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CCDR: Volume 43-11, November 2, 2017: Antimicrobial resistance and One Health
Tuberculosis drug resistance in Canada
Issue: Volume 43-11: Antimicrobial resistance and One Health
Date published: November 2, 2017
Volume 43-11, November 2, 2017: Antimicrobial resistance and One Health
Tuberculosis drug resistance in Canada: 2006–2016
V Gallant1, J Vachon1*, W Siu1
1 Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, Ottawa, ON
tb_surveillance@phac-aspc.gc.ca
Gallant V, Vachon J, Siu W. Tuberculosis drug resistance in Canada: 2006–2016. Can Commun Dis Rep. 2017;43(11):236-41. https://doi.org/10.14745/ccdr.v43i11a05
Background: Drug-resistant strains of tuberculosis (TB) pose a serious threat to TB prevention and control efforts. The Canadian Tuberculosis Laboratory Surveillance System (CTBLSS) was created in 1998 to monitor emerging trends and patterns in TB drug resistance in Canada.
Objective: To present a descriptive overview of TB drug resistance data collected through the CTBLSS for the years 2006 to 2016 in Canada, with a focus on 2016.
Methods: The CTBLSS is an isolate-based surveillance system designed to collect data on TB drug resistance across Canada. Each year, data are collected and analyzed by the Public Health Agency of Canada (PHAC) and then validated by the submitting laboratory.
Results: In 2016, anti-tuberculosis drug susceptibility test results were reported for 1,452 isolates. The proportion of TB drug-resistant strains remained relatively stable with 108 (7.4%) of the isolates classified as monoresistant, five (0.3%) isolates as polyresistant and 17 (1.2%) as multidrug-resistant TB (MDR-TB) strains. In 2016, there were no extensively drug-resistant TB (XDR-TB) isolates identified. Males accounted for 792 (54.5%) of all reported isolates and 64 (49.2%) of the resistant strains and females accounted for 11 (64.7%) of the MDR-TB strains. Between 2006 and 2016, individuals between 15 and 44 years of age comprised 47.4% of all reported isolates, 54.0% of isolates showing any resistance and 72.3% of MDR-TB strains.
Conclusion: TB drug resistance levels have been relatively low and stable over the past 11 years and have remained below the global average since national surveillance began. However, with growing worldwide concern about drug resistance and the emergence of XDR-TB, the CTBLSS will remain vital to the monitoring of TB drug resistance in Canada.
Tuberculosis (TB), an airborne infectious disease caused by the bacterium Mycobacterium tuberculosis, remains a major cause of morbidity and mortality in many parts of the world. In 2015, there were an estimated 10.4 million new TB cases worldwide, and 1.8 million people died from this curable diseaseFootnote 1. While the majority of TB cases are caused by strains that are susceptible to the best available TB drugs, drug resistance is a major concern for TB control. Whereas the average length of time to treat a person with fully susceptible TB is between six and nine months, treatment of drug-resistant TB may require 12 to 18 months (and possibly longer) with drugs that are more expensive but less effective and potentially more toxicFootnote 2.
Drug-resistant strains of tuberculosis (TB) pose a serious threat to TB prevention and control efforts. Although it has not been a major public health issue in Canada, drug resistance has the potential to become one as Canadians frequently travel abroad and many individuals immigrate to Canada from countries with high TB rates and associated drug resistance.
The Canadian Tuberculosis Laboratory Surveillance System (CTBLSS) was established in 1998. It is a collaboration between federal, provincial and territorial governments and the Canadian Tuberculosis Laboratory Technical Network (CTLTN), a pan-Canadian network of technical and scientific heads of provincial and territorial TB laboratories. The CTBLSS is managed by the Centre for Communicable Diseases and Infection Control (CCDIC) within the Public Health Agency of Canada (PHAC).
The primary objective of the CTBLSS is to monitor emerging trends and patterns in TB drug resistance in Canada. This surveillance report presents a descriptive overview of data for the years 2006 to 2016, with a focus on 2016, on resistance to first- and second-line TB drugs in Canada. The results are disaggregated by province/territory and, where feasible, by sex and/or age group. The CTBLSS captures minimal demographic information (age, sex and province or territory only). Therefore, no direct observations about drug resistance related to other demographic factors, including ethnicity, are made. As the primary source of national data on TB drug resistance in Canada, the data presented here are intended to inform public health action as well as policy and program development and assessment.
Previously, these data were published annually in a stand-alone report entitled Tuberculosis: Drug Resistance in Canada. This is the first iteration of the report to be published in the Canada Communicable Disease Report (CCDR). The data presented in this report are the most up-to-date at the time of publication and replace those previously published. Supplementary data tables are available onlineFootnote 3.
The CTBLSS is an isolate-based surveillance system designed to collect data on TB drug resistance across Canada. TB drug resistance is identified through susceptibility testing of biological specimens (isolates) collected from individuals with culture-positive TBFootnote 2. Details on the CTBLSS methods of data collection, data management and other laboratory processes have been previously describedFootnote 4. As well, a list of recommended first- and second-line anti-tuberculosis drugs and the recommended critical concentrations to be used for routine testing are presentedFootnote 4.
All participating laboratories tested for resistance to the four first-line antibiotics (isoniazid, ethambutol, rifampin and pyrazinamide) except for the Public Health and Microbiology Reference Laboratory in British Columbia, which did not routinely test for resistance to pyrazinamide. If resistance to any of the other three first-line drugs was detected, British Columbia subsequently tested the isolate for resistance to pyrazinamide. For all laboratories, results for second-line drug susceptibility testing were submitted for isolates showing resistance to isoniazid and rifampin in order to identify extensively drug-resistant TB (XDR-TB) isolates. Table 1 describes TB drug resistance patterns as defined in the Canadian Tuberculosis StandardsFootnote 2.
Table 1: Definitions of tuberculosis drug resistance patternsFootnote 2
Resistance pattern
Monoresistance Resistance to one first-line anti-tuberculosis drug only (isoniazid, rifampin, ethambutol or pyrazinamide).
Polyresistance Resistance to more than one first-line anti-tuberculosis drug, not including the combination of isoniazid and rifampin.
Multidrug-resistant tuberculosis (MDR-TB) Resistance to isoniazid AND rifampin with or without resistance to other anti-tuberculosis drugs.
Extensively drug-resistant tuberculosis (XDR-TB) Resistance to isoniazid AND rifampin AND any fluoroquinolone AND at least one of the three injectable second-line drugs (amikacin, capreomycin or kanamycin).
Drug susceptibility test (DST) results (sensitive/resistant/not done) for all Mycobacterium tuberculosis complex (MTBC) isolates demonstrated on culture, specifically M. tuberculosis, M. africanum, M. canetti, M. caprae, M. microti, M. pinnipedii or M. bovis, were voluntarily submitted to PHAC by provincial TB laboratories for inclusion in the CTBLSS. Data were submitted to PHAC either through the manual completion of a standard reporting form (M. tuberculosis Complex Antimicrobial Susceptibility Reporting Form) or electronicallyFootnote 5.
Standardized data recoding procedures were applied to all data to create a national dataset. All raw data (paper forms and electronic datasets) were retained in compliance with PHAC's directive for the collection, use and dissemination of information relating to public health.
No statistical procedures were used for comparative analyses, nor were any statistical techniques applied to account for missing data. Data in tables with small cell sizes (n=<5) were not suppressed, since disclosure was not deemed to pose any risk of identifying individual cases. These procedures were in line with the directive for the collection, use and dissemination of information relating to public health. The data presented in this report were extracted from the CTBLSS database on March 2017 and have been validated by the reporting laboratories. Microsoft Excel 2010 and SAS Enterprise Guide (SAS EG) v5.1 software were used for data cleaning and analysis.
In 2016, anti-tuberculosis DST results for 1,463 isolates were reported to PHAC. Of these, 11 (0.8%) isolates were identified as M. bovis Bacillus Calmette–Guerin and were excluded from further analyses. Of the remaining 1,452 isolates analyzed, 843 (58.1%) were reported as MTBC where the species were known (830 were M. tuberculosis, nine were M. africanum and four were M. bovis) and 609 (41.9%) were MTBC of an unknown species (data not shown) (Supplementary Table 1).
TB drug resistance patterns
In 2016, 1,322 (91.0%) of the tested isolated were sensitive to all four first-line TB drugs. The proportion of TB drug-resistant isolates remained low with 108 (7.4%) of the isolates classified as monoresistant, five (0.3%) as polyresistant and 17 (1.2%) as multidrug-resistant TB (MDR-TB) strains (Figure 1).
Figure 1: Tuberculosis drug resistance patterns as a percentage of isolates tested, Canada, 2006 to 2016
Text description: Figure 1
Tuberculosis drug resistance patterns as a percentage of isolates tested, Canada, 2006 to 2016
Monoresistant 7.70% 8.80% 6.90% 7.40% 6.90% 9.00% 9.10% 6.80% 7.80% 8.50% 7.40% 7.80%
Multidrug-resistant 1.10% 0.90% 1.10% 1.40% 1.30% 1.40% 0.60% 1.00% 1.30% 1.60% 1.20% 1.20%
Polyresistant 0.20% 0.90% 0.40% 0.80% 0.50% 0.10% 0.10% 0.30% 0.30% 0.20% 0.30% 0.40%
Extensively drug-resistant 0.10% 0.00% 0.10% 0.00% 0.10% 0.10% 0.10% 0.10% 0.10% 0.00% 0.00% 0.00%
For the period 2006 to 2016, DST results were reported for 14,872 isolates (Supplementary Table 1). Monoresistance was the most frequent pattern reported, representing approximately 1,167 (7.8%) of all the isolates tested over the period. In total, 173 (1.2%) of the isolates were identified as MDR-TB (excluding XDR-TB) and seven (<0.1%) of the isolates were identified as XDR-TB. While there have been small fluctuations in the proportion of isolates showing various resistance patterns, the results have remained consistent during the 11-year period from 2006 to 2016 (Figure 2; Supplementary Table 2).
Figure 2: Percentage of isolates tested with any resistance to isoniazid, pyrazinamide, rifampin or ethambutol, Canada, 2006 to 2016
Percentage of isolates tested with any resistance to isoniazid, pyrazinamide, rifampin or ethambutol, Canada, 2006 to 2016
Reporting year
Any resistance to isoniazid
Any resistance to rifampin
Any resistance to ethambutol
Any resistance to pyrazinamide
2006 7.30% 1.70% 0.90% 1.50%
Total 7.90% 1.40% 0.80% 2.50%
Any first-line drug resistance
In 2016, ethambutol, isoniazid and rifampin susceptibility results were available for all 1,452 isolates. The drug susceptibility test results to pyrazinamide were reported for 1,254 (86.4%) isolates. As a proportion of those tested, 113 (7.8%) were resistant to isoniazid, 38 (3.0%) were resistant to pyrazinamide, 18 (1.2%) were resistant to rifampin and 10 (0.7%) were resistant to ethambutol (Supplementary Table 2). Overall, 130 (9.0%) of the isolates were resistant to at least one of the first-line drugs. Between 2006 and 2016, the proportion of reported isolates with resistance to at least one of the four first-line tuberculosis medications was stable over time (Figure 2). Resistance to isoniazid alone or in combination with other drugs varied between 7.5 and 9.2% of isolates tested. Resistance to ethambutol, rifampin or pyrazinamide remained below 3.5% (Figure 2).
Monoresistance
In 2016, 130 (9.0%) of the total TB isolates were reported to be resistant to at least one of the four first-line drugs. Of those, 108 (83.1%) were monoresistant. Of the monoresistant isolates, 91 (84.3%) were resistant to isoniazid, 16 (14.8%) were resistant to pyrazinamide and one (0.9%) was resistant to rifampin. No isolates were found to be monoresistant to ethambutol (Supplementary Table 3 - Table 15; data not tabulated across tables).
Between 2006 and 2016, 1,167 (7.8%) isolates were found to be monoresistant to one of the four first-line TB drugs. Of these, isoniazid resistance was the most frequently reported with 946 (81.1%) of the isolates (Figure 3). During this period, 29 (2.5%) of the monoresistant isolates were found to be resistant to rifampin. On average, one to three rifampin monoresistant isolates were reported each year from 2006 to 2016 (Figure 3; Supplementary Table 3 - Table 15; data not tabulated across tables).
Figure 3: Percentage of monoresistant isolates resistant to isoniazid, pyrazinamide, rifampin, or ethambutol, Canada, 2006 to 2016
Percentage of monoresistant isolates resistant to isoniazid, pyrazinamide, rifampin, or ethambutol, Canada, 2006 to 2016
Isoniazid (INH) 76.60% 80.20% 85.10% 85.70% 87.50% 85.70% 78.10% 79.60% 77.60% 74.60% 84.30% 81.10%
Rifampin (RMP) 7.50% 1.80% 3.20% 3.10% 0.00% 1.70% 0.80% 2.20% 4.70% 1.80% 0.90% 2.50%
Ethambutol (EMB) 2.80% 4.50% 1.10% 1.00% 1.10% 0.00% 0.80% 0.00% 0.00% 0.00% 0.00% 1.00%
Pyrazinamide (PZA) 13.10% 13.50% 10.60% 10.20% 11.40% 12.60% 20.30% 18.30% 17.80% 23.70% 14.80% 15.30%
Polyresistant, multidrug-resistant and extensively drug-resistant TB
In 2016, five (0.2%) of the isolates were resistant to two or more of the first-line drugs (excluding the combination of isoniazid and rifampin) and were therefore classified as polyresistant. Two isolates were resistant to isoniazid and ethambutol and three were resistant to isoniazid and pyrazinamide.
Between 2006 and 2016, 54 (0.4%) of the isolates were identified as polyresistant. Of these, 23 (42.6%) were resistant to isoniazid and ethambutol, 24 (44.4%) were resistant to isoniazid and pyrazinamide and one was resistant to ethambutol and pyrazinamide. The remaining six (11.1%) isolates were resistant to isoniazid, ethambutol and pyrazinamide (Supplementary Table 3 - Table 15; data not tabulated across tables).
In 2016, 17 (1.2%) of the isolates tested were resistant to isoniazid and rifampin. Of these, six (35.3%) were resistant to only isoniazid and rifampin, four (23.5%) were resistant to isoniazid, rifampin and ethambutol, and three (17.6%) were resistant to isoniazid, rifampin and pyrazinamide. Finally, four (23.5%) of the isolates were resistant to all four of the first-line drugs (Figure 4; Supplementary Table 17).
For the period 2006 to 2016, 180 (1.2%) of the isolates tested were resistant to both isoniazid and rifampin. During that time, 73 (40.6%) were resistant only to isoniazid and rifampin, 27 (15.0%) were also resistant to ethambutol and an additional 27 (15.0%) were resistant to pyrazinamide. The remaining 53 (29.4%) isolates were resistant to all four of the first-line TB medications (Figure 4; Supplementary Table 3 - Table 15; data not tabulated across tables).
Figure 4: Number and percentage of isolates resistant to isoniazid and rifampin with or without resistance to ethambutol and/or pyrazinamide, Canada, 2006 to 2016
Number and percentage of isolates resistant to isoniazid and rifampin with or without resistance to ethambutol and/or pyrazinamide, Canada, 2006 to 2016
INH & RMP 9 0 6 9 6 6 4 6 10 11 6 73
INH, RMP & EMB 5 3 1 5 3 1 0 3 2 0 4 27
INH, RMP & PZA 1 1 3 2 4 4 2 1 3 3 3 27
INH, RMP, EMB & PZA 1 7 6 2 5 8 3 5 4 8 4 53
Abbreviations: EMB, ethambutol; INH, isoniazid; PZA, pyrazinamide; RMP, rifampin
Figure 4 footnote
Figure 4 - abbreviations
To determine XDR-TB, all isolates that were found to be resistant to both isoniazid and rifampin were subsequently tested for resistance to select second-line drugs. In 2016, of the 17 isolates identified as resistant to both isoniazid and rifampin, one was resistant to at least one of the injectable agents (amikacin, capreomycin or kanamycin) but susceptible to the fluoroquinolones, and two isolates were resistant to at least one fluoroquinolone but susceptible to all of the injectable agents. The remaining 14 isolates were all susceptible to both the injectable agents and the fluoroquinolones. As none of the 17 isoniazid- and rifampin-resistant isolates were resistant to both an injectable agent and a fluoroquinolone, no isolates were classified as XDR-TB. 2016 was the second year in a row with no reported XDR-TB isolates.
Between 2006 and 2016, of the 180 isolates resistant to both isoniazid and rifampin, 141 (78.3%) were found to be sensitive to both the injectable agents and the fluoroquinolones (Figure 5). Additionally, 18 (10.0%) were resistant to the injectable agents but susceptible to the fluoroquinolones and 14 (7.8%) were resistant to the fluoroquinolones but susceptible to the injectable agents. Finally, seven (3.9%) of the isolates were found to be resistant to both the fluoroquinolones and the injectable agents, identifying them as XDR-TB (Figure 5).
Figure 5: Number and percentage of isolates resistant to isoniazid and rifampin with or without resistance to fluoroquinolones and/or injectable agents, Canada, 2006 to 2016
Number and percentage of isolates resistant to isoniazid and rifampin with or without resistance to fluoroquinolones and/or injectable agents, Canada, 2006 to 2016
Resistant to both (isoniazid and rifampin), with or without resistance to fluoroquinolones and/or injectable agents
Number of isolates and the reporting year
Sensitive to both 12 8 14 15 12 16 4 12 16 18 14 141
Resistance to injecitable agent 2 2 1 1 2 1 3 1 1 3 1 18
Resistance to Flouroquinolone 1 1 0 2 3 1 1 1 1 1 2 14
Resistance to both 1 0 1 0 1 1 1 1 1 0 0 7
Total 16 11 16 18 18 19 9 15 19 22 17 180
In 2016, 1,314 (90.4%) of the isolates originated from five provinces: Ontario, Quebec, British Columbia, Alberta and Manitoba (Figure 6; Supplementary Table 16). Saskatchewan accounted for fewer than 5% of reported isolates while the northern territories (Northwest Territories, Nunavut and Yukon) and the Atlantic provinces (New Brunswick, Newfoundland and Labrador, Nova Scotia and Prince Edward Island) together accounted for 5% of the reported isolates. In 2016, all isolates reported from Nunavut, the Northwest Territories, Yukon, Newfoundland and Labrador, New Brunswick and Prince Edward Island were susceptible to all first-line drugs tested. Of the 17 MDR-TB isolates, seven (41.2%) originated from Ontario, four (23.5%) from Alberta and two (11.8%) each from British Columbia, Quebec and Manitoba.
Figure 6: Number of Mycobacterium tuberculosis complex isolates reported, by province or territory of origin and as a percentage of all isolates reported in Canada, 2016
Number of Mycobacterium tuberculosis complex isolates reported, by province or territory of origin and as a percentage of all isolates reported in Canada, 2016
Number of isolates reported
Percentage of all reported isolates for Canada
Ontario 505 34.8
Québec 218 15
British-Columbia 217 14.9
Alberta 206 14.2
Manitoba 168 11.6
Saskatchewan 65 4.5
Nunavut 33 2.3
Newfoundland & Labrador 18 1.2
New Brunswick 9 0.6
Prince Edward Island 4 0.3
Northwest Territories 4 0.3
Nova Scotia 3 0.2
Yukon & Territories 2 0.1
Canada 1452 100
Figure 6 - abbreviation
Abbreviation: Alta., Alberta; B.C., British Columbia; Man., Manitoba; MDR-TB, multidrug-resistant tuberculosis; N.B., New Brunswick; N.L., Newfoundland and Labrador; N.S., Nova Scotia; Nvt., Nunavut; N.W.T., Northwest Territories; Ont., Ontario; P.E.I., Prince Edward Island; Que., Quebec; Sask., Saskatchewan; Y.T., Yukon
Between 2006 and 2016, the 173 MDR-TB isolates originated from seven provinces: Alberta, British Columbia, Manitoba, New Brunswick, Ontario, Quebec and Saskatchewan. Ontario accounted for 97 (56.1%) of all reported MDR-TB isolates and has reported an average of nine MDR-TB isolates per year (range: 6-14) (Supplementary Table 11). Alberta accounted for 24 (13.9%) of the reported MDR-TB isolates, of which more than 10 (41.6%) were reported between 2014 and 2016 (Supplementary Table 3).
Between 2006 and 2016, both British Columbia and Quebec consistently reported, on average, fewer than two MDR-TB isolates per year. Manitoba reported seven MDR-TB isolates over the past 11 years, averaging less than one per year. New Brunswick and Saskatchewan reported one and two MDR-TB isolates respectively, between 2006 and 2016 (Supplementary Table 18).
Between 2006 and 2016, there were seven XDR-TB isolates reported. Of the seven, five originated from Ontario, one from Manitoba and one from Quebec (Supplementary Table 18).
In 2016, sex was known for 1,450 (99.9%) of the 1,452 individuals from whom isolates were collected (Supplementary Table 19). While males accounted for 732 (54.5%) of all reported isolates and 64 (49.2%) of the resistant isolates, females represented 11 (64.7%) of the MDR-TB isolates.
Between 2006 and 2016, males accounted for 8,265 (56.3%) of all the isolates reported, 726 (53.1%) of isolates with any resistance and 85 (50.0%) of the MDR-TB isolates (data not shown). Although there were only seven XDR-TB isolates reported between 2006 and 2016, five were from females. The proportion of females whose TB showed any drug resistance increased slightly during the 11-year period (from 8.1% in 2006 to 10.0% in 2016) and was higher than males (at 8.1%) in 2016 (Figure 7).
Figure 7: Percentage of isolates showing any resistance among all isolates tested, by sex, Canada, 2006 to 2016
Percentage of isolates showing any resistance among all isolates tested, by sex, Canada, 2006 to 2016
2006 9.20% 8.10%
2007 10.20% 9.90%
2011 9.30% 12.10%
Total 8.80% 9.90%
In 2016, age and/or date of birth was reported for all 1,452 individuals from whom isolates were collected (Supplementary Table 19). Of the 130 drug-resistant isolates, 26 (20.0%) of those with any resistance were from individuals between 25 and 34 years of age and 25 (19.2%) were among those between 15 and 24 years of age (Supplementary Table 19). Five isolates with any resistance were from individuals under the age of 15 years. In 2016, of the 17 MDR-TB cases, 16 (94.1%) were among individuals aged between 15 and 64 years of age and only one case was found in an individual between five and 14 years of age (Supplementary Table 19).
Between 2006 and 2016, individuals between 15 and 44 years of age accounted for 7,045 (47.4%) of all reported isolates, 757 (54.0%) of the isolates showing any resistance and 125 (72.3%) of MDR-TB isolates (Figure 8).
Figure 8: Proportion of reported isolates by resistance pattern and age group, Canada, 2006 to 2016
Proportion of reported isolates by resistance pattern and age group, Canada, 2006 to 2016
Age group (years)
All isolates reported
Isolates showing any resistance
MDR-TB isolates
<1 0.20% 0.10% 0.00%
04-Jan 0.70% 0.60% 0.60%
14-May 1.70% 1.10% 0.60%
15-24 13.50% 14.70% 22.50%
45-54 13.60% 14.00% 9.80%
65-74 10.50% 9.20% 4.00%
75+ 14.80% 9.60% 3.50%
Unknown 0.50% 0.90% 1.20%
Total 100% 100% 100%
Table Abbreviation
Abbreviation: MDR-TB, multidrug-resistant tuberculosis
In Canada, between 2006 and 2016, trends in TB drug resistance remained relatively low and stable. In 2016, although there was a slight increase in the number of isolates reported as compared with previous years, this did not translate into an increased proportion of drug resistance. Of the results submitted in 2016, 9.0% of all isolates tested were resistant to at least one of the four first-line drugs; the majority (83.1%) of those were resistant to only one drug. Of isolates tested, MDR-TB was identified in only 1.2% and XDR-TB was not identified among any results reported in 2016.
Isoniazid monoresistance was the most commonly reported pattern in Canada. Rifampin, along with isoniazid, is one of the most effective first-line medications; fortunately, rifampin monoresistance remains low but ongoing surveillance will continue to be important to identify any changes in resistance patterns to this drug.
In 2016, the data showed some regional variation, including slightly increased levels of MDR-TB in Alberta. As well, the proportion of females with resistance appeared to slightly increase over time and was higher than the proportion of males with resistance.
In many parts of the world, drug resistance is a major challenge to preventing and controlling TB. Eastern Europe and Central Asia continue to have the world's highest proportion of MDR-TB casesFootnote 1. Such cases pose a considerable challenge to treatment and prevention efforts because the availability of effective anti-tuberculosis drugs becomes limited.
As reported in Tuberculosis in Canada - Summary 2015, foreign-born individuals continued to account for the majority of reported cases, at 71% of active TB cases diagnosed in CanadaFootnote 6 and it is likely that these individuals acquired the infection outside of Canada. Therefore, although data on country of origin is not collected in the CTBLSS, TB drug-resistance patterns in Canada are probably affected by drug-resistance patterns elsewhere in the world.
Data published by the World Health Organization show that, globally, in 2015, about 3.9% (95% CI: 2.7%–5.1%) of new TB cases and 21% (95% CI: 15%–28%) of previously-treated TB cases were MDR-TBFootnote 1. Although the data captured through the CTBLSS do not distinguish between isolates from new versus previously-treated cases of TB, it is reassuring that only 1.2% of isolates tested in 2016 were MDR-TB (which is considerably lower than global estimates). In addition, only seven XDR-TB cases were identified between 2006 and 2016 indicating that XDR-TB in Canada remains rare.
A few limitations should be considered. Although efforts were made to ensure that multiple records for any one individual in a given year were removed, given the minimal identifying information available for each isolate (age and sex), it is possible that multiple isolates from one individual were included in the database. This bias is likely minimal given the validation process with provincial and territorial data providers.
Demographic and clinical data collected through the CTBLSS were limited, and no data were collected on the ethnic origin, diagnostic/clinical status or treatment outcome of the individual from whom the sample was collected. Additional demographic and clinical information would facilitate a more in-depth epidemiological assessment of drug resistance patterns in Canada. Differentiation between primary and acquired drug resistanceFootnote 1 and differing resistance patterns among new cases in comparison to re-treatment cases was not possible based on data collected through this surveillance system. However, the Tuberculosis in Canada—Summary 2015Footnote 6 and Tuberculosis in Canada 2012Footnote 7 surveillance reports provide an overview of the overall reported active TB cases and corresponding incidence rates in Canada by select demographic and clinical characteristics, and present case-based (vs. isolate-based) data on primary and acquired drug resistance in Canada that were not presented here. Together, these reports provide a comprehensive overview of TB case and drug resistance surveillance data from a national perspective.
Typically, only MDR-TB isolates or other extensive resistance patterns will undergo select second-line drug sensitivity testing. Although the Clinical and Laboratory Standards Institute (CLSI) recommends that isoniazid-monoresistant isolates as well as other polyresistant non-MDR isolates be tested for second-line drug resistanceFootnote 8 this is not universally reported in Canada. Other isolates that are not MDR-TB may be resistant to fluoroquinolones because of the widespread use of these antibiotics for other respiratory infections. To some extent, this limits our understanding of the emergence of second-line drug resistance within Canada.
The Public Health Agency of Canada continues to work with its provincial and territorial partners to achieve the goal of TB elimination in Canada. With the growing worldwide concern about drug resistance and the emergence of XDR-TB, the CTBLSS remains vital to the monitoring of TB drug resistance in Canada.
Authors' statement
VG – Conceptualization, Methodology, Software, Validation, Formal Analysis, Writing – Original Draft
JV – Conceptualization, Writing – Review & Editing
WS – Writing – Review & Editing, Supervision
The Surveillance and Epidemiology Division, Centre for Communicable Diseases and Infection Control at the Public Health Agency of Canada would like to acknowledge the members of the Canadian Tuberculosis Laboratory Technical Network and their teams as well as colleagues at The National Microbiology Laboratory for their contribution to and participation in the Canadian Tuberculosis Laboratory Surveillance System.
This work was supported by the Public Health Agency of Canada as part of its core mandate.
World Health Organization. Global tuberculosis report 2016. Geneva: WHO Press; 2017. http://www.who.int/tb/publications/global_report/en/
Return to first footnote 1 Referrer
Menzies R, Wong T (eds). Canadian Tuberculosis Standards, 7th Edition. Canadian Thoracic Society. Canadian Lung Association. Public Health Agency of Canada; 2014. http://strauss.ca/OEMAC/wp-content/uploads/2013/11/Canadian_TB_Standards_7th-edition_English.pdf
V Gallant, J Vachon, W Siu. Tuberculosis drug resistance in Canada:2006—2016 Supplementary data [Internet]. Can Commun Dis Rep. 2017;43(11). https://canada-preview.adobecqms.net/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2017-43/ccdr-volume-43-11-november-2-2017/tuberculosis-drug-resistance-canada-2006-2016-supplementary-data.html
Public Health Agency of Canada. Tuberculosis: Drug resistance in Canada 2015, Ottawa (Canada): Minister of Public Works and Government Services Canada; 2017. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/tuberculosis-drug-resistance-canada-2015.html
Public Health Agency of Canada. M. tuberculosis Complex Antimicrobial Susceptibility Reporting Form. https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases/tuberculosis/m-tuberculosis-complex-antimicrobial-susceptability-reporting-form-eng.pdf
Gallant V, Duvvuri V, McGuire M. Tuberculosis in Canada—Summary 2015. Can Commun Dis Rep. 2017;43(3):77-82. https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/publicat/ccdr-rmtc/17vol43/dr-rm43-3-4/assets/pdf/17vol43_3_4-ar-04-eng.pdf
Public Health Agency of Canada. Tuberculosis in Canada 2012. Ottawa (Canada) Date modified: 2015-05-29. https://www.canada.ca/en/public-health/services/infectious-diseases/tuberculosis-canada-2012.html
Woods GL, Brown-Elliott BA, Conville PS, Desmond EP, Lin G, Pfyffer GE, Ridderhof JC, Siddiqi SH, Wallace RJ, Warren NG, Witebsky FG. Susceptibility testing of mycobacteria, nocardiae, and other aerobic actinomycetes; approved standard–Second Edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2011:31(5).


This outstanding china statue of a geisha was made in Japan during the 1945-1952 Allied occupation. It's marked "MADE IN OCCUPIED JAPAN" in black print under the glaze on the bottom. While she has Asian facial features, her hairdo is a Western one typical of the 1940's-1950's, pinned up on each side by pink pom-poms or flowers. She's wearing a pearl grey kimono, decorated with black calligraphy symbols down the front, not one of which means anything in Japanese. The same thing applies to the pink decorations on her white fan, held by her hand with delicately red polished nails. Her white socks are peeking out from her hem and she's standing bowed in a subservient posture on a black base.
This is a tall geisha, standing 12 inches high and resting on a 4 inch diameter base. It's in exceptional condition and a wonderful find for collectors and decorators alike.


Riding a bike is a sustainable, green, eco-friendly transport option, right? Well, "it's not what you do, it's the way that you do it" as the old saying goes. If you want to know how to destroy the planet faster, undermine community spirit and generally be 'part of the problem' in all ways possible by riding your bike, then you'll love this step-by-step guide!
This entry was posted in Permaculture, What's New! and tagged bike riding, cycling, problem cyclists, sustainability, sustainable transport. Bookmark the permalink.
This author obviously doesn't like cyclists nor does the author reflect the values & principles of practicing permaculture so not sure why it was posted.
The author obviously IS a cyclist (who incidentally owns two bikes), and the author HAS reflected permaculture community building principles in his article through the use of satire, sarcasm and irony!
"Well, there's a reason we don't get irony, and it's not because we're daft.
As explained by INSEAD professor Erin Meyer in 2014 bestseller "The Culture Map: Breaking Through the Invisible Boundaries of Global Business," it comes down to the difference between low-context and high-context cultures.
Cultures are considered low- or high-context based on the degree to which communication there assumes common reference points and shared knowledge.
Low-context cultures prefer communication that is precise, simple, and clear. Messages are expressed and understood at face value.
High-context cultures prefer communication that is sophisticated, nuanced, and layered. Messages are both spoken and read between the lines.
Any gap between countries on this spectrum can lead to miscommunication. Notably, the British, despite being more low-context than many cultures, are far more high-context than the Americans. Thus they will often say things with implicit meanings that are contrary to their literal meanings — aka irony — that go right over American heads.


Kanchan Font is another simple Nepali font. This font is thinner in size when compared to Preeti font and Kantipur Font. You can Download the Kanchan Font from below link. You can download the Nepali Kanchan Font and install it on your computer.
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text:
كوردی عربي Türkçe
From people
Video Photos
Al-Khasfa: Mosul's notorious death hole
Ninewa- Al-Khasfa sinkhole before it was filled by IS, Photo: Al-Arabiya
KirkukNow- Ninewa
Muhammad Hussein, 30, was arrested by Islamic State (IS) fighters at his house in Mosul who accused him of writing slogans against the group. His penalty was death, and his body was dumped in a sinkhole called al-Khasfa.
Om Ala'a who is in her 60s broke in tears as she told KirkukNow about the day her son Muhammad was arrested. "On a cold evening of February 2015, an armed group dressed in the group's black attire stormed our house and said they were taking my son for investigation."
When Muhammad's father asked the gunmen why they were taking him, they said he was posting anti-Islamic State slogans.
"They turned to my husband and asked him: Do you agree with that? My husband stood speechless," said Om Ala'a.
"On August 7, 2015 news came that IS has posted lists of people detained by the group on the walls of the al-Jimhuri general hospital on the right side of Mosul. My husband and my son Ala'a went to look for his name in the lists, but when they came back they said they were told that Muhammd had been executed and that his body was dumped in the al-Khasfa sinkhole," she added.
Al-Khasfa is a deep hole located in the desert area south of Mosul.
IS turned this sinkhole into a mass grave after they overran Mosul in 2014, and used it as a dumping ground for the lifeless bodies of those who were mass executed by the group.
Eyewitness relates the horror at al-Khasfa
Mousa Hussein Muhammad, member of the Tribal Mobilization forces says he has been to al-Khasfa 4 times when Mosul was controlled by IS.
"Al-Khasfa is a dark creepy sinkhole. When you throw a rock into the pit you cannot hear the sound of its collision. I tried this several times with some friends," he told KirkukNow.
"When we were getting close to the sinkhole we could smell the corpses. The sinkhole is located in an abandoned area, which makes it even more creepier."
He added that IS militants have filled it and booby-trapped it with explosives, making excavation particularly complex for local and federal authorities.
Al-Khasfa is located near al-Athba village, 20 km south of Mosul.
Al-Khasfa, a site for summary executions
Iraqi writer and researcher Abdul-Jabbar al-Jiburi says al-Khasfa witnessed a mass extermination campaign against the residents of Mosul. "The dumping of the bodies of over 2070 in this sinkhole by the Islamic State extremist group is a crime against humanity," he said.
Al-Jiburi criticized the government for not allocating compensations for relatives the victims of the Islamic State's brutality.
He indicated most of al-Khasfa victims are believed to be "security personnel, judges, media workers, election candidates and tribal leaders who were executed by the group and their death was announced on August 7, 2015."
Ninewa- Relatives of al-Khasfa victims demand their rights, August 2019 Photo: KirkukNow
What is al-Khasfa? Is it possible to reach its bottom?
According Alwan Rabih, researcher specialized in geology says the al-Khasfa sinkhole is 184 meters deep and 50 meters wide, indicating the lack of a detailed study about the site due to government negligence.
"Local teams are unable to reach the bottom of the pit because they do not have the necessary equipment, and also due to the existence of poisonous gases," he said, emphasizing that foreign teams should undertake the excavation task to unearth the bodies of the victims.
Earlier a Human Rights Watch report indicated that IS had executed hundreds of detainees and disposed of their bodies in a location near Mosul.
Om Ala'a lost her son more than 4 years ago; Muhmmad has no grave so she could visit. Meanwhile, authorities refuse to enlist him as a martyr.
For Om Ala'a and her husband who has been suffering from hemiplegia and other illnesses, patience is the only thing they have, hoping for a better future.
A nine year old Lawand, a shout that was never heard
Turkmen are happy for their national days designation by Kurdistan Region's parliament
Khanaqin's new commissioner takes office
Lionel Messi, Antar Ibn Shaddad and Beep Beep Character employed in Mosul
Tough competitions between Al Jabouri and Al Ubaid tribes for power in Kirkuk
Airstrikes kill commander of YBS in Sinjar
News Report Follow-ups
My Story From people Photos
Video Contact About
Territories covered by
(KirkukNow)
(KirkukNow) is an Independent electronic news website publishes stories and events taking place within or relevant to Iraq's disputed territories with the aim of promoting coexistence in those areas and providing easy access to information

redpajama_set_name: RedPajamaCommonCrawl


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text:
Cauchas sedella is a moth of the Adelidae family or fairy longhorn moths. It was described by August Busck in 1915. It is found in North America, including Colorado.

References

Adelidae
Moths described in 1915
Moths of North America

redpajama_set_name: RedPajamaWikipedia


October 30, 1993 – Saturday – 8:10 p.m.
Yesterday at school there was a memorial service for Mrs. Nance. The whole school was almost in tears. I was one of the students who was not.
Christi bought a new Broadway Musical Soundtrack and she recorded a copy for me. It's called Miss Saigon.
I thought Les Miserables was sad, and I thought Phantom of the Opera was sad, but Miss Saigon tops them both.
I've listened to it almost six times and I've gotten chocked up each time. I balled like a baby the first three times.
I will cry when someone dies in a movie or a play, but I have never cried over a person who has died in real life. Jonathan said it is because in real life we don't accept it.
At the wake, or the viewing, whatever you call it, Mrs. Nance didn't look like Mrs. Nance. She just wasn't there. She wasn't moving. She wasn't breathing. It looked like someone else's body.
Afterwards, we went to the lock-in for the youth group. Kevin came back from college for it and to go to a cross country meet he and Jonathan were going to early Saturday morning.
Ryan and Christi weren't at the lock-in, but mostly everyone else was. We watched videos and talked and ate.
Amy and Cheryl told me that Christi wasn't a part of the church or the youth group anymore. I'm not sure what that is about. I haven't talked to Christi yet. I have no idea what happened.
Ryan simply had to babysit.
I slept almost two hours this morning while some people watched Return to Snowy River. I had an eye appointment at 11:30 a.m. at Wal-Mart. I went to that and then Marcus and I went to a place called Britt's in Sanford and boy does that place have one fine waitress.
We ate there because I talked to Hank and Patti earlier and they said they were going to take Christi out to lunch there between her rehearsals for The Sound of Music. They showed up, but without Christi. She didn't have enough time so they grabbed her a burger instead.
I wanted to talk to her, but I couldn't.
We came home after that and Henry felt the need to lecture us again. This time is was on "conversing." Yeah, I don't know either.
At the lock-in there were a lot of junior-high kids there. Only about half of the original Endtime Warriors were there. Cheryl said that everyone is leaving and new kids are coming in. Cheryl is a freshman; she'll be here for a while.
But she was right. I received my acceptance letter from Lees-McRae today. I will be there in less than ten months.
And in 20 days I will see Les Miserables.
October 28, 1993 – Thursday – 6:12 p.m.
Something happened yesterday. You're probably thinking something happened at church. Well, you're wrong, this happened at school.
On March 5, 1993, a Friday, I wrote something in my first Book of Days about a woman named Mrs. Nance. She was my chemistry teacher then. I would not have given her that letting, sharing the gospel with her, if I did not know she was dying of cancer. No one ever knew if she was a Christian or not. We all just knew she was a firm believer in evolution and not creation. She's had cancer for a long time and during my junior year she would be out for weeks at a time. I liked it when that happened because we didn't actually have to do chemistry when the substitute teacher was there. I hated chemistry with a passion; it was so confusing.
Mrs. Nance often talked about dying. She talked about how much money and pain it was costing her just to stay alive a little longer. Once day a student asked her if she considered quitting and not spending the money to pay for all the chemotherapy and just let it all go.
Two weeks ago, Mrs. Nance left school. The doctor had given her two weeks left to live. She looked so pitiful; her skin was yellow.
We got word yesterday that she passed away.
I fear this poem has a meaning I haven't entirely grasped yet, but as I get closer to the lighthouse, I know I will.
October 26, 1993 – Tuesday – 11:30 p.m.
Well today was college day at school. I visited the Lees-McRae table and a few other places.
Brandon called tonight. He is okay. I told him that Anne and Jason broke up and he wanted Anne's number in college. I told him I would call Cheryl to get it and then I would call him back later.
I called Cheryl and her mom said she was spending the night at Ryan's.
So, guess what? I called Ryan's. I didn't want to at first because I knew what would happen. But I did anyway.
Amy answered. I talked to her for about a minute. Then she said Ryan wanted to talk to me. Ryan asked me if I was going to go see the play she is in next Wednesday. I said I would.
We talked a little more and then I talked with Cheryl. She said she would call her mom and get the number and then I could call her back in five minutes. Right after I hung up, Mike came over and we began playing Street Fighter II. Then 30 minutes later I remembered I was supposed to call her 25 minutes ago. Oops.
So I called over to Ryan's and she answered. We said a few things and joked around. Then Cheryl gave me Anne's number and I said my goodbyes.
I knew it would happen. I had talked to Ryan and then I couldn't get her off my mind for the rest of the night. The sun is setting, but it sure is going to take a long time.
I wonder if the only way it will go completely down is if another sun rises.
October 24, 1993 – Sunday – 10:05 p.m.
The sun began to set today. Its still going down if it hasn't already.
This morning I went back in children's church after praise and worship. Cheryl and Amy were back there. The way children's church works will soon change. There used to be two different drama teams. Gary and I were on each one. Now there will be three, and I will only go into children's church every third Sunday instead of every Sunday. This starts in about two weeks. Next week will be the last time I'm in children's church with Ryan and Christi. My drama team is now just Elizabeth and I.
Well, anyway, Cheryl and I were talking. And she asked me if I knew who Marcus liked. I said, "Yeah, I know, Trish." Then she wanted to know if I still liked Ryan. I told her that I did, but that I didn't see the two of us as anything.
We talked some more. Then I told her that I knew Ryan liked this guy at school named Kevin. No one ever told me that; I just overheard a conversation.
She asked me if I was upset.
Tonight I looked at some pictures of Ryan's and I saw a picture of Kevin. He had one of those wild hair cuts. But I haven't met the kid, I'm not going to judge him because of his hair. He must definitely be a great guy if Ryan sees something in him.
I also found out tonight that Trish and Marcus are actually becoming a thing.
Marcus and Trish, Cheryl and Matt, Ryan and Kevin, Christi and Adam, Jacob and Nobody.
I'm alone. It's weird when there is no one out there who you really like. You try to find something else to look forward to beside seeing her.
I wish someone new would come along.
It was this time last year that Veronica and her family began coming to the church. I will not do something like that again though, just because I couldn't have Ryan.
I'll manage. I know I will. I'll just watch my friends continue in their lives and their relationships. Then I'll say goodbye and I'll start all over again in a little corner of the world called Lees-McRae.
October 23, 1993 – Saturday – 10:20 p.m.
We didn't have skit group today. We didn't have singing practice either. I stayed home all day. A lot happened. Too much to explain. I'm happy right now. Really happy. So happy it's scary.
Today I got up around nine o'clock. I took a shower, moused my hair, and then watched some TV. Jonathan called. Everyone left to go wherever they went.
A whole Saturday. A whole house. All to myself.
Actually, I don't really know. I wrote a little while listening to The Phantom of the Opera. I watched some more TV and then I prayed in the spirit for a while. I played the Power of One soundtrack super loud and danced to the music in the kitchen. I practiced my monologues for my college audition and tonight I watched four hours of TV in a row. I haven't done that in a long time. I watched Star Trek: The Next Generation, Baywatch, and the movie Mermaids. Mermaids was really good.
Everything is going to be fine. My dreams will come true. I will write. I will make movies. And I will find that right girl out there in the world. Whether she lives in Florida, North Carolina, or somewhere else; I will find her.
I dare you to keep reading. By the loving grace and blessings of God, my dreams will come true.
October 21, 1993 – Thursday – 4:30 p.m.
I wish Ryan could go with me.
We could be free together.
Things have been rough these past few days. Yesterday I had an Orthodontist appointment at 11:00 a.m. Henry was supposed to pick me up at 10:30 a.m. from school. I can't leave unless he comes to sign me out. He didn't know that and he stayed in the car for 40 minutes. At 11:10 he decided to come in and get me for my 11:00 appointment. And he often brags about his intelligence. I said I wasn't going to the appointment, that I would reschedule, and he agreed but got really upset about it.
The water in our well has been low this past week and it must have been my mom's time of the month. They bought me a car. It's a Toyota. A 1980 something. They said they got it because they want me to be home by 3:00 to watch Nate. They still give me all these lectures and rules and junk that they just say to hear themselves talk and have power.
Other stuff has happened. Stuff that, at least according to them, is my fault. And Henry is upset with me because he doesn't think it is right for me to have a car when I have totaled two cars in the past year. It's not that I'm a bad driver. I just can't drive well while I'm eating or sleeping.
Hopefully things will turn around and be okay. Nothing majorly bad is happening, just nothing good is happening.
At church last night, I felt so wonderful. I feel so loved at church. I don't feel loved at home, but I know I am.
Emily hasn't written me back in about three weeks. My dad hasn't called. I wish I could see Brandon.
At school there is this guy named David. I was talking to him about this girl who always stares at him in the hall. He is going out with the Student Council President, a fox. Well, I just got to thinking: the only girls who have ever liked me have been girls I've had no interest in talking to or looking at. Except one. Her name was Veronica, but she was younger and well, that must say something about a guy.
It hurts in a way. I don't think there is anything wrong with me.
I like me. I just wish somebody would love me.
October 17, 1993 – Sunday – 9:31 p.m.
I didn't want to, but I said, "I guess." I hardly touched her, but she just embraced me. Uggh.
Earlier Saturday, I had an eye appointment and I got a free trial pair of extended wear contacts. They are nice.
I then went to Scott's new house and I shot a 12-gage shotgun for the first time. It about knocked me down.
This morning we performed a skit about healing. It was really moving and almost everyone in the audience was crying. So it turns out this little skit group isn't dead after all. I don't know if we will ever perform the old stuff, but we are still alive.
Things went well this weekend. This afternoon we played football at Danny and Peter's. Ben was there. Together we all watched Transformers The Movie. As a child, transformers were my favorite toys. Watching that movie brought back so many memories. I remember going to see that movie in the theater.
You know what? I'm young. I mean really young. I've got a long way to go. My senior year is already a quarter of the way through. It is going by quicker than I thought.
And soon I'll be at Lees-McRae. It would be awesome to have a car in college. Please God, I need one. You are my provider.


behavioral priming, and in building a new field of health neuroscience. He is the lead investigator in the health and human performance at CMU.
Dr. Louise Lambert, PhD., is a Registered Psychologist (#2659, College of Alberta Psychologists, Canada) with over 15 years' experience in counselling centres, mental health, not-for-profit organizations, higher education and research, and primary healthcare organizations. She has lived in the United Arab Emirates for eight years and is finishing her current role as Associate Professor at the Canadian University Dubai and will start in January, 2018 with the United Arab Emirates University (UAEU) in Al Ain, UAE, where she will be developing the Middle East's first Positive University.
With a concentration in positive psychology, she has developed and delivered many evidence-based positive psychology intervention programs. Her "Happiness 101" program is used in clinical settings and has shown 6-month post treatment effectiveness (Lambert D'raven, Moliver, & Thompson, 2015), while the "Strengths Compass Program", a program used for the development of workplace character strengths in teens, young adults and entry-level employees (Lambert, Budhraja, Mullan, & Gupta, 2018) is being used in Saudi Arabia. More recently, her "Happiness Matters in University" program successfully showed sustainable increases in wellbeing after three months relative to a control group, as well as decreases in the fear of happiness (Lambert, Passmore, & Joshanloo, forthcoming). Her most recent program was adopted by the Kuwait Ministry of Education for use across all government schools under the "Bareec" title and under the patronage of Sheikha Intisar Al Sabah.
She is the co-editor and author of a locally relevant introductory psychology textbook and regional textbook in positive psychology, in which one of those chapters is a proposal for the development of wellbeing policy in the GCC region. Both of these have been accepted for publication by Springer for 2018. Dr. Louise is also the Editor of the Middle East Journal of Positive Psychology, a journal dedicated to uncovering human excellence in the Middle East region and heartily believes that a local, indigenous psychology can and must be nurtured, and has several publications on wellbeing in the region.


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Virginia Mason Health & Wellness Blog
A conversation about health, wellness and life.
Fine-Tuning Cells to Tune Out Disease: Immune System Discoveries Spur Hope
February 25, 2021 by Virginia Mason Leave a Comment
To understand what causes type 1 diabetes (T1D), imagine a spy novel. It starts with a hero, the T-cell, that roams your body like James Bond. The T-cell hunts down enemies — bacteria and viruses — and snuffs them out. Then something goes terribly wrong: The hero becomes a villain.
Like a double agent, T-cells can turn against your body and attack your pancreas, triggering T1D. It keeps attacking for years, methodically destroying your ability to produce insulin and control blood sugar. Your T1D becomes ever more debilitating.
Fortunately, there's hope: One of Benaroya Research Institute's real-life heroes, Alice Long, PhD, is moving closer to a therapy that makes the enemy T-cells so exhausted they surrender.
BRI researcher Alice Long, PhD
"We think it could be possible to make the T-cells say 'we give up, we're too tired to keep attacking the pancreas,'" Dr. Long says. "That could slow down T1D or maybe even stop it."
This approach of manipulating T-cells to stop disease could extend far beyond T1D. That's why Dr. Long is teaming up with other BRI researchers, including BRI President Jane Buckner, MD, to study the machinery inside these cells more closely than ever before.
"This could reveal ways to dial T-cells down to stop autoimmune disease, or dial them up so they attack cancer," Dr. Buckner says. "It's a new frontier of immune research and BRI is excited to be at the forefront."
T-cell Discoveries
Dr. Long has dedicated her career to finding better therapies for the millions of people with T1D. The best available treatment is to inject insulin. Even then, T1D increases the risk of serious health issues like heart disease and stroke.
"There's a desperate need for therapies that protect the pancreas so it can keep producing natural insulin, because that helps people with T1D stay healthier and have fewer complications," Dr. Long says.
Dr. Long believes that understanding a phenomenon called "T-cell exhaustion" could unlock these therapies. Several years ago, researchers discovered the body is home to exhausted T-cells, which are alive but have stopped attacking. Everyone has these exhausted cells. But subsequent research showed that people with autoimmune disease who have higher numbers of these cells also have less severe disease and fewer complications. Then Dr. Long and Peter Linsley, PhD, made a key discovery of their own.
They showed that T1D progresses more slowly in people who have higher numbers of exhausted CD8 T-cells. They also found that a drug called teplizumab increased exhausted CD8 T-cells in most individuals. Even better, BRI researchers led a study that showed treatment with this drug delayed the onset of T1D by approximately three years in people who were susceptible to the disease.
"Those were 'a-ha moments' — we started to think, maybe it's possible to create a therapy that exhausts these cells and stops T1D," Dr. Long says. "But first we needed to understand these cells in much greater detail."
Fine-Tuning the Immune System
Dr. Long recently received a $2.6 million National Institutes of Health grant to investigate why CD8 T-cells become exhausted and how this influences T1D. She's also collaborating with Dr. Buckner and Erik Wambre, PhD, on an NIH-funded project that looks at T-cells in cancer patients.
People with cancer have the opposite problem as people with T1D and other autoimmune diseases. In cancer, T-cells should attack cancer cells, but something about cancer leaves them too exhausted to attack. Drugs called checkpoint inhibitors can nudge those cells back into attack mode. But those drugs can push T-cells into overdrive, until patients end up with symptoms similar to autoimmunity.
"If we can understand the process that leads to autoimmunity in these patients, it could help us understand the biological dial that controls how much T-cells attack," Dr. Buckner says.
The BRI team's vision is to be able to control both sides of the T-cell equation. This means they could adjust cancer therapies to prevent autoimmune attacks, or create therapies that exhaust attacker cells and stop autoimmune disease.
"We're getting closer to being able to turn the immune system up or down depending on a patient's needs," Dr. Buckner says, "And that means we're getting significantly closer to improving the lives of people with everything from T1D to cancer, and maybe even to stopping those diseases altogether."
A version of this story originally appeared in the Benaroya Research Institute Autoimmune Life Blog.
Filed Under: Benaroya Research Institute Tagged With: autoimmune disease, Benaroya Research Institute, cancer, T-cells, Type 1 Diabetes
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Q: Enqueuing style and script based on template not working In WordPress, I have a template file called vertical-page.php.
When a page has this template applied, I want to load in a specific stylesheet and script.
I have tried to use is_page_template(), but it doesn't work. When I view the source of the page, the script and styles are not being loaded?
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A: Try putting the add_action after the function

A: If your page template file is something.php and it's location is the main folder of the active theme, you need to pass an argument to the is_page_template() function like this: is_page_template('something.php')

redpajama_set_name: RedPajamaStackExchange


text:
CU/See Me campaign highlights diversity on campus
December 10, 2019 6:57 pm by Shudder Hurd-Burnell Views: 60
Roughly a month after its initial announcement, leaders of Castleton University's CU/See Me initiative are looking forward to the spring after already facilitating a handful of successful events.
The initiative focuses on creating programming on the broad topic of diversity, specifically through the perspective of individuals on campus.
"There's a lot of opportunity for all of us to learn from our international students, from our students of color, our veterans and non-traditional students," said Charlotte Gerstein, Castleton University librarian and CU/See Me Committee member. "For us to build community by knowing each other better and to know a little bit more about their story."
Organizers of the initiative include a host of deans, professors and staff including Charlotte Gerstein, Peter Kimmel, Amy Bremel, Victoria Angis, Cathy Kozlik and Sherrill Blodget.
The committee originally formed out of the realization that much of what we imagine when we think of diversity is just visual.
"The idea of CU/See Me was that we should look beyond the surface of people and appreciate that they may have a different identity than what we see on the surface," said Peter Kimmel, dean of the College of Health and Sciences. "In lots of ways, you know, in terms of gender, their orientation, their politics, you know, all kinds of things."
In one of the country's whitest states, it's no surprise that Castleton is often seen as lacking in diversity. One of CU/See Me's goals is to show how that's not necessarily true.
"For many years, maybe as long as I've been here, we frequently get the comment that Castleton is very white," said Victoria Angis, associate dean of Students. "We realized that, rather than focusing on what we don't have, that we should focus on what we do have … a lot of diversity that perhaps is unseen."
The committee is planning an array of programs for the spring semester. Roughly nine separate events are planned as of now, four of which will be part of Soundings and two will span multiple days.
Kicking off the semester on Jan. 23 will be a convocation-like event currently called "2020 Vision: CU See Me," which will include a variety of shows on the topic of diversity, such as music, dance, art and talks from students.
Planned for February is a weekly program called "Every Spartan has a Story." Similar to "Every Woman has a Story," the events will feature Spartans from all walks of life sharing their experiences.
A short film project is also being created by a group of students with help from media and communication professor Sam Davis-Boyd. The video will focus on diversity within the CU community through first-hand stories.
The group is looking for "different voices on campus, whether it's students, faculty, or staff," said Davis-Boyd. "People that want to share their story about their identity and how they're a part of the community on campus."
Filming will likely begin in the spring. Anyone who's interested in being filmed for the project can reach out to Davis-Boyd.
The CU/See Me committee is working to not only create their own events, but to work with individuals and groups on campus who want to create programming on the topic as well.
"We're looking at all the above," said Amy Bremel, coordinator of Advocacy, Activism, and Non-Violence Education at CU. "We're looking at the first-year seminar program, we had that diversity component added this fall … Soundings programs, then convocation right now. There've also been other ideas tossed out there, so we're not limiting ourselves, that's for sure."
Organizers are eager to collaborate with anyone on campus who's interested in helping. Like with the film project, anyone in the community is welcome and can contact Victoria Angis or Dean Peter Kimmel to learn more.
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Church Road Winery is conveniently located just 10 minutes drive from Napier in Taradale. Come and experience one of the interactive tours on offer.
Immerse yourself in the history of Church Road and learn more about our winemaking philosophy on a Church Road Winery and Museum Tour.
Visit our wine museum housed underground in old concrete wine vats where some of the oldest winemaking relics in the country are entombed.
The Church Road Winery and Museum tour includes a tutored wine tasting from our innovation tasting menu.
With glass in hand, sample wine directly from our cellars whilst you gain a technical insight into the crafting of Church Road wines.


What is the abbreviation for Kentucky Association of College and University Residence Halls?
A: What does KACURH stand for?
KACURH stands for "Kentucky Association of College and University Residence Halls".
A: How to abbreviate "Kentucky Association of College and University Residence Halls"?
"Kentucky Association of College and University Residence Halls" can be abbreviated as KACURH.
A: What is the meaning of KACURH abbreviation?
The meaning of KACURH abbreviation is "Kentucky Association of College and University Residence Halls".
A: What is KACURH abbreviation?
One of the definitions of KACURH is "Kentucky Association of College and University Residence Halls".
A: What does KACURH mean?
KACURH as abbreviation means "Kentucky Association of College and University Residence Halls".
A: What is shorthand of Kentucky Association of College and University Residence Halls?
The most common shorthand of "Kentucky Association of College and University Residence Halls" is KACURH.


Google quietly pushed out an update to the iOS version of the Google Maps app that now checks for faster routes to a destination as you drive.
The new iOS version of the Google Maps app and the Android app will notify you if there's a faster route available while you are in transit.
This feature is available on both iPhone and Android where Google Maps navigation is available.


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Chet Cunningham remains one of my favorite authors of pulpy men's adventure fiction, but I've had trouble connecting with his popular series 'The Penetrator' written under the pseudonym of Lionel Derrick. The series ran for over 50 installments and was launched to capitalize on the success of Don Pendleton's 'The Executioner." Cunningham's take on the serial vigilante genre was mostly silly and over-the-top and usually not very good. For me, it's always been a challenge to remain focused on the written page when I'm so busy rolling my eyes.
"Mankill Sport" from 1976 is the 14th installment in the series, and I was seduced by the plot synopsis which touts the book as a 1970s take on Richard Connell's "The Most Dangerous Game" in which a hunter stalks men through the deep woods as prey. It's a premise that has been re-worked dozens of times over the past century, and I was curious to see what Cunningham would do with the concept. The book review is below and a discussion of the novel was featured on the Paperback Warrior Podcast on July 8th, 2019 (LINK).
For the uninitiated, Mark Hardin is The Penetrator, a half-Cheyenne former U.S. Army killing machine with a brilliant mind and expert marksman skills. As "Mankill Sport" opens, Hardin is two-and-a-half years into his one-man war in crime and has achieved folk hero status among millions of groupies worldwide. Early in the paperback, he receives an assignment from his mentor to target a Detroit drug lord and big game hunter named Johnny Utah.
At his best, The Penetrator recalls Detective Comics' Batman - no super-powers but well-resourced, violent, and quick access to cool gadgets. The first half of "Mankill Sport" has Hardin following Utah's trail across North America to force a deadly confrontation. Because it's disclosed on the book's cover, I'm comfortable telling you that Utah's hobby is kidnapping innocent people and hunting them through the thick Canadian woods like animals, and the climax of the novel finds Hardin in the role of Utah's prey. Can The Penetrator turn the tables and transform the hunter into the hunted?
I've read several paperbacks in 'The Penetrator' series, and this one is the best of the batch I've sampled. The premise is derivative as hell but it's extremely well-executed and ultra-violent. Moreover, the entire series is available for purchase on your Kindle for super cheap. I can't necessarily endorse other books in the series, but "Mankill Sport" is essential reading for men's adventure fans.
Buy a copy of this book HERE
Labels: Chet Cunningham, Penetrator, Vigilante


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Email your event poster to usa.events@beltdrivebetty.com and Dave will do the rest.
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I want to deliver more material for the fans this year like I originally planned. Hopefully these tracks on The Refill will tide the fans over until we put out Relapse 2 next year."
Of course, Relapse 2 never happened and Recovery was released in 2010 instead.
Legal Peter Paterno for King, Holmes, Paterno & Soriano, LLP, Lisa Donini, Esq. & Theo Sedlmayr, Esq.


A top level meeting between Burton's politicians and the brewing industry has taken place.
A meeting arranged by Burton's MP Andrew Griffiths brought together the Chief Executive of Molson Coors, Mark Hunter, and Conservative MEP for the West Midlands, Malcolm Harbour. Andrew brought Mr Harbour along to Molson Coors as he is the Chairman of the hugely influential Committee on the Internal Market and Consumer Protection in the European Parliament.
Mr Harbour said: "Our visit to Molson Coors was extremely informative, to find out about future business plans as well as some of the issues and challenges it is facing.


DATE NIGHT option! 2 canvases become 1 masterpiece OR create on a single canvas!
PUBLIC PARTY at Six Mile Tavern!
**LIQUOR POLICY: This event will have a full menu and bar available for purchase! We will have a server during the event! Due to liquor licensing for this location, only outside wine bottles will be allowed for this location with a $15 cork fee!
Painting: I Love You. I Know.


RedsZone.com - Cincinnati Reds Fans' Home for Baseball Discussion > Former Sun Deck > The Sun Deck > Jeff Suppan?
View Full Version : Jeff Suppan?
After his success this postseason any chance the Reds go after him? He is a free agent after the season and is a midwest guy!
I remember Jeff Suppan from his KC days, as well as his Boston days (both times).
I think he's personally one of the more overrated pitchers in the whole league.
I'd pick him up cheap, but he's peaking right now. So he's likely to crash down next season. The Cards are getting the best out of him; whoever gives him a FA contract will be paying him dearly for past performance.
Suppan's basically been an average starter the last 4 years. We definitely need another starter next year if we want to compete, and I would gladly take Suppan, but I'm not sure I want Krivsky shelling out a big contract for a #4 starter.
Pass, for all the reasons mentioned above.
He's looked better this week than anyone else the Reds have other than Harang and Arroyo. Yes, he has history of being mediocre, but he has stepped up on the big stage in October.
Isn't that what we want for the Reds?
2. Milton might have it in him to pitch like this in October, when and if the Reds need him to.
We'll see how Suppan does this week.
I like Suppan as a bottom of the rotation #4 or #5 type pitcher. The Reds have many candidates for those 2 roles (Milton, Lohse, Lizard, Belisle, Claussen and eventually Bailey) and need to spend any money that they spend on pitching to get some one for the top part of the rotation. If Suppan can be had cheaply as insurance to cover for the 3 bottom rotation pitchers coming off surgery and as a cheaper alternative to Lohse, then he is ok. If the idea is to pay him to fill a role in the 1 through 3 spots, then I look elsewhere. His numbers wouldn't look so good at GABP. He's been a HR guy most of his career. He'll be 32 next season.
Given the team's needs and its limited resources, I wouldn't give Suppan more than $2 Million per year to fill the role that he could likely fill. The Reds have options for the bottom part of the rotation. If you can get him for cheap, then Lohse needs to be traded or non-tendered. I think some one will give Suppan $5 or $6 million. I hope its not the Reds.
suppan's price is going up greatly right now.
however he seems like the type of guy who would take a "hometown discount"
so i expect him to stay with stl.
The first thought that leaps to my mind is that the NY Yankees would pay him more than he's worth and for longer than he's worth.
There's no need to waste money on a guy like Suppan.
I like the chances of finding internal candidates for the 4th and 5th spots of being just as effective as Suppan. Plus with his good pitching in the play-offs, you know someone will overpay for him.
Unless the Reds can pick up a guy that can put up an ERA at or below 4.00, I don't think they should pursue starting pitching in the FA market.
I'd take him, but only really cheap (unrealistic). Someone will overpay, probably the Cardinals or Yankees.
He's under the Dave Duncan spell, much like Weaver. He won't be as good anywhere else as he is in StL.
Is Dave Duncan a free agent this offseason? Maybe we can sign him. He might just be the answer to our pitching woes.
See, if you are a member of this board long enough you will get to hear Chip say something intelligent.
Well done Chip!! I expect another intelligent thing to come flowing off your keyboard in 2008.
I bet Marquis would love hitting in our ballpark.
If Krivsky wants to show Reds fans the organization is serious about winning, then ownership needs to open up the pocket book and make a strong push for either Zito, Schimdt or Mussina.


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What Causes High Protein Count in Urine?
Credit: Peter Dazeley/Photographer's Choice/Getty Images
Protein in Urine Symptoms - Really Useful Information!
AllMedicineData.info/Protein/Urine
Protein In Urine Is Excess Protein Found In A Urine Sample ... Read More Here!
The causes of a high protein count in urine include chronic kidney disease, diabetes, kidney infection, hypertension and heart failure, according to Mayo Clinic. Although they are not necessarily signs of kidney damage, conditions such as fever, cold exposure and emotional stress may also result in elevated urine protein.
Protein in urine, or proteinuria, is the presence of a higher than normal amount of protein in the urine, explains Mayo Clinic. Typically, high protein count in urine indicates kidney disease, which damages the kidney filters, leading to protein leakage into the urine, notes WebMD. People who are 66 or older have a relatively high risk of having a high protein count in their urine. Native Americans, African-Americans and the obese are also more vulnerable to high protein counts in urine. In some cases, high urine protein may occur as a result of standing.
To determine the amount of protein in the urine, doctors perform a protein urine test, reports MedlinePlus. In this test, a doctor obtains a urine sample from a patient and applies a dipstick fitted with a pad that is sensitive to color. The color of the pad changes depending on the amount of protein in the sample. The patient should inform the doctor of any medications he takes before the test to ensure accuracy of the results.
What Does It Mean When You Have High Protein in Your Urine?
What Causes High Systolic Blood Pressure?
What Is a Recommended Diet for Chronic Kidney Disease?
What Causes Pain in the Left-Side Abdomen?


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Pregnant women should not take ibuprofen after 20 weeks, FDA says, because it could harm baby's kidneys
Adrianna Rodriguez
Some of the most commonly used pain and fever medications could be harmful to pregnant women and their unborn babies, the U.S. Food and Drug Administration announced Thursday.
The agency requires labeling changes for nonsteroidal anti-inflammatory drugs (NSAIDs) to explain that if women take these medications at about 20 weeks or later into their pregnancy, they can cause fetal kidney problems.
NSAIDs include both prescription and over-the-counter drugs such as ibuprofen and naproxen, commonly known by the brand names Advil and Aleve. They also include diclofenac, celecoxib and aspirin above 81 mg.
According to the FDA, these medications work by blocking the production of a chemical in the body that causes inflammation.
From lotto millions to a felony indictment. How reality TV could undo a Texas sheriff. Anger over 'The Eyes of Texas' threatens to engulf Longhorns' season Is it the flu or COVID-19? How to tell the difference Prime Day 2020 is ending soon: These are the best deals you can still get Get the latest news straight to your phone: Download the USA TODAY app
"It is important that women understand the benefits and risks of the medications they may take over the course of their pregnancy," said Dr. Patrizia Cavazzoni, acting director of the FDA's Center for Drug Evaluation and Research.
Fetal kidney problems can lead to other pregnancy-related complications as the kidneys are responsible for producing amniotic fluid, the protective cushion surrounding the baby.
Fetuses produce the most amniotic fluid beginning about 20 weeks after conception, and kidneys damaged by NSAIDs could result in low levels of amniotic fluid, reducing a baby's protection inside the mother's womb.
Jennifer Wu, an obstetrician and gynecologist at Lenox Hill Hospital in New York City, said low levels of amniotic fluid could cause problems with the baby's development.
Pregnant women with COVID-19:Sick moms don't need to separate from their newborn after birth, study suggests
Doctors can detect a decrease in amniotic fluid levels as soon as two days after taking these medications, the FDA said, but levels usually return to normal after a pregnant women stops taking them.
The agency recommends pregnant women avoid NSAIDs after 20 weeks and opt for other medicine to treat pain and fever during pregnancy, such as acetaminophen.
Wu said taking ibuprofen and other NSAIDs in the third trimester also could cause heart problems in the baby.
"When you're pregnant, your baby is exposed to every medication you're taking," Wu said. "So you need to be careful and check with your health care provider before taking any medications, including over-the-counter medications."
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
© 2022 www.ocala.com. All rights reserved.


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> Action/Adventure
Cars: 3-movie Collection Blu-ray
Starring Owen Wilson, Paul Newman, Bonnie Hunt, Richard Petty, Michael Keaton, Larry the Cable Guy, Michael Caine, John Turturro, Jason Isaacs, Emily Mortimer, Armie Hammer, Tony Shalhoub, Cheech Marin, Cristela Alonzo
Directed by John Lasseter
Triple bill of Pixar animated comedies following a group of talking automobiles.
In 'Cars' (2006) successful rookie racer Lightning McQueen (voice of Owen Wilson) crashes through Radiator Springs while travelling to compete in a big race and is forced to remain in town until he repairs the damage he has caused.
At first, the tight-knit community doesn't accept Lightning's bad attitude but he eventually befriends Mater (Larry the Cable Guy) and falls in love with Sally (Bonnie Hunt).
However, unable to get the gruff Doc Hudson (Paul Newman) to change his mind about him, Lightning soon learns the inhabitants of the town had a different past that's now painfully absent, and vows to do his best to help them enjoy life once more.
In 'Cars 2' (2011) when slow-witted tow truck Mater travels to Tokyo with his superstar friend Lightning McQueen for the international Grand Prix, sleek Aston Martin Finn McMissile (Michael Caine) and his sidekick Holley Shiftwell (Emily Mortimer) become convinced that Mater is, despite his unassuming appearance, nothing less than a brilliant international spy.
Finally, in 'Cars 3' (2017), with a new generation of highly-tuned, ultra-fast racers led by seemingly unbeatable rookie Jackson Storm (Armie Hammer) dominating races, legendary speedster Lightning McQueen suddenly finds himself being muscled out of the sport he loves.
After then pushing himself to the limit and crashing out of a meet at the Los Angeles International Speedway, Lightning is forced to step away from competing in order to recover from his injuries.
However, determined not to give up on his dreams Lightning seeks help from enthusiastic race technician Cruz Ramirez (Cristela Alonzo) in a bid to make it back to the top and defeat his flash new rivals on Piston Cup Racing's biggest stage.
Region: A,B,C
Certification: (PG)
Catalogue number: BUH0275801
Also directed by John Lasseter | View all
Toy Story 1-3
Out of Stock - more expected soon
Available with free
Cars: 3-movie Collection


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Dale At Home To Gateshead In Emirates FA Cup First Round
Rochdale will face Gateshead in the first round of the 2018/19 Emirates FA Cup.
The tie at the Crown Oil Arena will be played on the weekend of Saturday 10th November.
A fixture date and ticket details will be confirmed in due course.
Dale reached the fifth round of the competition last season and have reached the fourth round in four of the last five campaigns.
Gateshead are currently 7th in the Vanarama National League.
Do you like to dream big? Back Dale in this season's FA Cup by taking out a sleeve sponsorship!
FA Cup Draw


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Meet the Devs: Blue Bottle Games
By Dan Fedor
Dan Fedor here, founder of Blue Bottle Games. The fine people at Modern Wolf asked if I'd mind chatting a bit about my studio's origin story. So let's take a stroll down memory lane, shall we?
I was pretty familiar with computers as a kid. We always had one at home that I used for things like drawing, writing, music, and even some crude BASIC programming. At one point, my dad got a game-making toolkit called STOS, and I tried my darnedest to make something like the games I saw at arcades, or even the stuff we downloaded from BBSes.
But I wasn't quite there yet.
At school, we had Apple PCs. What's more, in middle school, we even had a programming class! I loved it. I still remember finishing my lessons early, and using the spare time to write a choose-your-own-adventure in BASIC. (A sign of things to come.) It was still a far cry from the games I hoped to make, but it was starting to make more sense.
Fast forward a few years, and I finally had an IBM compatible of my own at home. I was mostly playing games, but I remember getting a copy of Dark Reign, which supported modding. I think I spent the whole summer trying to make a total conversion mod for Rifts in that engine. Sprites rendered and animated from 3D models, data files with stats from the RPG book...it was as much an experiment as it was a love letter to that bonkers RPG.
Around this time, I was mid-university, majoring in physics. I liked science, but I was starting to realize my true love was making stuff for games. There wasn't a program at my university for that yet, though, and I didn't have a clear picture of what opportunities were out there. So I mostly muddled my way through tutorials and personal projects as I finished my degree.
After graduation, I was hardly qualified to get noticed by any game studios. And despite what you may think, physics degrees are not particularly lucrative.
But I had picked up another relatively unknown skill in my spare time: webpage development. And in 1999, anyone who could slap angle brackets around tags could write their own ticket into the job market. Which is just what I did. After a false start working on a local paper's webpage (without a desk or *computer*), I was hired into an IT team for a big publisher in New York.
It was good experience, and it satisfied at least some of my cravings for interactive development. I even attempted, at one point, to convince management to offer game development services to clients. They humored me, but few of their clients were interested in that sort of thing.
During this time, I was still plugging away at personal projects. Trying to hone my skills. And I'd apply to studios whenever something seemed like I had a long shot.
Bizarrely, my first job offer came from pretty much my top choice: BioWare Corp. They wanted me as a tech artist! And much like with web development before, it was a field with more jobs than candidates at the time, making me a shoe-in.
BioWare was a dream come true for me for a long time. (7 years, in fact!) Great people. Awesome games. (Sub-Mars surface temperatures.) But towards the end, I was starting to crave more creative freedom and hands-on time with game development. And that's a hard thing to have in a huge studio with huge projects.
So in October 2010, I announced my intentions to resign. I still worked another 6 months, to help smooth the transition. But on April 2011, I said my goodbyes.
And in May of that same year, I began work on what was to become my first game: NEO Scavenger.
It was originally meant to be a sponsored Flash game. Flash sponsorships were a big thing right around then. You could get a few hundred, a few thousand, or in some cases, tens of thousands of dollars if your game caught the right website's eye. And I was pretty handy with Flash, art, and even a bit of writing.
I expected to put something together in a few months. License it to a sponsor, then repeat. Enough to pay the bills, get some practice, and work towards a bigger project.
Six months later, I was still working away at it. And what's more, it was starting to look more like a premium game. (It certainly was starting to have the cost of one.) So I pivoted to a new plan. I'd aim to release the demo on my own website, and charge folks to access the full browser version.
Right around this time, kickstarting and beta-funding were starting to become a thing, too. So I aimed to have the demo show the customer what was on offer, and allow them to pay for access to all future updates. I'd also let buyers vote on future features, and in some cases, pay for special edition perks like a signed postcard.
The signed postcard was an...interesting experiment.
As was the game! Over the course of development, it grew from a modest browser game, to a fully-downloadable Steam title. It received regular updates from early 2012 to its launch in December 2014, and a dozen updates beyond that. It was ported to both iOS and Android. And received a fair amount of both customer and critical acclaim, paving the way for what was next.
A note aside: A lot went on during that time. More than I could go into in any one post. So if this is something you want to know more about, here's a link to more than you'd ever want to know!
The NEO Scavenger mobile port is also where I met Fernando Rizo, now co-Founder and CEO of Modern Wolf, who helped with a last-minute marketing push during the game's release. Our partnership there was in no small way an influence on my studio's current partnership with Modern Wolf, though we'd work together once more before that happened.
With NEO Scavenger mostly stable, and approaching 4 years in development, I started to turn my attention to what was next. I needed a break from NEO Scavenger, and I was still harboring a flame for a game about building and captaining a spaceship. Some of my favorite sci-fi games and shows of years past included Firefly, Traveller RPG, RIFTS, Cowboy Bebop, and Alien(s), not to mention systems/simulation games like Sims, Dwarf Fortress, Starflight, Rimworld, and Prison Architect.
I had carefully left the door open to space colonization in the scraps and clues of NEO Scavenger. Maybe I could make a spaceship life sim, and keep it in the same world?


The Florida Panthers unveiled their new logo and jersey designs on Thursday.
After months of build-up, the Florida Panthers finally unveiled their new logo and jersey design at a lavish fan event on Thursday.
The initial reaction: pretty sharp. It won't be universally loved, but there's a boldness to it that should grow on most fans after they let it breathe a bit. And it's definitely an upgrade over the leaping cat design that was starting to feel a bit dated after nearly a quarter-century of use.
The Panthers wanted a look that reflects their maturity as a franchise, and this hits that mark. The color palette is familiar, but slightly warmer, with white and red as the dominant motifs and the blues removed from everywhere but the collar and the background of the main patch. The Montreal-style mid-chest band with gold border is a smart choice that offers a stark contrast to the new logo.
The leaping panther has been replaced by an alert bust within a shield, a retro-pastiche that was inspired by the "screaming eagle" emblem of the U.S. Army's 101st Airborne Division.
It's jarring at first, but it works.
The real charm though is revealed in the minor flourishes. The crossed neck string evokes the Florida state flag, which also is utilized in concert with a prowling panther on the arm patches. Those will also feature a Florida (home) or Panthers (road) wordmark bar, but those particular patches will be added only once a player has made the 23-man roster. There also will be special bars worn by the captain and the alternates in addition to the letters typically displayed on the left breast, a first in the sport and a pretty cool idea. Since they're drawing heavily on military-style adornments, it wouldn't be surprising if they later added patches for all-stars, leading scorers or other milestones.
Overall, it's a solid redesign that reflects the evolution of one of hockey's most promising franchises.


Last week I had the opportunity to share the role of principal for a day with Attorney Myles Conway of Schwabe, Williamson & Wyatt and Mark Fairbanks, CEO of The Center. We were greeted by two enthusiastic and dedicated vice principals, Al Hulbert and Michael McDonald (Summit Principal Dr. Lynn Baker would arrive later following a dental appointment).
While our job for the day was 'acting principals' we quickly learned that we were actually there for an education and an opportunity to fully appreciate what goes on in our public schools. This is a school that is providing a sophisticated education for its students while serving as a significantly important liaison between students, parents, community….anything that has an influence over young people while they're preparing to become an adult.
As in every area of our lives today the economy has added additional challenges to the staff and teachers at Summit (free and reduced lunches are up; school district wide it's now at 42 percent and students are stressed and oftentimes embarrassed to admit that their parents are struggling with finances and how to provide for the families).
Summit is an unusual school in that it has a very open design and you can see what's going on from many vantage points. It gives the impression of a cooperative effort between teachers and students and there's a sense that kids really like being there, feel comfortable there and will blossom there.
Which, evidently they have. Summit was awarded the Oregonian Cup for being outstanding in its category. The award is based on many factors including overall school experiences, GPA, extracurricular activities including athletics and sportsmanship. Summit was the only public school that received an award, the other honored schools were all private.
When we had an opportunity to meet with Principal Lynn Baker he graciously shared what he thinks are the two biggest challenges at Summit: 1) getting a high performing school to continue improving, 2) meeting the challenges of the diverse and changing social economic background of students now attending Summit.
My favorite visit was with Kent Child, school-to-career program manager who hosts what they call the Future Center. This is the jumping off point for students, a place to help plan your college or vocation after high school as well as find ways to intern at local businesses while testing the waters for your career choice. Kent told us that her department plans to speak directly to every single student in the school, encouraging them to make plans and know specifically what they will do following graduation.
Mark Fairbanks said he found Summit High to be a terrific place of learning, thoughtfully organized with a healthy atmosphere for the students. "I am encouraged by the way the administration and teachers anticipate best practices and the continued impact of accelerated technologies and their implications to classroom and social learning," he concluded.
The Principal for a Day program is part of the Education Foundation for the Bend-La Pine Schools. The non-profit Foundation seeks funding support for general operations, a Classroom Grants program and activity fee scholarships. Donations can also fund awards designated for a specific project, subject, technology or school.
The organization launched a new membership opportunity called Friends of the Foundation. For an annual contribution of $10, $25 or $50 you can become a member and enjoy not only helping the schools but invitations to foundation and educational events throughout the year.
To participate call 541-322-5493 or education.foudnation@bend.k12.or.us.
Mark your calendars for Saturday, January 23, 5:30pm at the Seventh Mountain. Proceeds from this year's event will benefit summit High School Technology and athletic department needs. $100 per person Poker tournament, $50 person for Monte Carol Nigh Only.