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Resources What Can You Do With a Master's in Public Health?
What Can You Do With a Master's in Public Health?
Career Paths and Salaries for MPH Graduates
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While doctors and nurses work one-to-one with the patients they serve, public health professionals look at communities and populations as a whole. Pursuing a master's of public health (MPH) allows individuals to take part in meaningful and life-saving work in a variety of settings and industries. If you're considering an MPH but want to learn more about potential career opportunities before taking the leap, this guide is for you. Read on to find information on industries, concentration areas, and top jobs in the field.
Renyea Colvin, MPH, CHES
Founder of Healthier Futures, LLC
Katy McWhirter
Public Health Industries
Types of Careers for MPH Graduates
Top 10 Careers for Master's in Public Health Grads
Interview with an MPH Graduate
Before getting into individual jobs and career paths, it is helpful to understand that the public health field consists of different industries. Each industry offers a variety of jobs for MPH graduates. While reviewing the industries highlighted below, consider how your skills could be best used in each and whether you can see yourself working in these spaces.
Government (Federal, State and Local)
Local health departments frequently hire individuals with public health knowledge, as do state boards of health, public schools and local food agencies. Employment opportunities can also be found in the federal government, for example, in roles at the Food and Drug Administration, the National Institutes for Health or the Agency for Toxic Substances and Disease Registry. MPH grads pursuing roles in the government can hold positions that focus on program planning, research, data analysis, disaster management and emergency preparedness, or international health outreach.
Individuals who pursue jobs at public or private universities and colleges can choose between two paths: teaching and research. Some MPH graduates feel drawn to the classroom and want to use their knowledge and skills to train new generations of practitioners. Some schools may accept those applicants with work experience and a master's degree, but others require applicants to hold a doctorate. For those who choose the research path, they can use their skills in epidemiology, biostatistics, social and behavioral sciences, and health sciences to further research being done in the field.
Nonprofit and NGOs
Though they may pay less than other employers, nonprofits and nongovernmental organizations offer a range of opportunities for MPH graduates to take part in meaningful and effective work. Individuals may find themselves working on program development and planning, research, outreach services, international public health initiatives, emergency response or logistics. Yale University's School of Public Health provides a list of some of the public health nonprofits in existence.
Health/Healthcare
According to a 2018 article by The Atlantic, healthcare employs more American workers than any other industry. Positions abound for public health graduates who want to tackle crises through education, administration, research and communications. Some of the positions commonly found in this industry include public health nurse, hospital administrator, director of family health services, outreach specialist, disease ecologist, and health and wellness manager. Some individuals may also decide to continue their education and become public health physicians.
Consulting can be a great fit for MPH graduates who want to work in various industries and use their skills to help multiple clients. Public health consultants work alongside nonprofits, governmental agencies, businesses and communities to enhance program effectiveness and delivery. They conduct research to understand issues and challenges, present findings, create plans, evaluate current public health programs, and develop new strategies for increasing public awareness and overall health.
In addition to the high-level industries reviewed above, individual public health careers can be categorized into different focus areas. The following section gives prospective students a sense of common MPH concentrations and how those translate to real world employment after graduation.
Analytical individuals who enjoy combining science with creative solutions often pursue health policy careers. Using their skills in communication, policy analysis and statistics, these professionals work to develop effective and beneficial health policies that create better outcomes for individuals, workplaces and communities. Some individuals may work at the state or federal government, crafting legislation that improves existing laws or creates new health guidelines that affect entire systems or specific demographics. Others may develop new health and wellness programs and policies for large corporations. Individuals may work for a single entity or pursue consultancy roles that allow them to work with a spectrum of clients.
Health Education and Outreach
This concentration area is all about spreading or increasing awareness and promoting preventive behaviors. These professionals often work for the government or nonprofits and seek to create interactive and innovative programs to educate the public. Individuals pursuing this path will have robust knowledge of models that help improve health behaviors, the tools needed to create effective programming, data and analytic skills to evaluate program effectiveness, advocacy skills to fight for health improvements, and strong communication skills to engage with communities as well as to seek grant funding for future health promotion projects.
Individuals who pursue public health roles in research and analysis typically enjoy delving deeply into topics to understand them from all sides. They may work for a government organization such as the Centers for Disease Control and Prevention, at a research-focused college or university, or for a company focused on creating products or innovations that improve the health of the greater population. Some of these professionals, such as epidemiologists, focus on the scientific side of research while others, such as public health historians, study the more social and cultural aspects.
Health Program Planning and Evaluation
While individuals in health education and outreach develop and execute public-facing initiatives, those in health program planning and evaluation do more of the behind-the-scenes work. These individuals hone skills in qualitative research methods, social marketing, and marketing research to better understand how to create programs and resources that will benefit communities. Many work as market research analysts to understand public health trends, while others may function in a consultative role to organizations and companies. Still, others work more on the research side of things to evaluate past resources and study what did and did not work.
Master's in public health degrees provide graduates with a wide spectrum of career prospects, catering to interests ranging from research and data analysis to public education and program management. Many of these positions offer opportunities for career progression in the form of leadership and management. A few popular options are highlighted below.
Epidemiologists research human disease and injury for patterns. The overarching goal of their research is reducing occurrences and encouraging a healthier populace. Specific responsibilities include designing and overseeing research projects, gathering and analyzing data, translating that data into accessible information for the public, and presenting findings to stakeholders, other public health professionals and academic conferences. They also oversee technical and clerical staff.
Annual Salary: $69,660
As the name implies, these individuals help interpret data collected by biologists, public health officials and medical professionals. They use various statistical models to understand how variables such as populations, communities and individuals influence the information collected. Biostatisticians may also develop new statistical models that can be used in clinical trials, spatial studies and human genetics to help create frameworks for understanding and interpreting the findings.
A perfect fit for public health professionals who enjoy the scientific aspects of the field, research scientists gather raw data and analyze findings to draw conclusions about specific populations, diseases, infections or chronic illnesses. They may work primarily in a lab with other research scientists, or they may work for a nonprofit, think tank or organization that focuses on creating solutions to public health epidemics. After completing a research project, they share their findings with the public health and scientific communities.
This position may appeal to individuals who like working with and teaching others how to best care for themselves. Public health educators get to know the communities they serve by assessing health needs, developing educational programs and events, teaching individuals how to care for themselves and making referrals for appropriate health services. They also evaluate programs for effectiveness, train other staff and write grant proposals to receive funding for ongoing outreach initiatives.
Public Health Microbiologist
Working within a lab, public health microbiologists detect, identify and attempt to contain diseased organisms that could spread to the general population. Standard responsibilities include analyzing samples brought into the lab, discerning whether they contain contagions, reporting findings to others in the lab and public health community, creating antibodies and strategies for containing and eliminating harmful microorganisms, and managing lab technicians working on similar projects.
Infection Control Practitioner
These individuals conduct investigations into infectious diseases to better understand how and why they affect individuals and populations. They dig deeper into the research by looking at how the disease translates differently within target communities. After gathering this information, they consider how to develop effective control strategies based on disease behaviors and risk factors. This information is then translated into reports and disseminated to other public health and medical professionals.
Public Health Administrator
Whether working for a local government, in a hospital or another type of health care institution, public health administrators work to make sure the populations they serve have access to information that help them make informed health decisions. They give health presentations at community events, communicate with other public health officials to set goals, train staff to carry out departmental plans, set and oversee budgets, and develop new awareness-raising campaigns.
Public Health Program Manager
Working more on the business side of public health, these professionals typically oversee public health programs to ensure they meet their end goals. They may hire qualified staff, set and maintain budgets, create timelines, liaise with the client to ensure the project runs smoothly, evaluate initiatives along the way, develop procedural guidelines, manage all program documentation, conduct reviews and carry out quality assurance checks.
Public Health Emergency Preparedness Manager
Public health emergency preparedness positions appeal to individuals who like to think creatively about how to develop solutions for future problems. These professionals consider possible emergencies (e.g. natural disasters, epidemic or infectious disease outbreaks) and create detailed plans for what to do if/when they happen. They also train other staff, disseminate emergency plans, test for flaws within the plan and host drills to ensure individuals understand their roles.
Public Health Nurse
Rather than focusing their efforts on the day-to-day care of patients, public health nurses work to educate patients and their families in health maintenance and identified risk factors. These professionals may work in a hospital or for a local government. They may work one-to-one with patients while in the hospital or offer group classes at community centers or health clinics. In addition to creating training materials, they evaluate programs to ensure they resonate with patients and groups.
Renyea Colvin holds an MPH from Georgia State University and has used her education in inspiring and innovative ways. Below she provides thoughtful answers to some of the questions prospective and current MPH students most frequently ask.
Why did you decide to pursue a master's in public health?
While interning as a health educator at a clinic, I realized everyone who had the kind of job I wanted had an MPH degree. I had never even heard of public health before that internship, but I absolutely loved the work I was doing and knew I wanted to continue my education in a related area. Once I started learning more about the degree, I quickly saw that it perfectly merged my passion for health with my interests in social justice and human behavior in very practical ways. From there, it was a no-brainer.
Do you have to get a master's degree in order to work in public health?
In my current role, I work with doctors, nurses, social media and communications experts, educators and statisticians who are all doing public health work. Certainly, an MPH degree prepares you with a particular set of knowledge and skills. But, the beauty of public health as a field of study is its interdisciplinary nature. There are many aspects of our daily lives that directly and indirectly affect our ability to have good health. Public health harnesses the expertise of them all.
How did you figure out what type of public health career was right for you?
I focused on the areas where I had a natural talent and curiosity. That led me to health promotion and behavior. I tried many things along the way including policy and research. But my aptitudes and interests always led me back to understanding and influencing human behavior in a way that promotes and sustains good health.
How did your MPH degree prepare you for your career?
I attended graduate school at an urban research university and my MPH program was practice-based. So, by the time I graduated I had a real-world understanding of the complex health issues affecting the urban populations I intended to serve. Aside from a thorough knowledge of theory and public health history, my MPH program helped me become a skilled writer, public speaker and advocate for my own health and that of my community. I knew how to assess community health needs and plan programs to meet those needs. I had applied work experiences in a variety of settings including a community-based clinic, a grant-making nonprofit and a county health department. Everything I learned by navigating those systems prepared me for my current role in program management at a major health sciences university.
If MPH students aren't sure what to do with their degree after they graduate, what advice would you give them?
I would encourage students to research the career trajectory of others who have an MPH degree and interests and skills similar to their own. Talking with faculty in your program is a great place to start. An MPH gives you many options if you know what your skills and interests are and how to leverage them.
I would also advise students to utilize the resources available to them while in school. Outside of school, it's difficult to find access to free services like career advisement, mental health support, fitness opportunities and a community of hundreds of faculty, staff and students who have the answers to all your questions or can point you toward the right direction. Utilize all of those resources to direct your path. You don't have to be certain. The truth is, few people are as certain as they seem. You just need to figure out the next best step. As a student, you have access to people who can help you do that if you have the courage to ask.


There are more photos from Owen County alumni listed at Classmates.com®. Click here to join Classmates.com® for free and share more OCHS pictures.
Share pictures of your Owen County High School experiences here. You can also relive memories and check out what other images alumni have posted. Click here to upload your own photos.
Don't forget to upload your Owen County High School pictures and check on the latest info about any Owen County High School reunion.


The Japanese Bobtail is a breed of cat which is known for its short tail, which looks like the tail of a rabbit. It was originally from Japan and Southeast Asia, though it is now bred all over the world.
On Catisserie, Japanese bobtails can breed with any other cat from the Yes Class.


This poly cotton polo is a new item for 2015 from Gildan which has a fabrication of 65% Polyester, 35% Ringspun cotton - The GSM is also heavy make it ideal for detailed logo works. The material is White 200gsm, Colours 207gsm making it ideal work wear clothing. We have a wide range of sizes on offer which include S, M, L, XL, 2XL, 3XL (36"", 38/40"", 40/42"", 42/44"", 44/46"", 48/50"") "


Post-apocalyptic atmosphere arise huge interest lately. Its bigger and bigger popularity results from the thrill, insecurity, and adrenaline, which are its inseparable elements. Because of that, the authors of books, comics, films, or even video games reach for post-apocalyptic topics. The crafting game sZone Online combines FPS elements (which is first person shooter) and MMORPG (massive multiplayer online role playing game, which is an RPG type of game, where you can play in virtual world with multiple people). The game was inspired by the popular post-apocalyptic cycle S.T.A.L.K.E.R. The game is also called "STALKER Online" or "S.T.A.L.K.E.R. Online". Release date: December 29, 2015. Available only on Microsoft Windows PC.
What is this (FPP) game all about? Initially, the players create avatars from the scratch, and then they move to dangerous Zones, where you can find numerous dangerous and horrifying mutants, very precious artefacts, and terrifying anomalies. Get sZone Online Download and join today to the MMOFPS game!
The game sZone Online (TPP) is inspired by post-apocalyptic shooters like Stalker. They were developed by Ukrainian studio GSC World. The action takes place in alternative reality, luckily for us. Here, the Chernobyl disaster began the series of terrifying anomalies unknown to the scientists. They change areas covered by them in so-called Zones. Almost no one is going over there, because there are no basic rights of physics in there, and everything that lives begins to mutate in horrifying and sometimes disgusting creatures. At the same time; however, you can find artefacts so needed for the scientists and human kind. Because of that, zones are visited by those, who want to find above-mentioned artefacts for their own purposes or for the welfare of the whole world. The players personate such stalkers. Get sZone Online Download and embark on a dangerous journey into unknown world full of danger!
The whole gameplay begins from creating our own character. Everything can be customized the way our taste and needs tell us. Everything is possible thanks to easy in use and clear editor. What's more, in sZone Online there is a special mechanism that simulate natural changes in virtual world. It makes the game even more realistic because everything changes. Therefore, locations of anomalies and mutants constantly change. Download sZone Online and start fulfilling subsequent missions and tasks delivered by the authors of the sandbox game.
We can fight with the adversaries controlled by artificial intelligence or our own colleagues. Everything depends from our own settings. We can create necessary items and trade with other heroes. We can cooperate with other stalkers, create teams and set our own bases. In the co-op game there is a lot of fighting and the possibilities of exploring the unknown world by using talents and skills of our hero.
The multiplayer game sZone Online was made based on BigWorld Engine, which was created from the scratch by Cybertime Systems studio. They applied new technology but the authors managed to present the cult climate of S.T.A.L.K.E.R. cycle.
Processor: Intel® Core™ i5-3330 3.0 GHz or better.
Graphics: 2 GB NVIDIA® GeForce® GTX 660 or better.
Operating system: Windows® 10 (64-bit).
Disk space: 9 GB HDD.
Worked great, very fast download indeed.


This substantial 2007 (a blend of 60% Cabernet Sauvignon and 40% Merlot) exhibits a deep ruby/purple-tinged color along with a big, sweet kiss of licorice, forest floor, tobacco leaf, black currants, and cherries. It possesses a lovely texture, a round, ample mouthfeel, sweet tannin, and low acidity. It is drinking well now, and should continue to evolve for a decade or more.


text:
IFCs must focus on new markets
International financial centres must target new markets, such as those in Latin America, if they are to survive in an increasingly regulated environment, says Bahamas Financial Services Board chief executive officer Aliya Allen.
International financial centres (IFCs) must concentrate on innovative products, foster creativity in the financial services industry and target new markets if they are to survive in an increasingly regulated environment, says Bahamas Financial Services Board (BFSB) chief executive officer Aliya Allen.
Speaking at the 3rd Caribbean Conference on the International Financial Services Sector yesterday, Allen told participants that a greater burden of compliance has put pressure on IFCs since the financial crisis of 2008 and offshore jurisdictions such as The Bahamas need to be strategic in how they attract, and cater to, new business.
"Going forward, small Caribbean states will have to demonstrate their nimbleness, their stability, their human capital [and] their expertise," she said, adding that savvy centres were looking to capture new markets such as Latin America.
"The world's eyes are shifting towards Latin America," she said. "There are enormous opportunities. We are seeing a lot of business coming from Brazil and Mexico. You cannot deny the economic strength and opportunities in the Americas."
Allen said that The Bahamas has already seen a lot of interest from Latin American clients in its wealth management products, particularly in SMART Funds, which have experienced a 25 per cent growth in the last year, and said that the industry was committed to accessing new markets "in a very focused and dedicated way."
She said creative new ideas such as SMART Funds arose from the industry and emphasized the importance of fostering creativity within the sector.
The BFSB head was part of a panel discussing how IFCs could compete by accessing new markets and developing new products. She said The Bahamas is exploring many avenues for the future including fund administration, asset management, developing an arbitration centre and fulfilling Freeport's potential as a logistics hub.
The conference took place March 31-April 2 and was held at the British Colonial Hilton, Nassau. Prime Minister Perry Christie delivered the keynote address and delegates also heard from Minister for Financial Services Ryan Pinder. The event was sponsored by the Caribbean Export Development Agency and welcomed attendees from across the region.
cmorris@dupuch.com
BFSB targets Swiss, LatAm markets
Allen: Innovation key to tapping LatAm
BFSB puts The Bahamas on the map
Spearheading change
Bahamas sets sights on LatAm with ICON
Latin America drives demand in funds sector
Finance Ministry eyes the Americas
BFSB set to stage events in Brazil
Roadmap for financial services
BFSB announces 2016 marketing initiatives
Speaking at the opening ceremony for the 3rd Caribbean Conference on The International Financial Services Sector March 31, Prime Minister Perry Christie said that the success of the financial services sector depended on innovative products and development of human resources.
The monopoly on cellular phone services enjoyed by Bahamas Telecommunications Co has come to an end, with the market being liberalized yesterday. Watch a ZNS Network news report here.
PM urges creativity, innovation in FS sector
Bahamas prepares for liberalization of cell market – video

redpajama_set_name: RedPajamaCommonCrawl


Ahli Capital Investment Company is a Kuwaiti Shareholding Closed Company (K.S.C.C) founded in 2006. The current capital is KD 18,000,000. The Company is under the supervision of Kuwait Capital Markets Authority.
Ahli Capital Investment Company provides a wide range of financial services which include asset management, fund management, portfolio solutions, investment banking, custody services and advisory services.
The Company has wealth management solutions which serve high net worth individuals and institutions to help build, preserve and manage wealth effectively.


The last of the demolition of the old Royal Akarana Yacht Club building has now come down.
The a-frame exterior wall of the Hyundai M-Class Lounge was the last piece of the building to be pulled down by the digger on Tuesday morning the 4th April at 0930 hours.
The site will now be cleaned up with all the rubble taken offsite.
The next important date on the construction calendar is the "turning of the sod" ceremony on Wednesday 12th April from 1500 hours. Members are invited to attend this event and are asked to RSVP to ensure we have enough catering.


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Q: In Recyclerview projects Mainactivity create object of url, Adapter parse load Url in default browser. Try to in WebView? there is Images, Names and URL object in MainActivity code which is view in recycler item:
  protected void onCreate(Bundle savedInstanceState) {
        super.onCreate(savedInstanceState);
        setContentView(R.layout.activity_main);

        toolbar = findViewById(R.id.toolbar);
        toolbar.setTitle(getResources().getString(R.string.app_name));
        recyclerView = findViewById(R.id.recyclerView);

        images = new int[]{R.drawable.google, R.drawable.facebook,
                R.drawable.gaana, R.drawable.youtube, R.drawable.oracle,
                R.drawable.wikipedia};

        webNames = new String[]{"Google", "Gacebook", "Gaana",
                "YouTube", "Oracle", "Wikipedia"};

        webUrl = new String[]{"https://www.google.com.",
                "https://www.facebook.com",
                "https://www.gaana.com",
                "https://www.youtube.com",
                "https://www.oracle.com",
                "https://www.wikipedia.org"};

Adapter which hold Image, Name and Url which parse to recyclerview items and  by onClicklistener it load in default browser:
 @Override
    public void onBindViewHolder(final PlaceViewHolder holder, int position) {
        holder.webName.setText(webNames[position]);
        holder.wIcon.setImageResource(images[position]);

        holder.wIcon.setOnClickListener(new View.OnClickListener() {
            @Override
            public void onClick(View view) {

                  Intent intent = new Intent(context, WebPage.class);
                  intent.putExtra("webUrl", webUrl.toString());
//                Intent intent = new Intent(Intent.ACTION_VIEW);
//                intent.setData(Uri.parse(placeGuide[holder.getAdapterPosition()]));
                  context.startActivity(intent);
            }
        });
}

try to load url in webview:

    @Override
    protected void onCreate(Bundle savedInstanceState) {
        super.onCreate(savedInstanceState);
        setContentView(R.layout.activity_web_page);
        WebView webView = findViewById(R.id.weView);

        webView.getSettings().setJavaScriptEnabled(true);
        Bundle bundle = getIntent().getExtras();
        webView.loadUrl(bundle.getString("webUrl"));
    }

i want to load Url in Webview

A: RecycleView
Intent intent = new Intent(context, WebPage.class);
intent.putExtra("webUrl", webUrl[position]);
context.startActivity(intent);

Another Activity
Intent intent=getIntent();
String url=intent.getStringExtra("webUrl");
webView.loadUrl(url);

A: Replace webUrl.toString() in RecyclerViewAdapter to webUrl[position], everything will be ok.

redpajama_set_name: RedPajamaStackExchange


Tom and Jerry was produced by Rembrandt Films in 1960 in Eastern Europe. The production of the carton would eventually make its way back to the United States, in Hollywood. Sib-Tower 12 Productions handled production duties beginning in 1963. That would last for about 4 years, between the years of 1963 and 1967.
The Tom and Jerry series kept resurfacing throughout the decades of the 1980s, 80s and 90s. A movie was even produced in 1992. Tom and Jerry: The Mansion Cat, was released as a television short and aired in 2001. Tom and Jerry Kids, aired in 1990, and lasted until 1994. Younger versions of Tom and Jerry, Spike and Tyke and Droopy and Dripple were the show's primary characters.
Fans of the series were able to purchase a total of 30 shorts when the Tom and Jerry Deluxe Anniversary was released in 2011 to celebrate the cartoon's 70th anniversary. In 2009, the Tom and Jerry: The Chuck Jones Collection was released. It featured two DVD discs and 34 cartoons, along with two documentaries.
Time Warner currently owns the rights to the iconic cartoon, via their Turner Entertainment division. Warner Brothers takes care of the cartoon's distribution. Several spins offs have been produced via Turner Entertainment, amongst them, Tom and Jerry Tales.
UPDATE: Tom and jerry are still the best pals. Check out the latest episodes in 'tom and jerry show'.


Robyn and Ernie Kouros opened Regina's first Carl's Jr. location this month. Prairie Sign (Electra Sign's Saskatchewan branch) was pleased to work Robyn and Ernie and help with their branding awareness of the new location at 1920 Victoria Ave E Regina SK. This sign package features internally and environmentally friendly LED (light-emitting diode) creating a small ECO friendly footprint for there new location. It was very important that the signs be clean and readable to capture attention.
As consumers, we live in an age where an abundance of options are available for just about everything we buy. Most people would assume that quality and durability are a given no matter their choice; after all, why would anyone invest in the infrastructure to manufacture a product for a short term gain? It is probably a safe assumption that quality and durability exist for regulated products such as automobiles, or home appliances. But when it comes to a product that is custom manufactured, unless there is a very detailed specification provided from a reliable third party, you are at the mercy of the manufacturer's integrity.
Electra Sign was involved in tendering a large Winnipeg project that was very light on third party specification. There were a number of important points for us to consider while estimating the cost of this project.
1. There was a great degree of potential public liability so as always we took a very responsible approach to the products design.
2. The project was at such an extreme height that the design and the components used needed to not only minimize the need for service, but also economically accommodate service should the need arise.
Unfortunately we lost the tender to another Manitoba manufacturer by what the General Contractor deemed to be a significant price spread. The origin of this spread would soon become apparent. The installed sign did manage to weather the duration of the specified warranty period (despite some very obvious shortcomings on the lighting design). However, just over the two year mark the signs were removed, presumably as a consequence of structural failure.
Putting aside the missing sign's effect on branding, if the purchasers of the sign had saved $100k two years ago on their overall purchase price, the question is, would they have made enough of a return on their initial saving in those two years to pay for a $400K replacement?


All Hail the Power of Jesus' Name!
https://www.andrewremillard.com/wp-content/uploads/2014/02/cropped-blog-pic-2-300x98.jpg 0 0 Andrew https://www.andrewremillard.com/wp-content/uploads/2014/02/cropped-blog-pic-2-300x98.jpg Andrew2018-01-09 06:00:202018-05-24 10:09:47All Hail the Power of Jesus' Name!
3,000,000 YouTube Views and an Exciting Discovery!
https://www.andrewremillard.com/wp-content/uploads/2014/02/cropped-blog-pic-2-300x98.jpg 0 0 Andrew https://www.andrewremillard.com/wp-content/uploads/2014/02/cropped-blog-pic-2-300x98.jpg Andrew2017-12-27 11:42:272018-05-30 08:00:483,000,000 YouTube Views and an Exciting Discovery!


A few words on the man portrayed in Kill the Messenger.
All Gary Webb ever wanted to do was journalism, and be the kind of journalist we tell ourselves is essential for a free and democratic system to remain free and democratic. When he was a journalist, he was a man of great purpose. You could see it in the way he walked and in his wizened smile, but mostly you could hear it in his voice. You don't want to tangle with a man of great purpose when he is on to an important story, because this is what gives his life meaning. He certainly doesn't commit himself to journalism for the money, but rather for some quaint notion of informing the public and doing good. But then, when Webb's greatest story—a 12,000-word landmark series for the San Jose Mercury News called "Dark Alliance," about the CIA's complicity in the early years of the crack-cocaine trade—was destroyed by other journalists at powerful newspapers who were acting as handmaidens of the CIA and his own editors genuflected before official power, he was ruined. No longer able to do that which gave his life purpose, his marriage on the rocks, his house lost, he conceded to his despair at this bitter abandonment by journalism itself and shot himself in the head.
And, of course, Webb's reporting about the CIA was correct, and the stories he wrote were true. Gary Webb was right.
The new film Kill the Messenger tells the shameful epic of what happened to Webb. Played masterfully by a swaggering Jeremy Renner, he comes to life as something we seldom saw before Webb and may never see again: the journalist as hero. Renner has Webb laughing in disbelief after his reporting turns controversial and his editorial meetings are dominated not by editors but by corporate executives who see it as their business not to take a principled position and defend the prerogatives of journalism against the most powerful entities in the world, but rather to cut their losses and distance themselves from Webb, utterly discrediting him. It is Oliver Platt as Jerry Ceppos, Webb's cowardly editor, who delivers the coup de grâce. Kill the Messenger is not a great movie, but it is a necessary one. And, having known and worked with Webb, I consider it easy to overlook its flaws of storytelling out of sheer gratitude for its existence. Ten years ago, when alone he gave up, it seemed that the work of the cowards might be the last word on this terribly slandered investigative reporter. That a Hollywood movie with a stellar cast now serves as a monument to Webb and all that he lived for, standing to confound and dishonor the liars who destroyed him, counts as a small miracle.
There is one small but crucial flaw that I must make note of, however. At the film's end (at least in the early version I saw), a series of supertitles appears on the screen to resolve the story, and the last of these reads that after he was fired by his newspaper, "Gary Webb never returned to journalism." That is not true. Gary Webb did return to journalism. He wrote for this magazine ("Driving While Black"), and we were proud to call him a colleague.


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Shake it up in 2015
By Dan Malovany
Product diversity — not necessarily new products — is one of the trends for 2015, according to bakers and snack producers who participated in Baking & Snack's annual capital spending report, to be published in February. That's partly because retailers and food service operators want bakers and snack manufacturers to shake it up with limited-time offers that create excitement among shoppers.
"When it comes to consumer-driven trends, increasing diversity is the name of the game among retailers and consumers," said David Hays, owner, Bodacious Foods.
Specifically, offering products with new ingredient combinations prompts interest as retail and food service customers respond to a more diversified consumer base. Consumers, especially younger ones, tend to get bored with the same-old items offered by many food companies.
"Millennials want broader choices to mix things up," said Gerard Law, senior vice-president and assistant to the president for J&J Snack Foods. "If you try to respond quickly, you end up with more s.k.u.s (stock-keeping units)."
On the other hand, Michael Girkout, president and chief executive officer of Alvarado Street Bakery, suggested that consumers are looking for sprouted-grain bread and baked goods made with what he preferred to call "alternative grains." Many talked about non-bioengineered foods as gaining in popularity, but the movement is still at the niche level.
"G.M.O.-free products have started to draw some attention among certain consumers, but current logistics makes it very difficult to achieve certification with flour-based products," said Scott Kolinski, president and c.e.o., Lantmännen-Unibake USA.
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On June 21st, 2016 the FAA provided a new regulatory guide for small unmanned aerial systems. FAA Part 107. The FAA requires you to be certified to operate commercially. So our very own Ty Dodge, Professional Land Surveyor, for WI and MN can say he is FAA Part 107 certified!
Auth Consulting & Associates has always prided itself on keeping up with technology within the industry and providing their customers with great service. So it makes sense that AC/a would take the next step and add a drone to the team. AC/a bought its first Phantom 4 drone at the end of the year.
AC/a will now be able to offer detailed high resolution aerial photos to assist with collecting data for topographic surveys, site planning, and site design to name a few things. Also there are the added benefits of reduced time in the field and additional safety for our AC/a employees.
We look forward to using this technology on your next project.


NGOs are part of a system where accountability is relatively poor and the chances of misuse of funds can be high in some situation. A few such misuses or frauds can give the sector a bad name. There is a need for enhancement of Credibility of voluntary sector.
The voluntary sector in India plays a vital role in society. Due to the substantial increase in numbers in recent years, doubts have been expressed on the credibility of certain organisations, which then can affect the credibility of the whole sector. The corporate sector derives its legitimacy from well-defined corporate law, regulatory bodies, and easily measurable "bottom line" goals. The Government is accountable to people through the democratic process. The voluntary sector is not organised and the regulatory mechanisms in place do not adequately provide us the opportunity to enhance our credibility. A self-regulatory framework, built by us from WITHIN the sector that allows for the establishment of Norms, their promotion and adoption, and ultimately certification that organisations meet these Norms, would strengthen and enhance the credibility of the voluntary sector. It would increase its transparency and accountability. It would also pre-empt the imposition of a framework from outside.
Credibility implies confidence amongst the public and community we serve that an organisation is working towards its objectives. While there are several ways to enhance the credibility of an organisation, STAPI aims to enhance the credibility of the voluntary sector through promoting 'Norms' of good governance and by building capacities of organisations to comply. These Norms pertain to an organisation's identify; vision/aims and objectives/achievements; operations; governance; transparency and accountability. Compliance to the Norms is voluntary, because the underlying principle is one of self-regulation.


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The year 1970 brought about the Occupational Safety and Health Act (OSHA). Union support was instrumental in the passing of this law. Things still looked good for the first couple of years. Then President Nixon was elected into office and things took a turn for the worse. Difficult economic conditions prevailed for many working people in our nation, including the Pipefitters of Local 455. The Prairie Island Plant was still under construction.


Today, we're kicking it off with one of my wonderful fellow Sweet Sixteeners: Sarah Glenn Marsh writes young adult novels and children's picture books. An avid fantasy reader from the day her dad handed her a copy of The Hobbit and promised it would change her life, she's been making up words and worlds ever since. She lives in Virginia with her husband and four rescued greyhounds. When she's not writing, she's most often engaged in pursuits of the nerd variety, from video games to tabletop adventures and dungeon crawls. Her work is represented by Christa Heschke of McIntosh and Otis, and her debut YA historical fantasy, FEAR THE DROWNING DEEP, debuts from Sky Pony in September of 2016. Visit her online at www.sarahglennmarsh.com, and say hi to her on Twitter here.
I'll start with the first words that sprang to mind: as an author.
I'm an adoring wife and rescue dog mom, a lover of all things nerdy, and a painter. I'm of French, English, Irish, and Scandinavian heritage, and as someone who's very interested in genealogy, all of those places and people are important to me.
I smile a ton. I'm a friend. An animal advocate. A feminist.
…and I also have an autoimmune disease called type 1 diabetes.
2. What did it feel like growing up with type 1 diabetes?
I wasn't diagnosed until age 19. However, my younger sister was diagnosed at age 5, so I'd grown up around type 1 (previously known as juvenile diabetes).
Unfortunately, I also knew that life would now involve one of my greatest fears: needles. A type 1 diabetic's pancreas doesn't produce any insulin. This means that each time I eat a meal, and even in-between meals, I need insulin to keep my blood sugar from rising to dangerous levels.
I was lucky in a way, because I didn't have to deal with 6+ shots a day for long. My parents were quick to help me get an insulin pump, which is basically an artificial pancreas (it looks a lot like a cell phone!). The insulin pump is attached to me through a tiny piece of bendable plastic inserted into my stomach. I have to change out this plastic every three days, which involves—you guessed it—a big freaking needle.
Honestly, overcoming my fear of needles is an ongoing process even eight years post-diagnosis; my hands still shake and my mouth gets dry each time I use them.
Going through college with type 1 diabetes also felt isolating at times, as people tend to associate food with good times, and I suddenly associated it with pain and counting carbohydrates to know how much insulin I'd need. Many people I've interacted with outside my family aren't familiar with type 1, which has led to misconceptions that embarrassed me. Also, I didn't feel much like going to meals with friends anymore: At first, it meant having to run to the bathroom to take an injection. And after I got my insulin pump, it meant having to pull the phone-like device out of the garter I wear it in and explain that no, I'm not rudely texting. I'm taking medicine so I can enjoy this meal like anyone else.
Plus, knowing how many people share my dislike of blood and/or my fear of needles, I worried that I might make someone uncomfortable by doing things that are necessary for my survival, like checking my blood sugar or taking insulin in public.
Challenge #1: It's exhausting. Type 1 diabetes never takes a vacation. I have to monitor my blood sugar every day, multiple times a day to maintain control. (Note: that this is just my experience. Some type 1 diabetics, like my sister, don't have to check their sugar as often because they're more capable of feeling when their sugar is trending too high or low).
Challenge #2: The awkwardness of being attached to the insulin pump. Especially when it came to sexytimes with my now-husband, as having to be careful of the insulin pump's easily tangled plastic tubing was (and still is) far from hot. Also, getting that tubing caught on doorknobs? Not good. Not good.
Challenge #3: Eating! I try to eat a diet that's low in carbohydrates so I won't have to take as much insulin at mealtimes. (Though I still enjoy the occasional doughnut like the next girl, I can't eat nearly as much of anything sweet as I'd prefer!).
Challenge #4: The pain and uncertainty. High and low blood sugars don't happen with much predictability, at least not for me. A low blood sugar makes me shaky, and forces me to sit down and eat something. High blood sugar gives me headaches and bad moods. One or both of these things happens at least once in a given day for me. Both highs and lows can trigger anxiety, too.
A perk: Living with type 1 has helped me to eat healthier. All my meals are portioned, as I have to count carbs, and I don't consume a lot of sugar, which for me means no weight gain! And because being a type 1 means extra doctor visits, I'd like to think it makes me pay closer attention to my health overall.
Another slight perk: Regularly facing my fear of needles made me realize I'm capable of handling other difficult and uncomfortable situations as well.
4. What do you wish people knew about living with type 1 diabetes?
-That just because I don't look sick doesn't mean I'm not. High and low blood sugars have many unpleasant symptoms, but to an observer, I appear 'fine' even while my disease is waging war with me.
-That how type 1 affects the body varies by person, so my experience is unique to me. And this can make it an isolating disease (even if you have a cool sibling who also wears an insulin pump!).
-Type 1 diabetes is an autoimmune disease, so as with many autoimmune conditions, I'm more prone to catching anything contagious and I take longer to heal from injuries.
Often times, people assume I got diabetes by eating too much sugar or gaining weight. To clarify: no matter how much weight I lose, this disease will never go away. Type 1 is caused by a virus, or so researchers think, that causes the body to attack its own immune system and shut down the pancreas. Type 1 diabetics make up a very small portion of the total diabetics in America, which leads to confusion between type 1 and type 2, which is far more common. Only about 1.25 million Americans have type 1, while some 27 million have type 2.
Another stereotype I've come across is people assuming I'll die early. I've actually been told things like, "Oh, my grandma had diabetes. She died!" Modern medicine is awesome, and I may well live just as long as the lovely people reading this post! Please, please, please don't share your horror stories about diabetes from years before medical advancements. I know you're just trying to relate, but it does more harm than good.
Remember, it's so important for readers to see themselves reflected in the fiction they enjoy. I wish that, back when I was diagnosed, I'd have come across even a minor book character with type 1 so I could have felt less alone, acknowledged.
And of course, in addition to research, be sure you talk to people who actually embody the diversity you're trying to portray on the page!


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Trump's Victory Buoying White Nationalists, Anti-Discrimination Advocates Say
MORGAN WINSOR
A Ku Klux Klan group's plan to parade openly in celebration of Donald Trump's election as president is reinforcing concern among anti-discrimination activists that the Republican's victory is buoying hate groups and white nationalist movements in the U.S.
The Loyal White Knights of the KKK says on its website that its "Victory Klavalkade Klan Parade" will take place on Dec. 3 in North Carolina. The words "TRUMP = TRUMP'S RACE UNITED MY PEOPLE" are also seen above an image of Trump on the group's website.
No specific time or location is listed for the event, though the Loyal White Knights is based in Pelham, North Carolina, a small unincorporated community near the Virginia border. The group did not immediately respond to ABC News' requests on Friday for comment and more information about the parade.
The organization asserts on its website that it is not a "hate group."
The Anti-Defamation League calls the Loyal White Knights "perhaps the most active Klan group in the United States today." In 2015, it had about 150 to 200 members and was able to draw attention to itself in 15 different states, typically through posting fliers, according to a report by the Anti-Defamation League.
"The fact that the KKK feels comfortable enough to march in the streets in support of our president is a troubling development," said Ryan Lenz, senior writer and editor of the Southern Poverty Law Center's Hatewatch blog, which monitors extremists and hate groups.
An Anti-Defamation League director said that although the Klan has always held public events this one would be different.
"It's not uncommon for a Klan group to actually hold a rally. What's uncommon is for a Klan group to hold a rally in support of the president of the United States," said Oren Segal, director of the Anti-Defamation League's Center on Extremism. "Many white supremacist groups, alt-right groups, militia groups very much were emboldened by Trump's campaign, whether he intended to or not."
David Duke, a former "grand wizard" of the KKK who ran for U.S. Senate in Louisiana, supported Trump, tweeting after the election that "our people played a HUGE role in electing Trump!"
Trump has several times disavowed Duke.
The Republican's presidential bid also won support from a prominent KKK newspaper, The Crusader, which used Trump's campaign slogan "Make America Great Again" as its headline for an editorial in October lauding both the motto and the candidate. The newspaper, which bills itself as "the premier voice of the white resistance," didn't specifically endorse Trump, however.
The Trump campaign responded to the editorial with a Nov. 2 statement that "Mr. Trump and the campaign denounce hate in any form ... This publication is repulsive and their views do not represent the tens of millions of Americans who are uniting behind our campaign."
ABC News reached out to Trump's campaign for comment for this story, but did not immediately receive a response.
Teachers Across the Country Use Donald Trump's Victory as a 'Teachable Moment'
RNC Chairman Reince Priebus Advises Anti-Trump Protesters to 'Take a Deep Breath'
Trump's win in the presidential race was similarly cheered by Andrew Anglin, founder of the Daily Stormer website which both the Anti-Defamation League and the Southern Poverty Law Center have labeled as neo-Nazi.
"Our Glorious Leader has ascended to God Emperor. Make no mistake about it: we did this. If it were not for us, it wouldn't have been possible," Anglin wrote on the site. "The battle is far from over. Much, much, much work to be done. But the White race is back in the game. And if we're playing, no one can beat us. The winning is not going to stop."
Any resurgence in white nationalist groups may have started before Trump's presidential campaign.
A study published in September from a fellow with George Washington University's Program on Extremism found that U.S. white nationalist groups saw their followers on Twitter grow by more than 600 percent since 2012, outperforming the increase in followers for ISIS. One possible factor for the size difference between the two groups of followers may be the frequency with which ISIS accounts were suspended on Twitter during this period, owing to reports against ISIS-linked content and efforts to drive its supporters off the platform, the study said.
The researchers also found that followers of white nationalists on Twitter were "heavily invested" in Trump's presidential campaign.
Michelle Obama wears purple at inauguration in show of unity
What happens inside the White House on Inauguration Day
As the world celebrates the swearing in of Joe Biden and Kamala Harris, a highly-orchestrated transfer of power is also taking place behind the scenes at the White House. There, dozens of White House residence staff are quickly transforming the White House to the Biden's family liking by the time they return Wednesday evening as president and first lady. "There's a moving van that is positioned in one direction to take the belongings of the outgoing president and first family to leave the White House," Anita McBride, who served as chief of staff to first lady Laura Bush, told "Good Morning America" four years ago, when Donald Trump was entering office.


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Can Hampshire make it a double? CB40 semi-finals preview
by Ben Winstanley
Another Saturday, another day of knock-out cricket. After last week's Friends Life t20 jamboree, we have the two semi-finals in the Clydesdale Bank 40.…
Sussex v Hampshire
Hampshire travel to Hove after their triumphant visit to Cardiff last week in position to make it a great season in all three forms of the game. They're well in the hunt for promotion back to the top flight of the Championship and already have one trophy in the bag.
We saw last week (and, indeed over the last few years) how important slower bowling is becoming to success in limited-overs cricket. Somerset were the only side of the four at finals day not to open their bowling with spin and saw their defence of a below-par total never get off the ground. Good balls can - and, for Alfonso Thomas last week, did - go through gaps in the slips; it doesn't matter in four-dayers but put pace on the ball and a batsman's chances of streaky boundaries are increased. Hampshire showed how spin in tandem can be effective, and expect Danny Briggs and Liam Dawson, to get through plenty of overs.
Class act: Michael Carberry
Dawson has not taken many wickets in the CB40 this year but his economy rate - 4.65 - is excellent, and Briggs has taken more wickets - 17 at 22 - and goes at just under five runs an over. Michael Carberry and James Vince have been the stars with the bat; Carberry's hit nearly 500 runs in just seven innings and Vince, an everpresent during the group stage, averages 60.
Sussex lost to Yorkshire in last week's semi-final, their batsman stifled by both spin and pace as they chased what proved to be the highest total of the day. They went top of their group with a comfortable win over then-leaders Kent on Bank Holiday Monday with Luke Wright hitting 101 off 90 balls and Matt Prior, in his first CB40 game of the season, an unbeaten 78. They should play a big role again tomorrow.
Useful with bat and ball: Michael Yardy
Sussex are one of the best fielding sides in the game and their effort in that regard helped limit Kent to a below-par total. Steve Magoffin may play tomorrow - the Kent match was his first in the competition - and Chris Liddle will shoulder some of the pace-bowling responsibilities. They're not short on spin options: Michael Yardy, Will Beer and Monty Panesar all go at fewer than five runs an over, Yardy the pick at 4.15. They may not play all three of them tomorrow - Panesar the most likely to miss out - but they have a formidable side from top to bottom.
Lancashire v Warwickshire
Last year's county champions look almost certain to be relegated after a rain-sodden few weeks have put paid to their chances of salvaging some terrible early displays with the bat. They need to beat Middlesex and Surrey in their final two games to have a chance of staying up but this competition has offered a welcome distraction from their four-day troubles. They are, in many ways, a very strong one-day side. They've as good as cornered the spin market with Gary Keedy, Simon Kerrigan and one-day specialist Steven Parry in recent years and Steven Croft can switch to off-spin if the mood dictates.
Still got it: Glen Chapple
Croft is one of the key men with the bat- averaging amost 62 in 12 innings - along with opener Steven Moore, whose poor form in the Championship has seen him dropped yet hasn't affected his one-day displays. Then there's Tom Smith, who, in only his third CB40 match in an injury-hit season, blasted a 44-ball ton against Worcestershire this week as Lancs racked up more than 320 in 37 overs. If you let them get going, they can punish you. Ajmal Shahzad can be expensive or brilliant but will almost certainly take wickets and Glen Chapple rarely disappoints with the ball. Add Parry and Keedy and there's a very strong one-day side; indeed they qualified with ease, shrugging off a one-wicket defeat in the Netherlands to go top of the group with 9 wins and an abandonment from 12.
Warwickshire look good for the Championships title with two matches to go and are obviously in a good position for a fine double. Varun Chopra, with an average of 48 over nine innings, is one of their main dangerman with the bat and Will Porterfield has also hit plenty of runs this season. Rikki Clarke and Darren Maddy are a good bet for useful runs late in the innings.
Good season: Varun Chopra
Chris Wright and Keith Barker provide the bowling firepower, along with seamer Chris Woakes who has been permitted to play by England after he was left out in favour of Jade Dernbach for yesterday's win over South Africa at The Oval. That news is an undoubted boost - he has taken 13 wickets in the competition this season at just 13, bowling each over at an average of 4.3 runs.
Follow Ben on Twitter: @Ben_Winstanley
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My amazing wife sometimes comments on the silliness of literary analysis from English class in high school. I recall her saying more than once that maybe the symbols are just what they are and not symbols at all. Perhaps it's just a story. So, this was all an effort to troll her by making the story all symbols.


There's no better way to kick off the spring season than with a special Rosè tasting with wines from around the world. Join us Thursday, May 17th from 6pm - 8pm at Hudson Bar to sample, savor and sip some of the seasons' best varietals. $25pp plus tax + gratuity.


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JAMA Dermatology
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Prevalence, Incidence, and Risk of Cancer in Patients With Psoriasis and Psoriatic Arthritis
Association of Indoor Tanning Regulations With Health and Economic Outcomes in North America and Europe
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Chronic Recurrent Lymphocytic Sweet Syndrome as a Predictive Marker of Myelodysplasia: A Report of 9 Cases
Marie-Dominique Vignon-Pennamen, MD; Caroline Juillard, MD; Michel Rybojad, MD; et al Daniel Wallach, MD; Marie-Thérèse Daniel, MD; Patrice Morel, MD; Olivier Verola, MD; Anne Janin, MD, PhD
Author Affiliations: Departments of Dermatology (Drs Vignon-Pennamen, Juillard, Rybojad, and Morel), Biological Hematology (Dr Daniel), and Pathology and U728 INSERM (Institut National de la Santé et de la Recherche Médicale), University Paris VII, University Institute of Hematology, Institut Français de Recherche 105 (Drs Vignon-Pennamen, Verola, and Janin), Hôpital Saint-Louis; and Department of Dermatology, Hôpital Tarnier-Cochin (Dr Wallach); Assistance Publique–Hôpitaux de Paris, Paris, France.
Arch Dermatol. 2006;142(9):1170-1176. doi:10.1001/archderm.142.9.1170
Background Sweet syndrome is an acute neutrophilic dermatosis that occurs with malignant diseases, mainly myeloid hemopathies, in about 20% of cases. When associated with myelodysplasia, Sweet syndrome may be clinically atypical. It can be histologically unusual. Concomitant infiltration of mature neutrophils and immature myeloid cells has been reported, and its significance is still debated. In few patients, lymphocytic infiltrates are the presenting feature of Sweet syndrome with myelodysplasia.
Observations We present 9 male adult patients with chronic Sweet syndrome, all with recurrent eruptions of erythematous and annular plaques that were associated with relapsing polychondritis in 4 of the 9 patients. Results from sequential biopsies showed that infiltrates were initially composed of lymphocytes and that neutrophilic dermal infiltration typical of Sweet syndrome occurred 24 to 96 months later, except in 2 cases. Moreover, atypical mononuclear cells were present on all initial biopsy specimens and strongly reacted to CD68 and myeloperoxidase, indicating a myeloid origin. Myelodysplastic syndrome occurred in all 9 patients, concomitantly with the neutrophilic infiltrate in 4 cases.
Conclusions Lymphocytic infiltrates with a clinical aspect of Sweet syndrome might represent the initial stage of a cutaneous dysgranulopoiesis syndrome and should lead to the research of atypical myeloid cells in skin infiltrate, blood, and bone marrow for the early detection of an associated myelodysplastic syndrome.
Sweet syndrome is a disorder characterized by tender erythematous plaques predominating on the face, neck, and upper limbs. Appearing mainly in women at mid-life, it is typically accompanied by fever and systemic symptoms including arthralgia, myalgia, and ocular involvement. Common laboratory abnormalities include leukocytosis and an elevated erythrocyte sedimentation rate.1-3 Histologically, an intense neutrophilic infiltrate of the mid and papillary dermis is associated with dermal edema. There may be leukocytoclasia but no evidence of vasculitis.3,4 Although the etiology is unknown, Sweet syndrome has been associated with a variety of autoimmune disorders and malignancies.5 About 20% of cases occur with malignant diseases, mainly myeloid hemopathies.6
The myelodysplastic syndromes constitute a broad spectrum of hematologic disorders in which the primary defect lies in the multipotent hematopoietic stem cell. Myelodysplastic syndromes are characterized by atypia of both the bone marrow and peripheral blood cells and pancytopenia, and they mainly affect older patients. They are classified in subgroups based on morphologic criteria, percentage of bone marrow myeloblasts, and cytogenetic and karyotypic abnormalities.7 Transformation into acute myelogenous leukemia occurs in 6% to 37% of patients with myelodysplastic syndrome.8 Sweet syndrome is commonly associated with myelodysplastic syndrome.9,10 In these cases, necrotic aspects and the presence of immature myeloid cells are reported.11,12 Recently, 2 cases of Sweet syndrome associated with myelodysplasia have been reported, with lymphocytic infiltrates as the initial feature.13 Therefore, we revised the sequential clinical and histological data of 9 patients with Sweet syndrome associated with myelodysplasia.
Over a period of 10 years (1995-2005), 70 patients with cutaneous disease and myelodysplastic syndrome were followed up in Hôpital Saint-Louis, Paris, France. Nine of these patients had chronic Sweet syndrome. For these 9 patients, at the different times of follow-up, the distribution and occurrence of skin lesions, laboratory abnormalities, hematologic diagnosis, and treatment were reviewed (Table 1). Hematologic diagnoses were established on peripheral blood smears and bone marrow aspiration and then were subclassified according to the French-American-British (FAB) classification scheme.7 For each patient, 3 to 7 skin biopsies had been performed. On these sequential biopsies, the analysis focused on the distribution of the infiltrates and their density. Cytological composition of the infiltrates was assessed, and their respective density in neutrophils, eosinophils, lymphocytes, macrophages, and atypical mononuclear cells was graded.
Clinical Findings and Course
For immunohistochemical studies, representative sections were examined by the streptavidin-biotin peroxidase method, using appropriate positive and negative controls. Slides were processed on the automated immunostainer Nexes (Ventana, Tucson, Ariz). The antibodies used, their specificity, their source, and dilution are given in Table 2.
Antibodies Used in This Study
The 9 patients were men aged 55 to 72 years (median age, 64.5 years). The clinical features were similar in all patients (Table 1). Clinical aspects of the recurrences were also similar over the course of their disease (Figure 1A and C), with multiple flares of edematous erythematous plaques over the face, trunk, and arms. On the trunk, plaques had an annular configuration with sharply marked borders. Some of them extended and became confluent. On the limbs, plaques and purple nodules were observed in 8 cases, with pustules on plaques in cases 3, 4, and 7. Three patients had purpuric papules with vasculitis (cases 1-3). All 9 patients had fever, with arthralgia in cases 3, 4, 8, and 9 or episcleritis in case 8. Findings from laboratory tests showed an elevated erythrocyte sedimentation rate (all patients), leukopenia (cases 2 and 6), and anemia (case 1). The diagnosis of Sweet syndrome was initially proposed on clinical grounds. After analysis of the first results of the skin biopsies, subacute lupus erythematosus and Jessner lymphocytic infiltration were also discussed. In all 9 cases, the lesions resolved spontaneously and recurred. The course of the disease was characterized by multiple relapses with progressively reduced normal intervals. Auricular and nasal chondritis appeared in 4 patients (cases 1, 3, 5, and 8) about 3 years after the onset of skin disease. The diagnosis of relapsing polychondritis was made on clinical grounds and confirmed by cartilage biopsy findings showing necrosis of chondrocytes and vasculitis. There were no systemic manifestations of relapsing polychondritis in our patients.
Clinical and histological aspects in "initial" lymphocytic Sweet syndrome (case 2: A and C) and in "late" neutrophilic Sweet syndrome (case 1: B and D). A, Disseminated erythematous plaques over the trunk and arms. B, Erythematous plaques with annular configuration. C, Dense lymphocytic infiltrates located in the superficial and middermis (hematoxylin-eosin, original magnification ×10). D, Massive dermal neutrophilic infiltrates without vasculitis (hematoxylin-eosin, original magnification ×20).
Though bone marrow aspiration was initially normal in 2 patients (cases 1 and 6), all patients developed leukopenia and/or anemia and macrocytosis when dermatosis relapsed. A myelodysplastic syndrome was finally diagnosed in all patients, 2 to 7 years after the onset of their skin symptoms (median, 3.5 years). The subtypes were refractory anemia (cases 2-5), refractory anemia with blasts excess (case 1), and unclassified myelodysplasia (cases 6-9).
Follow-up ranged from 3 to 10 years (median, 5.4 years). High-dose oral prednisone (60-80 mg/d) provided complete remission in all patients. However, the lesions worsened on tapering dosages, and 25 mg/d was necessary to control the disease. No significant benefit was obtained with hydroxychloroquine sulfate (200 mg twice a day), dapsone (100 mg/d), and colchicine (2 mg/d). Six patients were treated with thalidomide (100 mg/d for about 3 months), leading to complete resolution of cutaneous disease in 4 patients. On discontinuation of the medication for mental confusion, deep venous thrombosis, or thrombotic microangiopathy, skin lesions recurred in 3 other patients. In all 9 patients, the myelodysplastic syndrome was controlled by transfusions (3 patients) and erythropoietin therapy (1 patient). There was no progression to acute myeloid leukemia (median follow-up of 30 months). One patient was lost to follow-up, and 1 patient is alive and receiving oral prednisone (20 mg/d). The 7 other patients died from sepsis or vascular complications 3 to 48 months (median, 26.5 months) after myelodysplasia was diagnosed. The duration of cutaneous disease before patients died ranged from 3 to 9 years (median, 5.5 years).
Histological and immunohistochemical findings
Forty sequential skin biopsy specimens were reviewed. For each patient, 3 to 7 biopsies were performed from 3 to 54 months. Two histological patterns, lymphocytic and neutrophilic, were observed. A review of the patients' files showed that in 7 cases, the lymphocytic pattern preceded the neutrophilic pattern. These 2 patterns are accordingly named "initial" and "late" Sweet syndrome in our patients (Figure 1B and D). In the initial stage, 20 biopsy specimens from 7 patients (cases 1, 2, 4-6, 8, and 9) showed mononuclear infiltrates consistent with Jessner lymphocytic infiltrate, lupus erythematosus, or drug-related eruption. The infiltrates were moderate to dense, located in the superficial and deep dermis (Figure 2A and B). Superficial edema was observed in most of the cases and epidermis was spared. The infiltrates were composed predominantly of lymphocytes, histiocytes, and atypical mononuclear cells with large, eccentric, elongated, twisted, or kidney-shaped basophilic or vesicular nuclei and eosinophilic cytoplasm. These cells were located around blood vessels or dispersed in edema. Findings from immunohistochemical studies showed that atypical mononuclear cells were CD68 and myeloperoxidase positive (Figure 2C and D) and CD34 negative. CD56 was expressed by a few cells in 1 patient. The lymphocytes were mainly CD3 positive.
Histological features of "initial" Sweet syndrome (case 8). A, Perivascular mononuclear infiltrate; B, cells with a histiocytic appearance had kidney-shaped, twisted vesicular nuclei; C, strong immunoexpression for CD68; and D, immunoreactivity for myeloperoxidase (hematoxylin-eosin, original magnification ×40 [A], ×100 [B], ×20 [C], and ×20 [D]).
In 2 patients (cases 3 and 7), initial biopsy specimens diagnosed as dermal lymphocytic infiltration were not available for review. These patients were referred to one of us for evaluation of lupus erythematosus that did not respond to conventional therapy.
In the late stage, 16 sequential biopsy specimens from 7 patients (cases 1-4, 6, 7, and 9) were examined 2 to 8 years after the onset of disease and showed neutrophilic infiltrates consistent with the diagnosis of Sweet syndrome. The infiltrates were dense to massive, predominantly or exclusively composed of polymorphonuclear neutrophils in 3 cases (cases 3, 7, and 9) and associated with lymphocytes or histiocytes in the other cases. Superficial edema was observed, but there was no vasculitis. In 5 patients (cases 1, 4, 6, 7, and 9), medium-sized mononuclear atypical cells with eccentric, kidney-shaped nuclei, similar to cells observed in initial biopsy specimens, were also found (Figure 3), with the same immunohistochemical characteristics. In 2 patients (cases 5 and 8), no biopsies were performed in subsequent recurrences, and typical neutrophilic infiltrates were not observed.
Histological features of "late" Sweet syndrome (case 9). A, Neutrophilic infiltrates; B, immature granulocytes mixed with mature neutrophils (hematoxylin-eosin, original magnification ×40 [A] and ×100 [B]).
Vasculitis was observed in 3 patients (cases 1-3), with relapsing polychondritis in 2 of them. In 5 patients (cases 1, 2, 4, 6, and 9), "initial" lymphocytic and "late" neutrophilic patterns were observed. In these patients, the composition of the infiltrates and their respective density in lymphocytes, neutrophils, and atypical mononuclear cells were compared at the onset of skin disease and the onset of myelodysplasia (Figure 4), revealing that neutrophils were the predominating cells at the time of diagnosis of myelodysplasia.
Density of infiltrate is presented for each cell type as 4 categories according to the proportion of cells (A, lymphocytes; B, neutrophils; and C, atypical mononuclear cells) in the skin biopsy specimens (0, absence or negligible amount of cells; +, <10%; ++, 10%-50%; and +++, 50%-100%). Categories are represented on the vertical scale by the median value for each category, except for "+," which was placed at 10%. For each patient, T1 was the first biopsy performed at the onset of the skin disease; T2 was the biopsy performed at the time of diagnosis of myelodysplasia.
Sweet syndrome was described in 1964 by Robert Douglas Sweet2 as an "acute febrile neutrophilic dermatosis" with the following characteristics: pyrexia; neutrophilia; erythematous painful cutaneous plaques located on the upper extremities, head, and neck; a dense dermal infiltrate of neutrophils; and a prompt response to corticosteroid therapy. All 9 patients we studied had criteria proposed for the diagnosis of Sweet syndrome.14 They had both major criteria (clinical aspect of lesions and sequentially acquired neutrophilic infiltrate) and 3 minor criteria (fever, associated disease, and response to corticosteroid therapy). Sweet syndrome associated with myelodysplasia tended to be atypical. There is no sex predilection. Cutaneous lesions are more frequently vesicular, bullous, or even necrotic and ulcerative.11 It may lack systemic features such as neutrophilia or fever. Our series confirms most of the atypical features reported in Sweet syndrome associated with myelodysplasia. All of our cases were men. They had recurrent flares of a florid eruption with fever. Tender plaques with a dusky red center and well-defined, sharply demarcated borders were localized on the trunk. When cutaneous lesions appeared, some patients had leukopenia or anemia with macrocytosis. However, findings from bone marrow aspiration initially performed in 2 patients were normal. Four patients had relapsing polychondritis 1 to 4 years after the onset of cutaneous lesions at the time of diagnosis of myelodysplasia in 2 patients. Although unexplained, the association of relapsing polychondritis and myelodysplasia is considered significant.15 The only efficient treatment was corticosteroid therapy (prednisone), at 25 mg/d or more. Four patients had improvement with thalidomide therapy. Unfortunately, severe adverse effects were observed, and treatment was discontinued. The most important point was established by studying the results of sequential biopsies. In all 9 patients, the infiltrates were initially lymphocytic, and neutrophils were observed only after a mean of 4 years of evolution (range, 24-96 months). Lymphocytic infiltrates in the initial biopsy specimens were predominantly composed of T lymphocytes along with a CD68-positive monocytic population. In initial biopsy specimens, monocytic cells with kidney shape or vesicular nuclei and eosinophilic cytoplasm were observed, and the most striking finding was their strong reactivity for myeloperoxidase, a finding suggesting that these cells were immature myeloid cells, possibly precursors of neutrophils. In findings from sequential biopsies, 7 patients had neutrophilic infiltrates mixed with the same atypical mononuclear cells.
Sweet syndrome is associated with myelodysplastic syndromes or hematological malignancies in about 20% of cases.6 Sweet syndrome occurs at onset or follows a myelodysplasia9 and may herald a transformation into acute myeloid leukemia.16 The recurrence of Sweet syndrome may coincide with or precede a hematological relapse.6 No transformation into acute myeloid leukemia occurred in our cases. However, 7 of the 9 patients died in a follow-up period of 3 to 9 years, confirming the poor prognosis of Sweet syndrome associated with myelodysplasia.17
Interestingly, cutaneous lesions clinically characteristic of Sweet syndrome, but with lymphocytic infiltrate and atypical mononuclear myeloperoxidase-positive cells, preceded myelodysplasia in all 9 cases.
Four other cases (4 men aged 56 to 79 years) of atypical Sweet syndrome associated with myelodysplasia have been reported.13,18,19 Myelodysplastic syndrome occurred at the onset of cutaneous disease in 2 patients or followed it 3 years later in 1. Skin disease was clinically diagnosed as Sweet syndrome but was initially composed of lymphocytic infiltrates. With the recurrence of cutaneous lesions, dermal neutrophilic infiltrates were later found in 3 patients. In 2 cases, immunohistochemical staining of mononuclear infiltrates showed a mixed population of CD68+, CD4+, and CD8+ cells. No more characterization of cells was reported.
In a series of 37 patients with Sweet syndrome who had undergone sequential biopsies, the initial lymphocytic stage was followed by neutrophilic and then histiocytic infiltrates.20 Our findings confirm this view. However, an initial stage of lymphocytic infiltration preceding, for many years, neutrophilic infiltrates had never been recorded. Furthermore, in our patients, lymphocytes were accompanied with monocytic cells that strongly reacted to CD68 and myeloperoxidase.
Abundant histiocytes have already been reported in 2 series of 18 and 12 cases of Sweet syndrome.21,22 Unfortunately, myeloperoxidase expression was not studied.
In a recent series of 41 patients with Sweet syndrome, an immunoreactivity for CD15, CD45, CD68, and lysozyme was consistent with a monocytic-histiocytic profile.23 Moreover, intense myeloperoxidase reactivity was detected in the histiocytic cells. The authors ruled out the possibility of acute or chronic myelogenous leukemia. All patients were treated with oral prednisone or nonsteroidal anti-inflammatory drugs. The cutaneous lesions resolved within a few days and did not recur. The authors concluded that some acute lesions of Sweet syndrome included immature myeloid cells and proposed to name these forms "histiocytoid Sweet syndrome." This variant of Sweet syndrome, concerning patients with an acute, nonrelapsing disease, without predominantly lymphocytic infiltrates and without myeloid hemopathy, appears to be different from our cases.
In our 9 cases, the concomitant presence of immature myeloid cells and mature polymorphonuclear neutrophils within the same lesion has already been reported.12,24,25 The significance of this population of immature neutrophilic granulocytes in the skin is still discussed.26 They can constitute the incipient presence of a specific leukemic infiltrate and can represent the well-differentiated type of leukemia cutis. When cutaneous lesions are the initial presentation, an overt leukemia appeared a few months later in most patients.27 The circulating immature myeloid cells may also be innocent bystanders recruited to the skin through an inflammatory reaction stimulated by the Sweet syndrome. The ability of immature myeloid cell precursors to migrate to the skin in myelogenous leukemia is well known.28 Because blast cells recruited in the skin have the ability to differentiate to a morphologically and phenotypically heterogenous population including mature granulocytes, it can be suggested that immature myeloid cells admixed with neutrophils constitute a specific infiltrate.29 The atypical cells of leukemia cutis might also develop into mature neutrophils of Sweet syndrome through therapy-induced differentiation either with G-CSF25 or with all-trans retinoic acid.24 Finally, neutrophils infiltrating the skin could also be clonally derived.25
These hypotheses do not clarify the mechanism of the lesions we observed. Timing between the onset of cutaneous disease and myelodysplasia is not compatible with recruitment into the skin of leukemic cells not detected in blood or bone marrow. Our patients never received granulocyte colony-stimulating factor. Moreover, we found immature granulocytes with lymphocytic infiltrates in the initial biopsy specimens. We cannot rule out recruitment by dermal lymphocytes cytokines in our cases. The role of T lymphocytes in regulating neutrophilic skin inflammation is well known.30 CXCL8-producing T cells facilitate skin inflammation. These lymphocytes can promote the attraction of immature granulocytes by the secretion of cytokines such as interleukin 8, granulocyte-macrophage colony-stimulating factor, and tumor necrosis factor α, which can prolong cell survival, differentiation, and maturation to neutrophils.
In conclusion, in this series of 9 adult men, recurrent Sweet syndrome was initially characterized by lymphocytic infiltrates and atypical mononuclear cells identified as immature granulocytes. It later evolved to neutrophilic infiltrates and was associated with myelodysplasia. All those features may represent the cutaneous component of the dysgranulopoiesis syndrome. Why cutaneous disease appeared 2 to 8 years before myelodysplastic syndrome was identified remains unexplained, but this fact is of practical clinical importance and may help in the early diagnosis of myelodysplasia and management of patients.
Correspondence: Marie-Dominique Vignon-Pennamen, MD, Hôpital Saint-Louis, 1 ave Claude Vellefaux, 75475 Paris CEDEX 10, France (dominique.vignon-pennamen@wanadoo.fr).
Accepted for Publication: March 1, 2006.
Author Contributions:Study concept and design: Vignon-Pennamen, Wallach, Verola, and Janin. Acquisition of data: Vignon-Pennamen, Juillard, Rybojad, and Morel. Analysis and interpretation of data: Vignon-Pennamen, Juillard, Rybojad, Wallach, Daniel, Morel, Verola, and Janin. Drafting of the manuscript: Vignon-Pennamen, Wallach, Morel, and Janin. Critical revision of the manuscript for important intellectual content: Juillard, Rybojad, Wallach, Daniel, Morel, Verola, and Janin. Administrative, technical, and material support: Vignon-Pennamen, Juillard, Rybojad, and Verola.
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Suzuki YKuroda KKojima TFujita MIseki TShinkai H Unusual cutaneous manifestations of myelodysplastic syndrome. Br J Dermatol 1995;133483- 486PubMedGoogle ScholarCrossref
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Aractingi SBachmeyer CDombret HVignon-Pennamen DDegos LDubertret L Simultaneous occurrence of two rare cutaneous markers of poor prognosis in myelodysplastic syndrome: erythema elevatum diutinum and specific lesions. Br J Dermatol 1994;131112- 117PubMedGoogle ScholarCrossref
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Vignon-Pennamen M, Juillard C, Rybojad M, et al. Chronic Recurrent Lymphocytic Sweet Syndrome as a Predictive Marker of Myelodysplasia: A Report of 9 Cases. Arch Dermatol. 2006;142(9):1170–1176. doi:10.1001/archderm.142.9.1170
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Q: How secure is it to access a database in Laravel without API key provided? Prerequisites:
PHP: 5, Laravel: 5.1, MySQL: innodb 5.6.34.
Problem:
We built a web API with single endpoint "test". Now another endpoint ("health") should be added - this endpoint serves as health indicator for the API: when we call test.api.com/health?, the respective Controller should make direct connection to a DB and send two statuses as response to a user: status of API and status of DB (data is there, DB is live, everything's fine).
Question:
How secure is it to make such a Controller without an authentication middleware? Or in other words: how secure is it to call endpoint which connects to a DB without an api key?
Note, that framework can change in the future - probably to Python's Flask, as well as DB - to PostgreSQL. So even if you don't have expertise in Laravel or MySQL, nevertheless don't hesitate to give your feedback.

A: You shouldn't have a problem with this. You're not taking in user input so you're not prone to any sql vulnerabilities if that's what you were thinking. You may want to cache the response for a few seconds as to not hammer the database server. Optionally a rate limiter on the API may be a good idea.