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Experts Seek More Health Data On Workers In Stauffer Study
Source: The Tampa Tribune | August 1st, 2003 | by Mark Holan
Industry type: Phosphate Industry
ATLANTA – During the 34 years it processed phosphate ore, more than 2,400 people worked at the Stauffer Chemical Co. plant north of Tarpon Springs.
Most toiled in hot, dusty conditions described as torture. Claims that exposure to toxic chemicals was harming workers began as soon as the plant opened in 1947.
"When the furnace was tapped, it was said that hell existed on Earth," Agency for Toxic Substances and Disease Registry Ombudsman Ronnie Wilson said Thursday. "Numerous eyewitnesses have stated that birds flying over the facility nose-dived to their death if they happened to be flying over the facility when the furnace was tapped. One can only imagine what the employees' dose was at this point."
But more than two decades after the plant closed in 1981, questions about workers' health are largely unresolved.
Inside the ballroom of an Atlanta hotel Thursday, Wilson and other federal officials heard from eight medical and scientific experts about a preliminary public health assessment of the Stauffer Superfund site.
Responding to residents' complaints, Wilson issued a report in late 2000 stating the agency's 1993 health assessment was incomplete.
The experts said they were concerned about the lack of data on workers' exposure to chemicals and substances such as asbestos, chromium, nickel, quartz, silica, sulfur dioxide, lead and dust.
Agency officials have been unable to locate a quarter of the former workers, and there are information gaps about hundreds who have died.
The panel appeared split on proceeding with studies looking at the cause of death or studies examining disease among the living.
William Beckett of the University of Rochester School of Medicine said it might be difficult to determine the risk of disease because study participation might not include all workers.
The agency issued a 174-page preliminary assessment in March that said worker exposure at Stauffer "could cause an increased risk of cancer or other adverse health effects." But the report said the conclusions were based on limited data for the plant's last nine years of operation.
The final report is expected by year's end and likely will include a recommendation on whether to proceed with worker studies, officials said.
Meanwhile, the U.S. Environmental Protection Agency is reviewing a second round of reports on site cleanup. The reports were ordered following questions about conclusions for containing or removing toxic waste.
EPA officials have scheduled a meeting for 5 p.m. Aug. 13 at the Tarpon Springs Public Library to discuss the next step with residents.
The Stauffer discussion continues as pollution from the Coronet Industries phosphate plant in Plant City has prompted a federally mandated public health assessment. Investigators also are probing allegations Coronet workers were ordered to dump hazardous waste and deceive government inspectors.
Experts at Thursday's meeting said they were most concerned about the risk of lung cancer and respiratory problems in Stauffer workers. The panel didn't consider health effects on people living near the plant. Nor was it asked about studying former students of Gulfside Elementary School, which opened across Anclote Boulevard four years before the plant closed.
"If they go through with these health evaluations for the former workers and find something, then they can't ignore those other groups," Tarpon Springs activist Chuck Lehr said.
Alan Bender of the Minnesota Department of Health warned about the psychological effect of continued studies on former workers: "We have to be careful about how aggressively we cast things."
Stauffer Management Co. general counsel Luke Mette said it was premature for the experts to offer advice because medical and scientific reports from Stauffer weren't made available to them.
Wilson, the ombudsman, said the federal agency "is the only hope" for former workers to get questions answered.
"I'm not saying they were harmed," he said. "Rather, I'm saying let's find out."
* Reporter Mark Holan can be reached at (727) 815-1082.


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Douglas Battista
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May 21, 2012 by Douglas Battista
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Talent Acquisition Is Vital to Business, Says Douglas Battista
Douglas Battista, Jenny Craig's President of North America Field Operations, had the opportunity to participate in an open dialogue at the 2011 Talent Acquisition Conference. During the conversation, this former Head of Talent Acquisition for Nestlé USA spoke about the benefits of teaming with a recruiting agency that has an established presence at home and abroad. Continue reading →
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May 4, 2012 by Douglas Battista
Douglas Battista | Self Discipline Is Key to Success
Douglas Battista is no excuses individual who believes that hard work and self-discipline are undoubtedly precursors to achievement.
As the President of North America Field Operations for Jenny Craig (a Nestlé Company), Douglas Battista knows a thing or two about success. Growing up in an Italian-American family in working-class western Pennsylvania, Douglas Battista was taught at an early age that working hard and treating others with respect were simple things he could do to pave the way to long-term success. Here, Battista presents a list of Italian- Americans who found success by overcoming their personal obstacles.
Jim Valvano
Jim Valvano was a college basketball coach, most notably for North Carolina State, which he led to victory in the 1983 NCAA Championship series. He is revered as one of the most inspirational voices in sports history, says Douglas Battista. He was diagnosed with bone cancer ten months prior to his death but did not allow this disease to damper his spirits. Douglas Battista remarks that "Jimmy V's" acceptance speech at the 1993 Arthur Ashe Courage and Humanitarian Awards Banquet is regarded one of the greatest sports speeches in American sports history. Jim Valvano was a true role model who stood strong in the face of adversity and has received numerous post-mortem honors, including an induction into the National Italian American Sports Hall of Fame. Continue reading →
Posted in Douglas Battista	| Tagged Battista, Doug Battista, Douglas, Douglas Battista, Douglas Battista CA, DouglasBattista, Self Discipline
Prior to being named President of North America Operations of Jenny Craig, Douglas Battista was Head of Talent Acquisition for Nestlé © USA, where he was responsible for the company's recruitment delivery, recruitment technology and employer branding. Douglas Battista began his employment with Nestlé © USA in 2006 as the Human Resource Director for the Logistics Division, where he caught the attention of company leaders after streamlining the HR processes through process improvement and technology. Early in his career, Douglas Battista earned a Master's Degree from the University of Hartford while working as a Food Services Director. He also holds a BS in Travel Tourism and Hospitality Administration from Niagara University.
Q & A With Douglas Battista: Difficult Co-Workers
High Pay for High Expectations
Douglas Battista: Fear Factor
Douglas Battista: When Interest Rates Rise, The Stock Market Falls
Douglas Battista Shares insight on Yoga's Value to Our Daily Lives

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Bet On European Football 18-19 May 2013
This weekend presents punters the last opportunity to have a bet on all of the European leagues, as the final day of the season approaches for most of the major leagues across the continent. All of the title winners have already been settled, and this last game of the season gives all the sides already secured of their places in the league next season, and with nothing left to play for in terms of European qualification, a parade of sorts before their fans, before heading to the close season for a well-deserved rest.
Bet365.com is the best place to bet on European Football, offering you a wide array of match selections and markets, including exciting in play options that you can have a punt on as the games progress. Below we look at some of the most popular bets that Bet365.com has to offer for this weekend.
Wigan's defeat at Arsenal midweek brought to an end their run in the Premier League, after several years of bravely staving off relegation, and brought the team back down to earth following the highs of their FA Cup triumph over Manchester City last weekend. With the relegation battle sewn up going into the final gameweek, and with Manchester United long having claimed the title, with their City rivals assured of second place, there are only the remaining Champions League spots to play for. Chelsea (4/6) host Everton (9/2), with a win securing them of third and automatic entry in the elite European competition next season, and a draw (31/10) securing at least fourth, while Arsenal (4/7) also require a win, at Newcastle (5/1) to enter the qualifiers. The only team that could topple those two teams is Tottenham (2/7), who could look destined to once again miss out on CL qualification unless they defeat Sunderland (11/1) and their rivals drop points.
All of the major discussion in the Serie A are equally resolved, with Palermo being condemned to the Serie B for the first time in a decade after their defeat to Fiorentina last weekend. As with the Premier League, the first two spots have long been decided, with Champions Juventus leading the way from Napoli. The only nuts left to crack are the European qualification berths. Milan (1/6) are favourites to finish third, with a win at already relegated Siena (14/1) securing them of third place. Fiorentina (1/6) have to make up two points to Milan, and will have to hope that their rivals drop points and that they keep up the pressure on them with a win at bottom-placed Pescara (14/1). Udinese (11/10) are currently occupying the last of the Europa League qualification places, and a win at Inter (9/4), who are ninth and having their worst season in a decade, will seal their place. Two points behind are Lazio (13/20), who may still qualify for the competition should they win the Italian Cup on the 26th against Roma, but they will nonetheless want to keep the pressure up on Udinese with a win at Cagliari (17/4).
La Liga is one of the few leagues across Europe that will not be entering the final gameweek this weekend, with three games left to play until the season is done. But with the first three places on the log already decided, it is not in a much different state than the other major leagues across Europe. And once again, the battle for the final Champions League spot is the most interesting, with Real Sociedad and Valencia currently sitting with the same points. Real Sociedad (13/5) travel to Sevilla (EVE), and after two games without a win, will see this as a crucial way to get back on track. Valencia (4/5), meanwhile, go to Getafe in a must-win game if they are to return to the Champions League next season.
Bet365.com is the place to go for all football betting for all the leagues in Europe. There you will find the best odds when it comes to European football markets as well as in-play options to play as the action unfolds.
Tagged With : European Football • La Liga • Premier League • Serie A
May 17, 2013 Daniele Polizzi Soccer No Comments


Laugavegur Ultra Marathon is a 55 km mountain race that will take place for the 18th time on Saturday July 12th 2014. Registration is open at marathon.is until June 30th.
Laugavegur Ultra Marathon is a 55 km mountain race that will take place for the 16th time on Saturday July 14th 2012. Registration is open but closes on June 30th.


Dr Mei Cheah is a skilled female specialist Obstetrician, Gynaecologist and Laparoscopic Surgeon based in Melbourne, Victoria. Dr Mei was born overseas and moved to Melbourne to complete her schooling. She is multilingual and speaks English, Malay, Cantonese and Mandarin.
Dr Mei graduated in Medicine from The University of Melbourne. She has worked in many areas of medicine and surgery, including Neonatal Intensive Care at Monash NICU before commencing her specialist training in Obstetrics & Gynaecology in Victoria. This experience complements her skillset in supporting and counselling pregnancy complications, having had first hand experience in one of the busiest tertiary centres in Victoria. During the course of her training, she has worked in many areas of O&G across Eastern Health, Peninsula Health and Monash Health.
"As a woman, I understand your journey – and we'll go on this journey together, taking care of you every step of the way".
After completion of her core specialist training, Dr Mei underwent advanced training in the areas of Reproductive Medicine, Fertility and Laparoscopic Surgery in South Australia before obtaining her fellowship. Dr Mei is a fellow of the Royal Australian & New Zealand College of Obstetricians & Gynaecologists (FRANZCOG) and is a member of the Australasian Gynaecological Endoscopy & Surgery Society (AGES).
She currently holds a Senior Medical Staff appointment at Monash Health. Being a training supervisor, Dr Mei is actively involved in teaching and mentoring junior doctors and specialists in training. She is also a senior clinician in the Menstrual Management Clinic. Dr Mei is one of the few clinicians credentialed to perform advanced gynaecological laparoscopic procedures as well as complicated obstetrics procedures including twins delivery and rotational forceps.
Dr Mei has a boutique private practice in Berwick and Mount Waverley. She is happy to accept new referrals and is able to see you promptly, especially for urgent conditions. She is an advocate of actively listening to her patients, respecting their wishes and presenting an evidence based care plan in a collaborative way. Her warm and friendly nature will make you comfortable, especially during trying and vulnerable times.
She delivers at St John of God Berwick Hospital and Waverley Private Hospital. She can continue to look after you should your pregnancy become high risk and require a transfer to Jessie McPherson Private Hospital. For gynaecological procedures, Dr Mei operates at St John of God Berwick Hospital and Waverley Private Hospital.


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Children, HIV and AIDS
• There has been significant success in reducing the number of new HIV infections among children since 2000 but, for children living with HIV, AIDs-related illnesses are still among the leading causes of infant mortality.
• Although prevention of mother-to-child transmission programmes are generally successful when implemented, there needs to be a greater scale-up of coverage, in addition to increasing early infant diagnosis after birth and during breastfeeding.
• More needs to be done to support the prevention of HIV among vulnerable children and to address the unique antiretroviral treatment adherence challenges that affect children living with HIV.
Explore this page to find out more about why children are at risk of HIV, HIV prevention programmes, early infant diagnosis, barriers to testing, access to antiretroviral treatment, treatment and support and the future of the HIV epidemic among children.
Globally, the annual number of new infections among children (0-14 years) has almost halved since 2010 with a 47% reduction in new HIV cases.1 Since 1995, an estimated 1.6 million new HIV infections among children have been averted due to the provision of antiretroviral medicines (ARVs) to women living with HIV during pregnancy and breastfeeding. The vast majority of these infections (1.3 million) were averted between 2010 and 2015.2
Despite this significant progress, the number of children becoming newly infected with HIV remains unacceptably high. In 2016, 24% of pregnant women living with HIV did not have access to ARVs to prevent transmission to their infants.3 In the same year, around 160,000 children became infected with HIV; this equates to 438 children a day.4
In 2015, in the 21 highest-burden countries, only 54% of children exposed to HIV were tested within the recommended two months.5 In the following year, an estimated 1.8 million children were living with HIV, but just 43% had access to ARVs. Although treatment coverage has improved since 2010, when just 21% of children living with HIV were on antiretroviral treatment (ART), the current situation means that around half of the children in need do not have access.6
The majority of children living with HIV live in Africa, where AIDS remains the leading cause of death among adolescents.7 Globally, 120,000 children died due to AIDS-related illnesses in 2016. This equates to 328 deaths every day.8 In fact, children aged 0–4 years living with HIV are more likely to die than any people living with HIV of any other age.9This is despite a 62% reduction in AIDS-related deaths among this age group globally, since 2000.10
In addition, millions more children are indirectly affected by the impact of the HIV epidemic on their families and communities.11
Regular HIV testing, treatment, monitoring and care for children living with HIV can enable them to live long and fulfilling lives. However, a lack of necessary investment and resources for adequate testing, paediatric ARVs and child-friendly prevention programmes mean children continue to suffer the consequences of the epidemic.
Why are children at risk of HIV?
Mother-to-child transmission (MTCT)
The majority of children living with HIV are infected via mother-to-child transmission (MTCT), during pregnancy, childbirth or breastfeeding. This is sometimes referred to as 'vertical transmission' or 'parent-to-child-transmission'.
MTCT of HIV can be stopped, as long as expectant mothers have access to preventing mother-to-child transmission (PMTCT) services during pregnancy, delivery and breastfeeding.12 With funding, trained staff and resources, new infections among many thousands of children could be avoided.
Breastfeeding is now responsible for the majority of MTCT.13 When formula feeding is not a viable option, women can greatly reduce the risk of transmitting HIV to their child at this stage if they exclusively breastfeed and are on ART. However, in 2013 only 49% of women continued to take ARVs while breastfeeding, compared to 62% of women who took ARVs during pregnancy and delivery. This highlights the urgent need for education about the importance of continuing treatment post-birth.14
Without ART, a third of infants who acquire HIV as a result of MTCT will not reach their first birthday, and half will not reach their second birthday.15
HIV infection in medical/healthcare settings
Although very rare today, HIV infection can occur in medical settings. For instance, through needles that have not been sterilised or through blood transfusions where infected blood is used.
It was reported in 2012 that over the past decade in Kyrgyzstan, 270 children have been infected with HIV in hospitals as a result of doctors not following universal precautions during medical procedures.16
Orphans and vulnerable children
One of the most devastating impacts of HIV is the loss of whole generations of people in communities hardest hit by the epidemic. In this regard, it is often children who feel the greatest impact via the loss of parents or older relatives.
An 'orphan' is defined by the United Nations as a child who has 'lost one or both parents'. An estimated 13.4 million children and adolescents (0-17 years) worldwide had lost one or both parents to AIDS as of 2015. More than 80% of these children (10.9 million) live in sub-Saharan Africa.17 In some countries which are badly affected by the epidemic, a large percentage of all orphaned children – for example 74% in Zimbabwe, and 63% in South Africa – are orphaned due to AIDS.18
Remarkable gains have been achieved in mitigating the economic and social impact of HIV and AIDS on children and families over the past decade. Still, children orphaned by AIDS, or who are living with sick caregivers, continue to face an increased risk of physical and emotional abuse as compared with other children in sub-Saharan Africa, including other orphans. This increases these children's vulnerability to HIV.19
HIV programmes focusing on orphans and vulnerable children (sometimes referred to as OVC) are a vital strategy for reducing vulnerability to HIV in children. These programmes focus on supporting carers of children, often older generations, keeping children in school, protecting their legal and human rights, and ensuring that their emotional needs are catered for.20
HIV prevention programmes for children
In June 2011 UNAIDS and the United States President's Emergency Plan for AIDS Relief (PEPFAR) launched the 'Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive' [pdf] along with 22 countries, which, at the time, accounted for 90% of the global number of pregnant women living with HIV. The Global Plan galvanised global and national political will and action, resulting in some of the most impressive and significant gains in the history of the HIV response.21
The 'Start Free, Stay Free, AIDS Free' initiative, which was launched in 2016 and is led by UNAIDS and PEPFAR, aims to build on the progress achieved under the Global Plan to scale up HIV prevention, treatment, care and support services for children, adolescents and young women. The initiative aims to elevate and amplify efforts that are already accelerating progress, including the DREAMS Partnership, the Accelerating Children's HIV/AIDS Treatment (ACT) Initiative and ALL-IN.22
This approach adopts a 'lifecycle approach' to programming, which means it responds to the changing contexts that people face at different ages.23
The Start Free, Stay Free, AIDS Free initiative has three parts:
Start Free aims to complete the job started by the Global Plan by reaching and sustaining 95% of pregnant women living with HIV with lifelong HIV treatment by 2018, and by reducing the number of newly infected children to fewer than 40,000 by 2018 and 20,000 by 2020.24
Stay Free has the objective of ensuring that children with an HIV-free start stay HIV-free throughout their childhood. It aims to do this by intensifying the focus on reaching and empowering adolescent girls and young women and engaging men and boys.25
AIDS Free targets the children and adolescents living with HIV who often are left behind by HIV responses. The initiative aims to provide 1.6 million children (aged 0 to 14) and 1.2 million adolescents (aged 15 to 19) living with HIV with ART by 2018.26
Prevention of mother-to-child transmission (PMTCT)
For many countries around the world, PMTCT is their most successful and important HIV prevention priority. However, considerable gaps in coverage exist across the world.
As of June 2016, Armenia, Belarus, Cuba and Thailand had been certified by the WHO to have eliminated MTCT.27 By 2015, seven countries in East and Southern Africa had greater than 90% coverage of PMTCT services. This includes South Africa, which is home to 25% of the region's pregnant women living with HIV. East and Southern Africa has achieved the largest decline in MTCT anywhere in the world, falling from 18% of infants born to mothers living with HIV in 2010 to 6% in 2015—a threefold decrease.28
The Middle East and North Africa is the region that has shown the least amount of progress, as nearly one third of women living with HIV passed the virus on to their children in 2015. The MTCT rates in Asia and the Pacific and western and central Africa were also well above the global average of 10%.29
An estimated 45% of new HIV infections among children in 2015 occurred in West and Central Africa. Although the region has seen a 31% reduction in new child (sometimes referred to as paediatric) HIV infections between 2010 and 2015 this is considerably lower than the 66% reduction in East and Southern Africa.30 The situation is particularly challenging in Nigeria, which in 2015 had the second largest HIV epidemic in the world. In the same year, Nigeria had the greatest number of new HIV infections among children globally—an estimated 41,000 — roughly equivalent to the next eight countries combined.
There has only been a 21% decline in new child HIV infections in the country since 2009, compared to an average reduction of 60% among other Global Plan priority countries.31
A major contributor to the successful increase in treatment coverage for pregnant women living with HIV has been the involvement of communities. Entry to, and retention in, care have been shown to greatly improve through community engagement and support, and through community service-delivery models. Networks and support groups of women living with HIV have been particularly valuable in boosting outreach activities and PMTCT service delivery, providing counselling, supporting treatment adherence, educating women about their reproductive rights, encouraging them to seek care and HIV testing, and providing psychosocial support to women coming to terms with a new diagnosis of HIV.32
At the end of 2015, more than half of the countries in sub-Saharan Africa were using community health workers to provide and support key HIV services, including PMTCT.33
Despite this, in 2013 around 54% of pregnant women did not receive an HIV test, and were therefore unaware of their HIV status. Of those who did receive a test and were diagnosed positive, 7 out of 10 received PMTCT services. This helped avert 900,000 new HIV infections in children between 2009 and 2013.34
Changes to PMTCT treatment regimens over the past five years have played a major part in the impressive decline in vertical transmission rates. In 2010, the majority of pregnant women living with HIV were provided with ARVs solely to prevent onward transmission to the child they were carrying at the time. But evidence suggested that immediate and lifelong ART for pregnant women diagnosed with HIV is more effective than on-again, off-again approaches. In 2015, the World Health Organisation (WHO) recommended that all pregnant women living with HIV be provided with Option B+, which involves the immediate offer of lifelong ART—going beyond pregnancy, delivery and breastfeeding—regardless of CD4 count (which indicates the level of HIV in the body). By 2015, 91% of the 1.1 million women receiving ARVs to prevent MTCT were on lifelong ART due to the global rollout of Option B+. This greatly improved rates of viral suppression, when HIV is reduced to such a low level that onward transmission is highly unlikely, during both the breastfeeding period and afterwards for these women.35
Some gains were also made in the efforts to prevent unintended pregnancies in countries with large numbers of paediatric HIV infections, although an unmet need for family planning still persists in many countries. Between the periods of 2000–2004 and 2010–2014, unmet needs for family planning among married women declined by more than 10% in Ethiopia, Kenya, Lesotho, Malawi and Rwanda.36 Among the countries with available data in sub-Saharan Africa, Zimbabwe had the lowest unmet need for family planning among married women (10%).37
However, there is still a lack of information about the use of contraception among many women in sub-Saharan Africa, specifically at the national level for women living with HIV. Some earlier studies have suggested that women living with HIV may be more motivated to use contraception and therefore have different unmet needs than other women, but there is still a knowledge gap in this area.38
There has also been little change in the rate of new HIV infections among women.39 An additional 5.2 million women of reproductive age were newly infected with HIV between 2010 and 2015, including 1.2 million in South Africa. As a result, the substantial need for PMTCT services for women of reproductive age will continue for the foreseeable future.40
Early infant diagnosis
When an infant has HIV the likelihood of them dying from an AIDS related illness declines by 75% if they are given ART within the first 12 weeks of life.41
As a result, the 2013 WHO treatment guidelines recommend that infants exposed to HIV be tested at the first postnatal visit—usually when they reach four to six weeks of age—or at the earliest opportunity thereafter, and that infants (and all children below the age of five) who test positive for HIV start treatment immediately.42
Despite significant investment, only 54% of children exposed to HIV received HIV testing within the first eight weeks of life in 2015 (described as 'early infant diagnosis'), although this marks a slight increase since 2014 when 51% were tested.43
Coverage of early infant diagnosis remains low in the majority of Global Plan priority countries. Only Lesotho, South Africa, Eswatini and Zimbabwe provided HIV testing to more than half the infants exposed to HIV within their first eight weeks of life in 2015.44
Infants infected in utero (in the womb) or during labour and delivery have a poor prognosis compared to infants infected during breastfeeding, and they require urgent ART to prevent early death. However, identifying those infants using the common antibody HIV test is a challenge due to the presence of maternal HIV antibodies, which may persist for as long as 18 months in a child's bloodstream.45
Some mothers do not bring their babies back for testing by the recommended six weeks, and other babies living with HIV may die within the first six weeks. In an effort to ensure that more infants living with HIV are diagnosed and initiate treatment, the South African National Department of Health launched guidelines that called for all HIV-exposed infants to be tested at birth and at 10 weeks in 2015.46 South Africa's experience with at-birth testing is being watched carefully to see whether key challenges can be overcome, such as mothers not bringing their babies back for the 10-week test after their babies test negative for HIV at birth.47
HIV-negative new mothers at high-risk of HIV are also insufficiently tested while they are breastfeeding. As a result, infants are exposed unknowingly to HIV at this stage.48 The shift in the timing of HIV transmission from mother to child, which has moved from pregnancy to breastfeeding, has created a new urgency for focusing on new-mother's adherence to ARVs and retaining mothers and infants in care to the end of the breastfeeding period.49
Despite this, many women living with HIV are not aware that they need to remain on treatment while breastfeeding their infants, and opportunities to reinforce the adherence messages and resupply women with ARVs are fewer once the baby is born, as women reduce their contact with the health system.50 It is essential that infants are re-tested for HIV when they cease breastfeeding but again many infants do not undergo this test.51
HIV testing for children
Access to HIV testing in children over 18 months of age remains poor in many countries, creating a bottleneck for the scale-up of treatment.52
Screening children for HIV at inpatients sites and nutrition clinics, alongside testing in the context of PMTCT programmes, provides the best opportunities for diagnosing HIV infections in children that might otherwise go undetected.53
Many HIV-positive children in low and middle-income countries remain undiagnosed. For example, one estimate from Kenya suggests that only 40% of children with HIV are diagnosed.54
Barriers to HIV testing for infants and children
The most commonly available virological HIV tests for infants require complex laboratory instruments and highly specialised personnel, making it difficult for caregivers in rural areas to provide consistent and timely results.55
In many rural, inaccessible areas, HIV testing is simply unavailable. Instead, healthcare professionals must use clinical diagnosis to ascertain a child's HIV-positive status. Unfortunately this results in a lot of infections going undetected.56
A number of portable point-of-care testing systems have been developed in response to this challenge. As of 2016 there were three on the market that can be run from battery packs or main electricity and are rugged enough for use in mobile laboratories. Because they are small and portable, and because they can be operated by trained non-laboratory personnel, point-of-care technologies are likely to increase access to early infant diagnosis and reduce loss to follow-up. An evaluation of the first commercially available point-of-care and near-patient testing, conducted in multiple African countries, suggests that these tests are as accurate as laboratory testing.57
Even when children and infants are tested, ineffective transport and poor communication systems may result in prolonged turnaround times between blood sample collection at clinics and the return of results. For example, a study in Zambia found that the turnaround time from sample collection to return of results to the caregiver was 92 days. This leads to higher proportions of exposed infants and children being lost to follow-up, initiating treatment very late or dying before they can start treatment. Others do not have access to appropriate paediatric formulations.58
Access to antiretroviral treatment for children
It is vital that infants and young children who are living with HIV receive HIV treatment as early as possible, and are followed up with consistent monitoring, as they have significantly worse treatment outcomes than adults. Without treatment, half will die by their second birthday.
Given the strong evidence of benefit, WHO recommends treatment for all children and prioritises it for the youngest infants and those with compromised immune function.59
Despite this recommendation, low rates of HIV testing in infants prevent those who need it getting prompt access to HIV treatment. Children are, as a result, less likely than adults to receive treatment: only 43% were receiving treatment in 2016 compared to 54% of adults.60
Antiretroviral treatment adherence
HIV treatments for children work. Unfortunately, there is limited range of age-appropriate antiretroviral drugs which are available in paediatric formulations – especially second- or third-line alternatives – which makes treatment even more challenging.
The palatability of drugs, for example, can be complicated as some are tricky to swallow and can taste unpleasant. In addition, the volume of medicines recommended for children under the age of three is a challenge, and some of these medicines need to be kept cool, which can be an issue in some countries. 61
However, there was a major breakthrough in May 2015, when the United States Food and Drug Administration gave tentative approval for an improved paediatric formulation in the form of small oral pellets. These pellets come packaged in a capsule that is easily opened, allowing them to be sprinkled over a child's food, or, in the case of a smaller infant, placed directly into the mouth or over expressed breast milk. Previously these formulations were only available in tablet form that could not be broken or a liquid that required refrigeration and had an unpleasant taste, making it extremely difficult to administer to infants.62
Children have a different immune response to HIV compared to adults as their bodies are constantly developing, and their high rate of metabolism makes the dosing of HIV medicines particularly difficult.63 As such, pediatricitians treating children growing up with HIV also need to be aware of special dosage instructions.
On average, people living with HIV who live with it from childhood will have to take ARVs 20 years longer than people who acquire HIV as adults, which heightens adherence issues. As more children are growing older with HIV, the inadequacies of HIV services for older children are coming to light.64
These include the complexity of adhering to treatment for children as they become adolescents, when they may want freedom rather than strict medical regimes, coupled with a lack of age-appropriate services and confusion around ARV regimes as they transition between child and adult treatment regimes.65
Drug resistance and treatment costs
Although the cost of initial (or 'first line') ART for children has reduced dramatically due to the availability of generic drugs, if a child develops drug resistance and needs to begin a second line of drugs, treatment becomes far more expensive.66
In fact, HIV drug resistance (HIVDR) to the select few medications which are palatable among children is becoming an increasing concern among health practitioners with more children developing treatment resistant strains of the virus as a result of the scale up of prevention of mother-to-child transmission (PMTCT) programmes. For infants exposed to PMTCT programmes, the WHO has also estimated that there is a HIVDR prevalence of 21.6%, compared to just 8.3% among those with no treatment exposure.
In 2017, the results from a five-year-long study observing the efficacy of treatment in Zambia found that 40% of infants diagnosed with HIV in Lusaka had resistance to at least one ART drug by 2014 compared to 21.5% in 2009.67
Despite the scientific advances made in research and development for new HIV medicines for adults, the options for children lag behind significantly. In high-income countries the market for HIV medicines for children has almost disappeared as new HIV infections among children have been virtually eliminated. As a result, the incentive for companies to develop formulations for children has reduced because children living with HIV in low- and middle-income countries represent a less viable commercial market. There is an urgent need for improvement in paediatric ARVs, in particular to keep their costs low.68
Loss to follow-up
Even where treatment is available and accessed, retention in care is frequently cited as a key issue in many countries.69
In 2014, a systematic review of 30,000 children living with HIV under the age of 10 showed that nearly 5-29% of patients were lost to follow up or had died within 12 months of starting their treatment.70
A similar study involving 13,611 children from low-income countries in Asia and Africa found that at 18 months after initiation of ART, 5.7% had died, 12.3% were lost to follow-up, and 8.6% had transferred to other clinics. Loss to follow-up was much greater in West Africa (21.8%) compared to Asia (4.1%).71
Children are more vulnerable to being lost to follow-up than adults because they rely on their parents or caregivers to gain access to healthcare services.72 Some of the reasons children are lost to follow up include lack of caregiver contact information, stigma and counselling challenges, the burden on people to return for results, and weak follow-up within clinics.73
CASE STUDY: Improving HIV care retention for infants in Uganda
In some areas of Uganda, less than 3% of infants born to women living with HIV in 2013 were retained in care after one month. With support from PEPFAR, the Ministry of Health worked with 22 health facilities to improve retention of mothers living with HIV and their babies. Mothers were interviewed to better understand their challenges. The survey showed that 80% of retention problems were caused by forgotten appointments, scheduling conflicts, lack of transport, privacy concerns and fear of disclosure to their partners.
The information was used to improve the quality of care. Peers were engaged to locate other mothers and their babies from the same community who had been lost to follow-up. By February 2014, 10 months after the baseline study, the 22 health facilities had all achieved strong gains, retaining more than 60% of mother–baby pairs.74
Many national health registries are still not properly formatted to facilitate long-term follow-up of HIV-exposed infants or mother–baby pairs. Several countries are moving to paper-based or electronic registers that capture data on HIV-exposed infants and mother–baby pairs through numerous care visits in order to prompt paediatricians to determine the final HIV status of the infant at the end of breastfeeding. Electronic health records allow for joint tracking of the mother and her infant using one tool, and enable babies to be tested and treated even when they are brought to the clinic for follow-up by someone other than the mother.75
Malawi is piloting the use of the short message service (SMS) widely available on mobile phones to send reminders to mothers who miss postnatal appointments. SMS is also being used in Kenya, South Africa, Mozambique, Zimbabwe, Rwanda and Zambia to send the results of infants' HIV tests from centralised laboratories to printers in community-level health facilities. A systematic review comparing paper-based systems and SMS systems showed that SMS printers quickened the delivery of test results by an average of 17 days. 76
In Kenya, an HIV Infant Tracking System (HITSystem), which sends computer alerts to health care and laboratory staff working on early infant diagnosis, alongside SMS alerts to mothers, increased the proportion of HIV-exposed infants retained in care nine months after birth; decreased turnaround times between sample collection, laboratory results and notification of mothers; and increased the proportion of infants living with HIV who initiate ART.77
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Treatment and support for children living with HIV
HIV disclosure
Conveying the importance of HIV treatment to a young child or adolescent can be difficult. Many caregivers delay telling a child about their HIV positive status for a number of reasons. They may be anxious about stigma from the community, guilt regarding transmission, uncertainty in how to disclose, and fears of negative reactions or difficult questions from the child.78
However, it is important for a healthcare worker or carer to disclose a child's status to them, to prevent the child feeling isolated and finding out their status accidentally or in public. Evidence also suggests that children who were given reasons for needing to take medication were much more likely to have improved viral suppression, adherence and remain in treatment for longer.79
A study of a nationally implemented intervention to assist healthcare workers and caregivers with HIV disclosure to children in Namibia found that, among children who reported incorrect knowledge regarding why they take ARVs, 83% showed improved knowledge after the intervention (defined as knowledge of HIV status or adopting intervention-specific language). At enrolment, only 11% knew their status but an additional 38% reached full disclosure following the intervention. The average time to full disclosure was 2.5 years. The study found the intervention helped improve adherence to ART which improved viral suppression.80
Psychosocial wellbeing
Many children living with HIV experience tough life events that could affect their psychosocial wellbeing, such as losing caregivers to AIDS-related illnesses, stigma, shock about their status, and not understanding the importance of adhering to treatment.
To mitigate these events, it is important to encourage children to have a positive outlook on life, which can be helped by making full use of services such as support groups.81
A 2014 study of families affected by HIV in Bangladesh found that, while children's lives are affected by any chronic condition their parents may have, when the condition is stigmatised and carries what the study describes as "social and moralistic connotations", the impact on the family is much greater in intensity and consequences. The study found that community members did not like to interact with HIV-positive people and their children due to a fear of being infected. It found peer support can be emotionally beneficial to children affected by HIV, as children – like adults – will often seek support from friends to cope with stressful situations.82
Young children listen and learn from peers and get easily motivated by each other, therefore awareness-building through peers, such as forming peer groups or youth clubs at schools, can play a key protective role in the lives of HIV-affected children. The study also recommends that children are enabled to inform the development of strategies that empower them to cope with living in families affected by HIV.83
I have faced problems in my community previously, due to HIV. People thought that as my mother is infected with HIV, we are also infected... When I was a child people asked me, does your mother have AIDS? Then many children did not play with me. Someone said, "Your mother has kharaprog [HIV] you also have kharaprog, don't come to us and don't play with our children." Our neighbours said that our father was a kharaplok [bad person]. As he did kharapkaj [bad practices] in India so he became AIDS patient.
- Rafik, a 15-year-old boy from Bangladesh whose mother is living with HIV and whose father died of an AIDS-related illness84
All children living with HIV have the right to attend school, just as any other child does. Policies need to be in place to ensure a child living with HIV at school is not subjected to stigma and discrimination or bullying, and that their status is kept confidential.85
The inclusion of sex and HIV & AIDS education for young children is vital for tackling the stigma surrounding HIV, and to teach others the facts about HIV transmission.86 HIV-awareness programmes are important to encourage openness about HIV rather than silence.87
There are many ways to reach young people; including through social groups, the media, and peer outreach - not just at school.
Family support for children living with HIV
Supporting a family holistically can be the best way to ensure a good quality of life for the child. This should include social protection schemes that provide external assistance to poorer families in areas where HIV prevalence is high. Such schemes are now seen as a valuable part of improving the lives of children affected by HIV.88
CASE STUDY: Building the resilience of families affected by HIV in Rwanda
A 2014 study of families affected by HIV in Rwanda focused on a locally adapted, home-based intervention which aimed to improve the functioning of families and caregiver–child relationships, connect vulnerable families to available formal and informal HIV services, and promote emotional and behavioural health among HIV-affected children.89
Thirty-nine children and adolescents (aged 7- 17) from 20 different families were enrolled in the study. It found that, six months after the intervention had been carried out, caregivers reported improvements in children's behaviour, and that family connectedness, good parenting and social support were sustained and strengthened. Children's self-esteem also improved, and symptoms of depression, anxiety and irritability declined.90
Financial support for children living with HIV
Reduced household income combined with increased expenses (for example for treatment, transport and funerals) can push families affected by HIV into poverty, which has negative outcomes for children in terms of nutrition, health status, education and emotional support. For example, a study of monthly household income of HIV-affected families in Cambodia found income to be 47% lower than non-affected families. Similarly, in China the income of the vast majority of HIV-affected families (93%) decreased by more than 30% following diagnosis.91
Enabling a household to move away from economic vulnerability can lead children to benefit from better nutrition, the opportunity to go to school instead of work and better access to healthcare.92 Evaluations of national social protection programmes have established that social protection (in particular, cash transfers) contributes to improving access to health, education and nutrition, strengthening social networks, increasing access to treatment and prevention and reducing child and adolescent vulnerability and risk-taking.93
For example, in Malawi a cash transfer programme that had specific conditions to keep girls in school reduced the school dropout rate by 35%. It also resulted in a 40% reduction in early marriages, a 30% reduction in teenage pregnancies and a 64% reduction in HIV risk within 18 months.94
The effectiveness of these interventions has seen the number of cash or income transfer programmes double in Africa between 2000 and 2012, supporting US$10 billion worth of transfers during this period.95
Childhood illnesses such as mumps and chickenpox can affect all children but children living with HIV may find these illnesses are more frequent, last longer, and are not as responsive to treatment.
In 2015, around 40,000 children living with HIV died from tuberculosis (TB).96 Although TB-related deaths for children living with HIV are in decline, having stood at 74,000 in 2012,97 many countries only report HIV as the underlying cause of death, with TB as the contributory cause, meaning this number may be higher than is currently recorded.98
The future of the HIV epidemic among children
Children are disproportionately affected by the HIV epidemic, and continue to be left behind in the provision of life saving treatment.
Interventions that meet the specific needs of families, driven by the experiences and recommendations of children, are needed to enable the 50% of children living with HIV who are without treatment to access it. Without this, children aged 0–4 years living with HIV will continue to be the age group most at risk of AIDS-related deaths.99
A combination of efforts are needed to prevent new HIV infections among children, ensure that their mothers remain healthy and improve the diagnosis and treatment of HIV for children. While huge gains have been made in preventing MTCT of HIV, the fact that an additional 5.2 million women of reproductive age were newly infected with HIV between 2010 and 2015 means the substantial need for PMTCT services will continue for the foreseeable future.100
Paediatric HIV diagnosis, testing and treatment needs to be scaled up to bring it in line with adult services and should be made available closer to where the children most affected live. Health workers need to be trained to provide effective HIV services for children living with HIV.101
Community support systems are invaluable and need to be strengthened to allow them to effectively support children and carers to keep them healthy and ensure that they have access to the HIV services they require.102
More medicines specifically adapted to the needs of children need to be developed, and kept at an affordable price. To achieve this requires political will and investment by industry. Government, nongovernmental organisations, research partners, health experts and civil society need to advocate strongly for the development of child-friendly fixed-dose combinations to ensure that simple and effective treatment becomes rapidly available and accessible for all children in need.103
Alongside this, there needs to be greater support for the families and communities that provide the material, social, and emotional foundation for a child's development.
Photo credit: ©AVERT by Corrie Wingate. Photos are used for illustrative purposes. They do not imply any health status or behaviour on the part of the people in the photo.
1. UNAIDS (2017) 'Ending AIDS: Progress towards the 90-90-90 targets'
2. UNAIDS (2016) 'Prevention Gap Report'[pdf]
4. UNAIDS (2016) 'HIV fact sheet'[pdf]
5. UNAIDS (2016) 'Children and HIV fact sheet'
7. UNICEF (2015) Annual Report[pdf]
9. UNICEF 'Seventh Stocktaking Report on Children & AIDS, 2016'
10. UNAIDS (2017) 'Ending AIDS: Progress towards the 90-90-90 targets'
11. UNAIDS (2016) 'Children and HIV fact sheet'[pdf]
13. UNICEF 'Seventh Stocktaking Report on Children & AIDS, 2016'
14. UNAIDS (2013) 'Global Report: UNAIDS Report on the Global AIDS Epidemic 2013'[pdf]
15. UNAIDS (2014) 'The Gap Report'[pdf]
16. The Telegraph (2012, 6 February) 'Kyrgyzstan officials say another 70 children are infected with HIV/AIDS virus'
18. World Health Organization (WHO) (2014) 'World AIDS Day: Business Unusual: Time to end the AIDS epidemic' [accessed June 2015]
21. UNAIDS (2016) 'Get on the Fast Track: The Life Cycle Approach to HIV'[pdf]
22. UNAIDS (2016) 'Prevention Gap Report'
24. UNAIDS (2016) 'Prevention Gap Report'[pdf]
53. Cohn, J. et al (2016) 'Paediatric HIV testing beyond the context of prevention of mother-to-child transmission: a systematic review and meta-analysis', The Lancet HIV
56. Aidsmap (2012, 13 September) 'Symptom screen frequently misses HIV in children and delays treatment, Kenyan study shows'
59. World Health Organisation (WHO) (2015) 'Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV'
60. UNAIDS (2016) 'HIV fact sheet'[pdf]
62. UNAIDS (2016) 'Children and HIV fact sheet'
63. IAPAC 'Children and HIV' [Accessed 25/08/2017]
65. Bernays, S. et al (2014) 'Children growing up with HIV infection: the responsibility of success' The Lancet 383(9925):1355-1357
67. World Health Organisation (2017) 'HIV drug resistance report'
69. Zhao Y et al (2013) 'Mortality and treatment outcomes of China's national paediatric antiretroviral therapy program'
70. Abuogi L, Smith C, McFarland E. 'Retention of HIV-infected children in the first 12 months of antiretroviral therapy and predictors of attrition in resource limited settings: A systematic review'
71. Leroy, V. et al (2013) 'Outcomes of Antiretroviral Therapy in Children in Asia and Africa: A Comparative Analysis of the IeDEA Pediatric Multiregional Collaboration' JAIDS 62(2):208-219
73. UNICEF/UNAIDS (2009) 'Children and AIDS Fourth Stocktaking Report'
76. UNAIDS (2016) 'Get on the Fast Track: The Life Cycle Approach to HIV'
78. Anouk, A. et al (2013) 'Promoting a Combination Approach to Paediatric HIV Psychosocial Support' AIDS 27(Supplement 2):147-157
80. Beima-Sofie, KM., et al (2017) 'Paediatric HIV disclosure intervention improves knowledge and clinical outcomes in HIV-infected children in Namibia' Journal of Acquired Immune Deficiency Syndromes: Published ahead of print: doi: 10.1097/QAI.0000000000001290
82. Islam MS., Minichiello V., Scott J. (2014) 'Children Living in HIV Families: A Review' J Child Adolesc Behav 2:170
84. ibid
85. Children and Young People HIV Network & National Children's Bureau (2005) 'HIV in Schools'[pdf]
88. International HIV/AIDS Alliance / Save the Children (2012) 'Good Practice Guide on Family Centred HIV Programming'
89. Betancourt, TS., et al (2014) 'Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial' July 2014 - Volume 28 - Issue - p S359–S368
94. Remme M., Vassall A., Lutz B., Luna J., Watts C. (2014) 'Financing structural interventions: going beyond HIV-only value for money assessments.' AIDS. 2014 Jan 28;28(3):425–34.
95. UNICEF (2013) 'Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013'
97. Graham, S.M. et al (2014) 'Importance of tuberculosis control to address child survival' The Lancet 6736(14):60420-60427
100. UNAIDS (2016) 'Prevention Gap Report'[pdf]
101. UNAIDS (2016) 'Children and HIV fact sheet'[pdf]
Last full review:
Next full review:
Stigma and a lack of HIV knowledge linked to low PrEP use
Where do young people like to get their sexual and reproductive health information from?
Sex workers report unexpected benefits of PrEP and HIV self-testing
How do negative views on contraception affect young women's choices?
Humanitarian emergencies, armed conflict and the HIV response
Young people, HIV and AIDS
HIV and AIDS in Kenya
Gender inequality and HIV
Global response to HIV and AIDS
59% of children suffering from severe immunodeficiency at treatment initiation
Antiretroviral treatment for children living with HIV
Mortality risks in children on ART measured by weight gaining


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text:
package com.zaradai.gluon.kafka;

public class KafkaConfig {
    public static final String DEFAULT_SERVERS = "localhost:9092";

    private final KafkaConsumerConfig consumerConfig;
    private final KafkaProducerConfig producerConfig;

    public KafkaConfig() {
        this(DEFAULT_SERVERS);
    }

    public KafkaConfig(String servers) {
        this(new KafkaConsumerConfig(servers), new KafkaProducerConfig(servers));
    }

    public KafkaConfig(KafkaConsumerConfig consumerConfig, KafkaProducerConfig producerConfig) {
        this.consumerConfig = consumerConfig;
        this.producerConfig = producerConfig;
    }

    public KafkaConsumerConfig getConsumerConfig() {
        return consumerConfig;
    }

    public KafkaProducerConfig getProducerConfig() {
        return producerConfig;
    }
}

redpajama_set_name: RedPajamaGithub


text:
Home / News / La'Naia Jones, Deputy CIO of ODNI, Announced as Keynote Speaker for Potomac Officers Club's 2019 Cybersecurity Summit
La'Naia Jones, Deputy CIO of ODNI, Announced as Keynote Speaker for Potomac Officers Club's 2019 Cybersecurity Summit
William McCormick May 1, 2019	News, POC Events
La'Naia Jones, Deputy CIO of (ODNI)
La'Naia Jones, deputy chief information officer for the Office of the Director of National Intelligence, will be featured as the keynote speaker during the Potomac Officers Club's 2019 Cybersecurity Summit on May 8th. You can register for the event right here.
At the event GovCon leaders from the public and private sector will discuss cyber resiliency and how to collaborate effectively on new cyber programs, initiatives and emerging technologies in the federal market.
Jones was selected to serve as deputy CIO of the intelligence community in July 2018. Prior to her selection, Jones served as the chief of Transformation and Transition for a global IT service provider within the Department of Defense.
Jones served as the technical director for a large global IT service provider between 2009 and 2017 and delivered the full spectrum information technology services to a global footprint spanning all time zones.
She also spent two years as the technical director and lead for various hostile area deployments in austere tactical environments. She collaborated with the Middle East, European Command, African Command and Central Command planners to provide communications and technical capabilities in support of military missions throughout diverse locations
In addition, Jones served as the technical lead for a large global IT service provider in Japan from 2005 to 2009, strengthened foreign relationships and enhanced domestic partnerships through resolution of complex, multifaceted IT entanglements of technology organizations.
Jones graduated with a bachelor of science degree in Mathematics and Computer Science from the University of Maryland Eastern Shore. She received a master of science degree in Technology Management from the University of Maryland University College.
Don't miss out on the 2019 Cybersecurity Summit on May 8th. You can register for the event right here.
Tags 2019 Cybersecurity Summit African Command Central Command Department of Defense DOD European Command GovConWire Jim Garrettson ODNI La'Naia Jones Middle East ODNI office of the director of national intelligence POC Potomac Officers Club Potomac Officers Club's 2019 Cybersecurity Summit Today's News from GovConWire University of Maryland Eastern Shore University of Maryland University College
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At DumpsterWire, we strive to bring you the best service at the best price available. We have a wide selection of dumpster sizes in stock in Fredonia, TX, with flexible & timley pickup and delivery. Give us a call today for all your dumpster rental and roll off needs.
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text:
Q: Keep a Running Tally of Duplicated Records in MySQL There have been many similar questions asked to this but I couldn't find a way to do exactly what I'm trying to do. I need to keep a running tally of duplicate entries in a column, and report that number in an "Owner Number" column. Example below:
Roll Number  |  Owner Name  |  Owner Number
000001       |  Patrick H.  |  1
000001       |  Paula H.    |  2
000002       |  Fred R.     |  1
000003       |  Chris P.    |  1
000003       |  Kayla A.    |  2
000003       |  Phil J.     |  3

In other words, I just need to count how many owners each roll has up to that point, not just a total number of owners for each roll. Any help would be greatly appreciated.

A: Mysql doesn't support window functions but it can be done with variables:
SET @num=0;
SET @roll='';
SELECT `Roll Number`,`Owner Name`,`Owner Number`
FROM
(
SELECT `Roll Number`,
`Owner Name`,
(CASE WHEN @roll=`Roll Number`
                            THEN @num:=@num+1 ELSE
                            @num:=1 END) as `Owner Number`,
@roll:=`Roll Number`
FROM table1
  ) as q;

http://sqlfiddle.com/#!2/788a4/5

A: You can do this using a subquery or two and a @variable
I.e. http://sqlfiddle.com/#!2/7c2fa/7
SELECT

  -- Re-selected at this level to tidy up the calculation fields
  f.rollNumber,
  f.ownerName,
  f.ownerNumber

FROM (
  SELECT

    d.rollNumber,
    d.ownerName,
    -- If the current roll number equals the previous, increment, else reset to 1
    @i := IF(d.rollNumber=@last,@i+1,1) AS ownerNumber,
    -- Sets @last to be == the "current" one for use on next row
    @last := d.rollNumber

  FROM
  (
      -- Get the raw data ordered by roll number
      SELECT

          LPAD(rollNumber,6,'0') rollNumber,
          ownerName

      FROM someTable
      -- Reorder / filter as much as you like, but always rollNumber ASC first
      ORDER BY
          rollNumber ASC,
          ownerName ASC
  ) d,(
      -- Set up the variables we will need shortly
      SELECT @i:=0,@last:=0
  ) v
) f;

redpajama_set_name: RedPajamaStackExchange


text:
PE4life manuals go countrywide
22 November 2021 | Education
Learners of A.I. Steenkamp Primary School with their booklets. Photo contributed
The PE4Life physical education manuals are being distributed across all regions to educators at schools.
The Ministry of Education, Arts and Culture (MoEAC), together with the University of Namibia (UNAM) and GIZ's regional programme "Sport for Development in Africa" (S4DA), have created these guides through the Integrated Physical Education and School Sports Programme (IPESS) – a total of 3 575 guides handed over to educators with a total value of almost N$320 000.
With manuals earmarked for the pre-primary to grade 3 and for the learners in grade 10 and 11, further handovers are planned in the coming months.
Following the first handover on 19 November at the A.I. Steenkamp Primary School in Windhoek, another 850 guides will soon be handed over to the educators for grades 4-7, valued at N$145 000.
Physical education and school sports are essential for learners and their overall health, social skills development and it teaches them to work and play in teams. These manuals will give the educators the relevant tools they need to teach all facets of quality physical education.
The guides complement the already existing PE syllabus and guide educators; such as teachers, coaches and community workers. It will give them a structured method in which to foster lifelong participation in physical activity and sport to the learners and to support a holistic development of the children; physically, cognitively, emotionally and socially.
The guides provide some theory around the concept of PE4Life (physical education for life) as well as setting out the roles and responsibilities of the PE4Life educators. Just as importantly, the guides will teach 'soft-skills' around the concept of safeguarding children during PE and sport. It is vital that any form of physical activity is done in a safe environment for learners.
Participating in sport should be safe, inclusive, and enjoyable for all participants and everyone. This means that learners with all levels of abilities and certainly those with any form of disability should be included and able to participate. The manuals deals with this topic specifically and how to adapt activities so that every can participate and do so safely.
Friederike Kroner of GIZ S4DA said: "Kids love to run and play games, during the pandemic this has been very difficult for them, but thankfully Namibia is opening up again. Now, even within the school environment they will be able to play sports and receive adequate physical education as part of their curriculum based on guidelines and activities set out in the PE4Life manuals." The creation of the manual is the result of an ongoing partnership between the Ministries and GIZ through the IPESS programme together with other stakeholders.
Principal Rudolfine Kamahene of the A.I. Steenkamp Primary School in Windhoek said: "It is so exciting for the teachers, instructors and especially for the children to know that their PE lessons will have the proper structure and transfer the skills they will be able to use the rest of their lives. Whether they are on the field of play or off it. The manuals will certainly be put to good use."
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Fennelly's Custom Sheet Metal Ltd. has been in business since 1989 and was incorporated in 1991. They are the longest established heat pump dealer in the Province. Jerome Fennelly takes pride in his company's association with internationally renowned Carrier, the industrial giant whose reputation has been built on providing reliable custom made 'indoor weather'. Jerome describes the heat pump as "the most energy-efficient way to heat/cool a home or business. It has the lowest operating cost of any other system on the market!" A family business (Jerome's two brothers, and Mr. Fennelly Sr. work with the company) it has since 1992 been a dealer for Carrier Heat Pumps, air conditioning/ventilation products.
That brings Jerome to the topic of sheet metal work: "Many people still think of the sheet metal worker as an old-time 'tin knocker', working primarily with tin snips and hammer, installing gutters, downspout, funnels and kettles, etc. However this image has long been outdated." "In spite of our nation's enormous growth and technological changes that have taken place, the sheet metal worker remains nearly the only tradesperson to start with raw materials, custom-make complex system and then install them. He can transform flat sheets of metal into any size or shape that is required by working from a blueprint or verbal instructions. The sheet metal worker is involved from the original design stage, fabrication, erection, all the way though final balancing, adjusting and testing of the installed air handling system. Hardly any other tradesperson gets involved in so many tasks. The sheet metal worker has technical and exacting work to do. His varied duties create never ending challenges." Jerome himself trained at the College of Trades & Technology some 30 years ago.
Experienced in the commercial/residential HVAC business he has worked provincewide in Newfoundland & Labrador and in Edmonton, Alberta. During the oil crisis of 1973, the Carrier company was ready with the energy-saving heat pump which in 1932 it had been the first to develop. As it was then, Fennelly's Custom Sheet Metal Ltd. and Carrier will be ready to offer the energy-saving heat pump into the future.


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Perfect Daily Grind > Café Owner > What Is A Café Au Lait?
What Is A Café Au Lait?
There are dozens of milk-based coffee drinks available on the average coffee shop menu. For those without a way to brew espresso or a steam wand, they can be difficult to replicate at home.
The café au lait is a notable exception. While it will be prepared with espresso in many cafés, it can be made with any highly-concentrated coffee at home. It is simple and easy to prepare, and variations of it are drunk all across the world under different names.
Read on to learn more about how you would make one, and precisely why so many versions of it exist.
Lee este artículo en español ¿Qué es un Café au Lait?
The Drink With Many Names
The café au lait hails from France. Its name directly translates as "coffee with milk"
In Europe, the café au lait is made by adding steamed milk to a shot of espresso in a 1:1 ratio. The drink is topped with little or no foam. In the US, however, it is often prepared by adding steamed milk to concentrated filter coffee.
Nicolas Clerc is a barista at Télescope Café in Paris, France. He says that the café au lait consists of a single espresso shot in a 170ml cup, combined with warmed milk. Nicolas says this creates a drinking-temperature beverage that isn't foamy which can be enjoyed immediately.
According to Tom Clark, who is the co-founder and President of Coutume Café in Paris, France, the café au lait is enjoyed in an oversized mug or even a bowl. He tells me that this is to allow the drinker to dunk their pastries into the coffee during breakfast.
Many versions of the beverage exist across the world. In Poland, it's called the kawa biala, in Germany, it's known as milchkaffee, in Hungary, it's tejeskávé, and the Dutch version of the drink is koffie verkeerd (this directly translates as "wrong coffee", as the Dutch generally drink coffee with very little milk). In Brazil, it is also known as a café com leite.
There are also drinks which contain the same ingredients, but are prepared differently. In Spain, for example, the café con leche is made with scalded milk, not steamed milk. In Switzerland, however, the café renversé is made by adding espresso to milk, rather than the other way around.
You may also like What Is a Flat White & How Is It Different From a Latte?
What The Café Au Lait Is – And Isn't
Tom says: "The cafe au lait is probably the most democratic and accessible milk-based coffee out there. It certainly has its role at the breakfast table and it's as good as the quality of the ingredients."
The café au lait differs from the café latte and flat white, even though all three are often mistaken for one another. The flat white is an espresso with a small amount of steamed milk and a thin layer of foam, while the latte is espresso topped with two distinct and thicker layers of steamed and foamed milk. Nicolas says that it differs from other drinks as the "cappuccino is foamier, the flat white is stronger, and the latte is milkier".
Many coffee shop chains – such as Starbucks – refer to the café au lait as a "caffe misto". This drink is made as an American café au lait drip-brewed coffee and 2% milk, to which flavoured syrups are often added. However, Tom notes that "the prevalence of the espresso machine" has caused the beverage to "morph into a latte with an espresso base".
It's important to note that the beverage must be made with warmed or steamed milk, rather than cold milk (which is just a white coffee). Steaming milk caramelises the lactose it contains, making it sweeter and more creamy. However, Tom says: "Depending on the café, it may be served with milk warmed over the stove-top (common in regional France) or textured milk."
As the café au lait has been adapted in many different countries across the world, it technically has many variations. However, one particularly interesting version of the drink comes from New Orleans.
Café du Monde is a coffee shop in the city's French quarter that has served its famous variation of the café au lait for more than 150 years. The café au lait served at Café du Monde combines chicory and coffee to create an intense, bitter brew with a thick mouthfeel.
This dates back to the American Civil War, when coffee was so scarce that it was frequently mixed with chicory so it would last longer. To offset the intensity of the drink, the coffee shop serves its café au lait with beignets – a deep-fried French pastry that is coated with sugar.
Will The Café Au Lait Stay Popular?
Nicolas believes that the café au lait will remain popular on menus for some time.
He notes, however, that there is some variation; the drink is prepared differently in different countries. Customers in France and in the US, for example, will get considerably different drinks when they ask their local coffee shop for a café au lait.
"In France, it's quite common to be asked [for a café au lait], but customers expect a smooth cappuccino, not a dark drip coffee with unsteamed milk." He adds: "I like to listen carefully to what clients want, and [meet] their expectations as close as we can."
Tom also points out that coffee shops will need to note that many consumers are moving away from consuming dairy milk. "I'm sure it'll always be enjoyed by some but honestly, I see milk drinks reducing over time.
"Coffee culture is evolving in parallel with the changing culture around dairy, and it's promoting dairy-free alternatives. As well as this, we have the fact that people are discovering delicious specialty coffee served simply as a [black] filter coffee."
Sadry Alexandre Abidi is a roaster at Café Moxka in Lyon, France. He says that he thinks that as more alternative milk options become available, the drink will evolve to accommodate them. "Milk-based coffees are very popular," Sadry explains.
"Nine years ago when we started, it was very hard to find anything other than UHT milk." Today, he says, it is a different case for coffee shops; and popular milk-based beverages may naturally evolve.
The café au lait is an important part of European coffee history. Despite the dozens of variations that exist around the world, it has still been popular for hundreds of years, and it doesn't seem to be going anywhere.
Its two simple ingredients mean there is huge potential for experimentation and evolution as coffee consumer trends change. For example, in years to come, it may be more and more common to see the café au lait made with plant milk in specialty coffee shops.
However, whether it changes or not, one thing is certain: this sweet, creamy beverage is a staple for many, and it's a great platform for tweaks and changes. So next time you're visiting a coffee shop, maybe it's worth asking how your barista would make a café au lait. You never know; it might surprise you.
Enjoyed this? Then read A Guide To Working With Plant Milks
Photo credits: Joan Dragonfly, WordRidden, Christopher Bowns
Janice Chinna Kanniah
Janice is a writer and editor. She is based in Johannesburg, South Africa
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A sample of the whisky pictured up above landed on our doorstep way back in December of 2016. It was part of a care package which included 18 other samples that was sent to us by Lauren Mayer of Spirit Imports. I wish I could explain why it took so long to get to out review of this whisky, but I honestly have no clue how this happened. All I can say is, "Lauren, can you find it in your heart to forgive us?".
Milroy's of Soho was founded by John 'Jack' Milroy in 1964 when he opened his wine shop at No. 3 Greek Street, in the heart of London's swinging-sixties Soho district. This was the time and place to be – the epicentre of the pleasure-seeking world of 'modern' music, fashion and of course the wines and spirits that fuelled the era.
Before long Milroy's was best known for selling the largest selection of whisky in London, perhaps even the world. John and his brother, Wallace, were delivering to the biggest names in the city; even the prime minister was a regular customer.
Over time the brothers established Milroy's as a whisky institution: Jack went on to bottle many whiskies under his own name "John Milroy" and Wallace wrote the still revered 'Malt Whisky Almanac' and 'Whisky In Your Pocket'. By the time Jack sold his "John Milroy" whisky brand to Berry Bros & Rudd Ltd in 2009, the name on the label had become synonymous with quality far beyond the UK.
Aroma: Very vapory at first. After a minute or two, it reallt starts to open up with hints of spiced green apple and pear, light brown sugar, cinnamon, candied orange peel, pipe tobacco, and a bit of menthol.
Taste: Starts off quite hot and dry with all of the flavors concentrated on the front third of my tongue. Definitely fruity with all of those baked apple and pear noted coming through. Some light sweetness in the middle along with some peppery spice. The long lasting and very dry finish brings a bit of cigar wrapper (and/or leather) and more of that sweet spiciness.
Mmmmmmmm! This is one super tasty dram of whisky. It brings the fruit. It brings the spice. And it even brings some delightful sweetness too. In other words, this whisky has a little bit of something for everyone. The only thing I can see someone complaining about is the dryness which can be a bit much if you're not into that type of a whisky. Since I enjoy a dry whisky every now and again, I'm good with everything that this Bunnahabhain brings to the table.