text:
HomeArtificial IntelligenceGame AIArtificial Intelligence for Games
Artificial Intelligence for Games
Introduction to Game AI
September 25, 2009 Ogail Artificial Intelligence for Games
It is a common mistake to think that the more complex the AI in a game, the better the characters will look to the player. Creating good AI is all about matching the right behaviors to the right algorithms
Knowing when to be complex and when to stay simple is the most difficult element of the game AI programmer's art. The best AI programmers are those who can use a very simple technique to give the illusion of complexity
You need to make sure that a characters' AI matches their purpose in the game and the attention they'll get from the player
Perceptions should only be what exactly AI character need not more
Take care of changing behaviors (2 solders conversion example – 63)
For in-game AI, behaviorism is the way to go. We are not interested in the nature of reality or mind; we want characters that look right. In most cases, this means starting from human behaviors and trying to work out the easiest way to implement them in software
Developing Game AI Could Use:
Hacks: ad-hoc solutions and neat effects
Heuristics: rules of thumb that only work in most, but not all, case
Algorithms (the "proper" stuff)
Developers rarely build a great new algorithm and then ask themselves, "So what can I do with this?" Instead, you start with a design for a character and apply the most relevant tool to get the result
Some if the AI doesn't require an algorithm or a technique it only requires a simple bit of code that performs an animation at the right point
Human beings use heuristics all the time. We don't try to work out all the consequences of our actions. Instead, we rely on general principles that we've found to work in the past (or that we have been brainwashed with, equally)
Problems with heuristics all the time: range units when shooting peons (65)
Common Heuristics:
Most constrained
For example, a group of characters come across an ambush. One of the ambushers is wearing phased force-field armor. Only the new, and rare, laser rifle can penetrate it. One character has this rifle. When they select who to attack, the most constrained heuristic comes into play: it is rare to be able to attack this enemy, so that is the action that should be taken
Do the most difficult first
For example, an army has two squads with empty slots. The computer schedules the creation of five Orc warriors and a huge Stone Troll. It wants to end up with balanced squads. How should it assign the units to squads? The Stone Troll is the hardest to assign, so it should be done first. If the Orcs were assigned first, they would be balanced between the two squads, leaving room for half a Troll in each squad, but nowhere for the Troll to go
Try the most promising first:
Hacks and heuristics will get you a long way, but relying on them solely means you'll have to constantly reinvent the wheel. General bits of AI, such as movement, decision making, and tactical thinking, all benefit from tried and tested methods that can be endlessly reused (use algorithms here)
Just remember that for every situation where a complex algorithm is the best way to go, there are likely to be at least five where a simpler hack or heuristic will get the job done
One of the major reasons that new AI techniques don't achieve widespread use is their processing time or memory requirements
Processor Issues in Game AI:
Complex AI that does work in games needs to be split into bite-size components that can be distributed over multiple frames. The chapter on resource management shows how to accomplish this. Applying these techniques to any AI algorithm can bring it into the realm of usability
SIMD:
Most modern CPUs have dedicated SIMD processing. SIMD (single instruction multiple data) is a parallel programming technique where a single program is applied to several items of data at the same time
Steering algorithms benefit from this feature
Multi-Core Processing and Hyper-Threading:
Modern processors have several execution paths active at the same time. Code is passed into the processor, dividing into several pipelines which execute in parallel. The results from each pipeline are then recombined into the final result of the original code. When the result of one pipeline depends on the result of another, this can involve backtracking and repeating a set of instructions. There is a set of algorithms on the processor that works out how and where to split the code and predicts the likely outcome of certain dependent operations; this is called branch prediction. This design of processor is called super-scalar
Normal threading is the process of allowing different bits of code to process at the same time. Since in a serial computer this is not possible, it is simulated by rapidly switching backward and forward between different parts of the code.
A multi-core processor effectively has multiple separate processing systems (each may be super-scalar in addition). Different threads can be assigned to different processor cores
Virtual Functions/ Indirection
Virtual functions add flexibility to the code but it's very costly
Memory Concerns:
If processors had to rely on the main RAM, they'd be constantly stalled waiting for data
All modern processors use at least one level of cache: a copy of the RAM held in the processor that can be very quickly manipulated. Cache is typically fetched in pages; a whole section of main memory is streamed to the processor. It can then be manipulated at will. When the processor has done its work, the cached memory is sent back to the main memory.
In my experience (author), dramatic speed ups can be achieved by making sure that all the data needed for one algorithm is kept in the same place
PC Constraints:
If the AI gets less time to work, how should it respond? It can try to perform less work. This is effectively the same as having more stupid AI and can affect the difficulty level of the game. It is probably not acceptable to your quality assurance (QA) team or publisher to have your game be dramatically easier on lower specification machines
Develop your AI code to be an AI Engine that could be reused
Try to develop tools that can generate you AI Code ( as in steering behaviors)
AI-Implant's Maya module, for example, exposes complex Boolean conditions, and state machines, through graphical controls
Introduction to AI
What is AI?
Many of trivial problems ( playing Connect 4) were solved by computers but there are many things that computers aren't good at which we find trivial: recognizing familiar faces, speaking our own language, deciding what to do next, and being creative. These are the domain of AI: trying to work out what kinds of algorithms are needed to display these properties
In academia, some AI researchers are motivated by philosophy: understanding the nature of thought and the nature of intelligence and building software to model how thinking might work. Some are motivated by psychology: understanding the mechanics of the human brain and mental processes. Others are motivated by engineering: building algorithms to perform human-like task. Where game developers concerns with the last motivation
History of Academic AI:
The Early Days:
In the early days (before computers) some questions appeared (in philosophy of mind) as:
What produces thought?
Could you give life to an inanimate object?
What's the difference between cadavers (جثة) and human it previously was?
Pioneers of the field these days were: Alan Turing (father of AI), von-Neumann, Shannon
The Symbolic Era:
From 1950s till 1980s main thrust in AI research was in "symbolic" systems
A symbolic system: is one in which the algorithm is divided into two components (as Expert Systems):
Set of knowledge: represented as symbols such as words, numbers, sentences, or pictures
Reasoning algorithm: that manipulates those symbols to create new combinations of symbols that hopefully represent problem solutions or new knowledge
Other symbolic approaches in games: blackboard architecture, pathfinding, decision trees, state machines, steering algorithms
Common disadvantage of symbolic systems: when solving a problem the more knowledge you have, the less work you need to do in reasoning
The more knowledge you have, the less searching for an answer you need; the more search you can do (i.e., the faster you can search), the less knowledge you need
The Natural Era:
From 1980s to 1990s frustration symbolic approaches come into two categories:
From engineering point:
early success on simple problems didn't seem to scale to more difficult problems
From philosophical point:
Symbolic approaches are not biologically plausible (i.e. You can't understand how a human being plans a route by using a symbolic route planning algorithm)
The effect was a move toward natural computing: techniques inspired by biology or other natural systems (like ANN, GA and simulated annealing)
The no-free-lunch theorem and subsequent work has shown that, over all problems, no single approach is better than any other
The narrower the problem domain you focus on, the easier it will be for the algorithm to shine. Which, in a roundabout way, brings us back to the golden rule of AI: search (trying possible solutions) is the other side of the coin to knowledge (knowledge about the problem is equivalent to narrowing the number of problems your approach is applicable to)
Game AI:
Till 1990 all computer-controlled characters used FSM
In 1997 the new technique included was ability to see colleagues and notify them when killed
In mid-1990s RTS games (Warcraft II) was the first time popular game having robust pathfinding implementation
The AI in most modern games addresses three basic needs:
The ability to move characters,
The ability to make decisions about where to move
The ability to think tactically or strategically
Model of Game AI:
Movement refers to algorithms that turn decisions into some kind of motion
Examples (49):
Super Mario example when attacking enemies with bullets
Guard that want to reach alarm example
Decision Making:
Involves character working out what to do next
Examples: take the decision to attack, defend, patrol…
To coordinate whole team you need a strategic AI
In the context of this book, strategy refers to an overall approach used by a group of characters
In this category are AI algorithms that don't control just one character, but influence the behavior of a whole set of characters
Example: surrounding a player in FPS Game
These are Information Gatherer (perception) and execution management issues
Agent-Based-AI:
agent-based AI is about producing autonomous characters that take in information from the game data, determine what actions to take based on the information, and carry out those actions
Techniques in this book are implemented into 3 categories: Algorithms, Data Structures, Game Infrastructure
Key elements to know when implementing algorithms:
Know the problem the algorithm want to solve
A general description of the working mechanism of the algorithm including diagrams
A pseudo-code presentation of the algorithm
Indication to the data structure used in the algorithm
Particular implementation node
Analysis of the algorithm performance: execution speed, memory footprint and scalability
Weaknesses in the approach
Before Chapter # 1
This book is an outworking of that experience. It doesn't tell you how to build a sophisticated AI from the ground up. It gives you a huge range of simple (and not so simple) AI techniques that can be endlessly combined, re-used, and parameterized to generate almost any character behavior that you can conceive


text:
CHIPS Articles: Forum focuses on hot topics of collaboration, partnerships to increase readiness, speed to fleet
Forum focuses on hot topics of collaboration, partnerships to increase readiness, speed to fleet
By AIR-6.0 Public Affairs - February 2, 2016
NAVAL AIR SYSTEMS COMMAND, PATUXENT RIVER, Md. — It was a standing-room-only crowd for Naval Air Systems Command's (NAVAIR) Logistics and Industrial Operations (AIR 6.0) Hot Topics Forum here Jan. 20. The resounding theme for the day was collaboration as leaders from AIR 6.0 joined with those from across several services' agencies encompassed in the Naval Aviation Enterprise (NAE) to discuss key issues and challenges with the workforce.
Brig. Gen. Greg Masiello, assistant commander, AIR 6.0, kicked off the discussion with the "big picture" perspective, laying out his strategic imperatives that align with the mandate Vice Adm. Paul Grosklags put forth when he took the helm of NAVAIR as its commander.
In his "Commander's Intent," Grosklags stressed NAVAIR should be "ready to fight tonight" and must continue to develop the capabilities and capacity to win the future. To achieve this, he set two courses of action: align resources to better support today's readiness; and reduce costs and increase speed of products to the fleet.
The Hot Topics forum recognized the challenges that face naval aviation — including an increased operating tempo and flying airframes past their intended life — and sought to begin the dialogue to resolve them.
"Enabling a globally responsive fleet that is ready, affordable and effective — that is our job," Masiello said. "We need to innovate and make things happen and we need to sustain emphasis on readiness and an in-service mindset."
Speakers at the forum included Brig. Gen. Allan Day, Commander, Defense Logistics Agency (DLA) Aviation; Russ Howard, assistant deputy commandant of Aviation (Sustainment), Headquarters United States Marine Corps; and Rear Adm. Paul Verrastro, Commander, Naval Supply Systems Command, Weapons System Support (NAVSUP WSS).
Verrastro spoke to NAVSUP WSS efforts to expand repair capability and capacity to meet the Fleet's requirements through partnerships with industry, DLA, NAVAIR and the depots.
"When we leave this forum, our success will be determined by how well we leverage the linkages among the NAVAIR team, DLA, NAVSUP WSS and our many partners, to effectively deliver required readiness to the Fleet. Today's discussion ensured our collective efforts were aligned to tackle key supply and maintenance enablers to improve Fleet readiness," Verrastro said.
Capt. Joe Parran, lead, Supply Department, Commander, Fleet Readiness Centers (COMFRC), agreed that the forum stressed the need to have "dedicated working relationships from an Enterprise perspective. Air 6.0 and COMFRC are continuously striving to drive readiness and a link among the organizations is crucial to improving aviation readiness. Knowing this going into the session made it clear and easy to reinforce and have candid discussions on the specific roles and responsibilities of this strategic partnership."
The second half of the forum featured speakers from the AIR 6.0 Planning and Sustainment Department (AIR 6.7). Almost all presenters pointed to the expanded role of new technologies, specifically Additive Manufacturing, and increased use of data metrics, such as Vector, the impending web-based version of the Integrated Logistics Support Management System (ILSMS), to drive forward the changes necessary to meet the mission.
Remote NAVAIR sites in Florida, New Jersey, North Carolina and California joined the meeting by video teleconference. Hot Topic Forums began in January 2014 and are held regularly to inform the logistics workforce of current trends in improving support to the warfighter.
For more information, contact AIR-6.0 Public Affairs at 301-757-7178.
TAGS: Data Strategy, InfoSharing
NAVAL AIR SYSTEMS COMMAND, PATUXENT RIVER, Md. -- Rear Adm. Paul Verrastro, commander, Naval Supply Systems Command, Weapons System Support (NAVSUP WSS) addresses attendees at the Naval Air Systems Command's (NAVAIR) Logistics and Industrial Operations (AIR 6.0) Hot Topics Forum at the Center Stage Theater Patuxent River on Jan. 20. The forum addressed the need for collaboration among Naval Aviation Enterprise (NAE) service agencies to recover and sustain readiness requirements. Photo courtesy of U.S. Navy.
NAVAL AIR SYSTEMS COMMAND, PATUXENT RIVER, Md. -- Brig. Gen. Greg Masiello speaks to participants at Naval Air Systems Command's (NAVAIR) Logistics Hot Topics Forum. Photo courtesy of U.S. Navy.
Chief Learning Officer Visits Naval War College, Discusses Priorities
NSWC Dahlgren Internship Impacts U.S. Naval Academy Midshipman's Senior Capstone Project
NSWC Dahlgren's OTA Opens the Door to New Business Opportunities
NSWC Corona's Data Analytics Enables Navy to Dominate the Threat
Input Sought in Developing DON IM/IT Policy

redpajama_set_name: RedPajamaCommonCrawl


A long time and highly respected city employee by the name of Ray Harden passed away on November 1, 2008. The day he was buried in the St. John's cemetery of Clay County was like coming full circle once more. It was in the St. John community that he found the love of his life and his faithful companion, a very pretty young girl by the name of Tessie Thrasher. After they married, it was Tessie who stayed by his side and tenderly cared for him any time he was sick, and especially so during his last illness. A monument bearing both their names was recently placed on his grave. Included in the information on that monument was an inscription suggested by a family friend, Mrs. Della Harvey, that says: "To know them was to love them." Everyone who is only slightly acquainted with either Tessie or Ray will agree wholeheartedly with that phrase. They are both at the top of the list of what I call "the gentle people of the earth." Here is a look back at their early years.
Ray Harden came from a family of four children, three boys and one girl whose names were Elbert, W.J. and Lana. His parents were Harrison Harden and wife Lillie Stanford Harden. The Harden family made their home in the Lilly Dale community. At a very early age, Ray carried the mail on horseback, and would sometimes haul mail in a wagon pulled by a team of mules. Sometimes when he rode in a wagon on the mail route, and the weather was cold, he heated bricks, placed them in a tub, and covered the bricks with hot coals and ashes to help keep his feet warm while delivering the mail. He went to school at Lily Dale through the eighth grade, and even went back an extra year just to be in the eighth grade one more time.
The Harden family lived near the banks of the Obey River in the Lilly Dale community, and experienced their home being flooded on several occasions. The river got up high enough during one of these floods that a pot of beans sitting on the wood burning kitchen stove floated off and ended up sitting on the kitchen table when the water went down. On another occasion, Harrison Harden checked on the damage to their home during a flood by paddling around inside the house in a canoe.
Ray and Tessie met at a neighbor's home where a dance was being held. Ray not only danced on these occasions, but called sets at these dances. Folks who held dances in their homes moved out as much furniture as possible from the front room or even a bedroom to make room for the dancers and musicians. Ray asked Tessie, who was only fourteen years old at the time, to dance with him that night, and that was the beginning of a four year courtship.
Tessie's parents made their home in the St. John community near Willow Grove. They were Burr Thrasher and wife Venice Colson Thrasher. Tessie's father was a mail carrier and farmer. There were eight children in the Thrasher family, four boys and four girls. The names in the order of their births are: Lucille; Tessie; Doyle (who was killed in World War II); Willie, who was known by the nickname "Scrutcher"; Juanita; Elise, Randall; and Eddie Ray. The Thrasher children attended school at the St. John, a one room school not too far from their home. Two of the teachers Tessie remembers having there were Chester Ledbetter and Nan Sewell. In the later years of this school, an additional room was added on for the smaller children. Pie suppers and spelling bees were always well attended events at St. John school. After completing the eighth grade at St. John, Tessie went on begin high school at Willow Grove, but dropped out because she didn't like it. She found work in one of the homes there in Willow Grove through a government program that employed women in that area. In this particular home, mattresses were made. A lady by the name of Myrtle Capley oversaw the fifteen or twenty women who made the mattresses. Some of the women even took their work home with them and were supplied with the patterns and materials to complete the job at home. After two years on this job, Tessie found another job as a cook at the St. John school. She, along with Claudine Ledbetter Sells, did all the cooking of school lunches for the 50 to 60 children who attended school at St. John then.
Ray and Tessie were in the early days of their courtship when this photograph was taken while attending the Clay County Fair one year.
During the years Ray and Tessie were courting, Ray would walk from his home at Lily Dale to go to church with Tessie and her family at the St. John Church of Christ which was also the place school was held. Tessie was cooking at the school on the day Ray came to get her so they could run off to get married. That was on November 14, 1941. Tessie was 19 and Ray was 29, and with the help of Ray's uncle Sidney Stanford, they traveled to the courthouse in Celina where they were married by a county official named Willie Hunter. The young couple moved in with his parents for a few months prior to their moving to Livingston to live. Upon learning that his daughter had gotten married, Tessie father made the statement, "There goes my good work hand."
Tessie recalls how the families would load into wagons to go to "meetin" at churches on the other side of the Obey River from Lily Dale. She especially remembers how scary it was to cross the river after dark and go up the steep bank on the other side. This was prior to the bridge being built at Lily Dale, a job Ray helped with. The road on the other side of the river could be traveled to either Byrdstown, Tennessee, or Tompkinsville, Kentucky.
Tessie Thrasher Harden stands on the Lily Dale bridge to have her picture taken.
For a period of time, Ray had a job with the construction of Dale Hollow dam. After moving to Livingston, he and Tessie rented a house not very far from the property they later bought located on West Seventh Street in Livingston. In 1944, Ray worked as a clerk for Mr. R.D. Reed at his grocery store on Church Street. Tessie took care of their home and always made a big garden every year, and in 1945, she got a job at the shirt factory, even though the day she was hired, she just went there with a friend who was looking for work. She ended up working until the factory closed sometime in the 70's. It was while Raleigh Needham served as mayor of the Town of Livingston that he came to see Ray to ask if he would be interested in taking a job reading meters for the Town of Livingston. Raleigh had known Ray for some time, and considered him to be an honest and trustworthy person, someone he knew he could always depend on to do a good job. Ray accepted Raleigh's offer, and worked for the Town of Livingston until he retired in 1991.
Ray and Tessie lived in one of Livingston's older homes on West Seventh Street until 1984, the year they built a new brick home nearby. Raising a big garden was always something Ray and Tessie did together. Neighbors and others who were acquainted with them would often come by during the gardening season to buy vegetables from them. Ray and Tessie have been long time members of the Allons Church of Christ where Ray taught a Bible study class. He was always well prepared for that class, and spent many hours in preparation and study each week. He was bedfast the last couple of years he lived. During that time, Tessie made it a point to always be at his side, but should he awaken to find that she had stepped out of the room for a minute or two, he would inquire of Tessie's whereabouts. He always made the same statement when asking for Tessie. He would say, "I want to see my Tessie." If Mrs. Della Harvey happened to be there on these occasions, she would ask Ray to tell her what Tessie looked like, he would always reply: "She's of average height; average build; the prettiest lady in the county; and she's good too. You can't bet her anywhere." Tessie said Ray was very easy to take care of, and that he never complained. It was quite easy to see how devoted to each other they were. The very special memories of their early years together, beginning with a time they shared their first dance, to Ray's last days spent on earth, will be carried in Tessie's heart forever. I'm very happy she allowed us, through this story, to share in those special times too.
Ray Harden plows ground behind what was once known as the Albert Evans home. The field he was plowing was on Miller Street.


text:
Travel February 2012
British Airways Committed to Japan
By Julian Ryall
• Closed by earthquake, Haneda route open again
• £100mn invested in renovated
• First class cabins
• Started Reassure and Rebuild Campaign with UKTI
When British Airways (BA) started its services out of Tokyo (Haneda) International Airport on 19 February last year, it had no inkling of the tragic events that were about to engulf Japan.
The new route had to be suspended, but it's now up and running again, and there was never any question of Britain's flag carrier reconsidering its commitment to this market.
"British Airways has a long-standing history with Japan; you are our friends and our business partners", said Vishal Sinha (right), BA manager for Japan and Korea.
"We have flown to Japan for more than 60 years and have continued to fly to Tokyo since the earthquake", he told ACUMEN. "And, although we took the difficult decision to temporarily suspend our Haneda service following the quake, we are pleased to have now reinstated that flight in order to drive business to Japan".
In the immediate aftermath of the triple disaster, BA's staff worked around the clock to support people travelling to and from Japan. At the corporate level, they worked closely with the authorities in Japan and the UK to ferry British rescue teams to Japan so that they could help search for survivors, to bring in aid, and also to assist those who wanted to leave the country.
Last May, BA ran a campaign in which it donated ¥5,000 to food bank Second Harvest Japan for every ticket sold on the Japan-UK route. This was designed to help support their efforts to deliver food and other much-needed supplies to some of the hardest-hit areas of Tohoku. The effort generated more than ¥20mn.
Just as important, from a longer-term perspective, for helping to reconstruct a national economy that had taken a serious hit, was the collaboration with UK Trade & Investment at the British Embassy Tokyo on the Reassure and Rebuild Campaign.
The three key objectives are:
• Reassure investors in the UK that Japan is safe and open for business
• Help rebuild the Japanese economy by encouraging trade, investment, research and development assistance
• Support firms in Japan with operations affected by the disasters
"As part of our efforts to rebuild business, BA will provide 50 return tickets between Japan and the UK in our business class cabin, Club World, to support mutual trade and investment", Vishal added. "Of those tickets, 20 are being offered to companies in Japan that want to expand their business in the UK, but whose operations have been affected by the earthquake and tsunami".
And the airline's presence at Haneda is important in terms of future efforts to bring back stability.
"Commercial demand on the Tokyo to London route is encouraging, and that is why we launched the Haneda route", he added. "Operating from two airports in Tokyo provides our customers greater travel options and flexibility with their travel plans.
"Haneda airport offers more domestic connections for our customers and, as Haneda is located near the business centre of Tokyo, this is ideal for our premium customers who are pressed for time".
Another positive factor is that the new international terminal at Haneda is one of the most modern in the BA network, and "has been very well received by our customers", Vishal said.
"The size and design of the building makes navigating around the terminal extremely quick and easy".
From the airline's point of view, it was important for BA to become a recognised carrier at Haneda after Japanese aviation authorities fully reopened the airport to international traffic in October 2010, after 32 years of restrictions, Vishal said.
Narita International Airport, meanwhile, continues to serve as a key cargo hub and has a large presence among members of the Oneworld aviation alliance.
"Both airports benefit from a strong network of connections, with international destinations served by our Oneworld partners at Narita, and an extensive domestic network served by Japan Airlines at Haneda", Vishal explained.
The airline is operating brand new Boeing 777-300ER aircraft on its Narita route and, such being the importance attached to the Japanese market, has invested £100mn in a renovated first-class cabin, which is described as "the ultimate in luxury".
"First brings together balanced privacy, comfort, space and contemporary British design", said Vishal. "It draws on the airline's heritage, focusing on quality and attention to detail".
Vishal said BA welcomes the results of the latest bilateral civil aviation talks, which agreed to add Narita to the Japan–UK open skies agreement in 2013, as it will give customers greater choice.
"We are currently reviewing all options and opportunities arising from the agreement but, in general, we believe that increased connectivity and flight options between Haneda and London Heathrow would be greatly beneficial to customers—both leisure travellers and business travellers".
Top pic: Haneda's international terminal just before it opened in 2010.
More articles in Travel
Travel August 2019
Cruise or lose
Japan's love of British culture helps sea voyage sector
Travel April 2019
Naturally Nikko
Publicity January 2019
Gorgeous gateway
Experience the wonders of Kobe
Travel October 2018
Fore! Two men Plus two triumphs
Travel September 2018
Nikko's Victorian legacy
Tea and scones served at 19th century British villa
Travel July 2018
Keen on cruising
Japan joins the latest global travel trend


When David Anderson visited us last month, he mentioned that we must make sure project policies are explicit by writing them down. Recently, I had a some sort of epiphany that some of these policies could be visualized as well – directly up on the wall.
I prefer a whiteboard and post-its for our Kanban wall, at least as long as the team is co-located. This gives us an instant overview of the flow, and we gather around it to discuss how to optimize the throughput. It's simple, but flexible.
To keep track of lead time and cycle time we update the tickets with important dates as we move the tickets across the board. However, I noticed that tickets weren't always updated with necessary information for my statistics, so we needed a better approach.
First we standardized the way the tickets look, with fixed places for different items, but routine glitches still happened every now and then. Then we started to visualize the criteria for moving a ticket to a new state.
First arrow in the image above shows the transition when the ticket is prepared and moved into the backlog. The person moving the ticket fills in the current date in the upper left corner (the red square). Similar happens in the next transition from backlog to analysis.
When moving from development to test, another person must test the new feature (or defect).
When tickets are done, the completed date is added, accompanied by a subjective well-being using :-), 😐 or :-(. The latter is later used in the retrospective.
Most of these visual elements were added just a couple a weeks ago, but so far the notation seems to be easily understood and effective.
Are you visualizing any of your project policies?
P.S.: Thanks to Jim Benson for a great tip on how to measure the subjective well-being, as an input to the retrospective.
This is an awesome set of policies.
I love the idea of making them icons on the board.
In several situations, with both Personal Kanban and kanban with teams, people have realized they have too much backlog because "it doesn't fit" on the board any more.
This type of visualization makes a few easy and beneficial policies fun and easy to adhere to. If you get too many policies, the board will become cluttered and people will rebel against the control and confusion.
I completely agree, this is best suited for simple policies, too many or complex will make the board confusing.
Very impressive. Definitely something others should consider adapting and adopting for their own systems. Icons to communicate simple policies is a great idea!
Previous Previous post: Who's your safety valve?


Ambassador Brownback will meet civil society representatives as well as university students and faculty to discuss efforts to advance religious freedom.
On March 26, Ambassador Brownback will participate in a roundtable discussion with Iranian religious minority representatives and meet with members of the Vietnamese Interfaith Council in the USA to discuss ways to bolster efforts to protect religious freedom for those respective communities.
Ambassador Brownback will also deliver keynote remarks on addressing 21st century challenges to religious freedom at the National Religious Broadcasters International Christian Media Convention. The host will determine media coverage. Media wishing to be credentialed should register here: http://nrb.org/pressregistration/.
On March 27, Ambassador Brownback will meet with members of the Korean Church Coalition for North Korea Freedom to discuss U.S. support for North Korean religious communities seeking to exercise their right to religious freedom.


text:
Brittany Valles
by Stefanie | Sep 17, 2018
As executive chef at Oak Gill, Brittany Valles oversees the seasonal menus served at breakfast, lunch and dinner, and is responsible for creating the shareable bites menu enjoyed at Aqua Lounge, a chic and vibrant night-time gathering spot. She is a strong proponent of using locally produced ingredients and whenever possible, utilizes the whole plant or animal for her dishes, which feature bold, bright flavors. Prior to working at Oak Grill and Aqua Lounge, she served as chef de cuisine for seven years at now-closed ink.well by Michael Voltaggio in West Hollywood, Calif. Chef Voltaggio remains a cooking and personal mentor to Valles, along with her early teacher Chef Cole Dickenson, who recognized her potential when she worked with him at Wolfgang Puck Catering at the beginning of her culinary career. Valles gained a prestigious nomination for Star Chefs' Rising Star Chef in 2017 and was the "Sandwich Queen" in an episode on munchies on Chef's Night Out. She earned an Associate of Arts degree from Le Cordon Bleu College of Culinary Arts in Los Angeles, Pasadena campus in 2010.


PasoPort is a ten year old family winery with production of about 1500 cases focusing on port-style wines. Our bottles are branded with original artwork in the style of the 1940's and 50's. In 2013 the winery purchased an alembic pot still for the purpose of producing our own brandy to fortify the port-style wines.


text:
Q: Misplacement of the ticks on the secondary x-axis in pyplot I am trying to plot a time series with labels corresponding to GMT time at the bottom and local time (GMT-7) at the top between Julian Days 128 and 158. I am using twiny() to create the secondary x-axis but somehow the labels on it are not placed properly. How can I fix this?
import matplotlib.pyplot as plt
from matplotlib.ticker import MultipleLocator, FormatStrFormatter

fig = plt.figure(figsize=(20,6))
ax1 = fig.add_subplot(111)
ax2 = ax1.twiny()

dayTickLocations=range(128*24,158*24,24)
dayTickLabels=range(128,158)

dayTickLocations_loc=range((128*24)-7,(158*24)-7,24)
dayTickLabels_loc=range(128,158)

ax1.set_xlim(128*24,158*24)
ax1.set_xlabel('Julian Days (GMT Time)')
ax1.set_xticks(dayTickLocations)
ax1.set_xticklabels(dayTickLabels)
ax1.grid(True)

ax2.grid(True)
ax2.set_xlabel('Julian Days (Local Time)')
ax2.set_xlim(128*24,158*24)
ax2.set_xticks(dayTickLocations_loc)
ax2.set_xticklabels(dayTickLabels_loc)

plt.show()

A: Changing the order of the commands in the 'ax2' block somehow solved the problem, though I don't understand how.
ax2.set_xlabel('Julian Days (Local Time)')
ax2.set_xticks(dayTickLocations_loc)
ax2.set_xticklabels(dayTickLabels_loc)
ax2.grid(True)
ax2.set_xlim(128*24,158*24)

redpajama_set_name: RedPajamaStackExchange


After ten years, this home's original landscape required an update. When the homeowners moved in, their children were toddlers and preschoolers. Now they are middle and high schoolers. The homeowners decided the backyard should be a destination, a place where family and friends could just hang out.
Their award-winning backyard is designed for fun times with friends and family. With amenities like a dining patio, fire table, and swimming pool, this landscape is ready for summer pool parties and fall evenings around the fire (or enjoying the hot tub).
An eight-foot change in elevation from doorway to property line is nothing to sneeze at. In order to build a level area for the patio, pool, and other amenities, it was necessary to install a retaining wall. This wall is 30-36" (which only partially took care of the slope in the back yard) so there are steps on the other side of the pool.
The full-size swimming pool uses a salt-water filtration system instead of chlorine, which is great for people with sensitive skin. The pool's mechanical elements are easily accessible but out of the way – tucked behind the trees and boulder wall.
Night lighting adds to the ambience but also helps the family navigate their way around the backyard as day turns into night. Audio speakers dot the plant beds for a surround sound experience.
The lower-level of the home was recently renovated. An outdoor bar and sliding windows connect the outside to the indoor entertainment space. This backyard has become the go-to destination for the homeowners' children and friends.


text:
package org.apache.camel.example;

import javax.xml.bind.annotation.XmlRootElement;

import org.apache.camel.Body;
import org.apache.camel.Handler;
import org.apache.camel.builder.RouteBuilder;
import org.apache.camel.test.junit4.CamelTestSupport;
import org.junit.Test;

public class JaxbErrorLogTest extends CamelTestSupport {

    @Test
    public void testErrorHandling() throws Exception {
        // the 2nd message is set to fail, but the 4 others should be routed
        getMockEndpoint("mock:end").expectedMessageCount(4);

        // FailingBean will cause message at index 2 to throw exception
        for (int i = 0; i < 5; i++) {
            sendBody("seda:test", new CannotMarshal(i));
        }

        assertMockEndpointsSatisfied();
    }

    @Override
    protected RouteBuilder createRouteBuilder() {
        return new RouteBuilder() {
            @Override
            public void configure() throws Exception {
                from("seda:test")
                    .bean(new FailingBean())
                    .to("log:end", "mock:end");
            }
        };
    }

    public static final class FailingBean {
        @Handler
        public void handle(@Body CannotMarshal body) {
            if (body.getMessageNo() == 2) {
                // fail on second message
                throw new RuntimeException("Kaboom");
            }
        }
    }

    /**
     * This class will throw RuntimeException on JAXB marshal
     */
    @XmlRootElement
    public static final class CannotMarshal {

        private int messageNo;

        public CannotMarshal() {
        }

        public CannotMarshal(int messageNo) {
            this.messageNo = messageNo;
        }

        public int getMessageNo() {
            return messageNo;
        }

        public void setMessageNo(int messageNo) {
            this.messageNo = messageNo;
        }

        public void setUhoh(String name) {
        }

        public String getUhoh() {
            throw new RuntimeException("Can't marshal this");
        }

        @Override
        public String toString() {
            return "MessageNo. " + messageNo;
        }
    }

}

redpajama_set_name: RedPajamaGithub


text:
Florida delivery man allegedly attacks elderly woman with mallet, sets her on fire
The woman, who would have turned 76 next week, died after being treated at a local hospital for a brain bleed and severe burns, police said.
Aug. 20, 2019, 9:36 PM UTC / Updated Aug. 20, 2019, 10:23 PM UTC
By Doha Madani
A Florida delivery man was charged with murder for allegedly attacking the elderly woman in Boca Raton who paid for him to install appliances purchased from Best Buy.
Jorge Luis Depre Lachazo, 21, allegedly attacked Evelyn Smith Udell with a mallet and set her on fire after he installed a washer and dryer for her on Monday morning, according to a police report from the Boca Raton Police Department.
Jorge Dupre Lachazo.Palm Beach County Sheriff's Office
Udell, who would have turned 76 next week, died after being treated at a local hospital for a brain bleed and severe burns, police said.
Police found her unresponsive on the floor of her laundry room, her clothing "fully engulfed" according to the report, with blunt force trauma and severe burns after another delivery driver partnered with Lachazo called 911.
The second driver, David Gonzalez, told officers he stepped outside to make work calls and heard screams from the house. Gonzalez found Udell on the ground with blood on the floor when he rushed back into the house.
"Lachazo was acting very strange and told Gonzalez multiple times that they needed to leave," the police report said. "Gonzalez was in fear for his life and stepped outside the residence."
Lachazo allegedly fled the scene with the delivery truck while Gonzalez was on the phone with 911 dispatch.
Police quickly tracked down the truck and found Lachazo sweaty, nervous and shaking, according to the report. Officers observed the hair on his legs looked as though it was burned off and there appeared to be ash on his legs.
Evelyn Udell was beaten and burned to death by a delivery driver in Florida.
The suspect later confessed to detectives that he used a wooden mallet to hit Udell on the side of the head. Lachazo told police he then grabbed a "chemical agent" from the garage.
"He then made a motion with his hands indicating that he doused Evelyn Udell and the room with the chemical agent," the police report said. "He then made a motion with his hands that the chemical agent spontaneously combusted. He denied knowing the ignition source that was used to start the fire."
The police report stated that responding officers found an open container of acetone in the kitchen, where the stove was pulled away from the wall.
Detectives said Lachazo also confessed to recently using cocaine and vaping marijuana.
Lachazo was denied bond on charges of murder without premeditation, aggravated battery with a deadly weapon on a person over the age of 65, and arson.
The Boca Raton Best Buy where the appliances were purchased was closed on Tuesday in the wake of the attack.
Best Buy CEO Corie Barry said in a statement that the company has severed ties with the delivery company Lachazo worked for and is fully cooperating with the police investigation. Best Buy will also hire an independent security firm to review our existing screening and safety programs.
"For more than 20 years, millions of Americans have trusted us to come into their homes and, on days like this, I am fully aware of how precious that trust is and how vital it is that we do everything in our power to earn it," Barry said. "Today, we redouble our efforts to do just that."
Doha Madani
Doha Madani is a breaking news reporter for NBC News.


text:
Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment
Lubiao Chen1 na1,
Dujing Bao1 na1,
Lin Gu2,
Yurong Gu1,
Liang Zhou1,
Zhiliang Gao1 &
Yuehua Huang1,2
Tuberculosis (TB) and chronic Hepatitis B virus (HBV) infection are common in China. Fist-line anti-TB medications often produce drug-induced liver injury (DILI). This study sought to investigate whether TB patients with chronic HBV co-infection are more susceptible to liver failure and poor outcomes during anti-TB treatment.
Eighty-four TB patients developed DILI during anti-TB treatment and were enrolled, including 58 with chronic HBV co-infection (TB-HBV group) and 26 with TB mono-infection (TB group). Clinical data and demographic characteristics were reviewed. The severity of DILI and incidences of liver failure and death were compared. Risk factors of clinical outcomes were defined.
The patterns of DILI were similar in both groups. Compared with patients in the TB group, patients in the TB-HBV group who did not receive anti-HBV therapy before anti-TB treatment were more susceptible to Grade-4 severity of DILI (36.2% vs. 7.7%, P = 0.005), liver failure (67.2% vs. 38.5%, P = 0.013) and poor outcomes (37.9% vs. 7.7%, P = 0.005). Age > 50 years (48.1% vs. 22.6%, P = 0.049), cirrhosis (50.0% vs. 15.4%, P = 0.046) and total bilirubin > 20 mg/dl (51.6% vs. 14.8%, P = 0.005) were independent risk factors for the rate of death in the TB-HBV group, and HBV DNA > 20,000 IU/ml had borderline significance (44.1% vs. 20.8%, P = 0.081). In the TB-HBV group, nucleos(t)ide analogues as rescue therapy were not able to reduce short-term death (33.3% vs. 36.8%, P = 0.659) once liver failure had occurred.
Patients on anti-TB therapy with chronic HBV co-infection are more susceptible to developing liver failure and having poor outcomes during anti-TB treatment. Regular monitoring of liver function and HBV DNA level is mandatory. Anti-HBV treatment should be considered in those with high viral levels before anti-TB treatment.
Tuberculosis (TB) and chronic hepatitis B virus (HBV) infections are two major global health problems. In 2016, there were an estimated 10.4 million new TB cases worldwide and 1.67 million TB deaths according to the WHO global TB report in 2017 [1]. According to the 5th national tuberculosis epidemiological survey in 2010, China had a high incidence of active pulmonary TB (459/100,000 in the population aged > 15 years old) [2]. Although programmed HBV vaccination for newborns has been conducted since 1992, there were still an estimated 93 million chronic HBV infections and a prevalence of 7.8% hepatitis B virus surface antigen (HBsAg)-positive people [3]. The incidence of TB/HBV co-infection remains unknown. The treatment for TB patients co-infected with HBV is a challenging health problem in China as well as worldwide.
At present, isoniazid (INH), rifampin (RFP), pyrazinamide (PZA) and ethambutol (EMB) are first-line medications for those with drug sensitive tuberculosis infection in their initial intensive anti-TB treatment. Hepatotoxicity with INH, RFP and PZA has been reported more frequently, with an incidence ranging from 3 to 28% for idiosyncratic and intrinsic toxic reactions [4,5,6,7]. HBV is a non-cellular pathogen, but active HBV replication can lead to immune liver injury and even liver failure, especially in adults [8]. Although nucleos(t)ide analogue (NA) anti-HBV drugs including lamivudine (LAM), adefovir (ADV), telbivudine (LDT), entecavir (ETV) and tenofovir have been available, TB patients with chronic HBV co-infection receiving anti-HBV treatment prior to anti-TB treatment are still an overlooked problem in current general clinical practice.
Hepatotoxicity of anti-TB medications and immune liver injury caused by HBV replication exacerbate liver dysfunction [9, 10]. In this study, we conducted a retrospective investigation to analyze whether there were any differences in clinical characteristics and risk factors predicting differences in short-term prognoses between TB mono-infected patients and TB/HBV co-infected patients. We also aimed to focus on the importance of regular monitoring of TB patients receiving anti-TB treatment for their liver function and HBV DNA levels and to emphasize that anti-HBV treatment by NAs should be recommended before anti-TB treatment for those with active HBV replication to reduce the incidence of liver injury and liver failure.
Inpatients with TB who had undergone anti-TB drug-induced liver injury (DILI) before admission to the Third Affiliated Hospital of Sun Yat-sen University between March 2009 and September 2016 and had received anti-TB treatment in other hospitals were included. A total of 84 patients (Han Chinese) were enrolled, of whom 58 were HBsAg-positive (TB-HBV group) and the remaining 26 were HBsAg-negative (TB group). HAV, HCV, HDV, HEV and HIV co-infection, auto-immune hepatitis, liver cancer and Wilson's diseases were excluded. All patients were followed for 6 months (180 days) after their liver injuries were diagnosed or until death occurred. This study was approved by the Ethical Committee of the Third Affiliated Hospital of the Sun Yat-sen University.
Medical records were reviewed in detail. Prior to anti-TB treatment, liver functions were normal according to their local hospital's laboratory reference ranges in all patients. After initiating anti-TB treatment, they suffered from liver injury with different symptoms including fatigue, nausea, anorexia, vomiting, abdominal distention, pruritus, dark urine and jaundice and were therefore transported to our hospital. During the inpatient ward and follow-up periods, information on demographics (age, sex), serum HBV markers (HBsAg, HBV DNA levels), hepatic panel (including aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin [TBIL], etc.), complete blood count, coagulation index (prothrombin time [PT] and activity [PTA], international normalized ratio [INR]) and clinical complications were recorded. Medications used and influences related to anti-TB drugs during treatment were reviewed.
Inclusion criteria and causality assessments
Patients with abnormalities in liver function tests including any one of the following [11] during anti-TB treatment were enrolled: (i) ALT ≥5 fold elevation above the upper limit of normal (ULN); (ii) ALP ≥2 ULN in the absence of known bone pathology; (iii) TBIL > 2 ULN and ALT ≥3 ULN. Causality assessments were conducted by applying the RUCAM (Roussel Uclaf Causality Assessment Method) system [12] and patients with scoring ≥3 were included.
According to the American College of Gastroenterology clincal guideline [13] and LiverTox definition [14], R-value (ALT/ULN÷ALP/ULN) was calculated based on patient's first liver function test after admission to our hospital. Patterns of DILI were defined as follows: hepatocellular pattern as ALT levels ≥3 ULN and R-value ≥5; cholestatic pattern as ALP ≥ 2 ULN and R-value ≤2; mixed pattern as ALT ≥3 ULN and ALP ≥2 ULN with R-value between 2 and 5. A new grading system [11] was applied to classify the severity of liver injury from the time of study entry to the end of 6 month follow up. Besides elevated ALT or ALP levels reaching criteria for DILI (ALT ≥3 ULN, ALP ≥ 2 ULN), severities of DILI were defined as: Grade-1 if TBIL was < 2 ULN; Grade-2 if TBIL was ≥2 ULN; Grade-3 if TBIL was ≥2 ULN including any one of INR ≥1.5, ascites or hepatic encephalopathy (HE); Grade-4 if a patient died or underwent liver transplantation because of a DILI event.
Liver failure was defined as serum TBIL levels > 5 ULN and INR > 1.5 or PTA < 40% with or without overt hepatic encephalopathy (HE) [15]. HE was not mandatory for the diagnosis of liver failure in this retrospective study.
Better outcome was defined as recovery (ALT < 2 ULN, TBIL < 2 ULN, INR returned to normal range) or improvement (ALT, TBIL and INR decreased) in the 6 months after DILI was diagnosed. Poor outcome was defined as exacerbation (increase in TBIL and INR or development of irreversible complications) or death in 6 months after the diagnosis of DILI.
Laboratory assays
All laboratory assays were conducted in the Department of Laboratory at the Third Affiliated Hospital of Sun Yat-sen University. Liver function tests were measured using a Hitachi 7180 automatic analyzer (Hitachi Corporation, Japan) (Normal reference range: ALT 3–35 U/L, AST 15–40 U/L, TBIL 4.0–23.9 umol/L, GGT 10–60 U/L, ALP 45–125 U/L). Full blood count was assayed using a SYSMEX XE5000 system (Sysmex Corporation, Japan), and coagulation tests were performed with a STAGO STR automatic analyzer (Stago group, France). Serum HBV antigens and antibodies were detected by time-resolved fluorescence immunoassay (Sym-bio Corporation, China). HBV DNA levels were quantified by an ABI 3700 thermal cycler (Applied Biosystem, USA) using Da'an reagents (Da'an Corporation, China) (detection range from 100 IU/ml to 1.70E + 8 IU/ml).
Diagnosis of liver cirrhosis
All patients received the Doppler ultrasonographic exmination (MylabTwice, Esoate, Genoa, Italy) after admission to our hospital. The examination was performed by the experienced ultrasound physician. An ultrasosographic scoring system consisting of liver surface (score: 1, smooth surface; 2, mild uneven or waveform surface; 3, undulated or irregular nodular surface), liver parenchyma (score: 1, homogeneous appearance; 2, heterogeneous appearance with fine scattered hypoechoic and hyperechoic areas; 3, coarse liver with irregular pattern), hepatic vascular structure (score: 1, smooth vessel wall; 2, obscured vessel with normal diameter; 3, irregular and narrowed vessel), and splenic size (score: 1, spleen size index [the product of the oblique and diagonal diameters] of less than 20 cm2; 2, larger spleen) was applied to describe the severity of hepatic paranchymal damage [16]. Score ≥ 7 was used to make the diagnosis of liver cirrhosis.
No patient received liver biopsy for fibrosis analysis. Only 9 patients received liver transient elasticity measurements by FibroScan (Echosens, Paris, France) because this technique was not introduced to our hospital before 2013.
All statistical analyses were performed using SPSS 22.0 (SPSS Inc. Chicago, USA). Quantitative data with normal distributions were denoted as the means ± standard deviations. Student's t test was used to compare the differences. Abnormally distributed quantitative data were denoted as medians (interquartile ranges) and Mann-Whitney U test was performed to compare the differences. Categorical variables were compared using Fisher's exact test or chi-square test, as appropriate. The proportion of surviving patients in different groups was analyzed using the Kaplan-Meier method, and comparisons of the differences were performed using log-rank test. The risk factors of liver failure and poor outcomes were investigated by logistic regression analysis. The odds ratio (OR) and 95% confidence interval (95%CI) were calculated for each variable included. A two-tailed P-value of < 0.05 was considered statistically significant.
The clinical and laboratory characteristics of all patients are not shown (more details seen in Additional file 1). Sixty five patients (77.4%) had pulmonary TB infection. There were more males in the TB-HBV group than in the TB group (91.4% vs. 53.9%, P = 0.000). Roughly half of the patients in the TB-HBV group had liver cirrhosis (55.2% vs. 7.7%, P = 0.000) diagnosed by the experienced ultrasound physician. However, platelet (PLT) counts were lower in TB-HBV group than in TB group, although both groups were within the normal range. Otherwise, there were no significant differences in mean age, alcohol intake (> 40 g/d), serum creatinine level, or hospital stays between the two groups. Patients in the TB-HBV group were more susceptible to Grade-4 severity of DILI (36.2% vs. 7.7%, P = 0.005), liver failure (67.2% vs. 38.5%, P = 0.013) and poor outcomes (37.9% vs. 7.7%, P = 0.005) compared with patients in the TB group. Maximum TBIL level in TB-HBV group was significantly higher than that in TB group (Median [μmol/L]: 391.4 vs. 145.8, P = 0.007).
Most patients received first-line anti-TB medications, with doses including INH 0.3 g/d, RFP 0.45 g–0.6 g/d, PZA 1.5 g/d, and/or EMB 0.75 g–1.0 g/d, and a few of them received INH 0.3 g/d and ofloxacin or levofloxacin 0.6 g/d. According to the first time liver function tests after admission to our hospital, 56 (66.7%), 14 (16.7%) and 14 (16.7%) patients were classified as hepatocellular, cholestic and mixed patterns of DILI respectively. Nevertheless, the distributions of the DILI patterns were similar regardless of HBV co-infection. Compared to the TB group, the latency of DILI in the TB-HBV group was longer but not statistically significant (Median [days]: 84.0 vs. 79.5, P = 0.462).
Liver failure during anti-TB treatment
As shown in Fig. 1, the patients in the two groups with different severity grading of DILI developed liver failure and experienced different clinical outcomes. More patients in the TB-HBV group developed Grade-4 severity of DILI (36.2% vs. 7.7%, P = 0.005) (20 patients died and 1 patient received orthotopic liver transplantation [OLT]) and liver failure (67.2% vs. 38.5%, P = 0.013) than in the TB group. In the TB group, only two patients developed Grade-4 severity of DILI and 10 patients progressed to liver failure, while 21 and 39 patients in TB-HBV group. Both univariate and multivariate analyses indicated that the factors related to liver failure included HBV co-infection and cirrhosis in all patients (Table 1). Analyses of the TB-HBV group indicated that only cirrhosis was an independent risk for liver failure (Table 2).
Liver failure in the two groups and their clinical outcomes. Ten (38.5%) patients in the TB group developed liver failure compared to 39 (67.2%) in the TB-HBV group (P = 0.013). In the TB-HBV group, 20 patients died and 1 received orthotopic liver transplantation, which was classified as Grade-4 severity of DILI, while only 2 patients with Grade-4 severity of DILI in the TB group died. Abbreviations: TB, tuberculosis; HBV, hepatitis B virus; G, grade; LF, liver failure; R, recovered; I, improved; E, exacerbated; D, died; T, liver transplantation
Table 1 Analyses of risk factors for the incidence of liver failure in all patients (n = 84)
Table 2 Analyses of risk factors for the incidence of liver failure in the TB-HBV group (n = 58)
Clinical outcomes related to liver injury
Of all patients, 24 (28.6%) had poor outcomes (Fig. 1), 22 of whom (91.7%) died during the 6-month follow-up or during hospitalization. Univariate analyses (Table 3) showed that age > 50 years old, cirrhosis and HBV co-infection were correlated to poor clinical outcomes. Male gender, alcohol intake > 40 g/d, anti-TB medications including both INH and RFP, latency of DILI < 1 month, and hepatocellular pattern of DILI had no correlations to poor clinical outcomes. Further multivariate analyses (Table 3) demonstrated that cirrhosis was an independent risk factor of poor outcomes (OR = 4.382, 95%CI: 1.35–14.21, P = 0.014), but HBV co-infection and age > 50 years old had borderline significance. If the variable of cirrhosis was discarded due to its correlation with chronic HBV infection, we found that both HBV co-infection (adjusted OR = 8.012, P = 0.010) and age > 50 years old (adjusted OR = 3.346, P = 0.027) were risk factors of poor clinical outcomes.
Table 3 Analyses of risk factors for poor clinical outcomes in all patients (n = 84)
In the TB-HBV group, 22 (37.9%) patients developed poor clinical outcomes (20 died, 1 deteriorated and 1 received an OLT), and the overall survival rate was 65.5%. Age > 50 years old, low PLT count, high TBIL level, HBV DNA > 20,000 IU/ml, severe coagulopathy (elevated PT level, PTA < 40% or INR > 1.5), cirrhosis and complications including HE, spontaneous bacterial peritonitis (SBP) and ascites were correlated with poor clinical outcomes (more details seen in Additional file 2). We also found that NAs as rescue therapy including LAM, ETV, LDT and ADV did not have a substantial influence on short-term clinical outcomes. Other therapies for liver failure including glucocorticoids, plasma exchange and allogeneic stem cell transfusion were administered in a few patients, and these treatments did not exert a significantly different impact on the prognosis. Univariate analyses (Table 4) indicated that age > 50 years old, cirrhosis, and HBV DNA > 20,000 IU/ml were correlated with poor clinical outcomes, while NAs as rescue therapy were not (OR = 1.071, 95%CI: 0.36–3.33, P = 0.905). Further multivariate analyses demonstrated that cirrhosis (OR = 6.320, 95%CI: 1.53–26.06, P = 0.011) and HBV DNA > 20,000 IU/ml (OR = 5.808, 95%CI: 1.37–24.64, P = 0.017) were risk factors for poor clinical outcomes.
Table 4 Analyses of risk factors for poor clinical outcomes in the TB-HBV group (n = 58)
Kaplan-Meier survival analysis showed that patients in the TB-HBV group had a higher rate of death than those in the TB group (34.5% vs. 7.7%, P = 0.012, Fig. 2a). Further analyses of the TB-HBV group indicated that age > 50 years old (48.1% vs. 22.6%, P = 0.049, Fig. 2b), liver cirrhosis (50.0% vs. 15.4%, P = 0.046, Fig. 2c) and TBIL > 20 mg/dl (51.6% vs. 14.8%, P = 0.005, Fig. 2d) were significantly correlated with a higher rate of death due to anti-TB-related DILI. Moreover, there was a similar finding for high HBV DNA levels > 20,000 IU/ml (44.1% vs. 20.8%, P = 0.081, Fig. 2e) with borderline significance. The use of NAs as rescue therapy for anti-HBV treatment after the onset of DILI had no significant influences on the overall survival in this subgroup (33.3% vs. 36.8%, P = 0.659, Fig. 2f).
Kaplan-Meier curve for the survival analysis. Survival analysis in all patients showed that a HBV co-infection was an independent risk factor for death. Survival analyses in the TB-HBV group showed that b age > 50 years, c cirrhosis and d TBIL > 20 mg/dl were independent risk factors for death; e HBV DNA > 20,000 IU/ml had borderline statistical significance as risk factor for death. However, f NAs as rescue therapy were not able to reduce short-term death once liver failure had occurred
HBV DNA at baseline and after anti-TB treatment
All of the patients in the TB-HBV group received anti-TB treatment in other hospitals, and none of them received regular monitoring of liver function or HBV DNA. Only five patients had documented HBV DNA levels before anti-TB treatment had been initiated, and there was an increasing trend in HBV DNA levels after receiving anti-TB treatment. One patient exhibited a sharp increase in HBV DNA levels from 2.00 log to 5.13 log and consequently died, despite receiving anti-HBV treatment with ETV at 0.5 mg/d (Fig. 3a). Although all patients received HBV DNA quantification after being admitted to our hospital, most of their HBV DNA levels before anti-TB treatment were unknown, and overall dynamic changes in HBV DNA could not be available in this study. There were no significant differences in HBV DNA levels after admission to our hospital between the better and poor outcome subgroups (Median [log10 IU/ml]: 4.24 vs. 5.55, P = 0.156, Fig. 3b).
HBV DNA profiles in the TB-HBV group. a HBV DNA changes before and after anti-TB treatment. B1, B2, B3 and B4 (solid line) were patients with better clinical outcomes. P1 (dot line) indicated the patient who underwent a sharp increase in HBV DNA from 2.00 log to 5.13 log and subsequently died; b HBV DNA levels after the onset of liver injury and admission to our hospital in different outcome subgroups (Median [log10 IU/ml]: 5.55 vs. 4.24, P = 0.156)
This study examined the rates of liver failure, poor clinical outcomes and survival in 84 TB patients with DILI. We found a higher incidence of liver failure and poor clinical outcomes in TB patients with HBV co-infection than in those with TB mono-infection. Age > 50 years, HBV co-infection and TBIL > 20 mg/dl were independently associated with poor clinical outcomes in patients who developed DILI due to anti-TB medications. The fact that NAs as rescue therapy after the initiation of DILI did not prevent further progression of liver failure suggests that early intervention with antiviral prophylaxis and regular monitoring of HBV replication may be crucial to the management of hepatotoxicity.
The risk of anti-TB drug-induced hepatotoxicity was higher in TB patients with chronic HBV co-infection compared to uninfected subjects in the current study as well as in others [17, 18]. Our data showed more severe DILI (Grade-4: 36.2% vs. 7.7%), more frequent liver failure (67.2% vs. 38.5%), more liver cirrhosis (55.2% vs. 11.5%) and poor clinical outcomes (37.9% vs. 7.7%) in the TB-HBV group, suggesting that HBV co-infection was a high risk factor for liver injury due to anti-TB medications. Published studies have indicated that most first-line anti-TB drugs induce hepatotoxicity via the formation of reactive metabolites, mediation of adaptive immune response, or bilirubin interference [19,20,21]. A pro-inflammatory environment induced by active HBV replication may accelerate the detoxification process and increase drug toxicities [22]. HBV DNA levels > 20,000 IU/ml seemed to be another independent risk factor of poor clinical outcomes. But we noticed that HBV DNA levels after the onset of anti-TB drug related DILI did not represent the real viral profiles prior to anti-TB treatment. Whether anti-TB medications reactivate or promote the replication of HBV remains unclear. Nevertheless, highly active HBV replication can lead to hepatitis flares, progressive liver fibrosis and cirrhosis even without a history of elevation or remarkable fluctuations in ALT [23]. Reactivation of HBV can also have significant clinical consequences including liver failure, which has a high mortality rate [24,25,26]. Unfortunately, most of these patients in this study did not have HBV DNA levels checked before their anti-TB treatment had been initiated. Only 5 patients had documented HBV DNA levels before anti-TB treatment, and 4 of them exhibited elevated HBV DNA to some extent.
According to the natural history of chronic HBV infection, more patients would be at risk of severe liver fibrosis and cirrhosis as their ages advanced [23]. In the TB-HBV group, patients had an average 10-year history of chronic HBV infection (perhaps even longer) and had a mean age of approximately 49 years. We believe that this was the main reason accounting for the more frequent cirrhosis in co-infected TB/HBV patients. Two TB mono-infected patients were considered to have liver cirrhosis, which might be attributed to excessive alcohol intake (> 40 g/d).
In addition to HBV DNA level, age was also associated with an increased risk of poor outcomes. In a cohort of over 3000 TB patients receiving INH monotherapy, the incidence of DILI was higher in those aged 50 years or older [27]. The severity of hepatotoxicity and consequent mortality has also been reported to be higher after the age of 50 years old [21]. Consistent with these reports, our data from multivariate analyses indicated that advanced age (> 50 years) was an independent risk factor of poor outcomes and overall survival in patients with DILI due to first-line anti-TB medications regardless of HBV co-infection. However, most cases of chronic HBV infection in highly endemic areas are due to HBV infection at birth or during the first year of life, and cirrhosis may occur at early ages. Therefore, it is not surprising that poor outcomes would be much more likely in TB/HBV co-infected patients in an environment of chronic inflammation or hepatocyte necrosis. Moreover, individuals with chronic hepatitis B who are aged 40 years or older should be considered frequently for HBV DNA testing or liver biopsy or for the initiation of anti-viral therapy in some cases, according to guidelines from international associations [28].
In our investigation, anti-TB regimens including the first-line medications of INH, RFP plus PZA and/or EMB accounted for a major component of liver injury in both TB and TB-HBV groups. The patterns of DILI were similarly distributed according to hepatocellular, cholestatic and mixed subtypes. Anti-TB drug related DILI often developed 1 to 3 months after anti-TB treatment, as reported elsewhere [29]. Our data were in accordance with this duration, but the difference between TB mono-infected patients and TB/HBV co-infected patients was not statistically significant. Nevertheless, it seemed that chronic HBV co-infection did not exert an impact on the latency of DILI onset. In a study by WS Kim et al. [29], they found that the mean onset time of DILI in patients with and without chronic HBV and/or HCV co-infection differed somewhat but not significantly (Mean [days]: 83.3 vs. 43.9, P = 0.056). We noticed that almost all patients had not received regular liver function monitoring after they had initiated anti-TB treatment and were transported to our hospital when developing severe liver injury and even after liver failure had developed. The actual onsets of DILI were not well known or established.
Prompt withdrawal of the offending medications and administration of NAs including LAM, ADV, LDT and ETV for 39 TB patients HBV DNA levels > 2000 IU/ml could not slow the progression of liver damage. Similar rates of poor outcomes were observed between patients with and without NAs rescue therapy in the current study; 20 TB patients with HBV co-infection still died. This implied that once liver injury had developed, the use of NAs as rescue therapy for anti-HBV treatment seemed unable to affect short-term survival in this setting. Another retrospective investigation of a small sample found that baseline liver function test abnormality and HBV DNA levels > 2000 IU/ml were independent risk factors for the development of DILI in TB patients with HBV co-infection [10]. Our study was in accordance with these findings. Poor clinical outcomes might due to poor hepatocellular regeneration and pre-existing liver fibrosis or cirrhosis to some extent [30, 31].
We recommend that NAs should be administered for patients with active HBV DNA replication before anti-TB treatment to prevent the development of liver failure. Regarding the current clinical practice guidelines for chronic hepatitis B management [3, 23], patients with malignant tumors who receive chemotherapy should be regularly monitored for ALT and HBV DNA levels and treated with NA therapy upon confirmation of HBV reactivation prior to ALT elevation. Huang et al. [32] compared the use of prophylactic ETV before and after rituximab-based chemotherapy and found that early intervention with anti-HBV therapy can effectively prevent HBV reactivation. A recent randomized open-label, phase 3 study from China compared ETV with LAM for the treatment of HBsAg-positive patients with low viral loads receiving R-CHOP chemotherapy. The results revealed significantly lower rates of HBV-related hepatitis, HBV reactivation and chemotherapy disruption in the ETV group [33].
It is important to perform HBV screening before starting anti-TB therapy, ideally at the time of diagnosis of the condition requiring anti-TB treatment. In some cases, in which an HBV core-positive profile is only reflected after HBV infection (anti-HBcAb-positive and HBsAg-negative), so-called occult HBV infection [34], the positive results could also reflect passively acquired antibodies from recent blood products or may rarely be due to nonspecific reactivity or HBsAg mutant infection. Additional testing is critical to clarify patients' true HBV status. This means that there needs to be close collaboration between virology and clinical teams to ensure that all test results are interpreted accurately.
We acknowledge that this study is limited by its small number of patients, its retrospective nature, and the lack of overall information on HBV DNA levels before and at the onset of DILI. However, the results of this study highlight the importance of HBV DNA and liver function monitoring in TB patients with chronic HBV co-infection who plan to receive anti-TB treatment, as well as the fine balance between prompt initiation of anti-HBV intervention versus avoidance of unnecessary antiviral prophylaxis.
In this retrospective investigation, we found that patients in the TB-HBV group were more susceptible to developing liver failure and having poor outcomes during anti-TB treatment compared to those in the TB group. Advanced age, cirrhosis and severe hyperbilirubinemia were independent risk factors for the incidence of death in the TB-HBV group, and HBV DNA > 20,000 IU/ml had borderline significance. NAs as rescue therapy were not able to reduce short-term death once liver failure had occurred. These findings suggest that regular monitoring of liver function and HBV DNA level during anti-TB treatment is indispensable for TB patients with chronic HBV co-infection, and anti-HBV treatment should be considered in those with high HBV DNA levels before anti-TB treatment to prevent them from developing liver failure.
Adefovir
ALP:
Alkaline phosphatase
ALT:
AST:
Aspartate aminotransferase
DILI:
Drug-induced liver injury
EMB:
ETV:
HBsAg:
Hepatitis B virus surface antigen
HBV:
HE:
Hepatic encephalopathy
INH:
INR:
International normalized ratio
LAM:
Lamivudine
LDT:
Telbivudine
NA:
Nucleos(t)ide analogue
OLT:
Orthotopic liver transplantation
PLT:
PT:
Prothrombin time
PTA:
Prothrombin time activity
PZA:
RFP:
SBP:
Spontaneous bacterial peritonitis
TBIL:
Total bilirubin
ULN:
Upper limit of normal
World Health Organization. Global tuberculosis report 2017. Available from URL: http://who.int/tb/publications/global_report/en/. Accessed 28 June 2018.
Wang LX, Chen SM, Chen MT, et al. The fifth national tuberculosis epidemiological survey in 2010 [Chinese]. Chin J Antibiot. 2012;34(8):485–508.
Chinese Society of Hepatology. Chinese Medical Association, Chinese Society of Infectious Diseases, Chinese Medical Association. The guideline of prevention and treatment for chronic hepatitis B: a 2015 update [Chinese]. Zhonghua Gan Zang Bing Za Zhi. 2015;3(12):888–905.
Sharma SK, Balamurugan A, Saha PK, Pandey RM, Mehra NK. Evaluation of clinical and immunogenetic risk factors for the development of hepatotoxicity during antituberculosis treatment. Am J Respir Crit Care Med. 2002;166(7):916–9.
van Hest R, Baars H, Kik S, et al. Hepatotoxicity of rifampin-pyrazinamide and isoniazid preventive therapy and tuberculosis treatment. Clin Infect Dis. 2004;39(4):488–96.
Sharifzadeh M, Rasoulinejad M, Valipour F, Nouraie M, Vaziri S. Evaluation of patient-related factors associated with causality, preventability, predictability and severity of hepatotoxicity during antituberculosis treatment. Pharmacol Res. 2005;51(4):353–8.
Tost JR, Vidal R, Caylà J, et al. Severe hepatotoxicity due to anti-tuberculosis drugs in Spain. Int J Tuberc Lung Dis. 2005;9(5):534–40.
Bertoletti A, Kennedy PT. The immune tolerant phase of chronic HBV infection: new perspectives on an old concept. Cell Mol Immunol. 2015;12(3):258–63.
Pan L, Jia ZS, Chen L, et al. Effect of anti-tuberculosis therapy on liver function of pulmonary tuberculosis patients infected with hepatitis B virus. World J Gastroenterol. 2005;11(16):2518–21.
Patel PA, Voigt MD. Prevalence and interaction of hepatitis B and latent tuberculosis in Vietnamese immigrants to the United States. Am J Gastroenterol. 2002;97:1198–2203.
Aithal GP, Watkins PB, Andrade RJ, et al. Case definition and phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther. 2011;89(6):806–15.
Danan G, Benichou C. Causality assessment of adverse reactions to drugs I. A novel method based on the conclusions of international consensus meetings: application to drug induced liver injuries. J Clin Epidemiol. 1993;46(11):1323–30.
Chalasani NP, Hayashi PH, Bonkovsky HL, Navarro VJ, Lee WM, Fontana RJ. Practice Parameters Committee of the American College of Gastroenterology. ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-induced liver injury. Am J Gastroenterol. 2014;109(7):950–66.
Hoofnagle JH, Serrano J, Knoben JE, Navarro VJ. LiverTox: a website on drug-induced liver injury. Hepatology. 2013;57(3):873–4.
Sarin SK, Kedarisetty CK, Abbas Z, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int. 2014;8(4):453–71.
Hung CH, Lu SN, Wang JH, et al. Correlation between ultrasonographic and pathologic diagnoses of hepatitis B and C virus-related cirrhosis. J Gastroenterol. 2003;38(2):153–7.
Wang JY, Liu CH, Hu FC, et al. Risk factors of hepatitis during anti-tuberculous treatment and implications of hepatitis virus load. J Inf Secur. 2011;62(6):448–55.
Wong WM, Wu PC, Yuen MF, et al. Antituberculosis drug-related liver dysfunction in chronic hepatitis B infection. Hepatology. 2000;31(1):201–6.
Knowles SR, Uetrecht J, Shear NH. Idiosyncratic drug reactions: the reactive metabolite syndromes. Lancet. 2000;356(9241):1587–91.
Metushi IG, Cai P, Zhu X, Nakagawa T, Uetrecht JP. A fresh look at the mechanism of isoniazid-induced hepatotoxicity. Clin Pharmacol Ther. 2011;89(6):911–4.
Ramappa V, Aithal GP. Hepatotoxicity related to anti-tuberculosis drugs: mechanisms and management. J Clin Exp Hepatol. 2013;3(1):37–49.
Pirmohamed M, Naisbitt DJ, Gordon F, Park BK. The danger hypothesis-potential role in idiosyncratic drug reactions. Toxicology. 2002;181-182:55–63.
European Association for the Study of the Liver. EASL clinical practice guidelines: management of chronic hepatitis B virus infection. J Hepatol. 2012;57(1):167–85.
Yuen MF. Anti-viral therapy in hepatitis B virus reactivation with acute-on-chronic liver failure. Hepatol Int. 2015;9(3):373–7.
Philips CA, Sarin SK. Potent antiviral therapy improves survival in acute on chronic liver failure due to hepatitis B virus reactivation. World J Gastroenterol. 2014;20(43):16037–52.
Zhang Y, Hu XY, Zhong S, et al. Entecavir vs lamivudine therapy for naïve patients with spontaneous reactivation of hepatitis B presenting as acute-on-chronic liver failure. World J Gastroenterol. 2014;20(16):4745–52.
Fountain FF, Tolley E, Chrisman CR, Self TH. Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection: a 7-year evaluation from a public health tuberculosis clinic. Chest. 2005;128(1):116–23.
Vlachogiannakos J, Papatheodoridis GV. HBV: Do I treat my immunotolerant patients? Liver Int. 2016;36(Suppl 1):93–9.
Kim WS, Lee SS, Lee CM, et al. Hepatitis C and not Hepatitis B virus is a risk factor for anti-tuberculosis drug induced liver injury. BMC Infect Dis. 2016; https://doi.org/10.1186/s12879-016-1344-2.
Qu YW, Guo Y, Zhao GD, He HZ, Liu Y. The mechanism and prevention of hepatic damage caused by anti-TB drug [Chinese]. Zhongguo Fanglao Zazhi. 2001;23:56–7.
van den Brande P, van Steenbergen W, Vervoort G, Demedts M. Aging and hepatotoxicity of isoniazid and rifampin inpulmonary tuberculosis. Am J Respir Crit Care Med. 1995;152(5):1705–8.
Huang YH, Hsiao LT, Hong YC, et al. Randomized controlled trial of entecavir prophylaxis for rituximab-associated hepatitis B virus reactivation in patients with lymphoma and resolved hepatitis B. J Clin Oncol. 2013;31(22):2765–72.
Huang H, Li X, Zhu J, et al. Entecavir vs lamivudine for prevention of hepatitis B virus reactivation among patients with untreated diffuse large B-cell lymphoma receiving R-CHOP chemotherapy: a randomized clinical trial. JAMA. 2014;312(23):2521–30.
Trigo C, do Brasil PE, Costa MJ, de Castro L. Occult hepatitis B virus infection: clinical implications in tuberculosis treatment. J Viral Hepat. 2016;23(12):1027–35.
We sincerely thank all patients and their families for their participation, including accepting the telephone follow-up. This study was supported in part by grants from the National Natural Science Foundation of China (Grant number: 81371866) and the National Grant Program on Key Infectious Diseases (Grant number: 2014ZX10002002-002). We also thank John Wiley & Sons, Inc. for language editing service.
This study was supported in part by grants from the National Natural Science Foundation of China (Grant number: 81371866) and the National Grant Program on Key Infectious Diseases (Grant number: 2014ZX10002002–002).
The datasets used and/or analysed during the current study were available from the corresponding author on reasonable request.
Lubiao Chen and Dujing Bao contributed equally to this work.
Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University, 600, Tianhe Road, Guangzhou, 510630, China
Lubiao Chen, Dujing Bao, Yurong Gu, Liang Zhou, Zhiliang Gao & Yuehua Huang
Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, 600, Tianhe Road, Guangzhou, 510630, China
Lin Gu & Yuehua Huang
Lubiao Chen
Dujing Bao
Lin Gu
Yurong Gu
Liang Zhou
Zhiliang Gao
Yuehua Huang
LBC and DJB contributed equally to this work. LBC designed the study and drafted the main body of this manuscript and DJB analyzed the data. DJB, LG, YRG, and LZ collected patients' information, generated figures and also particitate in drafting this manuscript. Professor ZLG and YHH interpretated the data and revised the manuscript critically for important intellectual content. All authors approved the final version of manuscript and agreed to submit the paper.
Correspondence to Zhiliang Gao or Yuehua Huang.
The study was approved by the Ethical Committee of the Third Affiliated Hospital of the Sun Yat-sen University, which waived the need for informed consent because all the data used in this retrospective study were routinely obtained and no additional procedures were carried out.
Table S1. Demographics and clinical characteristics between TB group and TB-HBVgroup. It showed that more patients in the TB-HBV group experienced severe hyperbilirubinemia (Median of TBIL [μmol/L]: 391.4 vs. 145.8, P = 0.007), cirrhosis (55.2% vs. 7.7%, P = 0.000), Grade-4 DILI (36.2% vs. 7.7%, P = 0.015), liver failure (67.2% vs. 38.5%, P = 0.013) and had poor clinical outcomes (37.9% vs. 7.7%, P = 0.005), compared with those in the TB group. (DOCX 23 kb)
Table S2. Demographics and characteristics of patients in TB-HBV group with different clinical outcomes. Compared with those with better clinical outcomes, the proportions of patients with advanced age (Mean [years]: 53.9 vs. 45.5, P = 0.017; age > 50 years old: 63.6% vs. 36.1%, P = 0.041), severe hyperbilirubinemia (Median of TBIL [μmol/L]: 478.8 vs. 251.0, P = 0.000), cirrhosis (77.3% vs. 41.7%, P = 0.008) and HBV DNA > 20,000 IU/L (77.3% vs. 47.2%, P = 0.024) in the TB-HBV group were significantly higher. (DOCX 22 kb)
Chen, L., Bao, D., Gu, L. et al. Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment. BMC Infect Dis 18, 295 (2018). https://doi.org/10.1186/s12879-018-3192-8
Liver failure


text:
Billy Talent to host benefit concert for victims of Danforth shooting with
Canadian rockers Billy Talent will host a benefit concert next month in Toronto to support the victims of the deadly shooting on Danforth Avenue. Billy Talent pose on the red carpet as they arrive at the Juno awards, in Ottawa on Sunday, April 2, 2017.Sean Kilpatrick / THE CANADIAN PRESS
TORONTO — Canadian rockers Billy Talent will host a benefit concert next month in Toronto to support the victims of the deadly shooting on Danforth Avenue.
The band say they'll join fellow musicians City and Colour, Pup and a number of other unannounced artists to play the Toronto Together fundraiser at the Danforth Music Hall on Aug. 11.
The venue is steps away from the shooting where an 18-year-old woman and a 10-year-old girl were killed and 13 others injured when a gunman fired into restaurants and patios along the busy street.
Proceeds from the concert, which takes place during the bustling Taste of the Danforth festival in the area, will be donated to the #TorontoStrong fund.
Toronto's Greektown neighbourhood has long been home to a vibrant arts community. The late Tragically Hip frontman Gord Downie lived in the area while Billy Talent purchased a residence near the area years ago, which they converted into a studio space.
"What has happened in Toronto this summer, and with what happened on the Danforth a few blocks from our studio, has not only hit close to home — this has hit home," wrote the band in a statement for the Toronto Together fundraiser.
"All we know is that we can't just sit here. We don't know what we want but we want to do something. We want to throw a concert to show the world and more importantly our community that Toronto is a place of love, of community, of kindness and compassion. The violence that has happened here this summer does not represent the majority."
Tickets will be limited to two per person and go on sale for $50 each on Wednesday at 10 a.m. through the Toronto Together website: http://www.torontotogether.com/
Follow @dfriend on Twitter.


This recipe certainly lives up to its name!
This economical recipe is delicious, simple to make (only 7 ingredients!), and budget-friendly.
Here's everything you need to wow your guests with Million Dollar Chicken.
Place chicken pieces in a casserole.
Bake for 60 minutes at an oven of 160 degrees celsius (320 – 375 deg F).
Quick Tip: Serve this chicken dinner with a side salad, steamed veggies, or macaroni and cheese for a complete meal.


Whip all ingredients in a mixing bowl. I used a hand mixer, and whipped for about 1 minute. Taste test. If not sweet enough for you, blend in more powdered sugar to taste. Place the whip in the fridge for 30 minutes or more, allowing it to firm up a bit more. Whip just before serving (I just used a whisk).
The end result dolloped nicely and stayed perfectly in place for pictures and as I was eating it. But, if it isn't firm enough for your desires, additional powdered sugar and/or additional coconut oil (add when melted, but it will solidify as it chills) will firm it up more.


text:
DeSales Weekly, Home Page
Goodbye, Farewell, and Amen
Fans of the hit comedy, M*A*S*H, which aired for 11 seasons and ended in 1983, may recall the title of the final two-hour episode: Goodbye, Farewell, and Amen. I use this expression not to evoke images of concluding a war, as in the television show that chronicled the human side of the Korean Conflict, but to highlight the affection and friendship the sit-com portrayed, growing relationships into a prayer that concluded with Amen.
During the past five years of writing a weekly reflection, a bit of a community has grown, whether virtually or among friends and faith communities, to discuss some of the themes and ideas presented in DeSales Weekly. I realize we lost a number of subscribers as I attempted to intersect the Gospel and Salesian spirituality with pressing issues such as gun violence, immigration, hunger, and economic inequality; please know that my intention was never to offend. However, my favorite part of this Thursday email is the presentation of the Scriptures for Sunday Mass. We hoped that, with Fr. Michael Murray's solid Salesian reflection, after perusing the readings a few days before worshipping, readers would be alert to the Spirit when the Word is proclaimed at church.
With July 1 approaching, this will be the last DeSales Weekly I write. My ministry as the province's director of development and communications will end, and I look forward to new work at DeSales University in Center Valley, PA. Last week at our annual convocation, we Oblates elected a new leadership team. Fr. Lou Fiorelli will serve as provincial, and he will be assisted by provincial councilors, Frs. Michael Murray, Jack Kolodziej, Michael Vannicola, and Matt Hillyard. Once Fr. Lou settles into his new role, I am sure that he will offer a message through DeSales Weekly.
I thank my colleagues, Ian Kelley and Paula M. Riley, for their active role in editing and distributing this e-newsletter. I am grateful to Joseph McDaniel, our Oblate seminarian and high-quality writer, for his monthly contributions over the last two years. I also thank our now-former provincial, Fr. Jim Greenfield, whose dedicated service over the past 10 years inspired new ways of sharing our Salesian charism. Most importantly, I thank you, our friends who have supported our province in a variety of ways, with your prayers, generosity, and enthusiasm for our spirit. One chief way you supported us was to recommend to your friends a subscription to DeSales Weekly. Through the years we have grown to more than 12,000 readers.
We always pray that our Salesian hearts are filled with gentleness and humility, for St. Francis de Sales cherished the gospel verse where Jesus says to "learn from me, for I am gentle and humble of heart." Today, our hearts are also filled with gratitude.
Thanks for deleting us with gentleness.
Newer PostLive Jesus 2018 Thank You & Video
Older PostThe Air We Breathe


At one point or another, skin care professionals will all use salicylic acid – it is one of the most popular ingredients in anti-acne skin care. Salicylic is the only beta hydroxy acid used in skin care; it occurs naturally in wintergreen leaves, sweet birch, and other plants, and is topically an anesthetic and a keratolytic with a mild peeling effect. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It is derived from the metabolism of salicin, which is an alcoholic β-glucoside.
Salicylic accomplishes the same goals in skin care as alpha hydroxy acids, such as lactic acid and glycolic acid, but is used in a weaker concentration. Applied to the skin, it breaks down fatty compounds, such as the oily sebum that can clog pores; taken inside the body, salicylic acid (the main ingredient in aspirin) relieves pain and improves circulation. One of the most important benefits of this ingredient is that it is significantly less irritating than other products.
Salicylic acid acts as a keratolytic, which loosens keratin, therefore allowing thickened, scaly plaques of skin to shed more easily. Using an exfoliant that contains salicylic acid not only sloughs off dead skin like a traditional face scrub, but also contains mild acids that will decrease inflammation and prevent further breakouts.
As a mode of chemical exfoliation, salicylic acid increases cell turnover, refreshes the skin, helps kill germs and bacteria, and tightens pores. It is most useful in oily skin and, like aspirin, it can relieve inflammation and redness.
The word salicylic comes from the Latin salix, meaning a plant or a tree of the willow family – it was first made from a complex carbohydrate found in willow bark. The ingredient is not directly found in the bark; the powdered bark has to be treated with oxidants and filtered to make the acid.
It is a monohydroxybenzoic acid, a type of phenolic acid, and a beta hydroxy acid with the formula C7H6O3.
Phenolic acids or phenolcarboxylic acids are types of aromatic acid compound. Phenolic acids can be found in many plant species. Their content in dried fruits can be high.
Over-the-counter treatment products with 0.5 percent to two percent salicylic acid are safe to use in the treatment room, as well as at home. The problem with most acne products that list salicylic acid as their active ingredient is that they do not contain the correct concentration of salicylic acid at the right pH. For facial products, two percent salicylic acid is used with 98 percent of product being a neutral carrier agent. Up to three percent salicylic acid can be used on other body parts and a 10 percent to 30 percent spot treatment will dissolve warts.
Compared to alpha hydroxy acids in acne care products, which can be up to 30 percent, the same treatment is safely achieved by 0.5 percent to two percent concentration of salicylic acid. Because salicylic acid can cause mild stinging and skin irritation, dermatologists highly recommend using it in moderation.
Salicylic acid is generally a safe compound when applied at proper concentrations for the treatment of acne, but there are some instances where salicylic is contraindicated: People that are allergic to aspirin (which is a similar ingredient) or have rosacea/couperose should avoid salicylic acid.
Pregnant women and breastfeeding women should avoid salicylic acid.
This ingredient also should not be used on children younger than two years old and only with a physician's prescription for children because the absorption through skin is greater.
Also, doctors advise being cautious in the use of salicylic acid on Fitzpatrick types IV, V, and VI.
These three skin types contain many cells that produce the pigment melanin; the skin uses this melanin to limit inflammation. When treated by salicylic acid, acne in these skin types may be replaced by brown or black hyperpigmentation.
Be careful when using salicylic acid if the client already has a strong exfoliation routine. Professionals will need to advise them to limit exfoliation to two or three times a week and, furthermore, cut back on any facial scrubs, harsh soaps, or exfoliating masks. At home, it is recommended that clients use a salicylic acid exfoliant two or three times a week, but start with once weekly at night to determine how the skin will react. Salicylic acid does not have any effect on sebum production and does not kill bacteria, so it is important to use products with a variety of ingredients in addition to salicylic acid when working on acneic skin.
Among the most common types of products containing salicylic acid are peels. Jessner's Solution (or Jessner's Peel) is the common name often used for a deeper chemical peel solution consisting of 14 percent lactic acid and 14 percent salicylic acid peeling agent with a resorcinol solvent. The lactic acid assists in the exfoliation of the skin, salicylic acid aids in penetration, and resorcinol assists in the treatment of acne. This procedure was named after Max Jessner, the New York dermatologist who invented it, and is layered on the skin to treat uneven pigmentation, acne, and acne scarring and reduce the appearance of large pores, wrinkles, and uneven skin tone.
After the client's skin is thoroughly cleansed, the peel chemicals are applied. As a general rule, two-to-five coats are applied for the best possible results. The client can expect aggressive peeling and occasional crusting within two-to-four days after the peel has been applied.
Not everyone is a good candidate for a Jessner's Peel. The following people are contraindicated for this type of procedure: clients with active cold sores, sunburn, or severe asthma; clients with lupus, eczema, rosacea, or psoriasis; pregnant women; and clients with chronic skin disorders and dermatitis conditions.
For homecare, the most common product is salicylic acid exfoliants. Clients are encouraged to exfoliate two-to-three times a week maximum with pre-soaked salicylic pads or by applying the exfoliant to swabs and buffing the face for one-to-two minutes. This product is generally best removed with cold water, since it may have a stinging sensation while on the face and cold water alleviates any discomfort.
Another product based on salicylic acid that is advised for homecare is a salicylic acid-based spot treatment.
This type of product will generally contain camphor, zinc, magnesium, and iron oxide. It should be applied directly to the blemish at night for inflammation control. This type of product generally consists of two percent salicylic acid in an alcohol base and should only be used on the blemish directly and not on the entire face. Acneic clients will greatly benefit from using this product between their facial appointments to control and maintain their breakouts.
As with any ingredient, there are a variety of products containing salicylic acid advertised on the market. To stay away from toxic added chemicals, select product lines without parabens, added artificial fragrance and artificial colors, and those that are cruelty-free. High quality products will add value to services and be a great asset in the treatment room!
Dasha Saian, the co-founder and current CEO of SAIAN®, has over 17 years of experience in the spa industry. In addition to her Business/Marketing degree, she is a licensed aesthetician, certified Nutrition and Wellness Consultant, official Ambassador of the Aesthetics International Association (AIA), and certified Family Herbalist. Saian gives lectures and classes internationally and regularly contributes to global trade publications. She is an expert adviser on natural living, alkaline diet, alternative oncology protocols, and positive body image.


Less than an hour from downtown Ottawa, Tucker House is a great place for spiritual retreats, team visioning sessions, family reunions, and weddings! Excellent for community meetings, staff parties and workshops and so much more!
In the house, you have full access to two large meeting rooms, one great for meeting in a circle of 20 people or so, one great for board room style presentations or a meal for 20 people, an accessible washroom downstairs, 2 full bathrooms upstairs, and shared bedroom accommodations for up to 24 people.
We offer guided or self-guided tours on local history and heritage of the site and the sustainability features. Rooms feature original woodwork cut and milled on-site, lots of natural light, and design details by a Confederation-era architect. Other programs for children and adults available on request. Outside you can roam our 30 acre property and enjoy the fire pits, pool, picnic tables, learning barns, and of course the nature trails!
All rentals are under a single contract holder who signs and is responsible for the rental group. A non-refundable administration fee is due in advance, with the remainder due on the date of the retreat, payable by cheque, cash or card. The contract holder must be a responsible adult who is on-site for the duration of the rental.
We have a large, modern, eco-designed, and functional self-catering commercial kitchen for your pleasure.
Outside catering is more than welcome and feel free to ask us about our favorite spots in town!