A national survey for chronic hepatitis C has not been performed in Denmark and the prevalence is unknown. Our aim was to estimate the prevalence of chronic hepatitis C from public registers and the proportion of these patients who received specialized healthcare.
Patients with a diagnosis of chronic hepatitis C were identified from four national registers: a laboratory register, the Hospital Discharge Register, a clinical database of chronic viral hepatitis and the Register of Communicable Diseases. The total population diagnosed with hepatitis C was estimated by capture-recapture analysis. The population with undiagnosed hepatitis C was derived from the national register of drug users by comparing diagnosed and tested persons.
A total of 6,935 patients diagnosed with chronic hepatitis C were identified in the four registers and the estimated population diagnosed with the disease was 9,166 persons (95% C.I. interval 8,973 – 9,877), corresponding to 0.21% (95% CI 0.21%-0.23%) of the Danish population over 15years of age. The prevalence was highest among persons 40–49years old (0.39%) and males (0.28%). It was estimated that 40% of the diagnosed patients lived in the capital region, and 33.5% had attended specialised healthcare. It was estimated that 46% of hepatitis C patients had not been diagnosed and the total population with chronic hepatitis C in Denmark was 16,888 (95% C.I. 16,474-18,287), corresponding to 0.38% (95% CI 0.37-0.42) of the population over 15years of age.
The estimated prevalence of chronic hepatitis C in Denmark was 0.38%. Less than half of the patients with chronic hepatitis C in Denmark have been identified and among these patients, one in three has attended specialised care.
Hepatitis C is not a common disease in Northern Europe, where most prevalence estimates in the general population are below one percent [1–3]. Hepatitis C is a blood borne viral infection, and in the Scandinavian countries the large majority of patients have been infected through drug injection. In Denmark 83% of reported transmissions in 2007 were due to injecting drug use and in Sweden 88% of 31,000 reported HCV transmissions between 1990 and 2006 were due to injecting drug use [4, 5]. The reported prevalence of antibodies against hepatitis C virus (anti-HCV) among Danish injecting drug users was between 62% and 97% and half of them became infected within a year after the first injection [6–8].
Seroprevalence surveys of the general population are the gold standard for assessing the number of HCV infected within a country. This is time consuming and costly to perform and have never been done in Denmark. As the country has a long tradition of public registers and all residents have a unique civil registration number, the overlap between registers may be used to estimate the unregistered "hidden" population by capture-recapture analysis . This type of analysis is often hampered by dependence between registers, but by using combinations of multiple sources interactions between registers may be identified and accounted for.
The primary aim of this study was to estimate the population with diagnosed and undiagnosed hepatitis C in Denmark by the use of national registers. Secondary aims were to estimate the proportion of patients who attended specialised clinical care and the coverage of the national registers for diagnosed cases of hepatitis C.
As of 1 January 2008, Denmark had a population of 5.5 million inhabitants . Testing for hepatitis C was introduced in 1991 and medical care including treatment for hepatitis C has always been tax-paid and provided free-of-charge.
We used the unique 10-digit civil registration number assigned to all persons with permanent residence in Denmark to link the data sources described below. Persons without a valid civil registration number were excluded from the analysis.
Laboratory database (DANVIR): This research database included all patients tested for hepatitis C in 14 of the 18 Danish laboratories performing HCV tests (excluding blood donors). The laboratories contributing to the database served an estimated 85% of the Danish population and included data on 177,453 persons tested for hepatitis C. Data were included from the initiation of electronically stored test results used by all laboratories from 2000 onwards. From this register we included all subjects who had a positive HCV-RNA test not followed by a negative HCV-RNA. Thus patients who tested positive for anti-HCV, but had no HCV-RNA reported, were not included in the analysis.
Hospital Register: This was established in January 1977 (inpatients) and recorded all discharge diagnoses according to ICD-8 and ICD-10 codes, and since 1995 all hospital outpatient visits for patients treated in Danish hospitals. The International Classification of Diseases 8th revision was used until the end of 1993 and here after the 10th revision - ICD-9 was never used in Denmark.
From this register we extracted all individuals registered with chronic hepatitis C (ICD10 diagnosis B18.2).
Hepatitis database (DANHEP): This national clinical database contained all patients above 15 years of age with chronic viral hepatitis who attended specialist care in Denmark since 2002 regardless of the year of first contact. In 2009 it contained 6,489 persons. The database was updated once yearly and was complete as of 31.12.2007, the time of extraction. From this database we identified all patients with chronic hepatitis C (HCV-RNA positive at inclusion).
Communicable Diseases Register: This is a national public register of notifiable diseases and it contains mandatory report forms from the diagnosing physician of acute viral hepatitis C from 1991 and chronic hepatitis C from May 2000. The register is estimated to cover 35-40% of individuals diagnosed with chronic hepatitis C and contained a total of 8,202 persons with acute or chronic hepatitis B and C [11, 12]. From this register we included all patients reported with chronic hepatitis C.
Except for the laboratory register it was not possible to exclude patients who cleared the infection from the source registers. However spontaneous clearance of chronic HCV is less than 1%/year and in Denmark less than 2% of those infected have been cured by treatment [13, 14].
Drug Treatment Register: This national register included all persons treated for drug abuse in Denmark since 1996 with detailed information of drug use, but no information of viral hepatitis. This register was used to estimate the population of drug users infected with hepatitis C that had not been diagnosed.
The Civil Register: This register was established in 1968 and stored information on vital status, residency as well as immigration and emigration on all Danish residents. From this register we extracted vital status and residency.
In the study we included all individuals, who could be identified with chronic hepatitis C in one or more of the above four source registers. In order to assure equal chance of entrance into registers and to allow stratified geographical analysis we excluded all persons who were below 16years of age, had no assigned address or were reported dead, missing or emigrated in the civil register at 31.12.2007 Data were extracted from the above registers as of 31.12.2007.
We estimated the Danish population with chronic hepatitis C in a two step procedure.
The population with diagnosed chronic hepatitis C was calculated by capture-recapture analyses of the overlap between the four source registers stratified by gender, three age groups, five geographical regions and two time periods. This was based on log-linear modelling using the statistical program GLIM 4 [9, 15]. The final table contained 60 cells, and in total 113 different models including all possible two-way and three-way interactions were fitted to the overlap data. We primarily used the Akaike information criterion to select the 'best' fitting model, however when this model produced an estimate that differed markedly from the weighted estimate (averaged across all fitted model using the Schwartz criterion as a weight) then the Schwartz criteria was used to obtain the best fitting model. If there was discrepancy, or the choice between the Akaike and Schwartz criteria was not clear, then the model that produced an estimate closest to the ratio of known to estimated found in other strata was selected. Confidence intervals for the total estimate were derived from boot-strap analysis of 1000 samples [16, 17].
Statistical analysis was performed using SPSS v. 18.0. The study was approved by the Danish Data Protection Agency (J. 2008-41-2402).
The initial extraction from the four source registers identified 9,315 individuals diagnosed with hepatitis C. We excluded 2,380 persons (25.5%) of whom 88% had died, 11% had unknown vital status (emigrants and missing persons), 1% were below 16years of age and 0.3% had unknown address. The remaining 6,935 cases were included in the capture recapture analysis (Table 1).
Calculation of the fraction of diagnosed cases and total Danish HCV estimate end 2007 from diagnosed and tested population in Danish drug treatment register.
* first inclusion in any register.
Of the included cases 65% were men, but the proportion of men was lower in the clinical registers (hospital register and hepatitis database). These two registers also had a higher proportion of older people and a lower percentage of persons who had received treatment for drug use. In all registers most cases were included after the year 2000, and the geographical distribution was fairly constant between registers (Table 1).
The total estimate of persons alive with a diagnosis of hepatitis C was 9,166 cases (95% confidence interval 8,973 – 9,877) with a hidden population of 2,231 (24%) – these were individuals diagnosed with chronic hepatitis C but not identified in any of the source registers (Table 2). The estimate corresponded to 0.21% (95% C.I. 0.206%-0.226%) of the Danish population above 15years. The prevalence was highest amongst 40–49 year olds (0.39%), and was twice as high among men as among women (0.28% versus 0.14%). The regional prevalence ranged from 0.15% in the North region to 0.28% in Copenhagen, and the capital region represented 40% of all diagnosed cases. In all regions the age distribution changed over calendar time so that patients at inclusion were younger after 2000.
The proportion of diagnosed cases present in each register varied from 31% in the communicable disease register to 49% in the hospital register, and 33.5% (3065/9166) had attended specialised clinical care (present in the hepatitis database DANHEP) (Table 1).
The stratified analyses covered 60 strata and the best models fitted to the stratified overlap patterns contained an average of two significant interactions between the four source registers. The most frequent interaction was between the hospital register and the communicable diseases register, and the hospital register and the clinical register; these were both found in more than half of the strata, whereas an interaction between the communicable disease and clinical registers was not found to be significant in any strata. By the inclusion of interaction terms the total estimate of patients with the hepatitis C diagnose increased from 7,012 to 9,166 patients.
Among individuals alive and registered in the national drug treatment register, 33.1% (7,821/23,657) had a recorded test for anti-HCV and/or HCV-RNA in the laboratory register; 29.3% (2,293/7,821) had chronic hepatitis C (HCV-RNA positive), 15.3% (1,196) had past hepatitis C (anti-HCV positive and HCV-RNA negative), 38.1% (2,983) were unexposed (anti-HCV negative) and 17.3% (1,349) were anti-HCV positive, but had no recorded test result for HCV-RNA. In the laboratory register among all Danish patients with a positive anti-HCV and a test result for HCV-RNA, 62.2% (3,999/6,431; 95% CI 61.0-63.4%) were positive - indicating that 2/3 of Danish patients exposed to hepatitis C had developed chronic infection. Assuming that 62.2% (839/1,349) of anti-HCV positives in the drug treatment register not tested for HCV-RNA to be positive, the total prevalence of chronic hepatitis C among all tested drug users in the treatment register was 40.0% (3,132/7,821) (Figure 1). If 40% of the non-tested drug users in the register were also HCV-RNA positives, the total HCV-RNA positive population in the drug treatment register corresponded to 9,463 persons. The tested population was older (median age 40years/32years, p<0.001) and had a higher proportion of women (52% versus 40% p<0.001) than the not tested population. Drug users with hepatitis C were significantly older (43year/38years, p<0.001) whereas no gender difference was observed compared to drug users who did not have chronic hepatitis C.
In the drug treatment register 3,886 (16.4% of 23,657) had a diagnosis of hepatitis C in one or more of the four source registers (Table 1 and Figure 1). Adding the 24% unregistered cases (the hidden population derived from the national capture-recapture calculation) the total number of diagnosed cases increased to 5,136 (or 21.7% of 23,657) in the drug treatment register. Compared to the total of 9,463 patients with chronic hepatitis C estimated to be present in the drug treatment register, these 5,136 diagnosed cases represented 54.3% (95% CI 53.2%-55.3%).
We assumed the same diagnostic coverage (54.3%) among hepatitis C patients outside the drug treatment register. Including the 45.7% undiagnosed infections in the national estimate of hepatitis C, this rose from 9,166 to 16,888 (95% C.I. 16,474- 18,287), corresponding to a prevalence of chronic hepatitis C in Denmark of 0.38% (95% CI 0.37-0.42) of the population >15years of age.
Fifteen per cent of reported HCV transmissions in Denmark were not drug related, mostly nosocomial transmissions, and among these the diagnostic coverage may be different. Therefore we compared our estimates with a cohort of hepatitis C patients infected by blood transfusion and identified in the Danish hepatitis C look-back study . Among 124 patients with diagnosed hepatitis C transmitted by transfusion 17% were not present in our source registers (compared to 24% in our estimate) and among a total of 187 recipients possibly infected (including 63 not tested) the four source registers identified 55% in agreement with the 54% estimate from the drug treatment register) (S Just, personal communication).
We excluded 749 patients from the laboratory register as they were initially HCV-RNA positive but later became negative. However, 564 of these were registered with chronic hepatitis C in one or more of the other registers – most likely representing resolved or cured infections, but reinfection was also possible and therefore they were kept in the analysis. Excluding these 564 individuals did not influence the estimate significantly (data not shown). We additionally excluded 4,928 persons who were positive for anti-HCV but never tested for HCV-RNA in the laboratory register. Including these persons from the laboratory register, as well as patients reported with acute hepatitis C (corresponding to all persons ever exposed to HCV) gave an estimate of 13,184 diagnosed cases. Assuming that only 62% of the added cases were chronic infections (HCV-RNA positives) the diagnosed population was 11,657, and corrected for undiagnosed patients, this corresponded to a total of 21,468 patients living with chronic hepatitis C in Denmark (0.49% of the adult population).
In this large register based capture-recapture analysis we estimated the population living with a diagnosis of chronic hepatitis C in Denmark to be 0.21% of the population. Including undiagnosed patients the total estimate of patients with chronic hepatitis C corresponded to 0.38% of the adult population. The higher prevalence among men, persons 40–49years of age and residents in the capital region was in agreement with previous population surveys and the geographic distribution of hepatitis C infected Danish blood donors [3, 18, 19]. The South region had the highest proportion of young men. Here systematic screening for hepatitis C had been performed amongst drug users since 1996. The clinical registers (hospital discharge register and the hepatitis database) had a lower prevalence of persons <40years of age, males and drug users in the treatment register. This could indicate that these groups had less clinical illness due to hepatitis C, or that young males were less likely to seek clinical care for hepatitis C. The latter explanation is in agreement with a recent Danish survey reporting that drug users diagnosed with clinically significant chronic hepatitis C were unlikely to enter hospital based clinical care . It was surprising to us that only about a third of patients diagnosed with chronic hepatitis C attended specialised clinical care. With the improved therapies becoming available for hepatitis C these years, we suggest that new strategies must be developed in order to assure all patients with hepatitis C have proper care, once the disease has been diagnosed . It was also unexpected that half of all patients were not present in the laboratory register as the hepatitis C diagnosis cannot be made without a positive HCVRNA test. There may be several explanations for this: HCV tests became available in 1991–2, but most laboratories did not import old test results when testing was computerised in the late nineties and we had only access to electronic test result. In addition, the participating laboratories only covered 85% of the Danish population.
Our study had several limitations: Capture-recapture analysis requires a closed study population and the same case definition in all registers. To fulfil this we excluded patients who died, and extracted data from all registers at the same day (31.12.2007), but we could not identify patients who cleared chronic hepatitis C, either spontaneously or by treatment except in the laboratory register. Spontaneous clearance of hepatitis C after development of chronic infection is rare and it is estimated that only 2% of hepatitis C patients in Denmark have been treated [13, 14]. This bias could lead to overestimation of the hidden population. As for the case definition this may have changed over time. In the early nineties the clinical diagnosis had in some cases been based on positive anti-HCV (and elevated liver enzymes) in the communicable disease and hospital register. In contrast all cases in the laboratory and the hepatitis database (DANVIR and DANHEP) were based on positive HCV-RNA. Furthermore 9% of patients in the hepatitis database had cleared hepatitis C as a result of treatment . With different case definitions between registers, the hidden population will be over estimated. On the other side, we excluded 4,928 anti-HCV positive persons from the laboratory register as these had no available HCV-RNA test, but it is likely that 62.2% (3064 patients 95%CI 3006–3124) of this group had chronic HCV infection. Our register estimate is lower than the general population estimates from Scandinavia, so most likely the bias mentioned let to an underestimation of the HCV infected population .
Another limitation was that the capture-recapture method only estimated the number of patients diagnosed with hepatitis C and not the population that had never been tested for HCV. A direct estimate would require a general population survey which had not been performed in Denmark. Instead, we estimated the test coverage within the population of hepatitis C infected in the drug treatment register and applied this (46% undiagnosed) to calculate the total population with chronic hepatitis C in Denmark. If the prevalence of hepatitis C was lower among the drug users who had not been tested, this could overestimate the hepatitis C population. As the drug users that had not been tested for hepatitis C were younger such a bias would be expected but an independent population survey, performed in 2007 among drug users in treatment in the county of Funen, found a 40% hepatitis C prevalence, very similar to what we estimated from the national drug treatment register . Furthermore the hepatitis C prevalence among tested ever and never injectors in the treatment register were identical to the survey results (53% and 5%) giving further credibility to our estimate. An explanation of why an age difference did not correspond to a difference in hepatitis C prevalence could be that drug users becomes infected very rapidly after start of injection (50% within the first year) but on average do not enter treatment until after 4years of drug use and therefore the age difference is of less importance .
Another independent source was a national survey from 2004–2008, among 1009 drug related deaths, who were tested post mortem for hepatitis C. Their age and gender distribution was comparable to the drug treatment register (median age 38 years and 22% were female) and the estimated prevalence of chronic hepatitis C was 35% - slightly lower than our 40% treatment register estimate [23, 24]. If the true hepatitis C prevalence was 35% in the treatment register, 62% would have been identified and the corresponding national estimate of hepatitis C infected would decline to 14,783 (0.34% of the adult population).
The estimates of test coverage for hepatitis C (54% and 62%) among drug users in Denmark used two different methods but both were higher than a 42% test coverage reported among drug users in Scotland, suggesting that our national hepatitis C prevalence estimates could be too low .
Another limitation in the above calculations was that we assumed the same test coverage among hepatitis C patients outside the drug treatment register (former and never injectors). We found practically the same diagnostic coverage for a cohort of never injectors (patients infected by blood transfusion), but a cohort of former drug injectors could not be identified.
A comparable hepatitis C estimate from England and Wales (using multiple surveys, register data and mathematical modelling) found that former injectors constituted 47%, current injectors 38% and never-injectors 15% of the total British hepatitis C estimate (0.60% of the adult population) [26, 27]. Corresponding Danish estimates were 15-17% never users and 41% current injectors, deducing that former injectors may constitute 43% of the hepatitis C population [4, 28, 29]. A large proportion of former injectors with unknown but presumably low test coverage would make our estimate more uncertain and most likely too low. Our estimate was also lower than reported from two general population surveys from Sweden and Norway, both reporting an anti-HCV prevalence of 0.7% (corresponding to 0.45% and 0.5% with chronic hepatitis C infection) in the general population [2, 30]. If the true Danish prevalence of hepatitis C infection was 0.45% (corresponding to 19,645 patients), and our estimate was too low due to lower test coverage among infected former drug users, these would constitute 51% of the estimate (10,050) and the diagnosed proportion with hepatitis C amongst former injectors would be 39% (3948).
In conclusion we estimated the prevalence of chronic hepatitis C in the adult Danish population to be 0.38%, but due to bias and random variation the true prevalence could be within 0,34% - 0,49%. Of all patients with hepatitis C only half have been diagnosed and one third of the diagnosed attended specialised clinical care. This suggests that screening for hepatitis C should be improved and that new strategies are needed in order to deliver appropriate clinical care to the hepatitis C infected population. This will be of increasing importance as the treatment for hepatitis C continues to improve.
Peer Brehm Christensen received a grant from The Danish Agency for Science, Technology and Innovation (FSS 09–061687) for this study.
PBC contributed to the study design, collection and analysis of data and writing of the manuscript. GH performed the capture recapture analysis and revision of the manuscript. PJ, LHO, SAJ, HBK, NW, NO and SC provided source databases, participated in data analysis and revision of manuscript. All authors read and approved the final manuscript.


I can't believe my son first birthday just snuck up on me. I remember during my pregnancy people would tell me, " This time is going to fly by….before you know it he will be celebrating his first birthday." Oh boy! were they not kidding. I can't believe how fast the first year of my son's life came and gone. I've always enjoyed doing things on a small scale so the planning of his first birthday was just an opportunity for me to have a intimate get-together with family. Now I have seen families throw extravagant first birthday parties and they are just too darn cute but for me and my party styling I like to keep it simple and manageable.
Well you know my first order of business is to figure out a Party Décor and Theme. Of course, I gain all my inspiration from my favorite app, Pinterest. It's chalked full of ideas for just about any party you would like to throw. Of course there is tons of ideas for a baby boy's first birthday and I love them all. If you have been following my party style you know I like to do things on a unique scale so I chose to go with the John Deere theme and colors. This theme is very popular for little boys because it involves tractors, hay bales and farming activities. I could have went crazy with the party décor and theme but I had to keep in mind I only invited a small amount of people over so no need to go over the top.
Since I was working with a small crowd that cuts down on the food and beverage portion of the planning. I kept it simple by providing my guests with hamburgers, hot dogs, chips, cake and drinks. We fired up the barbeque grill and let the kids enjoy the pool. Anytime I am entertaining I love to go buy my paper goods, beverages and meats in bulk at BJs Wholesale Club. Purchasing wholesale allows me to stretch my dollar and have enough for everyone to enjoy without the fear of running out. However, for my special items like the birthday cake I wanted that specially made from Publix. Since Publix did my wedding cake, I decided to keep the tradition going by having my son's first birthday cake made by them. Set up was easy and the leftovers are always delicious!
There will be many more birthday celebration to come for my son, but his first birthday was very precious to me. Even though my son may have no understanding of what the day meant, it meant the world to me to create the memory. I wanted him to feel special, loved and happy. Every child should be able to enjoy their birthday in all types of party styles. Whether it be just immediate family, ice cream and cake or a backyard barbeque creating a Tableworthy Moment will last forever!


•...highlight Chevron's (CVX) potential breakout.
Talk about a change of heart.
Stocks went up after the Federal Reserve released its statement, which didn't feature too many changes. But alas, none could stay there. The S&P 500, Dow Jones Industrial Average, and Nasdaq Composite all finished down on the day. And while the 10-year Treasury yield initially chugged higher, hitting a high of the day around 2.93%, it too finished well off its highs at just 2.901% at the 3:00 p.m. close.
It's a strange reaction, given that the results were well within the range of expected possibilities. We got a quarter-point rate hike, just what the market expected. The Fed continues to project two more rate hikes in 2018, supposedly what the market was lo0king for too. Expectations for 2019 edge up a bit, and to some that appeared hawkish.
"The Fed's decision to raise interest rates by 25bp today was widely expected but some investors may have been caught off-guard by the degree to which Fed officials increased their projections for future interest rate hikes," writes Michael Pearce, senior U.S. economist at Capital Economics.
But was the decision really dovish? Rafiki Capital's Steve Englander argues that the Fed's inflation projections, which sit above 2%, suggest that it's willing to let the economy run hotter. "This is very dovish and asset markets have not yet reacted fully to the dovishness," he writes.
But maybe the decline wasn't just about the Fed. Rhino Trading's Michael Block notes that Facebook's (FB) Mark Zuckerberg is set to appear on CNN tonight, and that might have caused some selling in the tech sector, which finished down 0.6%, and there's still the possibility that tariffs against China will be announced later this week, another headwind for the market.
But even those and a supposedly hawkish Fed don't have to be the death knell for the market. "If people realize the Fed won't do anything crazy, tariffs come out and people realize it won't be all out war, I could see new highs by the end of April," he says.
Chevron's (CVX) gotten beaten up this year thanks to a disastrous fourth-quarter earnings announcement. But the stock is trying to break higher, and it got a big boost today, thanks to a rising energy sector.
JPMorgan analyst Phil Gresh expects it to get there. In a note today, he said that the Chevron has a "balanced" mix of production growth and free cash flow, which it can use to buy back stocks and raise its dividend. He raised his target to $135, from $130, which would take it to a new 52-week high.
The Dow Jones Industrial Average could not hold on to its gains today.


text:
AZW3
Work Header
Archive Warning:
Fandom:
Josh Lyman/Donna Moss
Josh Lyman
Donna Moss
Additional Tags:
i found another late 90s pairing!
that i love and cherish!
this is definitely my niche i feel
I wandered home saying your name
Kairach
"I'm fine, I just..." a thought occurred to him. "Wow, so no question of where I've been, what I'm doing in front of your apartment at this hour, how I even know your address, just straight in with the 'are you alright?'"
(happy holidays!
the title is from the song 'oviedo' by blind pilot
this probably won't have much of a plot, just wanted to finish something short!)
Work Text:
The scene in which he appeared at her doorstep had been playing on a loop in his head for the best part of an hour now. He had been whispering absentmindedly to himself the perfectly executed lines he would say once they met; some charming witticism that could make this situation any less weird. He stopped as soon as he noticed what he was doing.
This was weird, wasn't it? There was no real way to get past that fact. She had every right to slam the door in his face, of course. He wouldn't be annoyed at her if she did. It was when he saw the front door of her apartment building that he realized that he would have honestly braved pneumonia than make her uncomfortable.
He was drunk. Not embarrassingly drunk, he knew, but definitely drunk. He hoped maybe the 'dishevelled in kind of a sexy way' drunk: the kind that didn't lose agency, but just enough self-awareness to not care so much about a loosened tie or slightly ruffled hair, maybe a top button undone or something. Upon looking at himself in a parked car window, he was beginning to suspect that it was just the 'disheveled' part he had nailed. Leaving him out in the rain would definitely be understandable.
Josh loved the rain. Especially when it poured down like this. The quiet hum of it hitting the pavement was always soothing to him. He would have enjoyed how his breath was steaming in the wintry air (it shouldn't be this cold for February)-the kind of air where kids would pretend they were dragons or smoking cigars- if he wasn't so painfully, mind-numbingly cold. Josh had now been fully acquainted to the fact that there was infinitely more aesthetic enjoyment to the rain when he was listening to it tap against the windowpane, in the comfort and warmth of his own office, than to when he was stumbling through it on the street, trying to follow a half-remembered address with a body that seemed to lag a few seconds after his brain. He couldn't remember how long he had been walking for, but he knew with biological certainty that it had been for too long. He was so cold that every raindrop that hit his skin hurt.
But he didn't mind it so much, now that Donna had swung the door open on the second knock and was now standing in the doorway.
The moment had finally arrived, and for the life of him he couldn't think of what to say. It was as if the cold had frozen his jaw momentarily, all predetermined lines evaporating into the space between them. His teeth were chattering so hard he was scared he was centimeters away from biting his own tongue off, and his shirt was clinging uncomfortably to his back; but all he was aware of was how the warm glow from inside had cast a soft halo of light around Donna.
What was that Klimt painting- death looking upon a sea of gold and fabric?
"I t-totally get-t-it if you shut the d-door on me."
He knew that the drunkenness didn't quite explain why he felt so enraptured by his assistant at that moment in time.
"Josh? Are you alright?"
She was in tracksuit bottoms and an over sized t-shirt, with an innocuous baseball team logo plastered on the front. The concern on her face made his heart beat a little faster. Was it odd to have that kind of reaction?
He caught himself staring and looked away, down the street he had lurched down moments ago.
"I'm fine, I just..." A thought occurred to him. "Wow, so no q-question of where I've b-been, what I'm doing in front of your apartment at this hour, how I even know your ad-d-dress, just straight in with the 'are you alright?'"
"Are you annoyed by that?"
"No." he said. "no, it's uh, endearing. "
Endearing wasn't the right word.
He wasn't sure if he was imagining the guitar music in the distance, so soft he almost couldn't hear it. There couldn't have been buskers out at that hour, surely.
"Well, if you're interested, I know you took off early to meet with Sam and Toby, because Sam mentioned it before he left. And I gave you my address a few weeks ago, for that mailing thing the office implemented, remember? You made a joke about me living in 'the unfashionable part of town.'"
"I didn't hunt down your address from the mailing list, I just remembered you lived here." He waved it away with an aimless hand, trying to play off the rising levels of unease he felt. It really did look like he had to track her down. He did honestly just remember it.
"You still haven't answered my question."
"Are you alright? You're soaking." She gave him a quick once-over, the way she'd do before he rushed off to a meeting, to make sure nothing was out of place. "And swaying."
"My coat, I... left it somewhere, c-couldn't find it anywhere. Listen, I just need to borrow an umbrella or something, and I'll be on my way. Your ad-dress was the only one I could remember that was nearby, so I'm sorry if I'm off the mark here." It was hard to get the words across without them coming out in a rush of sounds, he had to focus on not getting caught on the consonants. He wished he would stop feeling so dizzy. Where did he put his coat? He had it on when he was walking to the bar.
"Come on inside, you're shivering."
"Are you sure? Do... do you actually want me to or are you just being polite?"
She laughed. "Yes Josh! I actually want you here!"
She took his hand and led him inside, stepping around him to close the door. He loved it when she took his hand, she did it so rarely.
He didn't realize how cold he really was until the chilblains started to gnaw at his hands. How long had he been out there for?
The hall was too small for both of them to be in there, but Josh waited for her to lead the way, up the stairs to her apartment. Donna went up the stairs in a light, practiced pattern- she knew which spaces didn't creak for each stair, whereas Josh made so much noise he was scared he was going to fall through the sanded wood.
"I'll see if there's a change of clothes for you somewhere, there's bound to be something."
"You really don't have to."
"No, I want to."
As soon as she opened the door to the apartment, a warm blast of heat greeted him, as well as a sugary-sweet smell to the air. He rubbed his arms for warmth, feeling himself relax a little more.
"Have you been baking?"
"Yeah, I was making a Victoria sponge." She seemed bashful to admit that.
"Aww." He grinned at her.
"You know when you just... something goes off in your brain that makes you immediately want to bake something?"
"Ah yes, the Betty Crocker sleeper agent. I'm glad I'm not the only one who has that. Why are you baking at this hour, though? Isn't it like, 2am or something?"
"Josh, it's 10pm."
He checked his watch. "Ah."
"I hope you realize that you're a huge lightweight."
"Hey! 10pm is also a weird time to bake. And I can drink with the best of them! with Toby, even. You know he drinks jack and cokes now?"
"Oh yeah? and what did you have?"
"I had..."
"You're adorable." Donna smiled.
"I resent that statement."
"You love it. Mind the cats, I'll be right back."
Donna disappeared up another flight of stairs on the landing. A black cat with bright amber eyes blinked passively up at him from the sofa as soon as he entered the living room; the quiet appraisal a cat gives to a stranger entering it's house. The gesture felt oddly human.
The living room itself was small, but cozy. The smallest wood burning stove in the world was on the opposite wall, with enormous mounds of firewood built up around it in neat piles. Framed posters of gaudy-looking 1950s romance films dotted across the walls: women being clasped in the arms of well dressed strangers and such. The TV faced the second hand sofas and a coffee table- the latter of which had a few scented candles and a book that was put face-down on its page, evidently in a hurry. The two sofas were draped in an array of homemade quilts and cushions, and when Josh made towards the closest one, a fluffy, expensive looking cat immediately hauled herself up to wind around his legs.
"You never told me you had cats." He tried to keep the distaste out of his tone.
"I don't, my roommate does."
The music had gotten louder. He was perplexed by that, until he noticed the vinyl player in the corner. It went nicely with the rain tapping on the windows. He nudged the cat away gently with his shoe and wandered back to the base of the staircase at the landing. "Is your roommate in?"
"She's in Toronto right now, won't be back for a few days. Ah!"
He heard the sound of something thudding to the floor, and a low curse.
"Donna?"
"I'm fine, just dropped a book. Are these okay?"
She threw down a large cotton t-shirt, a pair of boxers and some pajama pants. They felt soft, and fresh out of the dryer.
"Why do you have boxers?"
"They're comfortable to wear around the house."
"Huh." He ran his thumb across the waistband absentmindedly. "Whatever floats your boat, I guess."
She laughed.
"You've never said 'floats your boat' before." she reappeared, looking down at him from the stairwell. He was struck by how the hair fell around her face at that angle. "Hey, did you know that in the English language alone there are at least twenty five thousand idiomatic expressions?"
From the corner of his eye, Josh noticed that the cats had followed him into the landing. Cats had a funny way of latching onto the people who had no real interest in them, and ignoring the ones who did.
"I'm sorry." he said softly. More softly than he had intended.
"For what?"
"I just- appeared at your doorstep and more or less forced you to-"
"Ah, bullshit, you never asked me to do anything, I'm offering." There was a gleam in her eye, in this lighting. "Would you have preferred it if I had just slammed the door in your face?"
"You wouldn't have had the moral high ground, at least."
"You can use the shower, if you want."
"Thank you."
The shower sobered him up, stopped the room from spinning quite so much. He placed a hand on the cool tile wall to ground him, and let out a sigh as the steaming hot water hit his shoulders. It was a miracle he knew how to turn it on, let alone change the temperature. Not that he wanted to.
This wasn't weird. He was struck by how natural everything felt, showing up at Donna's door like that. She seemed surprised when he showed up, sure; but not uncomfortable. He thanked the stars for that.
Josh had never examined for a second how natural it felt to just be around Donna, and he preferred to leave it that way. Some things were put on the earth to be perpetually unexamined. Fuck Socrates, Josh would choose exile over hemlock any day.
Did that mean that Donna was Rome in this analogy? Is that really what he was doing?
More importantly, should he wash his hair?
Donna's shampoo smelled lovely, but he admitted it was a little unsettling. Now that he had used it, he felt like an apparition of her was nearby constantly; right behind him, or leaning towards him in the office, to point out an error somewhere in a document.
Josh took a moment to contemplate how strange the mind was. How it possessed the ability to process tiny, subconscious details about someone (how their hair smelled, the way they tilted their head), for seemingly no reason at all. Well, to remind you of them when they were gone, sure, but that seemed a little counterproductive. Why would your brain want to remember so much of someone when they were no longer there- what evolutionary purpose did that serve?
The pajamas he put on were soft and warm from being on the radiator in the bathroom, but they smelled unfamiliar. He carried the rest of his sodden clothes downstairs to put on the wooden clothes rack in front of the wood burner, which was blazing merrily.
"This isn't going to be like Misery, is it?"
He wandered to where Donna was and leaned against the kitchen door frame, watching her try and transfer a sponge cake from it's cake pan onto a cooling rack.
"I swear you just say random words sometimes, with the express purpose of watching me decipher them." she replied, not looking up at him.
"You know that film? The one with Kathy Bates?"
"Oh! Yeah, I've seen it."
"It starts with this woman finding a guy in a car crash and bringing him home to fix him up, and it's all nice, but then he realizes that he can't actually leave, because she's obsessed with him and doesn't want him to go."
"Well, when I start taking a sledgehammer to your ankles in the dead of night, you'll at least appreciate the homage to Stephen King. You know that story was like, a huge metaphor for his drug addiction, right?"
"And in the book, Annie chops off Paul's foot with an axe."
"Huh."
"See, now you appreciate my trivia."
"I always appreciate your trivia, Donna." he grinned.
"No you don't, you don't listen to them half the time." She said it in an almost matter of fact way.
"That's not true! And even if it was, it's only because you... infodump on me when I'm running to a meeting I'm ten minutes late for, or doing some other incredibly important stuff."
He paused. The last one she did was about the decline of Virginia bluebells- something about the soil erosion from the rain or surface runoff in certain areas. Perhaps they were her favorite flower.
"Did you think about Sam, walking here?"
That caught him off guard. "What?"
She talked as if it was the natural thread of conversation. Misery, to meetings, to Sam."I mean, with that woman. A photographer followed him to her apartment, then took a photo. Can't be good for public image, you being seen at your assistant's place in the dead of night." she replied, not unkindly.
"No, I didn't think of that. Don't worry, I'll flee the country and start a new life if we're on the front covers of all the newspapers tomorrow morning."
"I'll go with you."
That surprised him. "Of course. Okay."
They were quiet for a while, the matter somewhat settled. Josh sat on the counter, taking in everything around him, while Donna started dusting the cake with icing sugar.
The counter tops were wooden, with an assortment of kitchen appliances clustered together in a corner. A line of deep, bluish-green tiles ran in a line around the white kitchen. There were plants on top of the cupboards, ones with foliage that drifted down to eye level, so that you had to be careful not to get the leaves caught in the hinges when you opened or closed the doors. The cats were evidently not allowed in the kitchen, so they hovered in the doorway, their eyes flicking between Donna and him and meowing occasionally.
The air smelled sweet and warm, and Josh felt.. content. Quiet contentment. It was not a feeling he was used to, but he welcomed it nonetheless.
"I really appreciate the trivia. Every time. Even when I say I don't."
She smiled. "Thank you."
It was because of seeing Donna, he supposed. None of this would have felt quite the way it did if she wasn't there with him.
He didn't feel nearly as brave enough as he would have liked, but he wanted to try it anyway. "Listen, I... may be saying this because I've been drinking- and I want you never to repeat this to anyone." he waited for his thoughts to organize themselves. "I... never mind."
"Oh come on, you can't leave me hanging like that."
"No, it's stupid." He felt color rise to his face.
"Josh!"
Every time he looked at her now, he was reminded of bluebells. Not one but thousands, a carpet of them across a forest floor in spring; with the sun shining through bright new leaves in the treetops overhead.
He exhaled, speaking slowly, so as not to slur. "I just- I really appreciate having you around. And, I feel like I don't really say that enough. I'm glad you stayed on after the campaign. You're not only a tremendous asset to the office, but..."
The silence was unbearable.
He cleared his throat. "You're a really good friend to me. It would kill me if you genuinely saw me as a shitty person. Because you are the exact, polar opposite." Josh laughed to himself a little. "God, there's a reason why it's Sam who writes the speeches and not-"
The hug came unexpectedly. One second Donna was across the kitchen from him, then when he looked away, he felt her arms around him; under his arms and curling up to the middle of his back. He always knew that he had a 'factory reset' reaction to pressure between his shoulder blades, but it was never quite so apparent until then. It was the calmest yet most alive he had possibly ever felt, despite being ashamed to admit it.
He was still sat on the counter while she was standing, so her head was able to rest squarely in the middle of his chest. Josh hoped she wouldn't be able to hear his heart trying to hammer out of his own ribcage. She probably could.
He wrapped his arms around her, one hand threaded lightly through her hair (how was her hair so soft?), the other across her shoulders, and he let out a breath he didn't know he was holding. His knees just barely touched either side of her hips.
Gently, very gently, he kissed the top of her head, then rested his chin there, staring but not seeing, intent on only feeling, to preserve the moment in amber. It still felt like the most natural thing in the world, going there and kissing the woman he did not fall in love with at first sight, but feeling the elemental pull of knowing, as soon as he saw her, that he would. He would fall in love with her. Perhaps he was to be proven correct. It certainly felt that way now.
They both knew that, if Donna were to raise her head and reach up to kiss him, he wouldn't draw away. They both knew that if Donna kissed Josh at any point at all, in the past or the foreseeable future, he would never draw away.
But she didn't. It was better that way, leaving that professional (and emotional) can of worms unopened. Buried, even. They were both exiled into a relationship comprised of largely unanswered what-ifs. And that was okay.
For the rest of the night, Josh and Donna were lying on the sofa together, wrapped in homemade quilts, watching laughably bad films and eating cake. And yes, at some point in the evening, Josh yelled at the roommates' cats as they disappeared down the fire escape, for jumping up onto the counter and eating a part of the cake while him and Donna weren't looking. The mock-outrage was mostly to make her laugh, and it definitely served its purpose there.
At some point in the night Josh took the roommates bed and went to sleep, turning the evening over in his mind until he sank into a happy, vignetted doze.
He didn't realize until the next morning, when the sun was shining through the blinds in dusty golden bars across the duvet and walls, that yesterday was Valentine's day.
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Vic and I both battle the seaonal blahs/blues - whatever you want to call it. It is a tough season when you don't have light after work (or even after 4pm) for months and months. It is getting a little better as we are on the "good" side of the solstice now, but it is still dark and cold here. Minus 4 degrees celcius as I write this, which I know is nothing compared to our Canadian counterparts in Manitoba where I think it is minus 45 today. Good lord!
We combat our blahs through exercise. Vic runs and swims and I go to my fitness classes.
The other activity we do as a family is ski. Every weekend - we drag ourselves up to Silver Star Mountain. It is lots of exhilirating fun, especially once the kids have their gear on and are settled in. When I ski - especially when the turns are working out, I feel like a kid. It really is fun and takes my cares away.
Sophie finished up her Trail Blazer classes and will move up to Mountain Explorers. She is skiing at the intermediate level now and Fynn will be moving up to Racing Raccoons. He is doing well with blue runs.


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text:
Recycling revolution begins to roll away
Peter Gillette
Chances are, you haven't thought about recycling during the past week. Chances are, you haven't talked about recycling during the past week. But chances are, you've recycled something. Recycling has become second nature, in such swift time (a little over a decade) that it's easy to forget how remarkably Americans have begun to change the way we look at trash. Reusing bottles, while perhaps "bad for the economy" in some shape or form, and reusing paper not only seem like the right thing to do, but the cheaper choice.
"Reduce, Reuse, Recycle" entered the public lexicon so surely as to constitute a striking example of mass public reeducation at its finest, an example of how necessity nudges a movement once marginalized to the fringe of environmentalism toward a radical readjustment of the seemingly mundane.
But in a realm marked by the consequentially minute choices each of us semi-consciously daily, the battle is won and lost in whispers. To advocates of recycling, start listening up. Tides are turning, in stages ranging from New York City to your very own Lawrence University computer lab.
An even more important reason to examine recycling is because it is perhaps the most tangibly effective use of grade schools in the shaping of children into "environmentally conscious" citizens.
I still recall (and, if my informal polls of fellow students are any indication, you probably do too) the assemblies I would attend from first grade and following:
"Reduce, reuse, recycle. Reduce, reuse, recycle. Reduce, reuse, recycle."
"Reduce, reuse, recycle," became, to our generation, the ubi-quitous educational stock phrase, surpassing for a time even "Stop, Drop, and Roll" and "Lather, Rinse, Repeat."
The difference between "Reduce, Reuse, Recycle," and the other two, however, is that escaping fiery deaths and upholding reasonable standards of personal hygiene are, more or less, instinctive goals; separating papers, plastics, and glass into separate receptacles for the good of the species is a far more abstract concept to teach a child.
I recall that Mrs. Gehrls, my principal, would close each assembly with those three words — "Reduce, reuse, recycle" — whether we were watching a visiting dance troupe, Mr. Wizard, or Illinois' Democratic candidate for governor, Neil Hartigan.
Throughout the last 30 years, though, from Oregon's first "Bottle Bill" in 1971 to 1996, when newsprint prices fell to prices so low that collected paper began losing its market value, recycling took small steps toward being the norm.
It's important here to draw distinctions between Reduce, Reuse, and Recycle. Recycling pumps more money bank into the economy; however, with it creeps in the decidedly non-capitalistic consciousness of waste and reuse.
Wastepaper was quite a hot commodity around 1988: a cheap resource for paper manufacturers. However, for each 1% increase in curbside recycling programs, wastepaper loses 0.3% of its value. Between 1988 and 1994, curbside recycling increased in frequency by 600%. Wastepaper's value fell by nearly half during these six crucial years of the movement.
This is to suggest that paper is no longer fetching that much money for recycling companies. Beyond that, recycling costs cities a considerable amount to run.
Last winter, New York City Mayor Michael Bloomberg sought to kill recycling in a "no sacred cow" proposal that complained that recycling costs $240 per ton, while simply trashing it all costs $130 per ton.
Why buy recycled paper when you can just reuse paper? According to the Wisconsin DNR, in one year we use enough office paper to build a 10-foot-high wall that's 118 miles long, but we only recycle 65 miles of it. You're holding on to paper; do the right thing.
Perhaps you could find a use for it. Reusing saves you money. Why buy tinfoil for your lunch when you have a newspaper? And reusing bottles just makes sense.
And if you print text from the Internet, emails — generally anything other than formal prose — wouldn't it make economic sense to reuse your paper? That's not an option to you, though, if you use a university-owned printer.
The warranty for LU's new printers becomes void if any used paper is sent through the machines. LUCC's Student Welfare Committee was the first to publicize this, in a report earlier this week. The committee is going to look into other solutions to cut down paper waste.
The committee ought to be applauded; but one must be more than a tad concerned that, while busy "taking down" the World Bank, the Committee on Environmental Responsibility was mum on the paper issue. The CER ought to pay more attention to the campus. There's work to be done here before we change the world.
Bureaucratically, though, maybe there is a lesson here: that throughout the past couple of decades, waste disposal is no longer viewed as a "fringe" interest, but rather as a part of the general welfare whole.
As Americans, we must remember what often filters that sense of "general welfare." After 9-11, our civic duty was not to pray, was not to learn, was not to commune, but was to spend. Consumerism is, in some sense, a civic virtue.
Paper is no longer such a hot commodity. Neither is plastic. For these reasons, would not at all be surprised if recycling falls out of vogue with the quiet subversion of so much backpage news.
Don't take your recycling for granted. Remember what you learned in kindergarten, and recognize the breadth of the evolution, no matter how silently it came. Because the change came in the margins, it's often convenient to forget the realities of a world overflowing with trash.
Recycling posters from the 70s portray a utopian world, where proper trash disposal fixes social order. We're not there yet, and probably never will be.
But let's not slide back to the filthy city streets of Stuart-era London.
Mortgaging the future ought to violate each of our civic virtues. If it doesn't, then perhaps we have our virtues all mixed up.
The Lawrentian Staff - January 31, 2003
Peter Gillette Chances are, you haven't thought about recycling during the past week. Chances are, you haven't talked about recycling during the past week. But chances are, you've recycled something. Recycling has become second nature, in such swift time (a little over a decade) that it's easy to forget how remarkably Americans have begun to…


In this episode we play the cello concerto in C Major by Joseph Haydn. We decided to play it with organ since it sounds more like an orchestra and it makes a nice match. We are playing in a wonderful church called Mountainview United Church. We hope you enjoy it.


Parish/grade school attended: St. Maria Goretti (Madison, Wisconsin).
Colleges considering or attending: Indiana University, University of Minnesota, or University of Kentucky.
2. What is your ideal meal/snack before a game? Peanut butter on a bagel.
3. If you were trying out for American Idol, what would be your "go to" song? Bohemian Rhapsody by Queen.
6. How does your faith impact your approach to sports? I think that my faith informs how I play the game with good sportsmanship towards the other players and refs.
15. What is your favorite hour of the day? Why? Whatever time I go to sleep.
16. What is your nickname and how did you get it? Hurricane Annie because I was born during Hurricane Floyd in New Jersey.
17. Where is your favorite place to volunteer/provide community service? ESL Newcomer Meyer.
18. What is one hidden talent that you possess? Singing.
19. If time machines were real, and you could choose just one - to travel forward or backward - which would you select and why? Forward because I would like to see what my life will be like in a few years.
20. If you could pick one person, dead or alive, and ask them just one question that they had to answer honestly, who would you pick and what would you ask? Mia Hamm and ask her what it was like to win the world cup.