Mendelson E (2012) Bioterrorism and Surveillance for Infectious Diseases - Lessons from Poliovirus and Enteric Virus Surveillance. J Bioterr Biodef S4:004. doi: 10.4172/2157-2526.S4-004
Copyright: © 2012 Shulman LM, 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.
Visit for more related articles at Journal of Bioterrorism & Biodefense
Early recognition and rapid response are crucial for control of infectious diseases introduced by bio-error, bio-terror or Mother Nature. Early recognition requires surveillance. Surveillance includes methods for identifying the presence of infectious agents or the symptoms caused by the presence of such agents. Overlapping of different surveillance strategies improves the chances for success. Results from enteric virus surveillance of acute viral gastroenteritis in sentinel children wards and outbreaks and environmental surveillance for polio and non-polio enteroviruses in Israel are presented to exemplify surveillance for infectious disease agents and for use as yardsticks for evaluating response to intervention and to introduction of new vaccination programs and for their potential for evaluating acute gastroenteris syndromic surveillance.
Highly infectious pathogenic organism may be introduced into a region by bio-error, bio-terror, or Mother Nature. Bio-error is the accidental release of an infectious organism into the region. Examples include release from a vaccine production or storage facilities, archived biological material collected at the time when the organism was endemic, or from lab stocks either of the original organism or an extinct organism recreated by genetic engineering. Bio-terror is the intentional release of the infectious agent into the region from these sources. Finally, introduction by Mother Nature refers to the natural release of infectious organisms into a region. This most commonly occurs when infected hosts bring the organism into the region from an external reservoir or when changing living conditions increase the chance for zoonotic exposure within regions. Less common is reappearance as a result of release of an organism preserved in permafrost or by genetic evolution or genetic recombination in endogenous low pathogenic organisms that cause alterations in antigenicity reduce recognition by the immune system of individual hosts or host populations and/or which alter pathogenic organism-host interactions enabling the organism to change its host range or even the location within the host where that the organism can replicate. Included among low pathogenic organisms are live attenuated vaccines where evolution can lead to phenotypic reversion to a highly pathogenic form during infection of primary vaccines with functional immune systems, during persistent infections that may occur after vaccination or exposure of immune deficient individuals, and during subsequent person-to-person transmission to contacts of either of these types of individuals.
Early detection of the presence of the highly pathogenic infectious organisms is essential for containing the spread of these organisms in the flora or fauna within a given geographical region and for their elimination. This is true regardless of whether the infectious organism was introduced through bio-error, bio-terror, or Mother Nature. Early detection and measurement of efficacy of response requires high quality surveillance over extended periods of time. Integration of different surveillance strategies performed in parallel improves reliability and strengthens interpretation of data. The relatively unique combination of surveillance strategies for enteric viral infections in general and poliovirus infections in particular in Israel will be presented as a model for early detection of highly pathogenic organisms and subsequent monitoring of the efficacy of response. The main strategy that will be presented in detail uses environmental surveillance (reviewed in [1]) to identify the presence of pathogenic polioviruses in large populations before symptomatic cases occur. The second strategy that will be briefly reviewed is the systematic investigation of acute gastroenteritis in symptomatic cases from outbreaks and some or all admissions to sentinel departments in hospitals. Both approaches provide data about pathogenic organisms and provide a picture of what is going on at the community level. More importantly, both need to be in place for years to establish the base lines for recognizing the sudden appearance of unusual events. This depth is required to take into account seasonal and annual variations. Data gathered from these surveillance systems will also provide the basis for calibration and evaluation of a third approach, looking for unusual changes in the number and pattern of syndrome- specific admissions to hospital emergency wards or visits to HMO physicians. Specific examples will be provided to illustrate how classical and molecular data gathered from identification of pathogen-based strategies provide the epidemiological data needed for identification, response and follow up to bio-error, bio-terror, or Mother Nature triggered event.
Environmental surveillance for poliovirus and enteroviruses: Composite sewage samples have been routinely collected monthly from sentinel sites covering 30-40% of the Israeli population since 1989 using computerized automatic samplers that collect and pool aliquots hourly over a 24 hour period. When automatic sampling was not possible, peak hour grab samples were collected instead. Concentration, selection and isolation of polio and enteroviruses and downstream molecular epidemiological and phylogenetic characterization were as previously reported [2-5].
Acute viral gastroenteritis surveillance for enteric viruses: The enteric viral surveillance of severe acute gastroenteritis in sentinel children's ward and outbreaks reviewed in the discussion was performed as published for rotavirus [6-8]. The norovirus was assayed by semiquantitative Real Time RT-PCR for the amplification and detection of norovirus genotype GII RNA by TaqMan technology as previously described [9].
Sydnromic surveillance for community physician visits for patients presenting with acute gastroenteritis from any cause: All Israelis are registered in one of four HMOs: Clalit, Maccabi Health Care Services, Kupat Holim Meuhedet, and Leumit. The HMOs maintain computerized records that include the ICD-9-based code reason for the visits. The Israel Center for Disease Control has received this data from the Maccabi Health Care Services, the second largest HMO covering approximately 25% of the population and Hospital Emergency Rooms on a daily basis for many years and prepares a weekly report on the rates of visits or admissions based on the ICD-9 codes. In this manuscript we present the weekly and monthly visits to the Maccabi Health Care Service community physicians of patients who presented between January 2004 and June 2008 with acute gastroenteritis from any cause [protozoal intestinal disease uns, bacterial enteritis uns, viral enteritis uns, enteritis uns, infectious colitis, acute gastroenteritis, proven gastroenteritis infection, and presumed gastroenteritis infection] and for nausea and vomiting from any cause.
Electron microscopy: 10 μl of clarified stool suspension was dried on Smart grids (Dune Sciences, Or, USA). The material on the grids was negatively stained with uranyl acetate and then viewed on a Jeol LS200 EX II transmission electron microscope (Jeol LTD, UK) at a magnification of 30,000 to 40,000. Final identification on the basis of size and morphology was made at a magnification of 100,000.
VP1 Sequences: The VP1 sequences of the type 1 WP isolates represented in the phylogenetic tree in Figure 1 were submitted to the EMBL/GenBank/DDJB data bank. The accession numbers are listed in parenthesis after the short name (as it appears in Figure 1) and the full isolate name. Isolates from the Gaza District: P-1 = PV1/2335_1/ PAL91 (JQ228553); P-2 = PV1/2252_1/PAL91 (P2 JQ228554); P-3 = PV1/3313_25/PAL94 (JQ228555); P-4 = PV1/3313_27/PAL94 (JQ228556); P-5 = PV1/3380_7/PAL94 (JQ228557); P-6 = PV1/3381_3/ PAL94 (JQ228558); P-7 = PV1/3381_9/PAL94 (JQ228559); P-8 = PV1/3432_5/PAL95 (JQ228560); P-9 = PV1/3431_21/PAL95 (JQ228561); P-10 = PV1/3431_21/PAL95 (JQ228562); and P-11= PV1/3455_27/PAL95 (JQ228563). Israeli isolates: Is-1 = ISR87-5483 (AF528790) and Is-2 = PV1/3615/ISR95 (JQ228564).
Figure 1: The phylogenetic relationships among WP isolates between 1991 and 1996
The upper panel is a schematic representation of the phylogenetic relations among type 1 WP isolated from sewage after Israel became poliomyelitis free. The short names of actual isolates appear in the ovals (see materials for the full isolate names and accession numbers). The vertical axis is proportional to the month of isolation. The lengths of the branches are scaled to the number of nucleotide substitutions. The small circles represent hypothetical intermediates along the evolutionary pathways. Very long branches have been discontinued in their middle and each such "break" has been numbered. The actual nucleotide substitutions between each branch point are listed on the tree (format: nucleotide, previous nucleotide->substituted nucleotide; example: 543a->g) for short branches. The numbers and types of substitutions for longer branches are indicated in the lower table according to the numbers that appear beside each breakpoint in the long branches. The types of substitutions listed are the total number, and the numbers of transitions, transversions, substitutions back to previous nucleotides (example A->G->A), or independent parallel substitutions in separate lineages. All isolates in the tree were rooted to the 1987 isolates from the last type 1 WP outbreak that occurred in 1987-88 [13]. The patterns of nucleotide substitutions along branches between isolates were then compared to that for short outbreaks [5] to determine whether or not the substitutions that were observed could have arisen during local endemic person- to-person transmission. Those substitutions in isolates within the gray box (Group C) were consistent with local transmission, whereas the differences in sequence between isolates in C versus D and E were not, i.e. they represent separate introductions.
Environmental surveillance for polioviruses
Symptomatic and asymptomatic individuals excrete virus progeny into sewage during enteric viral infections. This is the basis behind the use of environmental surveillance to document poliovirus infections in populations [10]. More importantly from the public health point of view, sewage surveillance can detect silent poliovirus virus circulation before appearance of the first case of irreversible poliomyelitis [1] since less than 1% of infections of naïve children even with highly pathogenic wild poliovirus cause poliomyelitis, whereas >90% are asymptomatic. Most surveillance procedures involve concentrating the virus in a sewage sample followed by a biological amplification of the viruses on tissue culture before molecular analysis [1,11]. Countrywide routine monthly environmental surveillance for poliovirus in sewage was initiated in Israel in 1989 and is the longest running national comprehensive surveillance program to date [1]. Approximately 30- 40% of the entire population lives within the catchment areas of the surveillance sites. Since the initiation of surveillance, tourists and businessmen have traveled to and from regions were polio was still endemic. In addition there was a large influx of Palestinian families from poliovirus endemic regions into the West Bank and Gaza District in 1994-1995 after the signing of the Oslo Peace accords.
When polioviruses replicate, they have very high rates of nucleotide miss-incorporation because their RNA primed RNA polymerase lacks a proofreading capability [12]. The genomic regions encoding the entire VP1capsid protein from isolates from the last outbreak of poliomyelitis in Israel that occurred in 1987-1988 [13,14] were sequenced to establish the first high-resolution, full VP1 gene, molecular analysis of the rate and pattern of nucleotide changes that occur during short outbreaks arising from a single founder [5]. Jorba et. al. [12] analyzed additional outbreaks, some extending over many years, to establish a series of rates suitable for characterizing the relatedness of polioviruses isolated at very short to very long intervals depending on the classes of substitutions measured. These classes include synonymous third codon position substitutions, non-synonymous substitutions and transversion. These rates and the 10:1 ratio of transitions to transversions [12] can be used as a benchmark to distinguish between the possibility that two polioviruses isolated within a short time interval arose during personto- person transmission during an outbreak or resulted from two separate introductions from an external reservoir or different external reservoirs [2]. Introduction from an external reservoir is further supported when the pair-wise comparison of nucleotide sequence homology among isolates in the surveillance area is lower than between some of these isolates and isolates from external reservoirs [2].
Based on the performance of long-term environmental poliovirus surveillance (reviewed in [1]), the WHO has recently recommended that routine sewage surveillance be established in more countries (17th Informal Consultation on the Global Polio Laboratory Network, 2011, Geneva) based on standards previously recommended for environmental surveillance for polioviruses [11]. All of the recommended methods required a biological amplification and selection step. Specifically growing poliovirus in tissue cultures and using transgenic L20B marine cells. L20B cells express the human receptor for polioviruses and selectively amplify poliovirus but not other human non-polio enteroviruses [15,16]. Many of the countries that have or will institute environmental surveillance are wild poliovirus free and most or all samples should be negative for polioviruses. Sample integrity is especially important for the interpretation of a negative isolation. It was therefore important to introduce a control to ensure that the quality and integrity of the sample was maintained from the time of collection, during transport, and during processing in the laboratory. The control that was recommended [11] was to also test for the presence of nonpolio enteroviruses using cell lines that support growth of most human enteroviruses. The reasoning behind such a control is that the lability of other enteroviruses is similar to that of polioviruses and enterovirus infections are common everywhere.
The type of poliovirus in sewage depends in part on the vaccination program in use. There are three types of poliovirus: vaccine, wild (WP) and vaccine-derived poliovirus (VDPV) [17]. An isolate was defined as a vaccine strain if the difference between the nucleotide sequence encoding its VP1 capsid protein and its respective Sabin serotype was <1%. It was considered to be a VDPV, when its VP1 sequence divergence ranged between 1% and 15%. Isolates with >15% divergence were considered to be WP. Recently the upper limit for VDPVs was modified to include isolates with >15% divergence that could be phylogenetically related to VDPVs with <15% divergence. This change was recently instituted (Summary of the 16th Informal Consultation on the Global Polio Laboratory Network, Geneva, Switzerland, 2010) after it was shown that a number of isolates with >15% divergence were genotypically related to previously isolated VDPVs from long standing environmental surveillance programs carried out by Israel (discussed below) and Finland (reviewed by Hovi et al [1]).
Isolation of vaccine virus
Between 1989 and 2005, all children in Israel were vaccinated by the age of 15 months with three doses of inactivated polio vaccine (IPV) and three doses of live attenuated Sabin vaccine (OPV) [13]. From 1990 they were also vaccinated with an additional IPV dose at 6-7 years of age [13]. Annual vaccine coverage of at least three doses exceeded 95%. During the period when OPV was included in early childhood vaccination schedules, most of the live vaccine virus actually ended up in sanitary dumps because of the use of diapers, however some especially from older contacts routinely entered the sewage system. During this time >95% of the polioviruses isolated from sewage were vaccine strains. After 2005 Israel switched to exclusive use of IPV. OPV strains then rapidly disappeared from the sewage as had occurred in other countries that made a similar shift to exclusive use of IPV in their vaccination policies [1].
Isolation of WP
The appearance of wild poliovirus isolates in sewage collected from a poliomyelitis free region indicates the silent presence or transmission of wild virus. The longer the poliomyelitis free period, the more likely that the WP has been introduced from an external reservoir. No specific intervention is required when there is herd immunity sufficient to prevent local transmission, for example when documented vaccine coverage is >95%. Rapid intervention (vaccination) is required, however, when coverage levels are below this level or when there is evidence of local circulation.
Wild type 1 polioviruses were recovered from sewage collected from various sites in the Gaza District in 1991, 1994, 1995, 1996, 1999 and 1992 and from Ashdod, Israel in 1995. The entire VP1 of representative isolates were sequenced. The phylogenetic relationships among WP isolates collected between 1991 and 1996 are shown in Figure 1. The time course and pattern of nucleotide substitutions among the WP isolates was compared to the pattern from the 1987-1988 outbreaks [5]. The number of nucleotide differences between isolates in groups C (1994-5), D (1994) and E (1995) was much higher than the 1% per year expected for isolates from the same outbreak [2,12]. This large deviation from the expected rate for nucleotide substitutions and somewhat smaller deviations from the 10:1 transition to transversion ratios allowed us to infer that the isolates in group C, D and E in Figure 1 were progeny from separate introductions. In contrast, the kinetic pattern among group C isolates was consistent with the pattern of local transmission that occurred during the outbreak in 1987-1988 [5]. Furthermore, these WP isolates appeared during the peak in the influx of whole families with unknown vaccination histories into the Gaza District. This combination of events triggered an immunization response. Sewer surveillance was able to document the efficacy of the immunization response [1,4]. Specifically, there was a rapid decrease and disappearance of genotype-related WP isolates from subsequent samples from these positive sites.
In 2002, two WP isolates were recovered within a four-month interval from the Gaza District. Using the same approach for analysis, these were considered to be from separate introductions [2]. Namely there was a much higher difference in nucleotide substitutions than could be expected to occur within four months for an outbreak with a single founder, the transition transversion ratios were inconsistent, and the relative homology indicated that each isolate was more homologous with isolates from different regions of Egypt than the Gaza District isolates were to each other.
Two important principles that apply to bio-defense are illustrated from these WP surveillance studies. Advanced molecular analysis can indicate when virus isolates are introduced into a virus-free region, can infer whether such isolates represent subsequent local circulation or separate introductions, and can identify their probable external reservoir. This in turn can trigger the type of response in the surveillance region, and the same surveillance program can then monitor the efficacy of the response. A further advantage is that response can also be extended to the region of the external reservoir.
Isolation of VDPVs
In May of 1998, a serotype two VDPV (VDPV2) was isolated from a sewage sample collected at the entrance to the Shaf Dan wastewater treatment plant in central Israel [18]. Surveillance sites that were subsequently introduced throughout the catchment area of this sewage system are shown in Figure 2. In 1998, the catchment area of the Shaf Dan Plant encompassed a population of 1,600,000 individuals. Sequence analysis of the VP1 of the 1998 VDPV2 indicated that it had diverged by 8% from Sabin 2 and that extensive amino acid substitutions were present in neutralizing antigenic epitopes of the capsid proteins.
Figure 2: Schematic representation of surveillance sites along the sewage system in central Israel
Sewage in the Shaf Dan catchment area in central Israel flows north by gravitation to the Reading pumping plant. The sewage is pumped upwards at the Reading Station as well as at a point stream so that it can then flow south by gravitation to the Shaf Dan Waste Water Treatment Plant. Sewage is collected at the mouth of the Shaf Dan Treatment Plant by an inline automatic composite sampler. The direction of the flow is indicagted by the black arrows. Upstream samples are collected by portable automatic composite samplers lowered into the system at Reading, the mouth of Kav B and along the Ayalon trunk line at sites indicated by the circles. Samples are treated and analyzed for the pres- ence of polio and non-polio enteroviruses as described in Materials. The collec- tion sites in the figure correspond to the sites listed in Table 1. The Ayalon site in Figure 3 is located at the mouth of the Ayalon Line C just before it enters the Reading Pumping Station.
Between May 1998 and Sept 2011, 62 phenotypically related VDPV2s were intermittently isolated from an additional 43 sewage samples. During this period of surveillance, two strategies were pursued to increase isolations: sampling frequency was increased at established sites and additional sites were successively added at points above positive sites where major trunk lines converged (see Figure 1). Sewage samples that contained VDPV2s are shown by collection date in Table 1. Colored squares (pink, blue, and yellow) indicate a site that was positive for VDPV, white boxes indicate negative sites that were sampled within a month of the positive site, while grey boxes indicate a negative finding at a site that was sampled on the same day as the positive site. From left to right, columns in Table 1 represent the progressive spatial transition from the mouth of the Shaf Dan treatment plant to the most upstream site (see Figure 2). The rightmost two columns represent a positive VDPV2 site from Jerusalem and the only site from where a type 1 VDPV was isolated, a site in Haifa.
After a half-year trial, surveillance schedules were returned to previous frequencies since the increase in sampling frequency added considerably to the workload without increasing the frequency of recovery. In contrast, adding upstream surveillance sites proved effective in increasing isolations. Contributing to this was that VDPV2 virus from the excretor progressively increased as the site of excretion was approached. The catchment population of the first major positive junction site, Redding, was reduced to 800,000 and successive addition of upstream sites along the Ayalon trunk line, one of five that fed into the Reading site, have further reduced the population including the excretor to approximately 25-50,000 individuals.
The VP1 of each isolate was sequenced. Samples that contained VDPV2 isolates that were phenotypically related to the 1998 VDPV2 are represented by the pink boxes in Table 1. On Feb 2006, a phenotypically unrelated VDPV2 with 6.6% VP1 divergence was recovered from a single collection in Jerusalem. No related isolates have been found to date from that site in Jerusalem, however by Sept 2011, eleven phenotypically related isolates (represented by blue boxes in Table 1) have been recovered from eight samples from the Shaf Dan catchment area in Tel Aviv, starting with one from the Redding site that was isolated one month after the isolation in Jerusalem. The next ten related isolates were recovered from the Redding site or trunk line, Kav B, which is a different upstream trunk line from the sites that were positive for isolates related to the 1998 VDPV2. The catchment area of Kav B includes most of the major Mediterranean Sea shorefront hotels in north Tel Aviv and represents a 50,000 population. A change in the sewage system but not surveillance site has since reduced the catchment population for the Kav B positive site to 25,000.
The Shaf Dan-like isolates (pink boxes in Table 1) and the Jerusalem-Redding like VDPV isolates (blue boxes in Table 1) belong to two separate epidemiological events, i.e. persistent infection of two different immune individuals after separate exposures to serotype two Sabin vaccine [19]. The nucleotide substitutions within the VP1 genes from the VDPV2 isolates steadily increase from 8% to16.7% as time progressed. The VPDV2 isolates were shown to be highly neurovirulent in mice model systems and neutralizing antibody titers in the general public were three-fold lower than against respective Sabin strains [3,19]. Fortunately, despite the high nucleotide and amino acid divergence, these isolates were still as sensitive in vitro as the Sabin 2 strain to the antiviral effects of isoflavenes [20].
The identity of the individuals excreting the aVDPVs has not yet been established. To infer more about the excretors, additional segments of the 7400 nt genome of each isolate were sequenced. These additional regions included the 5'untranslated region and VP2, VP3 and VP4 capsid protein genes located 5' of the VP1 capsid gene, and the RNA primed RNA polymerase, 3D, located at the 3' end of the single open reading frame of the poliovirus genome. Phylogenetic analysis of all of the environmental aVDPV isolates indicated that excretion was limited to one individual and/or a very limited number of contacts for each of the epidemiological events. In the absence of identification of the excretor or excretors, this conclusion was based on the following lines of reasoning. (1) Most nucleotide substitutions that accumulate during evolution of poliovirus are random and most are silent third codon position substitutions [12,21,22]. Two different patterns involving high numbers of identical substitutions spread throughout the genome, despite overall sequence diversion of >10% among isolates indicated that there were two, and only two epidemiological events [19]. (2) Progeny that arose during person-toperson transmission in populations of immune competent individuals, cVDPVs, have very few amino acid substitutions in antigenic sites and most rapidly undergo multiple recombination with other polioviruses and non-polio enteroviruses [21,22]. In contrast, progeny that arise during persistent infections in immune deficient individuals have many amino acid changes in antigenic epitopes and most had not undergone any genomic recombination [21,22]. The Israeli aVDPV isolates were inferred to have come from persistent infections of either of two immune deficient individuals since the aVDPVs from each event had many amino acid substitutions in antigenic sites and there was different single recombination event within the polymerase gene for isolates of each event [19]. (3) Immune deficient persistently poliovirus infected individuals are rare; only 40 identified throughout the world to date [17]. (4) Vaccine excretion in healthy individuals is self-limiting and measured in weeks at most [23,24]. During the twelve-year interval of aVDPV isolations, the annual polio vaccine coverage of the Israeli population was >95% [13]. Thus the conditions for establishment of herd immunity were in place meaning that there would have been an insufficient number of naïve immune competent individuals available to maintain a chain of transmission over the 12 years during which the excretor or excretors were present in the catchment area, or the 24 years during which the virus evolved. And (5) the consistent recovery of each group of event-related isolates at separate geographical locations within the same city, e.g., at surveillance sites along different branches of the sewage system in a single city, when 30-40% of the entire country-wide population has been subjected to monthly surveillance throughout this period argues for minimal person-to-person spread. These arguments rely on one of the basic tenets of a good surveillance program, namely that in order to discover or rule out occurrence of an unusual event, there must be sufficient data from long-term routine surveillance.
Downstream sites are frequently negative when upstream sites are positive, and detection is intermittent even at the most upstream sites. This is shown by the surveillance entries for March 14th and 15th , May 29th , and July 20th of 2001 (Table 1) where multiple sites (see Figure 2) were simultaneously monitored at hourly intervals by automatic samplers; three sites for two successive 24 hour period and two sites for just the first 24 hour period. At four of the sites, composite samples were obtained for each 24- hour period by pooling samples. At the 5th site (C-75), hourly samples were collected and analyzed separately. On March 14th, starting from downstream sites and proceeding to upstream sites, no VDPVs were recovered from the Shaf Dan site, two VDPV2s were isolated from the Reading site, three of the first set of 24 hourly samples from C-75 located upstream contained a single VDPV2, two VDPV2s were isolated from site C-108 and one from C-109. On March 15th, no VDPV2s were recovered from the Shaf Dan site, one VDPV2 was recovered from one of the 24 individual samples from C-25 and one from site C-108. All of the isolates from the Ayalon line sites (C-75, C108, and C109) were related to previous Shaf Dan-Ayalon isolates. One of the two Reading VDPV2 isolates was related to these Shaf Dan-Ayalon VDPVs, while the other was related to the Jerusalem-Kav B isolates. The isolates from C-75 were obtained from samples collected at 09:00, 10:00, 04:00 and 08:00 AM suggesting that the virus is excreted from a residential site or less likely from a nighttime job.
These VDPV studies illustrate four additional principles and some limitations of environmental surveillance [1] that can be applied toward bio-defense. (1) Environmental surveillance is sensitive enough to detect virus excreted by one or a very small number of individuals in very large populations. (2) A negative finding does not mean the absence of the virus since the sensitivity is at the limits of detection. Most virus positive sewage samples contained one or at most a few poliovirus isolates, whereas it is estimated that 107 viruses are excreted per gram of feces [1]. Intermittency may also reflect the finding that poliovirus was isolated in most but not every stool sample collected from an identified, persistently infected individual [25]. (3) When enough surveillance sites are re-sampled for sufficiently long intervals it may even be possible to follow movements of the infected individual within large populations. This is illustrated by the shift from Jerusalem to Tel Aviv of the source of the second event (blue boxes in Table 1), and the shift within Tel Aviv of the source of the first event, i.e. the two times when progeny from the first event (pink boxes in Table 1) were isolated from the site on the Kav B branch, rather than along the Ayalon branch. And (4) The ability of environmental surveillance to determine the pattern of excretion within a region, specifically whether one individual or more than one is infected and when there is more than one, whether they live or at least excrete in different regions of the city. This is most clearly illustrated by the isolation of two unrelated VDPVs in the same sample (blue and pink box Table 1) from Reading site on March 14th2001 and the exclusive finding of isolates related to only one at simultaneously sampled upstream sites along the Ayalon trunk line. For reference, the Reading site is located downstream of the Ayalon and Kav B trunk lines from which most epidemiological event one and two VDPV2s were previously isolated, respectively.
Enteric viral surveillance
The WHO has recommended that a minimum of 30% of the sewage samples in a surveillance program be enterovirus positive to ensure that collection, transport and sample processing meet quality standards [11]. The annual rate of enterovirus positive samples in Israel has varied between 75 and 90% by plaque assay. Variations in the number of plaques provide a rough indication of the pattern of community enteroviral infections, since some enteroviruses may not grow on the cell line used for screening the sewage samples and others may not grow in tissue cultures at all. An example of the plaque counts from a single site representing a catchment population of 350,000 in central Israel over a 3-year period (2007 to 2009) is presented in Figure 3. Three samples also contained type 2 VDPVs (indicated by black arrows). Routine investigations of hospitalized cases from neurological wards for enteroviral infections compliment these findings and identify those viruses causing severe infections.
Figure 3: Enterovirus isolations from the Ayalon surveillance site (1A3) between 2007-2009 by month
Sewage was collected at hourly intervals over 23-hour periods by an automatic composite sewage sampler that was lowered into the sewage system at the mouth of the Ayalon line just upstream of the Reading pumping station (see Figure 2). The catchment area of this site includes 350,000 individuals. The samples (1 L) were processed as reported [2]. A 2.5 ml aliquot of each concen- trated sewage sample was plated on BGM cell monolayers under plaque form- ing conditions. The number of plaques from each sample is graphed according to the month that the sample was taken. The three black arrows indicate sam- ples that also contained VDPV2 isolates belonging to epidemiological group 1.
The viral etiology of acute gastroenteritis outbreaks between 2005 and 2011 has been systematically investigated, as has the etiology of all admissions between 2007 and 2011 of children less than five years of age for acute gastroenteritis at three sentinel hospitals in the northern Israel. These studies have provided information on the annual and seasonal pattern of severe rotavirus and norovirus infections in Israel [6,7].
Outbreak investigation requires close coordination between the National Center of Viral Gastroenteritis at the Central Virology Laboratory and District Health Officers and/or the staff of hospital Infectious Disease Departments. Real Time RT-PCR (rRT-PCR) was used to identify and quantify viral loads of norovirus infections, while rotavirus was identified by immuno-chromatographic (dipstick) assays and genotyped by RT-PCR. Stool suspensions from some of the outbreaks were first screened by electron microscopy (EM). Results based on size and morphology can be obtained in less than two hours using negative staining techniques and can focus the specific molecular identification tests that need to be carried out. On the down side, the limit of detection is 104 to 105 particles depending on the pathogen [26]. One hundred and one acute gastroenteritis outbreaks were investigated between 2005 and 2011. Genotype II.4 noroviruses accounted for all 67 (66.3%) of the outbreaks (Figure 4) and reovirus for another (1.0%). These outbreaks were due to the introduction of virus into groups of naïve individuals (Mother Nature). No viral etiology was found for 32 outbreaks (31.6%). Finally, stools from individual cases from one community-wide acute gastroenteritis outbreak contained different bacterial and viral agents including rotavirus and adenovirus and stools from some individuals actually contained more than on enteric pathogen. Subsequent investigation, in part directed by the pattern of pathogenic agents discovered during surveillance, revealed that bio- error (not bio-terror or Mother Nature) had caused the outbreak. In this case, inadvertent channeling of sewage into the community drinking water caused the outbreak.
Figure 4: Preliminary comparison of syndrome surveillance for gastroenteritis and clinical diagnosis for rotavirus and norovirus infections in Israel
Community physician visits for diarrheal gastroenteritis and for vomiting were compared with laboratory confirmed severe acute rotaviral gastroenteritis in children < 5 yrs requiring hospitalization and norovirus outbreaks among adults in Israel between January 2004 and June 2008. A. Bi-weekly number of labo- ratory confirmed, severe cases of rotavirus infections in children < 5 yrs who were admitted to a hospital in central Israel between July 2004 and June 2008 (adapted from the Annual Reports of the Central Virology Laboratory, Public Health Services, Israel Ministry of Health). B. The bi-weekly number of labora- tory confirmed outbreaks of norovirus among adults in hospitals, assisted living and old age care facilities in Israel between January 2005 and June 2008 (adapted from the Annual Reports of the Central Virology Laboratory, Public Health Services, Israel Ministry of Health). The numbers of individuals infected during each out break varied from a few individuals to more than two thirds of the patients and staff at each institution. The duration of the outbreak rarely lasted more than two to three weeks. C. Weekly rate of visits in cases per 10,000 members of the Maccabi Health Care Services in Israel to physicians in community clinics of patients who presented between January 2004 and June 2008 with symptoms of gastroenteritis from any cause (based on anonymous ICD-9-based data provided by the Maccabi Health Care Services, and the Is- rael Center For Disease Control, Israel Ministry of Health). D. Monthly rate of visits in cases per 10,000 members of the Maccabi Health Care Services in Israel to physicians in community clinics of patients who presented between January 2004 and June 2008 with symptoms of acute diarrheal gastroenteritis from any cause (based on anonymous ICD-9-based data provided by the Mac- cabi Health Care Services, and the Israel Center For Disease Control, Israel Ministry of Health). E. Weekly rate of visits in cases per 10,000 members of the Maccabi Health Care Services in Israel to physicians in community clinics of patients who presented between January 2004 and June 2008 with vomiting and nausea from any cause (based on anonymous ICD-9-based data provided by the Maccabi Health Care Services, and the Israel Center For Disease Con- trol, Israel Ministry of Health).
The current protocols for concentration, amplification in tissue culture and analysis of polioviruses takes 14 to 21 days. Genotyping of individual enterovirus plaques from the sewage samples is labor and resource intensive and is not practical for rapid routine surveillance (see discussion of timeliness in relation to syndromic surveillance below). Studies are underway to test the possibility of drastically decreasing processing time by eliminating tissue culture amplification and trying different concentration strategies. For example, directly extracting the nucleic acids from concentrates prepared with current procedures that take less than two days will be compared to extraction from virus in ultracentrifugation pellets, prepared after mid-speed clarification to remove larger particulate matter. The advantage of eliminating the tissue culture amplification step is two fold, a large reduction in time and the fact that fastidious enteroviruses and other enteric viruses would be included in the population sequenced. The main disadvantages are a significant decrease in the amount of nucleic acid available for testing, mixtures of many closely related viruses and the need to make nucleic acid extractions from materials that are known to contain high amounts of inhibitors of RT and PCR enzymatic amplification reactions that might be co-extracted. The use of next generation sequencing that can be completed within days on some of the smaller platforms currently available, should overcome some of the difficulties from analyzing mixtures of viruses from sewage but would not be able to determine whether or not individual virus isolates were excreted by humans. Bar coding of samples would allow for simultaneous analysis of viruses from different samples, but at the cost of reduced depth of sequencing (the number of times that a given sequence is sequenced). The next generation sequencing techniques will include resequencing (specific primer based amplification in a multiplex reaction that simultaneously targeting many viral amplicons) and sequence independent deep sequencing (ligating amplification specific oligonucleotide sequences to the ends of randomly amplified and/or randomly sheared nucleic acids). Finkbeiner and colleagues demonstrated the feasibility of this approach by identifying known and previously unidentified enteric viruses in human stools collected from patients with acute gastroenteritis [27]. The challenge will be to succeed in sewage where viral concentrations will be orders of magnitude lower.
The screening of all admissions to the three sentinel pediatric departments of the three children's hospitals to determine the etiology of severe acute gastroenteritis is part of an ongoing cooperative epidemiology study by the TAU-HCLV Study group (Tel Aviv University Epidemiology Department, the Hillel Yoffe, Carmel and Laniado Medical Centers, and the Central Virology Laboratory). The aim of the study was to characterize severe enteric infections in children before, during partial and after universal administration of rotavirus vaccines to newborn infants. This study has provided information on the economic burden caused by these viral agents [6] as well as preliminary information on rotavirus vaccine effectiveness [7]. It is mentioned here because the study has also provided annual molecular epidemiological surveillance data on the rotavirus and norovirus genotypes causing severe acute gastroenteritis in children and the prevalence and incidence of these viral infections that are of relevance for evaluating syndrome surveillance.
Syndrome surveillance
BT surveillance systems are usually based on analyzing changing patterns of symptoms and/or on programs based on the identification of specific pathogens [28]. Some examples of the latter have been described above. Their disadvantage is that they are limited to specific pathogens and would miss some bioterror or Mother Nature driven events. Syndrome surveillance has been studied as a means of identifying unusual or unexpected changes in rates of illness that may indicate the start of a bio-error, bio-terror or Mother Nature triggered event. Syndromic surveillance is predicated on (1) the observation that during these epidemiological events, people develop symptoms that lead to changes in behavior patterns (for example absence from work or school, increased purchases of over-the-counter palliative medicines), followed by visits to physicians where they present at first with general symptoms and later in the event with more specific symptoms, before the event is recognized and diagnosed [29] (2) the belief that it would be possible to develop effective methods to measure these changes in the pattern of symptoms as a means for early identification of the initiation of such an event and (3) that most pathogens that trigger bio-error, bio-terror or Mother Nature related events share symptoms with events caused by endemic or "routine" pathogens, particularly at early stages of their activity.
Two requirements for effective syndrome based surveillance are (1) timeliness of data acquisition, analysis, and reporting and (2) high sensitivity and specificity [28]. The potentially faster identification of unusual events through computer assisted syndromic surveillance compared with the labor intensive and time consuming surveillance for specific antigens described in the sections above and its ability to recognize unusual events because of symptom overlap with expected events are arguments in favor of its use or addition to existing surveillance programs. The number of people who will be infected and the difficulty in succeeding with intervention increase in relation to the time that elapses between initiation of the BT event and the notification that such an event is taking place [28].
A good case definition is needed to increase the signal to noise ratio [30]. However, too broad a definition will result in frequent false positive signals wasting limited resources and manpower in investigation. Conversely, too narrow a definition may exclude actual events. Integration of multiple data sources can significantly improve detection accuracy of syndrome-based surveillance systems [31]. Accuracy can be gauged and improved when syndromic surveillance programs are run in parallel with infectious agent surveillance. The use of laboratory confirmed influenza, especially pandemic influenza, to evaluate respiratory syndrome surveillance is one such example (see [28,32-34]). Some of these models have proven more successful at predicting Mother Nature triggered events than others. Similar evaluations can be conducted for acute gastroenteritis. Known pathogen driven events, such as laboratory confirmed hospital admissions with acute rotaviral gastroenteritis and norovirus outbreaks in adults, can be compared with community visits to physicians by patients presenting with acute diarrheal gastroenteritis or nausea or vomiting as shown for Israel (Figure 4). The most common cause for severe acute gastroenteritis in Israeli children under 5 years is rotavirus [6] followed by norovirus. The major symptom associated with rotavirus is diarrhea, while vomiting and nausea is more common for norovirus. There was a clear annual correlation between seasonality of severe rotaviral gastroenteritis requiring hospitalization in Israel (Figure 4a) and the second seasonal peak of physician visits (Figure 4C and D), In contrast there was none with the rate of visits for non-diarrheal vomiting and nausea. The causative agent of the first of the two annual diarrheal-triggered visits has not yet been identified. It is difficult to correlate norovirus outbreaks (Figure 4B) in adults with unusual activities of either diarrheal (Figure 4C and D) or non-diarrheal-triggered visits (Figure 4E) because of the low numbers of reported outbreaks. However, the small rise in visits at the end of the second peak of physician visits during the 2006-2007 winter season may reflect possible circulation of norovirus in the communities prior to the peak in a nationwide spike of norovirus outbreaks that occurred in hospitals and old age facilities between November 2006 and February 2007.
These preliminary comparisons for acute gastroenteritis in Israel illustrate some of the difficulties in validating syndromic surveillance. Monthly observations produce smoother curves (Figure 4C) than weekly observations (Figure 4D), but loose crucial timeliness required for bioterror surveillance. Lack of correlation may result from too restrictive a case definition (for example norovirus causes diarrhea in addition to vomiting and nausea). It may also arise when the categories compared are not completely equivalent. For example severe rotaviral gastroenteritis requiring hospitalization was compared with diarrheal-triggered community visits. Future validation should include clinical analysis of a representative sample of the less severe cases that are being monitored by the syndromic surveillance. As stated above. All Israelis are enrolled in one of four HMOs. All acute gastroenteritis visits to HMO physicians and to hospital emergency rooms are available for computerized prospective and retrospective syndrome surveillance. The information from the various enteric pathogen surveillance programs for enteric viral infections in Israel (described above) and initiation of laboratory surveillance of less severe community wide infections can and will be used to assess the quality of acute gastroenteritis based syndrome surveillance and help in fine-tuning the case definition.
One difficulty for evaluation of syndrome surveillance programs for detection of bioterror events is the lack of a reference standard for most currently envisioned infectious BT events [28]. However, symptoms during the initial stages of infections with many infectious BT agents resemble those at early stages of infections with natural pathogens. The more the resemblance, the more difficult it will be to recognize that the symptoms are associated with a BT event. On the other hand, the existence of "similar" natural infections suggests that they can serve as surrogate reference standards for BT events. Establishing the prevalence and incidence of usual illnesses over a number of years is required to establish the confidence limits of the seasonal pattern for a "normal" baseline for BT preparedness and for syndrome based surveillance programs [33].
Establishment of "normal" patterns can also serve as a yardstick for other public health programs. For example, the acute gastroenteritis study in the three sentinel hospitals in Israel and measurement of the rate of community wide physician visits for all causes of gastroenteritis (see above) established the baseline for measurement of the efficacy of the newly introduced rotavirus vaccination program [7] and will also serve as a baseline to determine whether the vaccination program exerts a selective pressure on the genotypes of the rotaviruses that still cause severe infections and on the relative incidences of severe rotavirus and norovirus infections.
This manuscript has focused on environmental and syndromic surveillance for enteric viral pathogens. Many potential pathogens that threaten mankind directly or indirectly by affecting domesticated fauna and flora either through bioerror, Mother Nature and especially bioterror can be transmitted through aerosols. Many pathogens are not even viral. As stated throughout this manuscript, the element of time is critical for identification and containment. Respiratory syndromic surveillance, mentioned above, is one important method that needs to be refined, expanded, and combined with pathogen detection and identification. In addition to more classical approaches discussed here for enteric pathogens, much effort has been devoted to the development of automatic semi-independent or autonomous remote rapid test systems that can provide warning in clinically relevant time frames. Included among such systems or surveillance programs that have already been tested and/or deployed are the Bio Watch (2003), Biohazard Detection (BDS), Biological Aerosol Sentry and Information System (BASIS; 2001-2), the Autonomous Pathogen Detection System (APDS; 2003) and Handheld Advanced Nucleic Acid Analyzer (HANAA) [https://www.globalseurity.org]. Monitoring using more common and widely dispersed items has included use of ventilation filters in public buildings [35] or airplanes [36]. Another area of active research is the development and testing of next generation sensor technology. These systems must take into account knowledge about the relation of particle size to transmission and detection [37] and the effect of environmental parameters on the survival of the pathogens [38] whether during transmission or during the interval between dispersal and analysis. This is especially true when a biological amplification step is required for detection
In conclusion, it is good to keep in mind as M. Stoto, Associate Director for Public Health at the RAND Center for Domestic and International Health Security pointed out, "An alarm system is only as good as what happens when the alarm goes off" [39].
We acknowledge the technical assistance (in alphabetical order) of B. Abramovitz, J. Alfandari, R. Azar. Ira Agabiev, T. Halmut, Y. Perepliotchikov, M. Hindiyeh, V. Levy and I. Silberstein. We would also like to acknowledge the members of the TAU-HCLV: Tel Aviv University (D. Cohen, Kh. Muhsen, G. Chodick, S. Goren, T. Ziv, A. Bialik, I. Pashai, W. Naamna, M. Brik), Hillel Yaffe Medical Center (E. Kasem, A. Kremer, F. Abu Rakia, E. Mahajna, M. Kaupstein, A. Athamna), Carmel Medical Center (M. Ephros, T. Zim, A. Kende), Laniado Medical Center (U. Rubinstein, J. Shachter, I. Weiss, A. Rimer, M. Israeli), and the Central Virology Lab (L. Shulman, I. Silberstein). The authors would like to thank the Israel Center for Disease Control and the Maccabi Health Care Services for providing anonymous data regarding outpatient visits to outpatient clinics for gastroenteritis
The Israel Ministry of Health funded most of the work described in this manuscript. The polio environmental surveillance involving simultaneous collections from multiple sites in central Israel in 2011 was part of grant 18-TSA- 032 for Post Eradication Sewage Surveillance - determining limits for detecting persistent polio excretors in large populations provided by the WHO, Geneva, Switzerland. The TAU-HCLV surveillance reviewed here was supported by grant V27-181-190 from the Department of Immunization, Vaccination, and Biologicals, WHO, Geneva, Switzerland.
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Anthrax Bioterrorism
Bio surveilliance
Biodefense
Biological Preparedness
Biological weapons
Biorisk
Bioterrorism Agents
Biothreat Agents
Emerging infectious disease
Epidemiology of Breast Cancer
Mass Prophylaxis
Probabilistic risk assessment
United States biological defense program
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August 17, 2018 12:17PM ET
Review: The Beths' 'Future Me Hates Me' Is a Power-Pop Monument
New Zealand band packs a career's worth of hooks into their great debut LP.
Jon Dolan
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A wonderful little record that never lets up, piling on unassumingly buzzy fun until you start realizing you might be in the presence of a true power-pop monument. The Beths are from New Zealand, so singer-guitarist Elizabeth Stokes' accent might make you think of Courtney Barnett a little – especially when she's firing off auto-critical logorrhea like "you're in my brain taking up space / I need for remembering pins and to take out the bins / And that one particular film that that actor was in I see your face superimposed over everything / It ain't right." But the Beths are more a band-band and a song-band than a singer-songwriter-band, brilliant at bright guitar frenzy, instantly memorable melodies and tune-mad group sing-alongs with the joy of Sixties bubblegum rock; there's a real love at solving pop formula here (they've got a song called "Uptown Girl," for gosh sake), but they never lose the sense of discovery at heart of rock and roll. Stokes sings about the usual self-doubt and affliction without getting bogged down in the sads, punching through pain on songs like "Great No One," "You Wouldn't Like Me" and "Happy Unhappy" with the help of lead guitarist Jonathan Pearce, whose sunny squall suggests a ritual sweetening of Bob Stinson's AOR god-barf. On "Whatever" love gets her so mixed up she threatens to swerve her car and you with it right into the water ("and wait for the maker") but the song is as sleek as, well, the Cars themselves.


The Malaga Symposia Series provides an international forum for scientific debate on the progress made in research into karst environments. The 2010 meeting of the 4th International ISKA presents 80 papers in four key areas: karst hydrogeology and investigations, karst landscape and ecosystems, human interaction with karst environments, and engineering geology in karst areas. This book will be a useful edition to the libraries of consultants, scientists, lecturers, and policy makers concerned with the special issues of karst terrains.


There used to be two mast ponds in the dockyard - the north and south ponds. Only the north pond survives; the south pond was filled in decades ago and is now a car park.
The north pond, bordered by the old railway lines from Gillingham, normally stands full of water as it would have done when it contained the masts of the tall ships built and repaired at the dockyard. When I went to the dockyard in September 2008, the pond had been drained.
A panorama looking North across the drained North Mast Pond in Chatham Dockyard.
Looking North across the drained North Mast Pond in Chatham Dockyard - the northern corner of the Mast Pond.
From here you can see the benches and anchors on the north corner of the mast pond.
Looking northwest along the gangway running across the drained North Mast Pond in Chatham Dockyard.
There are a lot of mineral deposits around the supports of the gangway - it's possible that one of the reasons the mast pond was drained was to clear these away. To the left you can see one of the dockyard's covered slipways; the original South Mast Pond was under the car park in front of the slipway.
A flowering plant grows from the edge of the drained North Mast Pond in Chatham Dockyard. The steel ring is one of many set into the concrete around the edge of the mast pond.
I'm not too sure what the metal rings are for - they're around six inches in diameter so maybe they're for rope, but I'm not sure there would ever have been boats in the mast pond.
There are also two strange-looking white deposits in the mud - there were quite a lot of these on the bottom of the pond when I visited.


Results of the Czech elections to the lower house in 2013.
The polls have closed, the votes for the various parties have been counted, and the media are analyzing who might form the next government of the Czech Republic with whom. Let's look at how votes were cast in places where a large majority of Romani people live, as well as in the places where neo-Nazis and racists held their marches this past summer.
We begin with the Chanov housing estate in the town of Most, where electoral returns are always interesting and the victor usually comes in first by a large margin. The results of 2010 did not repeat themselves - Chanov made the "somewhat incomprehensible" choice of Jana Bobošíková's "Sovereignty" party that year, with candidate list leader Bronislav Schwarz receiving 100 % of the preferential votes cast.
This time Bobošíková, who was the leader of the "Head's Up!" voting bloc, received not a single vote. Schwarz ran this time for the ANO 2011 movement; the party won just one vote and Schwarz received no preferential votes.
The overwhelming victory in the Chanov housing estate this year went to the Social Democrats (ČSSD), who repeated their 2012 victory in the vote for the Regional Authorities. They won 88.54 % of the votes, with the communists coming in second at 3.12 %.
The Green Party came in third at Chanov with 1.56 % of the votes (i.e., just three). The candidates running there were two Romani men from the Equal Opportunities Party (SRP), Jozef Miker and Štefan Tišer.
Miker received two preferential votes and Tišer received one. Voter turnout at the Chanov housing estate was only 21.63 %.
The details of the votes cast for the ČSSD at Chanov are interesting. Two politicians there received most of the votes cast.
In the Czech system a voter can choose up to four preferred candidates on a party list. Petr Červenka received 145 preferential votes and Karel Novotný received 143 preferential votes.
The result is interesting in Novotný's case because that politician has made very harsh anti-Romani statements in the past. In 2009 Novotný initiated a petition protesting against the reduction in rents by 20 % at Chanov.
"This is like a signal to other renters - destroy your apartments and your rent will be reduced, this is is simply discrimination against decent people," Novotný said at the time. In 2010 the ČSSD in Most, led by Novotný, played on anti-Romani sentiment in a billboard campaign using the slogan "Why should I regret being from the national majority in my own homeland? One state, one set of rules!"
The national party leadership was asked to take down the controversial billboards. Representatives of Romani organizations and institutions involved with human rights and integration believed they were playing a dangerous game with hatred of minorities.
At the Maršov housing estate in the town of Krupka, which is a frequent target of right-wing extremists due to its large number of Romani residents, voter participation was once again very low, although it was more than during the 2012 elections, which saw a maximum turnout of 17 %. This year voter participation was almost 30 % in electoral district number 8 and almost 23 % in electoral district number 9.
The results of Krupka as a whole were ČSSD (21.6 %), followed by ANO 2011 (21.1 %) and the communists (18.55 %). At the Maršov housing estate, however, the communists were the victors (22.89 %) followed by the ČSSD (22.52 %) and ANO 2011 (17.83 %).
The Green Party, which had Equal Opportunities Party (SRP) candidates on its list, won only 100 votes in Krupka (2.1 %). Jozef Miker, a retired miner who is one of the leading figures of the Romani movement in the Czech Republic, received only eight preferential votes there, five of them in district number 9 at the Maršov housing estate, a disappointing result.
The ultra-right DSSS previously seated their only town councilors in the entire country in Krupka. That result was not repeated for them there, as they won just 3.3 % of the total vote in the municipality.
In the town of Duchcov it seemed, prior to the elections, that Romani people were active, that they would turn out for the polls, and that they would be voting for the SRP candidates who had helped them in collaboration with the Konexe association during this year's anti-Romani marches there. Instead, Romani voters in Duchcov seem to have also chosen to stay home.
In district number 1, which lies in the southern part of town where Romani people live and where the anti-Romani marches were targeted, the communists won with 21.13 % of the vote. Second place went to the ultra-right DSSS (18.45 %), third to the ČSSD (15.77 %), while the Green Party and Equal Opportunities Party candidates won a mere five votes (1.48 %).
In Duchcov as a whole the communists were the victors (22.22 %) and the DSSS came in fourth with 9.26 %. Local racist leader Jindřich Svoboda received more preferential votes there than DSSS chair Tomáš Vandas.
The Green Party received 70 votes total there (2.16 %), with SRP chair Štefan Tišer receiving two preferential votes. Despite his personal engagement in responding to the anti-Romani marches in Duchcov, Jozef Miker did not receive a single preferential vote there.
Another place where racist anti-Romani marches took place this summer was the Máj housing estate in the town of České Budějovice, where V. Volfa Street was perceived as a bastion of Romani residents. That street is covered by electoral districts number 27 and number 28, with a total of 2 274 eligible voters, 974 of whom turned out (42.83 %).
Those two districts were won by the ČSSD (20.91 %), the communists in second place (19.77 %) and ANO 2011 in third (17.60 %). The ultra-right DSSS did not receive even 1 % of the vote either in the town as a whole or at the Máj housing estate.
The elections also produced an interesting result in Obrnice, which is considered an example of good coexistence between Czechs and Romani people. Just prior to the elections, the town won a Europe-wide competition sponsored by the Alliance of Cities and Regions for Roma Inclusion, which is part of the Council of Europe.
"Years of accumulated, unsolved problems in coexistence between long-term residents and the Romani community had paralyzed all efforts to develop and improve the municipality," Mayor Drahomíra Miklošová (Civic Democrats - ODS) commented. "In concert with the Czech Government Agency for Social Inclusion, municipally-funded organizations and nonprofits, we have succeeded in finding an effective recipe for at least minimizing these longstanding problems, if not eliminating them altogether."
The municipality has a population of not quite 2 500, 40 % of whom are of Romani nationality. Electoral results there show that it is not just anti-Romani rhetoric that scores political points.
The ODS came in second place in Obrnice with 21.25 % of the vote, an astronomically high number compared to their results in the state as a whole. First place went to the communists (28.83 %) and third place to the ČSSD (17.74 %).
In the Předlice quarter of Ústí nad Labem, as is traditional, Romani people did not turn out to vote. In electoral district number 14, which includes Beneše Lounského, Prostřední and Řeháčkova Streets, voter turnout was a mere 18.64 %.
Of 896 eligible voters, only 167 cast ballots and only 159 of them were considered valid. The ČSSD won with 62.89 % of the vote ahead of the communists with 15.75 %.
As news server Romea.cz has previously reported, 20 Romani men and women ran for the lower house this year, but none were elected. Five Romani people ran for the Romani Democratic Party (Romská democratická strana - RDS), which fielded candidates only in the Central Bohemian and Liberec Regions, coming in last place in the Central Bohemian Region with 395 votes (0.06 %) and next to last in the Liberec Region with 213 votes (0.1 %).
The Equal Opportunities Party (SRP) nominated seven of its members to run on the Green Party candidate lists, and those candidates won a total of 1 370 preferential votes. The SRP candidate with the most preferential votes was boxing trainer Stanislav Tišer in Prague (630 votes), followed by Čeněk Růžička (194) and Elena Gorolová (131).
Of the Romani candidates who ran on other parties' lists, the most successful was David Beňák, who won 2 275 preferential votes in Prague, but was not seated. Two Green Party candidates, Lucie Horváthová and David Tišer, also did well, with Horváthová receiving 370 preferential votes in Pardubice Region and David Tišer receiving 271 votes in Plzeň Region.


A Brian Petrie Painting of our Boat!
We asked Brian Petrie if he would do one of his paintings in his signature style so we could present the Beechgrove Team with a print to remind them of their time in East Haven.We did suggest that it should go in the office but Jim and George have other ideas. I think it's going in the Beechgrove potting shed.


text:
On Behalf of Kessler Matura P.C. | Dec 8, 2021 | Sexual Harassment At Work
Laws are in place that are designed to protect workers from sexual harassment at work. Unfortunately, despite such protections, these practices are occurring – and more frequently at several government offices throughout New York.
Women working for legislators and judges have alleged various sexual harassment practices and many in recent months have filed formal complaints. Some claim they were mandated to wear revealing clothing at work. Others indicated that they were referred to as "the boss's girlfriend" at work. Woman also alleged that they received invitations to strip clubs.
Public awareness about these complaints reveals that New York has a long way to go in combatting sexual harassment on the job.
Women in the workplace should know that they have rights and should assert them if they feel uncomfortable in their environment.
Federal laws pertaining to workplace sexual harassment
Title VII of the Civil Rights Act of 1964 governs conduct in the workplace. Federal law categorizes sexual harassment two ways: hostile workplace and quid pro quo. A hostile workplace is an environment where employees feel uncomfortable when completing their jobs due to unwelcome verbal or physical conduct. Quid pro quo, a Latin phrase to denote an exchange of goods or services, occurs when a person is asked to do a sexual favor in exchange for a promotion or raise.
Employees who have faced sexual harassment at work and are employed with an entity that has 15 or more employees can file a sexual harassment claim with the Equal Employment Opportunity Commission (EEOC).
Under the New York Penal Code, the following elements constitute illegal sexual harassment in the workplace:
Forcibly touching someone's intimate parts or in a sexually suggestive manner
Engaging in any form of sexual contact with another person without consent
Overt flirtatiousness that makes the recipient uncomfortable
What workers can do
The first step to stopping harassment is recognizing it and telling the person who makes you uncomfortable to stop what they are doing in a clear, concise manner.
Second, you should document the details of the harassment, including where and what time it occurred, the frequency of incidents and potential witnesses to the misconduct. You can also ask any possible witnesses to write down their account.
Then, report that behavior to your supervisor and your human resources department. Make sure the report is in writing and includes all of the evidence you gathered. If your supervisor or HR fails to respond accordingly, report to senior management who will hopefully follow through on the issue.
The chain of command will look different for federal, state and city complaints. However, it's important to speak up against harassment. You have rights under the law and should never be afraid to assert them. Seeking the counsel of an employment law attorney to advocate for you can also help.