Clapotis a la Ruby Port - DONE. It has a wonderful drape and very soft hand. I'm tempted to leave it without blocking, or perhaps to just block the corners so that they lie flat - the rest is so gorgeous that I think I should leave it. Here are a couple of photos.
No, this post is not about a mobius. But it is about the Clapotis, by Kate Gilbert - that wondrous scarf/shawl that almost every knitter has made at least once. Since this is my 2nd one, I wanted to write about why I felt the need to interrupt my own design/knitting to get this project onto the needles once again. There is something magical about the way this piece works up, no matter what yarn you use, how wide or how long you make it.
This go-round, I decided to take a fellow Raveler's advice and purl the stitiches that would be dropped. This really is a time saver and avoids the markers. I also chose to knit all the knit stitches into the back loop, and I love the additional texture that this creates on the front of the work. Since a ladder is formed every 12 rows and it is such a great diversion to let them fall down on their own, or to do each row individually, this scarf progresses in 12 row increments. Getting past the slanted increases of the first part is a milestone because the ladders aren't formed until you start to work even on the piece decreasing on one side and increasing on the other. Of course it's always a challenge to leave just enough yarn to do the final decreases, but I think I looked after that this time by weighing the yarn after I finished the increases. That way, I know what is needed to end the project (I think!) When the whole scarf is complete, the drape is fabulous because of the ladders. You can block or not, it doesn't seem to matter.
So the mobius reference....well, once I finish this 2nd clapotis, I know that there will be another in my future, and possibly another after that. Over and over, turning and twisting, beginning and ending, it's one of those comfort projects. Not too easy, not too difficult, but fabulous upon completion.
Here's my 2nd one so far knit in Ruby Port ASM by Sundara Yarn, 4 skeins total for the project, 4.5mm needles. I'm just over half way done, and I'll post the finished shawl when it's complete.


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Transgender 101 America's Foremost Transgender Woman
Variations in Transgender Expression: An Introduction
A starting vocabulary for neophytes to the transgender community
If you visit another country and don't know the native tongue? You often get lost in a hurry. Same holds true in the world of transsexualism.
As we just discussed in the last section, the primary difference between various transgender women is usually defined by two elements:
Where we are in the process of transformation and;
How far we intend to proceed with that evolution.
For some, this need is limited to a private quarterly sessions in the wife's pantyhose. For others, it requires sexual reassignment surgery. The rest? They find solace in-between these two boundaries.
Also, trans-girls often evolve through various phases in their gender journey and change the label associated with their gender expression accordingly.
With that precept in mind, here's some of the most common terms you'll hear regarding various people in the trans-community. Some labels apply generically to all trans-people - like "transgender". Also, some girls fall under more than one label: For example? Some transsexuals also perform as DRAG Queens, etc.
Additional chapters Included in this specific section on this subject, include:
What is the Difference Between Transgender and Transsexual?
What is the Difference Between Transgender and Gay?
What is the Difference Between a Transsexual and a Shemale?
What is the Difference Between a Transvestite and a Crossdresser?
What is the Difference Between a Transsexual and a DRAG Queen?
As previously discussed, "transgender" - is an all-encompassing term used to describe any person with alternative genera expressive behavior. Within this broad sector is a wide variety of subsets like cross dressers, transsexuals, transvestites, DRAG Queens, etc. Thus Transgender could be likened to a generic term "automobile" - whereas a transsexual could be likened to a Porsche. Continuing with that analogy - you'll find various makes and models for each brand of car / transsexual expression.
Other terms associated with this label are: TG - short for transgender.
Cisgender
Cisgender is the exact opposite of transgender. It represents a person whose completely happy and comfortable with the gender they were born. Most people on the planet identify as Cisgender. It's not a commonly used term in the public domain. Rather, its used most often as a non-transgender marker in gender based clinical studies.
GRS is an acronym for Gender Reassignment Surgery. It's also sometimes called SRS = Sexual Reassignment Surgery - but GRS is the current politically correct terminology. GRS is the surgery for creating a neo-vagina using the born male anatomy for vagina walls, clitoris, etch Nothing is wasted! It's also known as final surgery and bottom surgery.
Orchie
An Orchie is short for an Orchiectomy. This is essentially the procedure for castration - having the testicles removed. Since its irreversible, an orchid is often considered an acceptable alternative to legally be considered female in many US states. Also, an orchie costs much less than GRS.
MTF is an acronym for a male-to-female transgender person - meaning this person was born male but needs to present female - either on a part time or full-time basis.
FTM is an acronym for a female-to-male transgender person - meaning this person was born female but needs to present as male - either on a part time or full-time basis.
T-GIRL
"T-girls" is another "all encompassing" term used to describe transgenders - but only includes the MTF variant = "girls". This was my preferred self definition before I started transition vs. cross dresser, DRAG Queen or transvestite.
"T-girls" is another "all encompassing" term used to describe transgender women - but only includes the MTF variant = "girls".
GG / Born Woman / Born Girl
A GG is an acronym for a "Genetic Girl" - a woman naturally born as female. Other similar terms used to describe naturally-born females includes: Born-women, natal females and "natals".
HRT Therapy
HRT therapy or as commonly called in trans-world - "taking hormones" - is a specialized hormone regimen for MTF transsexual women that includes much heavier doses than administered to post-menopausal women. The programs include a variant of female estrogen and a testosterone blocker. This process tends to soften male tissue - particularly noticeable in the facial area. It also creates breast tissue and nipple growth - although usually limited to a A-cup or small B-cup.
Transsexual women usually remain on an HRT regimen throughout their lives albeit with less dosage following GRS or an Orchiectomy.
"Transition" is a phase a transsexual person goes through in order to successfully change their gender. It can take many years to successfully complete. It usually starts with professional counseling regarding confirmation and severity of Gender Identity Disorder issues (GID) and progresses to the use of a hormone replacement therapy regimen along with testosterone blockers to help create a more feminine platform to develop. In the case of FTM transsexuals, testosterone shots are administered. Usually, sometime during or after this step, a transsexual woman starts trying to live "full time" as a woman in her work and personal life. If and when they can afford it? Transsexual women will often get specialized cosmetic surgery to enhance their new gender presentation including FFS (Facial Feminization Surgery) and breast augmentation. There's also the painful process of facial hair removal - usually with electrolysis but sometimes just with laser. For FTM transsexuals? Early cosmetic changes usually include breast reduction or removal. It's during this phase that a transsexual learns to function in their new gender - often by trial and error. This period is often the most overwhelming aspect of transition since many old friends and family pull away as a symbol of protest. Additionally, lots of trans-people lose their jobs after going full-time…at the exact time transition related costs are increasing substantially. Eventually, most transsexual women seek GRS or an Orchie for their own gratification and to also satisfy the legal requirements for becoming female on various identifying documents.
Admirer
Admirer is a term used to describe a man or a woman whose naturally attracted to transgender women. Some guys who are into tranny's can't stand the label but no new term has ever arisen. There's both male and female admirer's. There's also Admirer's that are part time cross dressers. That usually means they cross dress but are still into transsexual women.
Tranny Chaser
Tranny chaser (AKA Chaser or TC) is a less endearing term used to describe men attracted to transgender women. The term was born from the gay male community during the earlier old days that specialized in trans patrons. These gay men would term straight guys that "cashed" after the transgender women as "tranny chasers". In today's trans culture? If a trans-woman calls a guy a "chaser" - it usually means they consider them completing fixated on the fact she's transcend vs. knowing anything about her as a person. If you're called a "tranny chaser" - it's often not viewed as complementary.
The term top is used to describe a variety of sexual & relationship manifestations within alternative love unions. It was born from who "gravitates to being on top" when two people lay down in bed. Some people are more naturally inclined to be on the top - feeling trapped and out of sorts when underneath another. Others, only feel comfortable on the bottom - beneath their partner when prone. It's also used to describe personality roles in a loving union: the top is most often the alpha, the person who defaults to decision making, etc. Sexually-speaking a top is the person whose doing the penetrating.
A "bottom" is the exact opposite, complimentary variant to the "top" just described above.
When someone says they are "versatile"? It means - sexually-speaking - they are comfortable performing as both top and bottom. In BDSM culture, this person is called a "switch".
Ladyboy is an Americanized slang used to describe Thai trans-women - but now its used universally for almost all Asian trans-women by American admirers.
Another "all encompassing" term used to describe transgender men. Only includes the FTM variant = "boys".
Additional chapters Included in This Section Include:
What is Transgender?
Variations in Transgender Expression: What's the differences?
Urban Dictionary: Transgender Terms
Urban Dictionary: Transgender Slangs
What do I do if I think the girl you're dating might be transgender?
My husband watches shemale porn: Is he gay?

redpajama_set_name: RedPajamaCommonCrawl


More than once I looked at the clock only to realize I had been playing for several hours without realizing it, and that's a pretty strong endorsement. Players who missed this on the PS3 will find a lot to like here, but for those who have already completed it I doubt the graphical upgrade is worth another play through.
The Last of Us is a great action game that you should play if you haven't already. And if you have played it before, the improvements here aren't so dramatic as to make the game feel like a new experience, but it is definitely one worth revisiting. In the world of The Last of Us, as in our own world, love might destroy you, but it's also one of the only things worth fighting for.
...a mighty fine looking title, and its framerate and resolution improvements only serve to solidify that. Of course, the onboard add-on packs and smattering of superfluous extras ensure that this is the definitive edition of an already outstanding affair – but, unsurprisingly, it's the touching tale at the heart of the package that once again sets it apart from its peers.
In 2013, I called The Last of Us on PlayStation 3 a masterpiece. The same holds true of its PlayStation 4 "Remastered" sibling. You can't go wrong with either version, but with Remastered you'll get a better framerate that smooths out gunplay, a prettier, sharper look, and a bunch of DLC content rolled into the package from the get-go.
The Last of Us Remastered takes a modern day classic and makes it even better. Moving as smooth as ever with 60fps and brand new higher resolution character models, Joel and Ellie have never looked better than they do on the PlayStation 4. In addition, we also get the major DLC released over the last year, including the story DLC that dives further into Ellie's past. With most ports of last-gen games, the verdict is to only buy it if you haven't played the original.
The overhaul feels a lot more significant, more than you'd expect for a game that's really not that old, and as such it may indeed be worth picking up, even for those who experienced the PlayStation 3 version. Still, as terrific as the game is, and as nice as the updates are, this is a port, and it does feel like more of a fresh coat of paint as opposed to an actual remaster. These are simply things one would do well to expect so as to avoid any potential disappointment.
All the graphical improvements are wonderful, but you may be wondering if The Last of Us Remastered is for you. Like the best visual updates, Remastered plays like you remember it. If you played 2013's Game of the Year near release and have been dying to return to the dark tale, then this is a great opportunity. If you never played The Last of Us at all, this is absolutely the way to do it. But be careful - you'll never want to go back to the PS3 original again after reveling in all the improvements.
All told, The Last of Us Remastered is the best version of one of the last generation's best games. Those expecting it to look totally 'next-gen' may be disappointed, as even at its peak it resembles a last-generation game being played at Ultra settings on PC. Still, it's obvious a lot of work and care has gone into this, and it will please both newcomers and old fans alike.
The Last of Us Remastered is the definitive The Last of Us experience. Its multiplayer is better, its level of immersion is higher, and its emotional impact is more profound thanks the inclusion of Left Behind. ...Those who have never experienced Naughty Dog's crown jewel are in for a treat, as are those who are ready to experience it for a second time. This is one of the best console ports in recent history, as it manages to fully capture the spirit of the original while improving upon it in nearly every way.
Overall, The Last of Us Remastered is as good as it gets thus far. Already a masterpiece, an upgraded Last of Us was going to be a win, but with the also brilliant Left Behind included as well as the resurgence of the multiplayer and the bonus featurettes, the remastered version is the best thing out right now. Even though Sony is trying to wrangle every dollar possible out of us gamers, The Last of Us Remastered is a must buy for long time fans as well as new players looking for a great game for their PS4. I can't recommend this enough.
Even if you've already played The Last of Us on the PS3, it's still worth revisiting. Sure, you've been through it all before, but the game's an emotional roller coaster that warrants a second ride through, thanks to all the bells and whistles that come with improved hardware. 2014 is indeed the year of the remaster and The Last of Us Remastered is undoubtedly the best of the bunch.
There's not really enough distance between the PS3 version of The Last of Us and this new Remaster to make it worth double-dipping, unless you're simply that fixated on counting lines of resolution. If you missed out the first time around, though, you really shouldn't let it slip past again. While it often works better as a movie than a game, it still stands at the state of the art. And the writing is good enough to enjoy even if you hate zombie genre fiction (like I do). The Last of Us is about refinement, not innovation, and this version takes the art of refinement another step forward.
If elsewhere your interactions with the world amount to little more than pressing a button to prompt additional dialogue, the contextual rewards are worth it. And when the action arrives, it's as good as ever, adding an extra wrinkle to combat. Fungal foes briefly become allies, as you smash bottles to guide them towards human pursuers: a necessary evil because you're less well-armed than in the main game.
Simply put, The Last of Us: Remastered is just better than the PS3 version. If you are lucky enough to be experiencing The Last of Us for the first time, then you are in for an amazing treat. If you have already purchased the original game, then still consider picking this up. Heck, trade in your PS3 version if you can. This is by far the definitive version of the game, and if you can get the price reduced even a little bit it's likely worth your money.
Technically speaking, The Last of Us is still one of the more incredible feats of engineering given how beautiful its animations, textures, and sound design come together. One of my favorite moments in the entire game comes fairly late and precedes another spoiler. ...If the film does come together, The Last of Us presents a serious, visually-stunning, and intelligent world to explore, but I actually liked leaving it behind after my first playthrough.
...any negative impression is constantly overshadowed by the enhancements that Naughty Dog has etched into a wonderful core concept. Naughty Dog gives PlayStation gamers a second, definitive chance to experience one of the greatest video game stories. The Last of Us Remastered's additional content, visual enhancements, and improved performance leave very little standing in the way of a perfect encore.
The Last of Us Remastered is a better-looking, better performing version of an already incredible game. As such, those who haven't played the original version should buy immediately, and those that have probably should as well.
The Last of Us llega a PS4 con el pack más completo, incluyendo campaña y contenidos descargables, dentro de una remasterización que brilla por pulir las pequeñas imperfecciones técnicas del original.... Para los que quieran revisitar las hazañas de Joel y Ellie es una buena opción, aunque para los que está especialmente indicado este lanzamiento es para aquellos que no pudieron disfrutar en su día de este espléndido exponente dentro del género aventurero y de la acción. Un "must-have" en toda regla.
Si ya lo jugaste y estás dudando si las mejoras compensan el nuevo desembolso (49,95 euros precio oficial, más barato si buscas un poquito), tendrás que poner sobre la balanza un montón de variables, como el hecho de haber jugado o no a Left Behind, la importancia que le des a los contenidos multijugador, la curiosidad que tengas por escuchar los geniales audiocomentarios, las ganas de ser un artista con el modo Foto, y lo fanboy que seas de los manidos 1080p 60fps.
The Last of Us: Remasterizado es una revisión y pack definitivo como ningún otro título ha conseguido en lo que llevamos de generación, nuevo récord en la historia PlayStation. Multitud de extras realmente interesantes, todos los DLCs incluido Left Behind y un tratamiento mimado como la joya de juego que es hacen a esta edición la, sin duda, más recomendable y honorífica, imprescindible para caprichosos fans empedernidos y para quienes no conozcan aún a qué viene tanto bombo con esta obra maestra.
Über die inhaltlichen und spielerischen Qualitäten von The Last of Us brauche ich nicht mehr viel zu sagen: Der Titel von Naughty Dog ist ganz große Videospiel-Unterhaltung auf höchstem Niveau, die durch die Integration von Left Behind auf der PS4 noch einen Hauch mehr Glanz bekommt. Gleiches gilt für die Technik, die vor allem von der höheren Bildrate profitiert und dadurch auch das Spielgefühl durch präziseres Zielen bereichert – und das sowohl in der Kampagne als auch dem gelungenen Mehrspielermodus.
Überhaupt ist es rein mechanisch gesehen vermutlich das erfüllendste aller Spiele dieses Entwicklers. ...Wie The Last of Us beiläufig neue Optionen im Kampf offeriert, während andere schwinden, weil man vielleicht nicht aufgepasst hat, ist absolut einzigartig. Nur wenige Spiele bieten einen derart dynamischen, sandboxartigen Ansatz in ihren Kampfsystemen und sind zu so starken Stimmungswechseln in der Lage.
Faut-il craquer pour The Last of Us Remastered ? Oui, si vous n'avez pas encore eu l'occasion de goûter à l'un des derniers masterpieces de la PS3. Sans forcer, le jeu profite des capacités de la PS4 pour afficher des graphismes en 1080p d'une netteté quasi irréprochable...The Last of Us Remastered ne dispose d'aucune innovation majeure justifiant un nouveau passage à la caisse, et le contenu du jeu se contente de reprendre les DLC proposés au compte-gouttes par Naughty Dog. Mais que l'on soit d'un côté ou de l'autre, le jeu reste une tuerie à posséder absolument.
The Last of Us dans sa version Remastered ne vous laissera sûrement pas de marbre. Si vous n'avez pas tenté l'expérience sur PlayStation 3, cette édition vous emballera à coup sûr puisqu'elle propose l'aventure complète, l'excellent DLC Left Behind, et la totalité des contenus multijoueurs sortis. ...Même un an après sa sortie, le titre reste une excellente expérience, poignante et marquante.
Si The Last of Us Remastered ne chamboule pas l'ordre établi par la version originale, force est de constater que la magie opère toujours. Les ajouts techniques améliorent une expérience de jeu déjà très costaude et optimisée. Hier incroyable sur PS3, il reste toujours aussi efficace sur PS4, malgré le peu d'ajouts au niveau du gameplay.
Époustouflant est le mot qui résume le mieux The Last of Us et l'expérience qu'il propose. Le titre de Naughty Dog débarque en patron avec le double exploit de s'imposer instantanément en tant que nouvelle licence et d'établir un nouveau standard de qualité pour les jeux triple A. Car The Last of Us n'est pas juste le plus beau jeu actuel ou une histoire forte, il est la synthèse de tout ce qui s'est fait de mieux sur cette génération.
Fatto sta che a Naughty Dog basta un restyling grafico per spazzare via la concorrenza su PlayStation 4 e imporsi nuovamente ai vertice del catalogo della console di Sony. ...La valutazione di questa edizione tiene dunque di un gioco che è a tutti gli effetti un capolavoro, e di un lavoro di adattamento professionale e puntuale ma senza particolari spunti.
The Last of Us Remastered è un buon pacchetto, un ottima tirata a lucido di un'avventura che ha indelebilmente segnato una generazione di console (e di giocatori?) e un acquisto praticamente obbligato per chiunque non l'avesse provato su PlayStation 3. Chi, invece, si è già goduto l'avventura di Joel ed Ellie, può passare alla cassa solo sapendo bene che andrà incontro allo stesso gioco, con una veste grafica migliorata, ma che difficilmente lo farà gridare al miracolo.
Tidak seperti game lainnya, apa yang membuat The Last of Us begitu menarik bukanlah gameplay penuh aksi yang mendebarkan. ...Demikianlah kesimpulan yang bisa saya ceritakan tentang The Last of Us. Apapun pilihan kamu, jangan pernah berpikiran untuk melewatkan game ini sama sekali. Karena game seperti The Last of Us belum tentu keluar setiap tahun. Jadi, sekali lagi, jangan lewatkan melodrama di dunia setelah apokalips ini.
The Last of Us: Remastered doet zijn naam op grafisch gebied veel eer aan, ondanks dat duidelijk is dat je te maken hebt met een game van de vorige generatie. Daarbij moet de originele ervaring volgens de studio intact blijven maar de schoonheidsfoutjes die je uit de sfeer van de oorspronkelijke game haalden, doen dat nu nog steeds. ...The Last of Us: Remastered blijft een schitterende titel met één van de meest memorabele verhalen uit de recente gamegeschiedenis.
Wie tijdens het spelen van The Last of Us op de PS3 vooral kon genieten van de geweldige omgeving van de postapocalyptische wereld, heeft wel degelijk meer om van te smullen. Over de vernieuwde graphics valt immers absoluut niets te klagen. Blijf op daken van hoge gebouwen vooral even stil staan om de omgeving in je op te nemen. Het is ongelofelijk hoe gedetailleerd alles is en met de verbeterde belichting lijkt het allemaal zó echt, dat je gewoon vergeet dat je er niet zelf staat.


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$76,500 to make the Green Left fighting fund target
How hard is it to raise $76,500 before the end of this year? Not hard at all for some organisations. As the November 1 Sydney Morning Herald reported: "Opposition Leader, Peter Debnam, took to the harbour last night for a fund-raising cruise with the property industry aboard a luxury cruiser owned by a developer, Greg Gav.
'Market solutions' won't stop climate catastrophe
"I'm just, I'm a little concerned with all this hysteria over this greenhouse gases and the environment, that the Liberal Party is not selling your message the way you sold it now to Leon, and that it's not getting through to the average man in the street" — this is what "Emile", an "unashamed supporter" of Prime Minister John Howard, had to say to the PM on November 2, during Leon Byner's talkback show on Adelaide's Radio 5AA.
Muslim-bashing won't advance women's rights
"When hypocritical old sexists like PM John Howard, Treasurer Peter Costello and radio shock-jock Alan Jones start delivering pious sermons about the rights of women, something very suspicious is happening", Pip Hinman, the Socialist Alliance's anti-war spokesperson, told Green Left Weekly.
Not in our name
Along with his contemptible "catmeat" analogy, Sheikh Taj El-din Al Hilaly's assurance to his congregation last month that, "If a woman is in her boudoir, in her house and if she's wearing the veil and if she shows modesty, disasters don't happen" was, of course, absolute bullshit. One in five Victorian women report being physically or sexually abused by an intimate partner at some time in their adult lives (VicHealth 2004). More than 20% of homicides involve intimate partners (Mouzos 2000). An estimated one in four children and young people have witnessed intimate partner violence (Office of Women's Policy 2002).
Bring David Hicks home!
The plight of Australian Guantanamo Bay prisoner David Hicks continues, as the government's arrogance and subservience to the US shows no sign of abating.
A win for the refugee-rights campaign
On October 21, two days after the anniversary of the sinking of the SIEV-X, shadow minister for immigration Tony Burke announced that he would recommend that the ALP change key aspects of its refugee policy.
Unionists share experiences, discuss strategies
Geelong Trades Hall was packed with unionists on October 28 exchanging ideas and experiences about surviving and fighting Work Choices. Some 130 unionists travelled from Victorian country centres such as Port Campbell, Portland, Hamilton and the Latrobe Valley to join unionists from across the country.
The illusory wage rise
In its first national minimum wage decision on October 26, the Australian Fair Pay Commission (AFPC) handed down an increase of $27.36 for workers earning under $700 per week and $22.04 for those earning more than $700 covered by awards.
Australia's Pacific intervention unravels
The strong parliamentary vote of confidence in Solomon Islands Prime Minister Manasseh Sogavare is a sign that the Howard government's Pacific intervention strategy is facing collapse.
Australian mining company's managers indicted for Congo massacre
A Congolese prosecutor has called for three former managers of the Perth-based Anvil Mining corporation to be indicted for "complicity in war crimes" - involvement in the massacre of up to 100 people in the village of Kilwa in October 2004. The slaughter, committed by Congolese Armed Forces soldiers ferried to the scene by Anvil-chartered planes and company-owned trucks, took place 50 kilometres from the company's Dikulushi silver and copper mine in the south-east of the Democratic Republic of Congo.
Green Left Weekly has been an invaluable source of serious left-wing journalism in this region for many years. I have come to rely on GLW for news from Australia and Asia in particular. GLW has also been a champion of our work at Unite Union and certainly one of the only sources for news on that in Australia. For that, we are also very grateful. May your good work continue.
Mike Treen
National Director of Unite Union, Aotearoa (NZ).


NEW YORK, NY -- Doyle was honored to auction photographs from the Collection of Anne Horton as a feature of the Photographs auction on December 13, 2018.
"Anne Horton launched the new, stand-alone photographs department at Sotheby's New York in 1976, at a time when reference books were few and the audience was small. It is hard to underestimate the resources available to photographs historians in those early days and hard to overestimate Anne's contributions to the field.
In her decade with photographs at Sotheby's, Anne orchestrated a number of landmark auctions: the 1980 Baron de Meyer sale, comprised of the contents of a recently discovered trunk of de Meyer's work; a 1980 Cecil Beaton sale; the 1982 "Photographs from the Collection of Robert Mapplethorpe," which cemented her friendship with Mapplethorpe; Eugène Atget, 1982; and perhaps most important, "Italian Futurist Photographs" from the collection of Giovanni Lista, also in 1982.
Anne's range of expertise covered the entire history of photography, and her writings were perceptive and articulate. She was well-known to the key players in the market at that time, among them Paul Walter, Sam Wagstaff, Robert Mapplethorpe, John Waddell, Weston Naef, Margaret Weston, Lee Witkin, and others. Inspired by her ready wit and quick insights, many became her personal friends. Her reputation as one of the founders of the modern photographs market is legendary."
MAPPLETHORPE, ROBERT (1946-1989) Irises, 1987.
DE MEYER, BARON ADOLPH (1868-1949) [Baroness Olga de Meyer in a dark hat], about 1915.
MAXEY, EDWARD (b. 1960) Melody, 1988.


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Could This S&P 500 Divergence Lead To A Market Correction?
by Chris Kimble | Sep 27, 2018 | Kimble Charting
After navigating an early year stock market correction, investors have seen the S&P 500(NYSEARCA: SPY) climb back to new all-time highs.
While making new highs is bullish, it's concerning when it comes with a significant divergence. In this case, it's a momentum divergence.
And history has shown that while some divergences are ignored for weeks or months, there have been a couple in the past 20 years that have lead to significant declines.
Both of these momentum divergences came when the S&P 500 made a "second high". See chart below. Looking at the chart below, you can see that while the S&P 500 is trying to breakout in September (and making a second high), it's seeing a lower momentum reading.
Two notable times we saw divergence patterns and readings like this were September 2000 and October 2007. Yikes! History doesn't always repeat itself, but it does offer investors a thoughtful reminder of why it's important to pay attention to risk indicators… and to always have a plan!
S&P 500 "Second" Peaks with Momentum Divergences
The 2000 & 2007 highs took place within weeks of the first day of fall (9/21), as momentum was hitting lower highs. Stock bulls are keeping fingers crossed that it's different this time!"
This article was originally written for See It Markets.com. To see original post CLICK HERE


Johnson Comitatus (Anglice: Johnson County) est Tennesiae comitatus in Civitatibus Foederatis Americae 17499 incolarum (anno 2000). Comitatus, cuius caput est urbs Mountain City , anno 1836 creatus est. In hoc comitatu minima pars incolarum (accurate 1.9 %) haud Anglice domu loquitur.
Vicimedia Communia plura habent quae ad Johnson Comitatum spectant.


A Vanuatu Court of Appeal decision has validated the acts and decisions of Prime Minister Sato Kilman's government between December 2nd last year and June 16th despite an earlier Supreme Court ruling that he wasn't properly elected.
In June, the Chief Justice ruled the parliamentary election of Mr Kilman as Prime Minister in December null and void due to the Speaker's failure to facilitate the mandatory secret ballot as required by Vanuatu's constitution.
The Attorney General Ishmael Kalsakau says while the Supreme Court ruling over the illegality of the vote was correct, Mr Kilman's intervening time in office remains valid on the principle of de facto operation.
"Whilst he was unconstitutionally elected, he remained for that period in office on a de-facto basis. And under that basis, everything undertaken by his government remained legitimate."


A person's survival instinct always puts himself in front of others when it comes to emergencies. Except when the person involved is a family member or your child, it is natural to put them first.
However, it is not easy to put your life on the line for someone you don't know. But some admirable people still do, without second thoughts.
The police force is one of the few bunches of people who spend their daily lives putting their lives at risk for the safety of other people.
One policeman from China showed how serious he was in giving service to the people he serves. At around 4 am last March 4, 2018, police officer Abdusalam Abulati was doing patrol duties with his fellow policemen when they chanced upon a suicidal woman.
It was reported that the woman, whose name was not included in the reports was fighting with her husband. Not willing to take it anymore, she decided to jump from their first-floor window.
At first, she was just sitting on the edge of the window but in one split second while the policemen were on their way to go near her and talk to her, she jumped!
Without having second thoughts, the policemen anticipated what will happen and used his body as a shield to her fall.
The policeman tried to catch her by hand but the momentum and the intensity of her fall brought them both back towards the pavement.
The fall resulted in the policeman having a spinal compression fracture, while the woman was safe from any injury.
Hats off to Abulati who was dedicated to helping others, but may this serve as a lesson to the woman also. The next time that they start a fight, she might as well think twice before attempting to jump again.


Phoenix police have released more details about the vehicle whose driver is suspected of striking four people — one of whom was a 2-year-old girl.
Phoenix police have released more details about the vehicle whose driver is suspected of striking four people — one of whom was a 2-year-old in a stroller dragged underneath the car for roughly 1,000 feet last week.
Sgt. Tommy Thompson told The Arizona Republic on Monday afternoon the vehicle is a Volkswagen Passat with the Arizona license plate AGB3745.
The vehicle's driver, an unidentified man, struck a 25-year-old woman and her three children ranging between 2 and 5 years old at the intersection of 71st Avenue and Indian School Road late Friday, police say.
Officials say the man continued driving, dragging the 2-year-old girl and stroller roughly 1,000 feet until witnesses stopped the man at the intersection of 71st Avenue and Indian School Road and told him someone was underneath his car.
Witnesses removed the stroller containing the 2-year-old before the driver fled north in his car.
Police said the woman and her three children were taken to nearby hospitals in serious condition. Thompson told The Republic on Monday afternoon that all four were expected to survive their injuries.
Police ask anyone with information about the suspect or his vehicle to contact the Phoenix Police Department at 602-262-6151. Those who wish to remain anonymous can contact Silent Witness at 480-WITNESS or 480-TESTIGO for Spanish.


text:
The Black Widow
Silva, Daniel
#1 New York Times bestselling author Daniel Silva delivers another stunning thriller in his latest action-packed tale of high stakes international intrigue featuring the inimitable Gabriel AllonMaster novelist Daniel Silva has thrilled readers with eighteen thoughtful and gripping spy novels featuring a diverse cast of compelling characters and ingenious plots that have taken them around the globe and back—from the United States to Europe, Russia to the Middle East. His brilliant hero, Gabriel Allon—art restorer, assassin, spy—has joined the pantheon of great fictional secret agents, including George Smiley, Jack Ryan, Jason Bourne and Simon Templar.Following the success of his smash hit The English Spy, Daniel Silva returns with another powerhouse of a novel—one that showcases his outstanding skill and brilliant imagination, and is sure to be a must read for both his multitudes of fans and growing legions of converts.
Publisher: 2016.
data file, rda
› Sample
Read more reviews of The Black Widow at iDreamBooks.com
Literature.
Thriller.


We just got back from what can only be described as the experience of a lifetime – a trip to Tanzania and Zanzibar with dear friends that are like family, literally. My husband and his friend Rich met the first week of college over 40 years ago and his children have called us "Auntie and Uncle" for as long as we can remember. So when his oldest daughter Amy married a wonderful guy from Tanzania a few years ago and they announced that at one point they wanted to take the "entire" family to Tanzania to meet Tony's family, they took it for granted that we would be included. How could we pass up such an amazing adventure? The answer was, we couldn't!
I'm not gonna lie, I had many sleepless nights of anxiety mixed with anticipation at the thought of traveling halfway around the world. I've traveled before, but never to such a far away place with so much that I had never before experienced.
Rather than "what if" myself into a frenzy, I decided to concentrate on researching and learning all I could up front, planning for what I learned and preparing accordingly. More, I could not do.
As with any and all new experiences, we are not the exact same person we were when we began the journey. One of the many benefits is the opportunity to expand our knowledge and take what we learn and apply it to future events. That definitely was a huge part of this trip and I can't help but notice the parallels to what I experienced and learned in preparing for my travels and how it can be applied to graduating seniors as they prepare to embark on their journey to a new land: COLLEGE! So, of course, I am sharing what I learned with you!
We were extremely fortunate to have someone like Tony who had grown up in Tanzania. His firsthand knowledge helped us to prepare for what we knew and brainstorm scenarios to anticipate. As such, our group was pretty proud of ourselves when between the ten of us we were able to navigate most situations and come up with whatever we needed.
There are a tremendous amount of resources and information out there to help students and parents prepare for college. Articles or websites such as these are just a few of the many available that talk about preparation and transition. And the colleges themselves host orientation events that provide students the opportunity to do everything from register for classes and meet fellow classmates to know how far the dorm is to the dining hall. You're able to know your roommate in advance and plan your room together. There are many resources to plan and prepare.
As perfectly planned as the trip was, there were tons of little things that happened that we could not have anticipated. Rather than let this derail us, we embraced it as part of the experience. Each of those instances provided the opportunity to learn something new and use what we learned to help us throughout the trip.
You can definitely expect that there will be much that is unexpected as your teen enters college. Let them know that there will definitely be transition time as they begin this new journey while also reminding them of how they successfully navigated all of the other "firsts" in their lives: first day of high school, first job, first time completing their college application. All of these things that feel second nature to them now, were new to them at one point. Remind them to be patient with themselves and to "expect the unexpected" and know that the experience of doing so will not only add to the adventure, it will equip them with skills and tools they can use throughout the journey.
Geographically, as well as culturally, we were navigating new territory so whether it was asking how to say something in Swahili or checking to see if we needed to cover our shoulders in a restaurant we made it a rule to ask for help, rather than assume we knew or go it on our own. At one point, a few of us asked for a "rest day" instead of driving an hour and a half to tour a spice market. We didn't want to spoil plans for anyone else, but we knew that we needed that downtime to process all we had experienced and gather energy for the following day. It turned out our speaking up was a great thing as the rest of the group felt the exact same way!
The ability to ask for help and find the support for what you need is a key skill that will make a huge difference in how your teen transitions to college life, and to life in general. It is amazing, as we found, how often others feel the way you do and the key is speaking up and asking for what you need. It also helps colleges properly know and prepare for the needs of their current and future students. There are a tremendous amount of resources available and as great a job as colleges do to share that information; it is impossible to communicate all that is available to everyone. A successful transition is not measured by your student having NO problems or challenges, but in recognizing when they do and asking for support to find the answers and resources for what they need, when they need it.
College, like our travels, is a mixture of navigating new experiences, exploring new ideas and learning about one's true self. It is certainly amazing and wonderful but not without some stress and anxiety.
The awareness that the bumps in the road are part of the journey, combined with the ability to utilize these tools will help in making college the "experience of a lifetime".


text:
SuperSport United beat Kaizer Chiefs and Orlando Pirates to Evans Rusike's signature
Ernest Makhaya
Gallo Images
Maritzburg United
SuperSport United
The Zimbabwean marksman had long been linked with a possible move to Gauteng, and Matsatsantsa have finally won the race for his services
SuperSport United have completed the signing of Evans Rusike from Maritzburg United.
According to the Tshwane giants, the Zimbabwe international has penned a three-year deal with immediate effect.
.@SuperSportFC and @MaritzburgUtd have agreed terms for the permanent move of Zimbabwean international striker Evans Rusike with immediate effect.
Rusike has signed a three-year deal with Matsatsantsa #WelcomeRusike pic.twitter.com/2qwOQrtuuL
— SuperSport United FC (@SuperSportFC) January 30, 2018
Rusike is seen a direct replacement for Jeremy Brockie who left SuperSport for Mamelodi Sundowns earlier this month.
Club CEO Stanley Matthews expressed delight at finally capturing the signature of Rusike, saying that they had been watching the 27-year-old marksman with keen interest over the past few seasons.
"We have been watching Evans with great interest over the last few years at Maritzburg," Matthews said in a statement.
"He has all the makings of a great striker with blistering pace, great skill and he can finish in the box. We are thrilled to announce his signing and look forward to him making a meaningful contribution for us over the next few years," added Matthews.
Rusike has netted seven league goals so far this season, and he will be expected to help the club move away from the bottom half of the PSL log in the remaining matches of the season.
The striker is aware of the challenges that lie ahead, and he intends to showcase his talent and possibly attract interest from European clubs.
"SuperSport United is a great club. They have achieved a lot in their short history, especially in the cups. They have also shown that they can get players to Europe and it remains my dream to play in Europe," said Rusike.
"I know I have to prove myself to the coach and management of SuperSport and I will give my best to boost the team into the Top 8 this season," he added.
Prior to joining Matsatsantsa, Rusike was on the radar of both Kaizer Chiefs and Orlando Pirates, but the Team of Choice opted to sell their star striker to the 2017 Caf Confederation Cup finalists instead.
The Buccaneers have since signed Augustine Mulenga from Zanaco FC, while Amakhosi signed Leonardo Castro from Sundowns in December 2017.
Pirates sign Zambian attacker Mulenga


I'm in mathematics, just in case that matters.
I submitted a manuscript to a journal, and got an extensive referee report from referee X. After sending the revision, the paper got rejected, so I sent it to a second journal where it got accepted.
Later, I got a note from the editor of the first journal saying that referee X found a way to improve my results, and the editor gave me a pdf file from referee X outlining his/her ideas. Unfortunately, since my manuscript had already been accepted for publication I could not change it at this point.
Nevertheless, the improvement that referee X suggested is significant enough to merit another paper. I asked the editor to pass on an invitation to referee X to work on a joint paper with me, but the editor refused, saying that he didn't want to violate referee anonymity.
I think the paper needs to be written, but I feel it would be strange for me to write a single-author paper when the most significant idea does not originate with me. (Referee X only gave me a vague sketch of the idea, there are things that still have to be worked out. I still have to do a lot of work, but the most important insight would be referee X's). I suppose I'm just going to write a few paragraphs in the introduction explaining the situation. I was wondering if there would be another way to handle the issue.
You can state something like "I am indebted to an anonymous reviewer of an earlier paper (give ref) for providing insightful comments and providing directions for additional work which has resulted in this paper. Without the anonymous reviewers supportive work this paper would not have been possible." The exact wording is of course up to you and what you see fits reality best.
I think it is a pity the editor does not want to forward your invite (I assume the review system is not double blind?). Asking is not a breach. I can, however, see that an editor does not necessarily want to become a messenger.
With a clear statement in the acknowledgement you have done what you can and I am sure the reviewer will pick up on it sooner or later and maybe after your new paper get in touch. After all, there is really not much you can do about it.
From my understanding of the details of the situation, the editor is not acting well in refusing to pass along your invitation to the referee. Doing so does not violate anonymity in any way (I am confident that the review process was not "double blind" -- i.e., the referee knows the author's identity -- in my experience, no mathematics papers are reviewed in this way.) Maybe what the editor is thinking is that in order to accept your offer the referee would have to violate anonymity.
However, is this an ethical issue? I have always held it to be the case that a referee can disclose her identity to an author at any time, and I have done this more than once as a referee. I can vaguely see some ethical problems which might arise if this process of referee-self-disclosure were very widespread, but it seems like a bit of a stretch. I would be very interested if someone can explain to me why this is a real concern.
Against the highly nebulous previous paragraph one must balance the ethical issue that academic ideas are not gifts that one person can freely bestow upon another. I wrote the previous sentence in full awareness of the fact that mathematics in practice does have some degree of noblesse oblige: one often encounters very eminent and senior mathematicians giving ideas away to younger / less experienced / less eminent mathematicians without wanting anything in return: in mathematics we are inculcated to have a view that certain contributions are "below our level" and thus not worth taking credit for. That is fine if "not taking credit" means not becoming an author on a paper. But if it means not disclosing your contribution at all -- with the consequence that the begifted junior mathematician gets "too much credit" for work that had a significant component that was not his own -- well, that is hardly a victimless crime in our current highly competitive job-market. In fact it seems to be a form of plagiarism.
Perhaps you should write back to the editor to express these ethical concerns. Getting the editor-in-chief of the journal involved (if this is not already the editor you are dealing with) is also a good idea at this point.
If you really don't know the identity of the author, then you need to indicate clearly the circumstances in whatever paper you write. You may also want to make it known in your circles that you would very much like to know the identity of the mathematician who helped you write your next paper. Depending upon how small / tightly knit your particular subcommunity is, you may have more or less luck with that, but it's certainly worth a try.
Not the answer you're looking for? Browse other questions tagged ethics intellectual-property acknowledgement peer-review or ask your own question.
How to offer a reviewer to be co-author?
What happens if the editor cannot find reviewers?
How to respond to a two very different referee reports?
How common is it for journal to reject a solicited paper?


text: Q: Exponential diophantine equation that I'm curious about For which $x,y \in \mathbb{N} $ does the following hold? $\forall k \in \mathbb{N} \exists a,b,c,d \in \mathbb{N} \cup \{0\} : x^{a} + x^{b} = y^{c} + k y^{d} $. What sort of restrictions do we need on $x$ and $y$? I've tried considering when $x$ and $y$ are prime, then reducing the equation modulo $x$ , but I don't know how to piece it together. Any help would be greatly appreciated.

redpajama_set_name: RedPajamaStackExchange


Jumbo seems to be quite a fad in cosmetics. We're seeing all kinds of chubby crayons from lipsticks to eye shadows. I guess I'm a chubby chaser when it comes to lipstick, because I love the ease with which they apply, just a few quick swipes and you're done. I do have one of the Clinique Chubby Stick Moisturizing Lip Balms and several Tarte LipSurgence sticks, but I wanted to see if there was something available at a drugstore price. The CoverGirl Lip Perfection Jumbo Gloss Balm ($7) display lured me in (okay, I wasn't really that hard to get).
There are 16 shades ranging from nudes, to pink, plums reds and browns. I chose #235 Coral Twist, a vibrant coral pink. This is a great spring and summer shade, it has no shimmer but really brightens up the face. There is plenty of pigment and it lasts a good long time. Beware, the cap colors are deceiving–being anywhere from one shade lighter to one shade darker than the actual color. I was disappointed because I expected a shiny gloss, but the finish is really more of a semi-matte. The texture does feel nice on the lips though and is not sticky. These don't have that real cushiony feel I get from a balm, but I think that's the trade off if you want pigment. Wear is average for a semi-matte gloss, about three hours. You may want to use a clear lip liner as the pencil did tend to bleed after a few hours. If you're not older than dirt like me, no worries!
Bottom Line: the shades are the pretty, the price is right, good pigment CoverGirl Lip Perfection Jumbo Gloss Balm could be a good choice for you!


To study the prevalence of hepatitis C virus (HCV) infection in blood donor (BD), haemodialysis (HD) and intravenous drug user (IVDU) populations in Singapore and assess the IL28B polymorphism if HCV positive.
The BD population were healthy volunteers, the HD population were patients who were on haemodialysis for at least six months of follow-up between January 2009 and December 2014. IVDU population was from inmates at halfway houses who consented.
Between 2011 and 2014, of 161,658 individuals who underwent screening prior to blood donation, 95 (0.059%) were positive for HCV. Of the 42 sera available, common genotypes (GTs) were GT-3 (47.6%) and GT-1 (31.0%). Of 1,575 HD patients, 2.2% were anti-HCV positive. The HCV GT distribution was HCV GT-1 (32.4%), HCV GT-3 (20.5%) and GT-6 (8.8%). 83 halfway house inmates were screened. Of the 47 IVDUs, 36.2% were anti-HCV positive with predominant GT-3 (%). IL28B polymorphism was noted to be CC predominantly 85.3%.
Prevalence of HCV infection has decreased in both the BD and HD populations. However, it remains high in the IVDU population. GT-1 remains the most common in the HD population; however, GT-3 infection is now more common among the BD population in Singapore. IL28B - CC is the predominant variant among the HCV-infected individuals in Singapore.
The last HCV epidemiology study in the general population of Singapore was conducted in 1995, and the prevalence of HCV infection was found to be 0.37% among the blood donor (BD) population.(7) We hope to determine the prevalence of HCV infection among various populations and certain high-risk groups in Singapore, as well as the prevalence of the IL28B single nucleotide polymorphism, which has previously been shown to be linked with response to therapy.(8) Through this study, we hope to better understand how best to use our limited resources to treat CHC in these populations. The primary objective was to study the prevalence of anti-HCV antibody and the frequency of various HCV genotypes in the following populations: (a) BDs; (b) end-stage renal disease patients on haemodialysis (HD); and (c) the IVDU population. The secondary objective was to study the prevalence of the IL28B human allele polymorphism within the high-risk populations to determine the possible treatment response to conventional versus newer, more expensive therapies for CHC.
This was a retrospective cohort study where the sera of the HCV-positive individuals were retrospectively analysed. Due to the heterogeneous nature of the three populations studied, the methods used to assess prevalence in each group are discussed in detail below.
In the BD population, data regarding HCV prevalence was provided by the Health Sciences Authority of Singapore for the period of 2011–2015. As part of the blood donation protocol, all BDs are voluntarily recruited throughout Singapore and every BD undergoes a medical examination and interview as part of the assessment. A quantity of 350–450 mL of blood is collected from each BD. Samples of the BD's blood are tested for blood-borne pathogens, including HCV. HCV infection is screened using both anti-HCV antibody testing with enzyme-linked immunosorbent assay and HCV nucleic acid testing. If either of the tests is found to be positive, the BD is recalled for counselling and follow-up. In addition, the residual blood serum samples of 40 HCV-seropositive and two HCV nucleic acid testing-positive anonymised BDs collected from 2011 to 2015 were retrieved for further analysis, along with information on age, gender and race.
For the HD population, data collected between 2009 and 2014 was extracted from the database of the Department of Renal Medicine, Singapore General Hospital (SGH), Singapore. The database consists of the records of end-stage renal disease patients who received medical consultation at SGH and underwent regular HD at a neighbouring dialysis centre in the community. Patients who were on HD for at least six months and had HCV serology testing done between 1 January 2009 and 31 December 2014 were included in the study. Patients who started dialysis before 2009 were excluded.
Routinely, all HD patients underwent HCV serology testing every six months while on haemodialysis. Positive HCV serology is defined as a positive enzyme immunoassay test (Architect i2000SR Immunoassay Analyzer, Abbott Diagnostics, Lake Forest, IL, USA), corroborated by supplementary testing with a line immunoassay (INNO-LIA HCV Score, Fujirebio Europe, Belgium). Those who tested positive for HCV RNA were further genotyped using Versant HCV Genotype 2.0 Assay Line Probe Assay (Siemens, Erlangen, Germany) Those who were anti-HCV antibody positive (AB+), based on data from the SGH renal database, were then approached to participate in the study. Informed consent was obtained to determine their HCV genotype (if not known previously) and IL28B genotype (rs12979860 single nucleotide polymorphism [SNP] allele) from their blood samples.
The IVDU population consisted of individuals who had known prior history of drug abuse. The Prisons Halfway House Scheme allows individuals who have a past history of drug abuse to spend the last stage of their detention in an out-of-prison facility prior to their release. Permission was granted for HCV screening of inmates in five of such halfway houses, under the Singapore Corporation of Rehabilitative Enterprises administration. Halfway house residents who volunteered to take part in the study completed a questionnaire about their prior history of drug use and their route of drug administration. Informed consent was taken prior to the administration of the questionnaire. Blood drawn was tested for the presence of HCV antibodies using the point-of-care Assure HCV Rapid Test (MP Biomedicals LLC, Santa Ana, CA, USA), which has a sensitivity and specificity of 98.1% and 98.9%, respectively. The remaining blood samples were transported to a tertiary healthcare institute for formal serology (i.e. enzyme immunoassay test), HCV genotyping and IL28B genotype testing. HCV genotyping was done at the National University Hospital, Singapore, clinical laboratory using a reverse line probe assay (Versant HCV Genotype 2.0 Assay Line Probe Assay) that requires a minimum viral load of approximately 2,000 IU/mL.
5-TGAACCAGGGAGCTCCCCGAAGGCG-3 allele C and 5-GAACCAGGGTTGAATTGCAC TCCGC-3 allele T. Polymerase chain reaction was performed using Applied Biosystems 7500 Fast Real-Time PCR System (Thermo Fisher Scientific, Waltham, MA, USA). The ABI Prism 7500 sequence detector was used to analyse the SNP allele of each sample.
All statistical calculations were done using SAS version 9.4 (SAS Institute Inc, Cary, NC, USA). This study was reviewed by the Centralised Institutional Review Board in accordance with the guidelines set forth in the Declaration of Helsinki (CIRB number: 2015/3168, 2016/2265).
In the present study, the prevalence of HCV infection in the BD population was 0.058%. For the purpose of comparison with the four-year record of the HD population, the prevalence of HCV infection in the BD population from 2011 to 2014 was calculated and found to be 0.059% (Fig. 1). The demographic profile of the 42 available sera of HCV-positive BDs is listed in Table I. It is noteworthy that among the racial groups listed under 'Others', seven out of the 11 individuals were of Burmese descent. HCV genotype analysis (Fig. 2) showed GT-3 (47.6%) to be the most predominant genotype among the HCV-infected BDs, followed by GT-1b (16.7%) and GT-1a (14.3%). Interestingly, the four BDs with GT-6 infection were of Burmese descent.
Chart shows the prevalence of HCV infection (anti-HCV AB+) among the blood donor (BD) and haemodialysis (HD) populations in 2009–2014.
Demographics of the blood donor population (n = 42).
Chart shows the breakdown of hepatitis C virus (HCV) genotype of the blood donor population according to race (n = 42). *Reported as considerable sequence heterogeneity within the sample.
Table II shows the gender, racial and age breakdown of the HD population. A total of 1,575 patient records were retrieved from the renal database. Of these, 920 (58.4%) patients were male. The majority of HD patients were of Chinese descent (n = 1,094, 69.5%), while those of other ethnicities made up the minority (n = 55, 3.5%). The mean age of individuals with anti-HCV AB+ and those with anti-HCV AB negative was 51.7 ± 13.3 years and 60.9 ± 12.5 years, respectively. The prevalence of anti-HCV AB+ in the HD cohort (2011–2015) was 2.2% (n = 34, Table II). The four-year (2011–2014) prevalence of anti-HCV AB+ in the HD cohort was 2.14% (Fig. 1). In contrast to the BD cohort, the HD cohort had a predominance of HCV GT-1 (32.4%) and HCV GT-3 (20.5%, Fig. 3) genotypes, respectively. HCV genotyping was not done in ten individuals with anti-HCV AB+ for various reasons: four were deceased; three had spontaneous resolution of HCV infection; one was uncontactable; and two rejected the study.
Demographics of the haemodialysis population.
Chart shows the breakdown of hepatitis C virus (HCV) genotype of the haemodialysis population according to race (n = 34). *Ten patients did not have genotyping done for the following reasons: deceased (n = 4); HCV infection resolved (n = 3); uncontactable (n = 1); rejected study (n = 2).
Table III shows the demographic information of the drug user population in our study. A total of 168 individuals attended the HCV screening across five halfway houses. Of these, 89 individuals volunteered to participate in the study, but only 83 were finally included and their data analysed – three were excluded due to poor venous access and three were excluded due to no prior drug abuse history as indicated through a screening questionnaire and interview. Out of these 83 drug users, 18 (21.7%) were found to be positive for HCV infection through screening. We further subdivided these individuals based on their method of drug use, namely via intravenous or non-intravenous route. Among 47 individuals who had ever used the intravenous route, 17 (36.2 %) were infected with HCV.
Demographics of the drug user population (n = 83).
Genotyping could not be done in five of the drug users who were anti-HCV AB+ due to low viral load, i.e. RNA < 2,000 IU/mL (4/18) and insufficient serum (1/18). Of the 13 genotyped specimens, the majority were of GT-3 genotype (8/13) and the remaining were of GT-1a (4/13) and an indeterminate genotype (1/13). Two of the four who had HCV RNA < 2,000 IU/mL had previously been treated for CHC.
Anti-HCV AB+ blood samples collected from both the HD and IVDU populations were tested for the allelic distribution of IL28B allele rs12979860 (Table IV). In total, 16 samples from the HD cohort and 18 samples from the IVDU cohort were evaluated for the IL28B allele. Of these, 29 (85.3%) samples showed a homozygous CC genotype. A binomial test of proportion was done, demonstrating a significantly higher proportion of CC genotype, as compared to the CT or TT genotype (p < 0.001).
Distribution of IL28B SNP allele in the haemodialysis (HD) and intravenous drug user (IVDU) populations.
Previous studies of HCV prevalence in the Singapore general population have put the estimated percentage at around 0.5% in 1995.(7,9-12) The blood bank handled approximately 70,000 BDs in 2015. Current results from BDs have shown a decrease in the prevalence of HCV within Singapore to 0.059% with a decreasing trend between the years 2010 and 2014 (Fig. 1). Analysis of retrieved anonymised blood samples tested for HCV by the blood bank showed a predominance of GT-3 genotype (47.6%), followed by GT-1 genotype (31.0%). These findings differ from those of past studies, which reported a predominance of GT-1 genotype in Singapore.(10) Of the current GT-3-infected BD population, Malay and Chinese individuals made up 50% and 25%, respectively (Fig. 2).
There is a wide range of HCV prevalence among HD patients worldwide, with a prevalence rate of about 10% in the United States(13) and 4% in Malaysia.(14) The HD population is one of the most at-risk populations for HCV infection.(15) In 2013, the National Registry of Disease, Singapore, reported a HCV infection prevalence rate of 3.7% in the HD population.(16) Our retrospective cohort study showed a prevalence rate of 2.2% (34/1,575) and a relatively stable annual prevalence rate throughout a five-year period (2009–2014). While our study was confined to HD patients who were on follow-up in one tertiary care hospital in Singapore, its large cohort size is able to provide insights on the prevalence of HCV infection among patients receiving HD in the Singapore community.
The lower prevalence of HCV infection in our HD populations, as compared to historical data, is consistent with the progressively decreasing HCV prevalence in our BD population. Implementation and enforcement of infection control strategies, as well as increased blood transfusion screening, have been shown to result in a reduction in blood-borne infections such as HCV,(13,17) and this has probably contributed to the decreasing prevalence in our HD population.
It is interesting to note that, while there is a change in the predominant HCV genotype of the HCV-infected BD population, that in the HD population had remained unchanged, with almost one-third of HCV-infected HD patients showing a GT-1 genotype. Nonetheless, GT-3 infection appears to be increasing in the HD population, as in the BD population.
As a secondary objective of our study, we looked at the frequency of IL28B rs12979860 allele in our HCV-infected HD and IVDU populations. Our results showed that there was a predominance (85.3% overall) of the favourable CC allele in these populations. Given our findings and the prohibitive cost of DAA agents, and keeping in mind that IL28B SNP is highly associated with increased sustained viral response following conventional PEG-IFN+RBV combination therapy for CHC,(8,21-24) it would seem reasonable to consider IL28B genotyping a priority, with the view of using PEG-IFN+RBV combination therapy as a first-line treatment for CHC, when appropriate, for a substantial proportion of the HCV-infected population in Singapore. Thus, the costly DAA agents can be reserved for the minority who have contraindications to, or poor predictive factors for sustained viral response following PEG-IFN+RBV combination therapy. This is particularly relevant to those with GT-3 HCV infection, such as the majority of the IVDU population, in which the choice of DAA agents is limited.
Our HD database was chosen due to its accessibility. However, this being a population followed up by a single public institution – albeit receiving haemodialysis from different HD centres in our wider Singapore community – has its limitations. Furthermore, our dataset did not allow us to calculate the length of time between the commencement of HD to the time of diagnosis of HCV infection. Future studies could explore the relationships between the risk of HCV infection and the length of time a patient has been on HD in the Singapore context. Our IVDU data was also limited by its small sample size of 47 individuals. This would account for the difference in significant values seen when comparing between unadjusted and adjusted odds ratios.
Similar to many developed nations, with increased blood surveillance and more widespread public awareness, the prevalence of HCV infection in both the BD and HD populations has dropped (0.059% and 2.2%, respectively), as compared to historical data. However, more work needs to be done for the at-risk HD population, as we expect increased morbidity and mortality in this population when infected with HCV.(17) The persistently high HCV prevalence in the IVDU population is an important source of spread of HCV. Education programmes targeted at at-risk groups that highlight dangerous practices leading to the spread of blood-borne infections could play a role. The high prevalence of the favourable IL28B CC genotype in our HCV-infected population suggests that the PEG-IFN+RBV combination therapy remains a viable treatment option in selected situations or individuals.
This study was funded by the departmental fund of the Department of Gastroenterology, SGH.
1. World Health Organization Hepatitis C. Fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed July 1, 2016.
2. Hajarizadeh B, Grebely J, Dore GJ.Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol. 2013;10:553-62.
3. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet. 2016;388:1081-8.
4. Aceijas C, Rhodes T.Global estimates of prevalence of HCV infection among injecting drug users. Int J Drug Policy. 2007;18:352-8.
5. Pawlotsky JM.Molecular diagnosis of viral hepatitis. Gastroenterology. 2002;122:1554-68.
6. Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology. 2015;61:77-87.
7. Wang JE.A study on the epidemiology of hepatitis C infection among blood donors in Singapore. J Public Health Med. 1995;17:387-91.
8. Ge D, Fellay J, Thompson AJ, et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature. 2009;461:399-401.
9. Sy T, Jamal MM.Epidemiology of hepatitis C virus (HCV) infection. Int J Med Sci. 2006;3:41-6.
10. Lim SG, Dan YY.A 2015 roadmap for the management of hepatitis C virus infections in Asia. Korean J Intern Med. 2015;30:423-33.
11. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST.Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57:1333-42.
12. Kuperan P, Choon AT, Ding SH, Lee G.Prevalence of antibodies to hepatitis C virus in relation to surrogate markers in a blood donor population of Singapore. Southeast Asian J Trop Med Public Health. 1993;24:Suppl 1127-9.
13. Kidney Disease: Improving Global Outcomes (KDIGO)KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2008;109S1-99.
14. 21st report of the Malaysian Dialysis and Transplant Registry 2013. Available at: https://www.crc.gov.my/wp-content/uploads/documents/report/21stdialysis_transplant_2013.pdf. Accessed September 1, 2016.
15. Pereira BJ, Levey AS.Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int. 1997;51:981-99.
16. Ministry of Health, SingaporeSingapore Renal Registry Report No. 10. Trends in chronic kidney failure stage 5 in Singapore 2012/2013. Available at: https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/trends-in-chronic-kidney-failure-in-singapore-2012-2013-web.pdf?sfvrsn=0. Accessed September 1, 2016.
17. Fabrizi F, Lunghi G, Ganeshan V, Martin P, Messa P.Hepatitis C virus infection and the dialysis patient. Semin Dial. 2007;20:416-22.
18. Central Narcotics Bureau, Singapore Drug situation report 2016. Available at: https://www.cnb.gov.sg/drugsituationreport/drugsituationreport2016.aspx. Accessed September 16, 2016.
19. Winslow M, Subramaniam M, Ng WL, et al. Seroprevalence of hepatitis C in intravenous opioid users presenting in the early phase of injecting drug use in Singapore. Singapore Med J. 2007;48:504-8.
20. Pybus OG, Cochrane A, Holmes EC, Simmonds P.The hepatitis C virus epidemic among injecting drug users. Infect Genet Evol. 2005;5:131-9.
21. Liu CH, Sheng WH, Sun HY, et al. Peginterferon plus ribavirin for HIV-infected patients with treatment-naïve acute or chronic HCV infection in Taiwan: a prospective cohort study. Sci Rep. 2015;5:17410.
22. Yan KK, Guirgis M, Dinh T, et al. Treatment responses in Asians and Caucasians with chronic hepatitis C infection. World J Gastroenterol. 2008;14:3416-20.
23. Thomas DL, Thio CL, Martin MP, et al. Genetic variation in IL28B and spontaneous clearance of hepatitis C virus. Nature. 2009;461:798-801.
24. Ekstrom V, Kumar R, Zhao Y, et al. Real world experience with pegylated interferon and ribavirin in hepatitis C genotype 1 population with favourable IL28B polymorphism. Gastroenterol Rep (Oxf). 2017;5:208-12.
1. World Health Organization. Hepatitis C. Fact sheet. Available at: http://www.who.int/mediacentre/factsheets/fs164/en/. Accessed July 1, 2016.
2. Hajarizadeh B, Grebely J, Dore GJ. Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol 2013; 10:553-62.
3. Stanaway JD, Flaxman AD, Naghavi M, et al. The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 2016; 388:1081-8.
4. Aceijas C, Rhodes T. Global estimates of prevalence of HCV infection among injecting drug users. Int J Drug Policy 2007; 18:352-8.
5. Pawlotsky JM. Molecular diagnosis of viral hepatitis. Gastroenterology 2002; 122:1554-68.
6. Messina JP, Humphreys I, Flaxman A, et al. Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 2015; 61:77-87.
7. Wang JE. A study on the epidemiology of hepatitis C infection among blood donors in Singapore. J Public Health Med 1995; 17:387-91.
8. Ge D, Fellay J, Thompson AJ, et al. Genetic variation in IL28B predicts hepatitis C treatment-induced viral clearance. Nature 2009; 461:399-401.
9. Sy T, Jamal MM. Epidemiology of hepatitis C virus (HCV) infection. Int J Med Sci 2006; 3:41-6.
10. Lim SG, Dan YY. A 2015 roadmap for the management of hepatitis C virus infections in Asia. Korean J Intern Med 2015; 30:423-33.
11. Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013; 57:1333-42.
12. Kuperan P, Choon AT, Ding SH, Lee G. Prevalence of antibodies to hepatitis C virus in relation to surrogate markers in a blood donor population of Singapore. Southeast Asian J Trop Med Public Health 1993; 24 Suppl 1:127-9.
13. Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl 2008; (109):S1-99.
14. 21st report of the Malaysian Dialysis and Transplant Registry 2013. Available at: https://www.crc.gov.my/wp-content/uploads/documents/report/21stdialysis_.... Accessed September 1, 2016.
15. Pereira BJ, Levey AS. Hepatitis C virus infection in dialysis and renal transplantation. Kidney Int 1997; 51:981-99.
16. Ministry of Health, Singapore. Singapore Renal Registry Report No. 10. Trends in chronic kidney failure stage 5 in Singapore 2012/2013. Available at: https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library.... Accessed September 1, 2016.
17. Fabrizi F, Lunghi G, Ganeshan V, Martin P, Messa P. Hepatitis C virus infection and the dialysis patient. Semin Dial 2007; 20:416-22.
18. Central Narcotics Bureau, Singapore. Drug situation report 2016. Available at: https://www.cnb.gov.sg/drugsituationreport/drugsituationreport2016.aspx. Accessed September 16, 2016.
19. Winslow M, Subramaniam M, Ng WL, et al. Seroprevalence of hepatitis C in intravenous opioid users presenting in the early phase of injecting drug use in Singapore. Singapore Med J 2007; 48:504-8.
20. Pybus OG, Cochrane A, Holmes EC, Simmonds P. The hepatitis C virus epidemic among injecting drug users. Infect Genet Evol 2005; 5:131-9.
21. Liu CH, Sheng WH, Sun HY, et al. Peginterferon plus ribavirin for HIV-infected patients with treatment-naïve acute or chronic HCV infection in Taiwan: a prospective cohort study. Sci Rep 2015; 5:17410.
22. Yan KK, Guirgis M, Dinh T, et al. Treatment responses in Asians and Caucasians with chronic hepatitis C infection. World J Gastroenterol 2008; 14:3416-20.
23. Thomas DL, Thio CL, Martin MP, et al. Genetic variation in IL28B and spontaneous clearance of hepatitis C virus. Nature 2009; 461:798-801.
24. Ekstrom V, Kumar R, Zhao Y, et al. Real world experience with pegylated interferon and ribavirin in hepatitis C genotype 1 population with favourable IL28B polymorphism. Gastroenterol Rep (Oxf) 2017; 5:208-12.


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