To evaluate the on-going scale-up of HIV programs, we assessed trends in patient characteristics at enrolment and ART initiation over 7 years of implementation.
Data were from Optimal Models, a prospective open cohort study of HIV-infected (HIV+) adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011 at 44 HIV clinics in 3 regions of mainland Tanzania (Kagera, Kigoma, Pwani) and Zanzibar. Comparative statistics for trends in characteristics of patients enrolled in 2005–2007, 2008–2009 and 2010–2011 were examined.
Overall 62,801 HIV + patients were enrolled: 58,102(92.5%) adults, (66.5% female); 4,699(7.5%) children.
. WHO stage IV at enrolment declined: 27.1%, 2005–2007; 20.2%, 2008–2009; 11.1% 2010–2011. Of the 42.5% and 29.5% with CD4+ data at enrolment and ART initiation respectively, median CD4+ count increased: 210 cells/μL, 2005–2007; 262 cells/μL, 2008–2009; 266 cells/μL 2010–2011; but median CD4+ at ART initiation did not change (148 cells/μL overall). Stavudine initiation declined: 84.9%, 2005–2007; 43.1%, 2008–2009; 19.7%, 2010–2011.
Among children, median age (years) at enrolment decreased from 6.1(IQR:2.7-10.0) in 2005–2007 to 4.8(IQR:1.9-8.6) in 2008–2009, and 4.1(IQR:1.5-8.1) in 2010–2011 and children <24 months increased from 18.5% to 26.1% and 31.5% respectively. Entry from PMTCT was 7.0%, 2005–2007; 10.7%, 2008–2009; 15.0%, 2010–2011. WHO stage IV at enrolment declined from 22.9%, 2005–2007, to 18.3%, 2008–2009 to 13.9%, 2010–2011. Proportion initiating stavudine was 39.8% 2005–2007; 39.5%, 2008–2009; 26.1%, 2010–2011. Median age at ART initiation also declined significantly.
Over time, the proportion of pregnant women and of adults and children enrolled from PMTCT programs increased. There was a decline in adults and children with advanced HIV disease at enrolment and initiation of stavudine. Pediatric age at enrolment and ART initiation declined. Results suggest HIV program maturation from an emergency response.
In the United Republic of Tanzania (Tanzania), HIV prevalence among adults aged 15–49 years was last estimated at 5.7% in 2008/2009 . An estimated 1,400,000 people were living with HIV by 2010, of whom 200,000 are children under 15 years of age . Approximately 610,000 persons living with HIV were in need of antiretroviral therapy (ART)  using the ART eligibility criteria in the 2006 World Health Organization (WHO) guidelines . ART coverage was estimated at 42% among adults and 18% among children, and Tanzania was one of five countries (together with Nigeria, South Africa, Kenya, and Uganda) that contributed to 50% of the global unmet need for pediatric ART . To address the HIV epidemic, Tanzania has been providing free HIV care and treatment, including antiretroviral therapy (ART) since 2004. Over 900 clinics provide ART in the country  and 258,069 patients were receiving ART by the end of 2010 .
The scale-up of ART services and the large number of patients receiving ART are important successes in Tanzania. An evaluation conducted in the early years of program implementation revealed that ART services had been introduced at 210 facilities within 3 years, but there was limited male and pediatric enrolment . Like many sub-Saharan African countries, Tanzania's HIV services were initiated at urban higher-level health facilities and prioritized patients with the most advanced HIV disease . Over time, there have been efforts to encourage HIV testing, decentralize HIV services, expand prevention of mother-to-child HIV transmission (PMTCT) programs, increase the number of people receiving HIV care and treatment, and phase out the use of stavudine due to significant toxicity [7–9]. In order to inform the continuing scale-up of ART programs in this country, we examined trends over 7 years in characteristics of adults and children attending HIV care and treatment clinics in selected regions of Tanzania.
ICAP at Columbia University with funding from the United States President's Emergency Plan for AIDS Relief (PEPFAR) provided programmatic, health facility and health systems support to Tanzania in the establishment of HIV care and treatment clinics (CTCs). ICAP's support in Tanzania began in 2004 and was regionalized to Kagera, Kigoma (north-west Tanzania), Pwani (east coastal region), and the island of Zanzibar. In 2007–2008, HIV prevalence among adults aged 15–49 years in these regions was estimated at 5.3% in Pwani, 3.4% in Kagera, 0.9% in Kigoma and 0.6% in Zanzibar. By December 2011, a total of 127 CTCs had been supported in these regions and a total of 89,780 HIV-infected patients enrolled into HIV care . ICAP support included training of health care providers, building capacity for sustainable clinical mentorship and supervision, and implementation of the national monitoring and evaluation (M&E) system for HIV care and treatment. The Identifying Optimal Models of Care and Treatment in sub-Saharan Africa (Optimal Models) study was funded by the Centers for Disease Control and Prevention (CDC) to analyze routinely collected patient and site-level data for program evaluation. Optimal Models is an open cohort, with patients entering and exiting according to their routine care.
When patients attend HIV care and treatment clinics, demographic and clinical characteristics and treatment details e.g. age, gender, source of referral, WHO staging, CD4+ cell count (CD4+), ART status and regimen are recorded on their patient medical card. During the study observation period, ART initiation was according to national guidelines which aligned with the 2003 and 2006 WHO ART initiation guidelines [3, 6, 8, 11]. The data were entered into a Ministry of Health Microsoft Access database, which is maintained at the site level, updated with every patient visit, and used for reporting to the national government and implementation partners. Implementation of the patient-level database in ICAP-supported regions was prioritized at clinics with the highest patient volume. By the end of 2011, the database was in use at 44 clinics and captured 70% of all patients ever enrolled across the 127 clinics. At the time of introduction of the database, all retrospective data were entered into the database. Quarterly supervision visits were conducted by ICAP in collaboration with Ministry of Health Regional and District Health Management Teams to support site-level data entry clerks in data quality assurance.
Health facility and program characteristics were captured annually using a site assessment tool [12, 13]. Data collected include the site characteristics e.g. location of the site and level of health facility (health centers and dispensaries were categorized as primary facilities; and district, missionary or regional referral hospitals as secondary. Program characteristics that describe the services provided (e.g. presence and location of Voluntary Counseling and Testing (VCT), PMTCT and CD4+ testing services) were also documented. Data from the most recent survey (2011) were used to give a descriptive snap-shot of site and program characteristics.
The patient record data were de-identified and anonymized, then combined across health facilities to create an analytic dataset. The analysis (using SPSS 18) explored trends in patient characteristics among adults (≥15 years) and children (<15 years) enrolled from January 2005 to December 2011. Seven patients were missing age data and excluded from the analysis. WHO stage and CD4+ at enrolment and ART initiation, respectively, were based on records within < 90 days before and < 30 days after date of enrolment/ART initiation with priority given to data before and closest to the enrolment/ART initiation date. ART eligibility was defined using the 2006 WHO guidelines . Descriptive comparative statistics were computed for differences in characteristics of patients enrolled in 2005–2007, 2008–2009 and 2010–2011. These time categories were estimated to represent particular phases of the ART program in Tanzania: the early start-up phase in 2005–2007 where ART services were introduced starting at major hospitals; the rapid scale-up and decentralization phase in 2008–2009 where ART was rolled out to a large number of clinics including lower level health facilities; and a maturation phase 2010–2011 where fewer clinics were newly implementing ART services and the focus for existing clinics was ensuring sustainability and enhancing service provision through support services. Differences and trends in patient characteristics between time categories were tested using chi-square tests for categorical variables and generating linear-by-linear association p values. Differences in medians over time groups were tested with the Jonckheere-Terpstra test, and for other nominal variables like gender and source of referral, the Kruskal-Wallis test was used. Adult trends in WHO stage and CD4+ were stratified by gender and pregnancy status. Missing data are an important focus area for data quality improvement, so for variables with >5% missing data, tables include an indication for data available for each variable with a test for trend over time.
Optimal Models involves analysis of de-identified routinely collected data and received non-human subjects research determination from Columbia University Institutional Review Board and the Centers for Disease Control. The study was also approved by Institutional Review Boards in mainland Tanzania and Zanzibar.
A total of 62,801 patients, 58,102 (92.5%) adults and 4,699 (7.5%) children, were enrolled at the 44 clinics, with peak enrolment in 2009 (Figure 1). The majority of patients (58.0%) and half the clinics were from Kagera region (Table 1). Most patients (80.9%) attended urban/semi-urban clinics, where 79.5% of the clinics were located. Nearly half of the patients (46.1%) were enrolled at the 29.5% public secondary health facilities, while 22.4% were enrolled at the 36.4% public primary health clinics. VCT and PMTCT services were available at all but 1 clinic, and all patients were enrolled at clinics that provided antenatal services and CD4+ testing on or off-site.
Enrolment of children and adults (men, pregnant women and non-pregnant women) by calendar year in Tanzania (2005–2011).
1 Excludes data from the national referral hospital. 2 Includes 1 tertiary facility in Zanzibar. 3 Off-site means blood is collected at care and treatment clinic (CTC), CD4+ analyzed at a laboratory outside the health facility and the results returned to the CTC where they are picked by the patient.
At enrolment, 66.5% were female and 12.5% of these were pregnant (Table 2). The overall median age was 35.2 years (yrs) (IQR 29.1-42.4). Median age of men (38.8 yrs, IQR 32.5-45.9) was significantly higher than non-pregnant women (33.4 yrs, IQR 27.7-40.2) and pregnant women (28.2 yrs, IQR 24.1-32.6). Half the adults (52.3%) were enrolled from VCT programs, 9.9% from PMTCT and 9.3% transferred in from other clinics. Overall, 84.4% adults had a WHO clinical stage recorded at enrolment, of whom 17.9% had advanced HIV disease with WHO stage IV. Among the 42.5% adults with documented CD4+ at enrolment, the overall median CD4+ was 251 cells/μL (IQR 104–463); and it was significantly higher among adults from PMTCT (432 cells/μL, IQR 254–620) compared with VCT (257 cells/μL, IQR 109–472) and other referral points (212 cells/μL, IQR 86–420); a difference that remained statistically significant after stratifying by gender and pregnancy status (data not shown). Only 29.5% of adults had documented CD4+ at ART initiation and median CD4+ was 148 cells/μL (IQR 67–236). Nearly half (49.2%) of the adults initiated ART across the 7 year period, and of these 58.2% were prescribed stavudine in the initial ART regimen.
1 1 adult missing gender data. 2 Denominator for percentage is females enrolled. 3 I TB/HIV clinics, inpatient clinics, outpatient clinics, and Persons Living with HIV associations . 4 CD4+ at any date < 90 days before or < 30 days after date of enrolment/ART initiation with priority given to date before and closest to the enrolment/ART initiation date. 5 Based on 2006 WHO eligibility criteria. 6 Denominator for percentage is all adults who started ART. 7 Denominator for percentage is females who started ART. 8 Denominator for percentage is those who started ART, stavudine and zidovudine containing regimens were combined with lamivudine and nevirapine or efavirenz. 9 Includes less commonly used drugs like abacavir, tenofovir and protease inhibitors.
Among females, the proportion pregnant at enrolment increased from 6.8% in 2005–2007 to 12.1% in 2008–2009 and 17.2% in 2010–2011 (p < 0.0001) (Table 2). Overall, adult median age at enrolment decreased modestly from 36.1 (IQR 30.0-43.1) in 2005–2007 to 35.0 (IQR 28.9-42.1) in 2008–2009 and 34.8 (IQR 28.5-42.1) in 2010–2011 (p < 0001). On stratifying by gender and pregnancy status, the decrease in median age over time only remained statistically significant among non-pregnant women (data not shown). VCT as a point of entry into care contributed 37.6% of HIV + adults in 2005–2007, 56.8% in 2008–2009 and 57.8% in 2010–2011, p < 0.0001. There were also increasing proportions of adults enrolled from PMTCT programs over time: 6.6% in 2005–2007; 9.5% in 2008–2009; and 12.6% in 2010–2011. The proportion of adults transferring in from other clinics increased from 4.2% in 2005–2007 to 12.2% in 2008–2009, then declined to 10.0% in 2010–2011, though the overall proportion was increasing over time, p < 0.0001.
There was an increase in WHO clinical stage documentation from 62.0%, 2005–2007 to 89.8%, 2006–2007, to 95.4%, 2010–2011 (p < 0.0001). The percentage of adults enrolled with WHO clinical stage IV declined from 27.1% in 2005–2007 to 20.2% in 2008–2009 and 11.1% in 2010–2011 (p < 0.0001). This decline was statistically significant among males as well as non-pregnant and pregnant women (Figure 2). Overtime, a slightly higher proportion of adults had CD4+ documentation at enrolment: 39.6%, 2005–2007; 44.0%, 2008–2009; 43.2%, 2010–2011, but there was a decline in CD4+ documentation at ART initiation 33.0%, 2005–2007; 31.2%, 2008–2009; 25.0%, 2010–2011, (p < 0.0001). In the sub-set of adults with CD4+, median CD4+ at enrolment increased from 210 cells/μL (IQR 88–418) in 2005–2007 to 262 cells/μL (IQR 111–484) in 2008–2009 and 266 cells/μL (IQR 112–468) in 2010–2011 (p < 0001). On stratifying by gender and pregnancy status, this increase was only statistically significant among the non-pregnant women (Figure 3). There were no statistically significant changes in median CD4+ at ART initiation even after stratifying by gender and pregnancy status (Figure 3). Median CD4+ at ART initiation was 143 cells/μL (IQR 65–225) in 2005–2007, 155 cells/μL (IQR 70–245) in 2008–2009 and 143 cells/μL (IQR 63–235) in 2010–2011, p = 0.6. There was a decline in stavudine use among the adults that initiated ART, 84.9%, 63.9% and 19.7% of those enrolled in 2005–2007, 2008–2009, and 2010–2011 respectively. A higher proportion of adults initiated AZT-containing regimens: 14.4%, 34.9% and 72.2% in the respective calendar year groups.
Changes over time in adult WHO stage at enrolment by gender and pregnancy status in Tanzania.
Changes over time in adult median CD4+ and inter-quartile range at enrolment and ART initiation by gender and pregnancy status.
Overall, 52.8% were female and median age at enrolment was 4.1 years (IQR 1.9-8.8), and at ART initiation 5.6 years (IQR 2.2-9.7). Main points of entry into care were VCT (44.4%) and PMTCT (11.2%); and 10.8% of children transferred in from other clinics (Table 3). The majority (85.5%) had documented WHO clinical stage at enrolment and 17.6% were stage IV. Nearly half (49.3%) were ≥5 years and of these, 40.6% and 28.5% had CD4+ at enrolment and ART initiation documented respectively. Median CD4+ at enrolment of children 5 years or older was 398 cells/μL (IQR 167–717) and at ART initiation 327 cells/μL (IQR 87–394). Overall, 55.3% initiated ART, of whom 35.4% were prescribed stavudine in the initial ART regimen.
1 Includes TB/HIV clinics, inpatient clinics, outpatient clinics, and Persons Living with HIV associations. 2 Based on WHO 2006 guidelines. 3 As a percentage of those who started ART, stavudine and zidovudine containing regimens were combined with lamivudine and nevirapine or efavirenz. 4 Includes less commonly used drugs in the initial ART regimen like abacavir, tenofovir and protease inhibitors. 5 CD4+ done at any date < 90 days before or < 30 days after date of enrolment/ART initiation with priority given to date before and closest to the enrolment/ART initiation date.
Although absolute numbers of children increased, there were no changes in the proportion of children over time: 7.4%, 2005–2007; 7.8%, 2008–2009; 7.4%, 2010–2011. The children's median age at enrolment decreased from 6.1 yrs (IQR 2.7-10.0) in 2005–2007 to 4.8 yrs (IQR 1.9-8.6) in 2008–2009, and 4.1 yrs (IQR 1.5-8.1) in 2010–2011 (p < 0.0001). Children aged <24 months at enrolment increased from 18.5% in 2005–2007 to 26.1% in 2008–2009 and 31.5% in 2010–2011, p < 0.0001, (Table 3). Referrals from PMTCT clinics tended to be younger (Figure 4) and were an increasing proportion of children over time: 7.0%, 2005–2007; 10.7%, 2008–2009; 15.0%, 2010–2011, p < 0.0001, (Table 3). The proportion of children transferring in from other clinics increased from 4.4% in 2005–2007 to 13.3% in 2008–2009 then declined to 12.7% in 2010–2011, but an overall upward trend was observed (p < 0.0001).
Changes over time in children's median age and inter-quartile range at enrolment and ART initiation by source of referral to HIV clinics in Tanzania.
There was an increase in WHO clinical stage documentation from 66.4%, 2005–2007 to 90.3%, 2006–2007, to 94.5%, 2010–2011. The percentage of children with WHO clinical stage IV declined from 22.9%, 2005–2007 to 18.3%, 2008–2009 to 13.9%, 2010–2011 (p < 0.0001). Among the 2,318 children ≥5 years, there was no statistically significant change in documentation of CD4+ at enrolment, and documentation of CD4+ at ART initiation declined over time (Table 3). In this subset of the 5 years and older children with CD4+ at enrolment (40.6%) and ART initiation (28.5%), median CD4+ at enrolment increased from 378 cells/μL (IQR 123–697) in 2005–2007 to 401 cells/μL (IQR 172–718) in 2008–2009 and 451 cells/μL (IQR 198–744) in 2010–2011 (p = 0.035), and median CD4+ at ART initiation was 208 cells/μL (IQR 81–350), 223 cells/μL (IQR 107–402) and 223 cells/μL (IQR 60–396) in the respective time periods (p = 0.34). Of the 2,599 children that initiated ART, 39.8%, 39.5% and 26.1% of those enrolled in 2005–2007, 2008–2009, and 2010–2011 respectively initiated stavudine-containing regimens (p < 0.0001). Median pediatric age at ART initiation declined from 7.4 yrs (IQR 4.0-11.1) in 2005–2007 to 5.5 yrs (IQR 2.3-9.3) in 2008–2009, and 3.7 yrs (IQR 1.4-8.1) in 2010–2011 (p < 0.0001). The proportion of children aged <24 months at ART initiation increased from 14.6% in 2005–2007 to 25.8% in 2008–2009 and 38.4% in 2010–2011 (p < 0.0001). Children enrolled from PMTCT programs initiated ART at a much younger age than those enrolled from VCT and other referral points (Figure 4).
We reviewed trends of adult and pediatric characteristics at enrolment and ART initiation over 7 years of implementing HIV care and treatment programs in the United Republic of Tanzania. Our findings suggest that increasingly, adults and children are being enrolled from PMTCT programs and with less advanced HIV disease. We found an increasing proportion of pregnant women enrolled, younger age at enrolment among adults, younger age at enrolment and ART initiation among children, and fewer adults and children starting stavudine in their initial ART regimen. However, fewer than half the patients had CD4+ documentation and there were no changes in median CD4+ at ART initiation among adults and children. Overall, a large number of adults and children accessed HIV care and treatment, demonstrating the successful establishment and expansion of HIV care and treatment programs in Tanzania. In the 3 ICAP supported regions of mainland Tanzania (Kagera, Kigoma and Pwani), these data from sites with electronic databases represent 43% of the adult population estimated to be HIV+ by December 2009, implying that a significant proportion of the population in these regions had accessed HIV services . Observed trends suggest progression from an emergency response to more mature HIV programs.
Over time, PMTCT programs had an increasing contribution to adults and children entering HIV care. This is further evidenced by the significant increase in the proportion of women pregnant at enrolment and may be an indication that the scale up of PMTCT programs is having a positive impact on linkage into care and treatment. Though small, the proportion of women pregnant at ART initiation also increased over time. The largest contributor to adults and children entering HIV care was VCT, particularly after 2007. This could reflect the success of the National Voluntary HIV Testing Campaign conducted in 2007/2008 . The population was encouraged to know their HIV status and subsequently access HIV care and treatment, and it is possible that there was increased population awareness of VCT in subsequent years. The proportion of patients transferring into the study clinics peaked in 2008–2009, a period associated with a rapid and peak increase in the number of clinics with ART services and decentralization . The declining proportion of patients enrolled with less advanced HIV disease over time is an encouraging finding, and may be linked to more referrals from VCT and PMTCT clinics which are typically attended by healthier patients as observed in our analysis and by others [17, 18]. It could also reflect maturation of the Tanzanian program which in the early years prioritized identification and ART initiation of the patients with the most advanced HIV disease as specified in the national guidelines .
There have been significant improvements in WHO stage documentation over time, but CD4+ documentation remains low, even among the most recently enrolled adults and children. As a result, ART eligibility at enrolment could not be determined for at least 1 in five patients in the study population (with the exception of the most recently enrolled adults). Considering the liberal window attached to the enrolment visit in our analysis (<90 days before and <30 days after date of enrolment), this is a concern. CD4+ testing is an essential complement to WHO staging in accurately diagnosing HIV disease progression [19, 20], but missing data due to various program and patient level factors is a common challenge in African programs [21–23]. A review of clinic data from ICAP sites suggests that inadequate lab facilities, frequent stock-outs of reagents, and machine breakdown contribute to the lack of CD4+ data . Newer technologies such as point-of-care testing and same day results for CD4+  should be explored as a strategy to improve availability of CD4+ data.
Despite the limitations with CD4+ testing, a large number of patients initiated ART, and it is possible that due to limited resources, CD4+ testing was deliberately omitted where patients had advanced HIV disease. According to Tanzania and WHO guidelines used during the study period [3, 6, 8, 11], patients with clinically advanced HIV disease (WHO stage III or IV) could initiate ART without a CD4+ cell count. In further analyses of our study population, 84% of adults without CD4+ documentation at ART initiation were classified as WHO stage III or IV, suggesting that patients missing CD4+ cell counts were more likely to have advanced disease than patients receiving CD4+ testing. Consequently, the median CD4+ at ART initiation observed in our study is likely an overestimate of population CD4+ at ART initiation if the less clinically ill patients preferentially had CD4+ testing done.
We observed a modest increase in median CD4+ at enrolment over time comparable to other sub-Saharan Africa HIV programs [26, 27], and suggesting healthier populations accessing care. Our data showed no statistically significant increase in median CD4+ at ART initiation, which could imply that greater efficiency is needed in the ART initiation process, or that clinics remain overwhelmed by the very ill patients in need of ART. This finding was unlike observations in other similar programs [26, 28, 29], but even in these programs, the absolute increase in median CD4+ at ART initiation was small. In Tanzania, implementation of changes in the ART initiation guidelines increasing the CD4+ threshold from 200 to 350 cells/μL began in 2010/2011, and this may contribute to the lack of change in our study observation period ending 2011. Our CD4+ trend data should however be cautiously interpreted due to the significant proportion of missing data. Further analyses of Optimal Models data to explore time to, and predictors of, timely ART initiation are planned.
There was a decline in stavudine use in the initial ART regimen, particularly significant among adults. This is in line with national and international guidelines that have advocated for the phasing out of this drug due to toxicities [7, 14]. It is important that additional analyses continue to monitor this trend and also report the proportion of patients currently using the drug. Stavudine was not as widely used in initial pediatric-ART regimens and the decline in use was less dramatic compared to adults. This may be because in such resource-limited settings, inadequate availability of pediatric ART formulations often limits treatment choices .
One in three adults enrolled were male, and this did not change significantly over time. Evaluations conducted in other regions of Tanzania and Africa [4, 31, 32] have reported limited male involvement, but in Tanzania, this proportion is in line with the general population where males comprise 37% of those HIV infected . Still, the impact of innovative strategies to encourage male access to HIV services, such as those explored in PMTCT programs [33–36] should be examined in this setting. The proportion of children in the study population did not increase significantly over time. This in a country with over 80% unmet need for pediatric ART  is a concerning finding and implies that efforts to diagnose and enroll children into ART care should be strengthened. Tanzania in collaboration with ICAP and other development partners is facilitating scaling up early infant diagnosis and creation of pediatric and adolescent friendly services [37–39]. This may explain our data showing younger age and less advanced children's HIV disease at enrolment over time, perhaps pointing to successful early testing and linkage to care strategies implemented within PMTCT and VCT services. It is also possible that potential increase in the proportion of enrolled children expected from improved case-finding of pregnant women and children through scale-up of PMTCT services, early infant diagnosis programs and other pediatric focused initiatives was leveled out by more successful PMTCT programs resulting in fewer HIV-infected children.
The strengths of Optimal Models lie in the large sample of HIV-infected adults and children, and a variety of sites represented from multiple regions of Tanzania over a long observation period. The data are collected from 'real-world' settings: clinics and facilities where patients received care, giving insight to grass roots activities. This analysis serves as a baseline, and additional analyses evaluating critical implementation issues are planned. A limitation of this analysis was inadequate data to determine which clinics transferred-in patients were coming from, possibly overestimating the overall number enrolled if patients transferred within the 44 study sites. However, the impact of this overestimation is likely minimal since patients could potentially transfer-in from over 900 other clinics in Tanzania and beyond. Further review of the data indicated that transferring out of the study clinics did not proportionally increase over time: it declined from 17.9% to 13.1% to 5.9% in the respective calendar year groups.
This analysis did not control for site-level effects when testing for trends, however the entire patient population at the study sites was used. Whereas the trends are indicative of observations at the 44 study sites, the data cannot be considered as applying to all clinics in Tanzania more generally. Another limitation with this analysis pertains to data quality barriers generally associated with routine program data [40–43]. For example, it may well be that CD4+ testing was done for more patients but not captured in the patient records or the database. Routine data quality assessments are ongoing to continuously improve the data and minimize missing and erroneous data. These data encouragingly show improvements in data completeness for WHO stage and point of entry over time, and there were minimal missing data for some key variables like gender and age at enrolment.
Over the early 7 years of HIV care and treatment program implementation in Tanzania, there was an increase in enrolment of pregnant women and adults and children enrolled from PMTCT programs. The proportion of adults and children with advanced HIV disease at enrolment declined, as did the stavudine use in the initial ART regimen. Median pediatric age at enrolment and ART initiation also declined. A large number of adults and children were enrolled into HIV care and initiated ART, demonstrating successful expansion of HIV services in the country. However, many patients were missing documentation of CD4+ at enrolment and ART initiation, an aspect that will require focus in further program enhancements.
This study was based on de-identified routinely collected data. There was no interaction with patients for study purposes. The protocol received non-human subjects research designation and consent waiver under 45 CFR46. As such, individual consent was not sought for participating individuals.
We gratefully acknowledge the health care workers, program and M&E teams from the Ministries of Health and Social Welfare in Tanzania and Zanzibar, ICAP in Tanzania, and the Tanzania Health Promotion Support (THPS) Organization, who implement the programs and collect the data. We thank the ICAP-New York Strategic Information team, and ICAP-New York leadership for their support. This research has been supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention under the terms of Cooperative Agreement Number 5U62PS223540 and 5U2GPS001537. The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of their supporting or funding agencies.
HNB, BK, GA, AK, AAA, GR, RM, WR, EJA contributed to the conception of the analysis idea; HNB, BK, GA, AK, AAA, WR, ML, RM, contributed to data collection and cleaning; ML merged and coded the data; ML, GA, AAA advised on the analysis; HNB conducted the analyses and wrote the manuscript; BK, GA, AK, AAA, WR, GR, ML, RM, EJA, reviewed and contributed to the manuscript, EJA gave overall technical oversight for the analytic process and manuscript writing. All authors read and approved the final manuscript.


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AMX Power Distribution Unit Selected as 2010 EXCITE Award Winner
CustomRetailer Magazine Awards NetLinx PDU - the Smart-Energy Device for Managing AV/IT Rack Equipment - in Annual Industry Showcase
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Heat Advisory in effect for New York City from noon Sunday, July 19, through 8 p.m. Monday, July 20
Cooling centers are open across the city Sunday and Monday. To find the nearest location call 311 or visit the City's Cooling Center Finder (Cooling Center Finder website will be active beginning 8 p.m. Saturday)
Attendees must wear face coverings inside all NYC cooling centers and adhere to social distancing guidelines
July 18, 2020 — The New York City Emergency Management Department and the Health Department today advised New Yorkers to take precautions to beat the heat. The National Weather Service has issued a heat advisory in effect for New York City from noon Sunday, July 19 through 8 p.m. Monday, July 20. High heat and humidity are in the forecast, with heat index values in the mid to upper 90s on Sunday and around 100 on Monday.
To help New Yorkers beat the heat, New York City has implemented a number of measures through the Cool It! NYC and Cool Streets initiatives, including:
More than 230 new cooling and misting sites in parks in heat-burdened neighborhoods
More than 160 Cooling Centers open throughout the City
More than 300 hydrants opened with spray caps
650 spray showers in city parks
16 Cool Streets
More than 40,000 air conditioners installed for low-income seniors
A citywide map of cooling elements can be found online at Cool It! NYC. To find your nearest cooling center call 311 or visit the City's Cooling Center Finder. DOT's Open Streets also highlights each Cool Street across the city.
"As the dangers of the hot weather collide with the COVID-19 pandemic, we are implementing a number of measures to ensure New Yorkers can stay cool while still being socially distanced. We encourage everyone who has an air-conditioner at home to use it; if you don't have an AC, we have opened cooling centers for you to seek relief from the heat," said NYC Emergency Management Commissioner Deanne Criswell. "Remember to check on friends, family members and neighbors who are sick, elderly, or people with disabilities who may need assistance during a heat emergency."
"New Yorkers isolating at home to protect against COVID-19 are also at greater risk of heat-related illness if they do not have or use air conditioning," said Health Commissioner Dr. Oxiris Barbot. "We urge all New Yorkers to get relief in air conditioning for at least a few hours a day, wear light cool clothing, drink lots of water and try to avoid strenuous outdoor activities during the hottest parts of the day. Check on friends, neighbors, and loved ones regularly. Making contact will help reduce feelings of isolation and loneliness during this difficult time and help those at risk for heat-related illness and death and COVID-19 stay safe during heat waves."
"As the first heat emergency of the summer is upon us, now is the perfect time for residents to take advantage of our new Cool It! NYC map, which highlights the closest parks with cooling features in each neighborhood," said NYC Parks First Deputy Commissioner Liam Kavanagh. "In addition to the new cooling map, we are adding new cooling features to parks in neighborhoods most at risk during heat events, making it even easier for New Yorkers to get cool and stay safe from the heat."
Cooling Centers
As the City continues its response to COVID-19, social distancing guidelines have been implemented to ensure the safety of any New Yorker who visits a cooling center to seek relief from the heat. Face coverings must be worn at all times inside cooling centers, and attendees must adhere to social distancing guidelines of six feet or more. Cooling centers will also operate at limited capacity. Cooling centers located at senior center locations will be reserved for seniors. To prevent the spread of COVID-19, individuals are reminded to stay at home if they are feeling sick or exhibiting symptoms of COVID-19.
Cooling center locations have changed from last year. To find a cooling center, including accessible facilities closest to you, call 311 (212-639-9675 for Video Relay Service, or TTY: 212-504-4115) or click here. Cooling centers are open Sunday, July 19, and Monday, July 20.
Cool Streets
The City recently unveiled the first set of "Cool Streets" for this summer, announcing expanded cooling options on existing Open Streets in the most heat-burdened parts of New York City. The Cool It! NYC program prioritizes new cooling options on blocks in vulnerable neighborhoods with the highest tree-based shade and fire hydrants with spray caps. During heat advisories, NYCDEP and FDNY will proactively install spray caps on these streets' hydrants to ensure every New Yorker living in a heat-burdened community is within 1/4 mile of an outdoor cooling element.
The Cool Streets initiative focuses on Open Streets in areas that rank highest on the Heat Vulnerability Index, which uses social and environmental factors to understand how heat-related health risks vary across NYC neighborhoods. The City is prioritizing its cooling efforts on HVI 4 and 5 zones, the most heat burdened communities, to serve vulnerable residents during extreme heat events.
Cooling Elements, Spray Showers, & Cool It! NYC Map
The New York City Parks Department will open outdoor cooling options to help individuals beat the heat. New Yorkers can find relief from the heat in spray showers and sprinklers in city parks, drinking fountains across the city, NYC beaches, and tree-based covered areas where temperatures can be up to 20 degrees cooler.
Parks has also identified locations within HVI 4 or 5 zones where new outdoor cooling elements can be added to parks during extreme heat events to create "community oases." These elements will consist of Parks hydrants and other plumbing fixtures that can be adapted to function as spray showers and misting features. By utilizing the map, visitors will be able to find up-to-date information on the closest sprinklers and water fountains in their neighborhood, and with the Leafiest Blocks and Park Tree Canopy categories, easily find Parks' recommendations for blocks and areas with the most shade to help stay cool this summer. Visit Cool It! NYC for more information.
During extreme heat, the Department of Social Services (DSS) issues a Code Red Alert. During Code Reds, shelter is available to anyone experiencing homelessness, where those experiencing heat-related discomfort are also able to access a designated cooling area. Transportation to cooling centers is available via DSS outreach teams who engage with potentially homeless individuals every day of the year and intensify engagement during extreme heat.
In New York City, most heat-related deaths occur after exposure to heat in homes without air conditioners. Air conditioning is the best way to stay safe and healthy when it is hot outside, but some people at risk of heat illness do not have or do not turn on an air conditioner. The New York City Emergency Management Department and the Health Department urge New Yorkers to take steps to protect themselves and help others who may be at increased risk from the heat. For more information, including heat-related health tips and warning signs of heat illness, visit NYC.gov/Health or NYC.gov/beatheheat.
New Yorkers are encouraged to sign up for Notify NYC, the City's free emergency communications program. To sign up for Notify NYC, download the free mobile application, visit NYC.gov/NotifyNYC, call 311, or follow @NotifyNYC on Twitter.
MEDIA CONTACT: Omar Bourne/Tashawn Brown
(718) 422-4888 / Press@oem.nyc.gov
STAY CONNECTED: Twitter: @NotifyNYC (emergency notifications); @nycemergencymgt (emergency preparedness info)


text:
is a song by the Japanese girl group E-girls. It was released on October 2, 2013, as the group's sixth single and it was released a week earlier digitally as their fifth digital single.

Background
The single release was announced on August 12, 2013, on E-girls' official website, along with release day, prices and editions. On August 30, the website announced more two editions of the single: One Coin CD and Music Card edition. On September 2, jacket covers and track list of the single were revealed. The single features a song of the group Flower, one of the groups included on E-girls. This is the second time a song of a specific group is being included in a E-girls single, with the first being "Dreaming Girls", of the group Dream, included on E-girls' debut single "Celebration!".

Editions
 CD+DVD (RZCD-59428/B): The CD+DVD edition includes the CD single with all tracks, the instrumental of "Gomennasai no Kissing You" and a DVD including the music video of the song and a making of from it. First presses of this edition comes in an EP package size.
 CD only (RZCD-59429): The CD only edition includes the CD single only with all tracks and the instrumentals of it.
 One Coin CD (RZC1-59430) and Music Card (AQZ1-76017~45): The One Coin CD edition includes the CD single with only the track "Gomennasai no Kissing You" and a different jacket cover. The Music Card includes only the track "Gomennasai no Kissing You" in a special card, only available in Japan. It was released in 29 editions, one per member. Both types were only available to purchase on mu-mo online shop, LDH Mobile shop and at live & event venues.

Composition
"Gomennasai no Kissing You" was written by Yu Shimoji, composed and arranged by Clarabell. "Hatsukoi" was written by Narumi Yamamoto, composed by Chris Meyer, Takumi Tsukada and Grace and arranged by Pochi. It is a song of the group Flower. "Fancy Baby" was written by Kanata Okajima, who also composed the song with Jon Hallgren. "Koi no Boogie Woogie Train" was written by Minako Yoshida, composed by Kanata Okajima, and arranged by Yuta Nakano.

Participating members

"Gomennasai no Kissing You"
 Vocalists: Ami, Shizuka (Dream), Reina Washio (Flower)
 Performers: Dream, Happiness, Flower, Yuzuna Takebe, Kyoka Takeda, Misato Hagio, Rio Inagaki, Anna Ishii, Nonoka Yamaguchi (Bunny), Risa Ikuta, Momoka Nakajima (EGD)

Music video
A short version of the music video for the song was revealed on September 9, 2013, on Avex Trax's YouTube channel. The full version was broadcast the following day, September 10, on the music channel M-On!. It features the girls in an amusement park performing the song. The middle part of the video includes a dance battle between the performers of the groups Flower and Happiness, and a special part including the members of the non-debuted group Bunny in marching band outfits. At the end, all the girls made the sign of "apology" in a circle. The music video was directed by Shigeaki Kubo.

Promotions
"Gomennasai no Kissing You" was used as theme song for the Japanese movie The Apology King. The song was also performed on some TV shows, such as Music Dragon and Music Japan. "Hatsukoi", Flower's song, was used as theme song for Samantha Thavassa's Samantha×Kawaii×Art TV advertisement for the month of September. "Fancy Baby" was used as theme song for CX's TV show Mezamashi News during the month of October.

Track listing

Notes
 The iTunes Store edition does not include Flower's song, "Hatsukoi", due to the group being signed with Sony Music Associated Records Inc., who released the song separately. It also does not include instrumentals.

Chart performance
The physical single debuted at number two in Oricon's daily singles, selling 32,246 in its first day. In its fourth day of sales, the single climbed to the number one spot, selling 8,533 copies on that day.

Oricon chart

Billboard Japan charts

Release history

References

2013 singles
Japanese-language songs
E-girls songs
2013 songs
Japanese film songs

redpajama_set_name: RedPajamaWikipedia


text:
A New Analysis of JILIN YATAI (GROUP) CO., LTD. (600881) (2019-07-05)
First of all, if you are trading JILIN YATAI (GROUP) CO., LTD. as of the time of writing (2019-07-05), we strongly advise subscribing to Wall Street Journal AT THIS LINK:
Reporting for 2019-07-05 | by tallahasseescene.com: JILIN YATAI (GROUP) CO., LTD. (600881) opened at 3.26, reaching a high of 3.28 and a low of 3.24 before closing at a price of 3.28. There was a total volume of 8338098.0. We saw an accumulation-distribution index of 16.36, an on-balance volume of -3.25, chaikin money flow of 3.0 and a force index of 0.0003. There was an ease of movement rating of -0.00012, a volume-price trend of -0.28777 and a negative volume index of 1000.0.
We also noted an average true range of 0.07, bolinger bands of 3.24, an upper bollinger band of 3.24, lower bollinger band of 3.24, a bollinger high band indicator of 1.0, bollinger low band indicator of 1.0, a central keltner channel of 3.26, high band keltner channel of 3.24, low band keltner channel of 3.28, a high band keltner channel indicator of 1.0 and a low band keltner channel indicator of 1.0. There was a donchian channel high band of 3.24, a donchian channel low band of 3.24, a donchian channel high band indicator of 1.0, and a donchian channel low band indicator of 1.0.
We calculated a Moving Average Convergence Divergence (MACD) of -0.00031, a MACD signal of -0.00013, a MACD difference of -0.00018, a fast Exponential Moving Average (EMA) indicator of 3.24, a slow Exponential Moving Average (EMA) indicator of 3.24, an Average Directional Movement Index (ADX) of unknown, an ADX positive of 20.0, an ADX negative of 20.0, a positive Vortex Indicator (VI) of 1.0, a negative VI of 1.0, a trend vortex difference of 0.1048, a trix of -6.97585, a Mass Index (MI) of 1.0, a Commodity Channel Index (CCI) of 66.66667, a Detrended Price Oscillator (DPO) of 0.3079, a KST Oscillator (KST) of -86.78373 and a KST Oscillator (KST Signal) of -86.78373 (leaving a KST difference of -0.62635). We also found an Ichimoku rating of 3.27, an Ichimoku B rating of 3.27, a Ichimoku visual trend A of 3.63425, an Ichimoku visual trend B of 3.5605, an Aroon Indicator (AI) up of 4.0 and an AI indicator down of 4.0. That left a difference of -8.0.
We found a Relative Strength Index (RSI) of 50.0, a Money Flow Index (MFI) of 33.93276, a True Strength Index (TSI) of -100.0, an ultimate oscillator of -14.93094, a stochastic oscillator of 200.0, a stochastic oscillator signal of 200.0, a Williams %R rating of 100.0 and an awesome oscillator of 0.00633.
There was a daily return of -8.67837, a daily log return of -0.30912 and a cumulative return of -0.30864.
A Deep Look Into Fujian Qingshan Paper Industry Co.,Ltd. (600103) (2019-07-11)
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New Things To Consider With Shanghai Carthane Co., LTD (603037) (2019-07-18)
REPORTING FOR 2019-07-18 | TALLAHASSEESCENE.COM: We have conducted a deep analysis of how Shanghai Carthane Co., LTD (603037) has been trading over the last 2 weeks and the past day especially. On its latest session, Shanghai Carthane Co., LTD (603037) opened at 18.18, reaching a high of 18.25 and a low of 18.1 before closing […]
A Deep Analysis of Ningbo Zhoushan Port Company Limited (601018) (2019-07-03)
On 2019-07-03 Ningbo Zhoushan Port Company Limited (601018) opened at 4.45, reaching a high of 4.45 and a low of 4.38 before closing at a price of 4.39. There was a total volume of 15819320.0. We saw an accumulation-distribution index of 77.90143, an on-balance volume of 4.46, chaikin money flow of 7.55932 and a force […]
Important Beijing Dynamic Power Co., Ltd (600405) Indicators (Just Released) (2019-07-05)
A New Analysis of SAURER INTELLIGENT TECHNOLOGY CO., LTD. (600545) (2019-07-05)
Trading JILIN YATAI (GROUP) CO., LTD.? We strongly advise 600881 investors to subscribe to MarketBeat.com's free daily email newsletter for updates, news and analyst ratings on 600881 - without this you may be missing out on very important developments for JILIN YATAI (GROUP) CO., LTD.:


AfterBorgWarner Inc.lowered its full-year earnings expectations when it reported third-quarter results last fall, investors in the automotive turbocharger and drivetrain manufacturer must have been apprehensive heading into its fourth-quarter earnings. However, the latest quarterly numbers were in line with expectations. Let's look at its earnings and outlook for 2015.
Stronger U.S. dollar biting profitsIn its third-quarter results, delivered in October, management reduced full-year earnings-per-share guidance to $3.23-$3.28 from a previous range of $3.25-$3.35. It cited "weakening foreign currencies" and the "slow ramp-up of a major program by a North American customer" within the drivetrain segment. Fast-forward to the fourth quarter and full-year non-generally accepted accounting principles EPS came in at $3.25 -- an impressive result considering that the U.S. dollar strengthened significantly since the third-quarter announcement.
As an exporter, BorgWarner has significant negative exposure to the dollar against certain foreign currencies. As the American currency strengthens, the value of the euro, yen, and other currencies is reduced in U.S. dollar terms. The company then earns less money on sales made in foreign currencies.Here is a look at how some of the major currencies that BorgWarner is exposed to have performed since the third-quarter announcement.
US Dollar to Euro Exchange Rate data by YCharts.
No change to 2015 guidanceFor 2015, management didn't fundamentally change the guidance it gave in mid-January. Instead, executives promised to update investors on the 2015 outlook in the first-quarter earnings release in April. The guidance given in mid-January is for full-year 2015 net sales growth of 9.5%-12%, excluding foreign currencies. On a reported basis, net sales are only expected to grow by 2%-6%. In other words, a stronger dollar is forecast to hold back sales growth.
Moreover, earnings are also predicted to take a hit from currency effects. The guidance in January was for full-year 2015 diluted EPS of $3.35-$3.55, suggesting EPS growth of 3%-9%. However, according to the company's mid-January press release, "excluding the impact of weaker foreign currencies, net earnings are expected to be $3.60-$3.75 per diluted share" -- indicating a growth rate of 11%-15% compared to 2014.
BorgWarner's underlying growth rate remains pretty strong, and if the U.S. dollar weakens in 2015, then investors can expect some upside to EPS forecasts going forward.
Segmental earningsTurning to the specifics in the fourth quarter, net sales rose 6% and operating income increased by 13%, with the engine segment leading the way in profit growth. A look at adjusted earnings before interest and taxes, or EBIT, demonstrates the divergence in performance between the segments in the quarter.
Source: BorgWarner presentations, all figures in millions of U.S. dollars unless stated.
The figures quoted in the table are headline data, but the underlying picture is somewhat stronger in both segments. Excluding currency effects and the impact of the purchase of Wahler ( a manufacturer of exhaust gas recirculation valves and tubes), adjusted EBIT margin for the engine segment would have been 17.4% -- a full percentage point increase on the 16.4% reported in last year's fourth quarter.
Three things negatively affected the drivetrain segment's sales and earnings in the quarter -- all of which could prove temporary.
Excluding currency effects, sales actually rose 2%.
Drivetrain faced a tough comparison from last year's fourth quarter, in which sales increased 10% (excluding currency effects).
There was a "slow ramp up" by a North American customer, referred to earlier.
The third issue is arguably the most concerning, and the matter was raised during the conference call. CFO Ronald Hundzinski responded to the question: "So if you take a look at , I believe that customer was running pretty high on volumes in the first two quarters of '14 as well. And so it would be more in the second half where you start to see the comps would even out."
In other words, the comparisons are likely to get easier in the second half of 2015.
Set for a strong yearBorgWarner seems set for a strong year, but investors should look for the updated full-year guidance that is scheduled to be released with the first-quarter results in April. The company offers investors an interesting mix of prospects, with long-term revenue growth opportunities balanced with restructuring to cut costs and margin expansion through the integration of Wahler. It also offers investors a good way to hedge the possibility of a weaker U.S. dollar.
The article BorgWarner Earnings: Underlying Growth Is Stronger Than You Think originally appeared on Fool.com.
Lee Samaha has no position in any stocks mentioned. He would love to think that the company was formed by a joint venture between Bjorn Borgand British actor David Warner (he played the photographer with the terrifying haircut in the original Omen movie) over a few pints at Wimbledon, but doubts it's the case. The Motley Fool recommends BorgWarner. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.


Geaux Wild Conference in NOLA!
When I was first approached to keynote the inaugural Geaux Wild conference in New Orleans, I was SO excited. One of our company initiatives this year is to get out and meet as many of our fabulous fans as possible, so this made for an easy decision in sponsoring the conference, and bringing our fab marketing team on the road for the party!
We all met at LAX, and of course we won the most stylish luggage at the airport award. We're asked quite often if we are going to carry luggage again, and we may…. we just have a few other exciting projects to conquer before revisiting that realm.
We landed in New Orleans and embraced the humidity as we drove to the hotel. We could not have prepared for our arrival in our wildest dreams. The hotel lobby was filled with hundreds of attendees who welcomed us with so much joy. These amazing women all use their planners to manage their lives in a different way, and it was incredible to hear the different stories of how we help them stay organized. After a few selfies and hugs, we headed to our rooms.
That night we headed out to Peche for an amazing seafood dinner and cocktails. We enjoyed Bourbon Street, O'Brien's, and we were even caught in a flash storm. We seriously were soaked to the bones, and arrived back at the hotel like drowned rats! The lobby was again filled with amazing fans that wanted to meet us all, and we were happy to hug, chat, and take 'mascara running down our faces' selfies with them.
Geaux Wild day 1, was incredible. We were blown away with the professionalism of the conference, the charge of energy in a room of 450 smart women, and we realized that we had found our people! Planner Nerds Unite! We enjoyed the day listening to the various speakers, meeting so many of our customers and fans in person (beats email communication any day), and answering questions about our products.
Friday evening was very special. A handful of girls that we have worked with for years were also attending the conference. We knew we had to do something special to show our appreciation of their hard work, and to finally get to know them, outside of an email inbox. We planned an intimate dinner at Emeril's and together, we all celebrated our journey, made personal connections, and toasted to future endeavors. It was a very special evening. I even shared my engagement story to #foxyhilary (I saw online somewhere that he had his own hashtag… ha!), we lamented the challenges that we've faced as a growing business, and shared a 'Cheers!' tradition (we'll save that for another blog post!) and we ate, drank, celebrated, and gave party favors to all!
Saturday was also fantastic. This was the day of my keynote speech and I was blown away by the support and warmth I felt from the room of over 400 like-minded, beautiful, strong women. Also, shoutout to Jen Dufore who spoke before me, your speech was AMAZING! It was such an inspiring afternoon, and the party was just getting started.
We were still on a high from the keynote, but had a lot of work to do to prepare for the grand finale…. PlanJama! We set up a lounge to view the new LifePlanner™ collection, blew up massive balloons, added our products to the tables, and set up a meet and greet area. We headed out for a quick dinner and then raced back to our rooms to put on our matching mid-century circle PJ's that were made especially for this event!
We arrived at Planjama and the party was in full swing. We spent the night dancing, mingling, taking selfies, and greeting all of the attendees. It was SO much fun and I can officially say – all parties should require pajamas.
We were a little slow getting up on Sunday… we packed, ate one last amazing New Orleans meal (obvi), grabbed beignets from Café Du Monde, and headed to the airport.
Thank you so much to the Geaux Wild organizers for having us and making us feel so welcome. We were truly touched to meet each and every attendee at the conference, and we're looking forward to taking our party on the road again soon!


Effective 2019-2020, the Kids Plus Accident Insurance program is being discontinued. All active policies and claims currently being processed for the 2018-2019 school year will remain in force until expiry on September 30, 2019. They will still be accepting new applications for this program until May 31, 2019, for the 2018-2019 school year.
We are offering you the opportunity to voluntarily purchase student accident insurance through the Kids Plus™ Accident Insurance program, underwritten by Industrial Alliance Insurance and Financial Services Inc. (iA Financial Group).
Insurance premiums for children are $14.50 or $33.50 per year, depending on the plan selected. A discount is available for families with three or more children. Adults, age 20 to 64 can also be insured for $32.00 per year.
For more information or to apply online, please visit kidsplus.ca or speak with a Kids Plus™ Client Service Administrator at 1-800-556-7411.


Just got an e-mail from editors over at Every Day Fiction letting me know that they have accepted "Good Advice" for publication on their site (a specific date to be determined) – and so the goal of two stories in 2010 has been accomplished ahead of schedule!
I wrote "Good Advice" in June and submitted it to Daily Science Fiction, which was just being established at the time (it began publication on September 1st). It seemed like an exciting project that I wanted to be a part of. They passed on "Good Advice" a few weeks later, but said it was a tough call in the rejection letter. I don't know if it was actually a tough call, or if they were just being nice to me, but I was encouraged by this response and have since submitted three more stories to them. Two were quickly rejected (without any "tough call" claims) and the third is in their hands now, so I have my fingers crossed.
Meantime I was reading a lot of online magazines, to see what short fiction is out there, and to figure out where I want to send my submissions. Every Day Fiction stood out as I enjoyed much of what I was reading there, so I sent in "Good Advice" to them in mid-August, and the second time turned out to be the charm, in this case.
This entry was posted on Tuesday, September 21st, 2010 at 11:30 pm and is filed under Uncategorized.	You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.


The f-91w-1dg resin watch - black Men Watche is manufactured by Casio and was added around April 2017.
This version of the Men Watche comes in Color : Black , Special Features : Waterproof , Watch Shape : Rectangle , Strap Material : Resin , Watch Type : Digital , Watch Movement : Quartz.
The best price for the Casio F-91W-1DG Resin Watch - in Egypt is EGP 402 sold at Souq and available with free shipping and delivery within Delivery in 3-7 days.
CASIO F-91W Classic Digital Watch Unboxing!
8 Reasons Casio F-91W is the best watch in the world!


Royal Bank of Scotland yesterday said it is considering selling most of its banking businesses in China, part of plans to exit Asia following its ill-fated purchase of ABN Amro.
RBS, which has already sold its entire stake in strategic partner Bank of China, plans to sell ABN Amro China's retail and commercial banking businesses, but will keep ABN's global operations, RBS said in an e-mailed statement.
RBS said it will ensure customer services will not be affected before the businesses, which include its Van Gogh-branded business, are sold and transferred to their new owner. RBS, which reported the biggest annual loss in British history for 2008 and received a capital injection from the UK Government, is selling its Asian banking units to raise cash.
The lender boosted its presence in Asia through its acquisition of ABN Amro in 2007, a deal blamed in part for its financial woes.
The Dutch Government nationalised ABN Amro last October as part of a rescue of Belgian-Dutch group Fortis, which bought ABN in a consortium with RBS and Spain's Santander for €70 billion (Dh321.2bn).


We listened to the great feedback that we have been receiving about our Tesla Cup Holders. One common piece of feedback we have received is that they wished that they could easily remove the REAR Tesla Cup Holder after it was installed. Our STANDARD mounts for our REAR Tesla Cup Holder are 3M Command Strips which give a more long term adhesion once installed. This works great for most Tesla owners as they do not have many people in the back seats, or do not need to normally remove it.
Our optional new Ultra-Thin, Ultra-Strong Velcro is the solution that you have been waiting for! This new super slim Velcro still allows for the arm rests to be used, while allowing for the easy removal of the REAR Tesla Cup Holder with a single finger! We know that it may not seem like much, but the Velcro has been tested to hold over 10 pounds ( 2 XL drinks weigh MUCH less than that ) and has held up great in super hot temps and high humidity!
Check out the Velcro in action!
These New Velcro Strips are available here on the TeslaPride website.
Vinyl wrapped Tesla Cup Holders - Temporarily Unavailable!


text:
Q: Which tools can find unicode (UTF-8) text in files containing any form of normalization? I like to find international text, like "müller", or even chinese text, in files, no matter which unicode representation and case is used.
I.e, it should not matter whether the "ü" is stored in NFC or NFD format.
I'd think that grep could do this, but at least the version available on macOS 10.13.6 finds only one normalization form.
I'd expect that, with algorithms like Aho–Corasick that can search for alternatives of letters in words, it should not be so difficult to build a tree that includes every alternative form of a UTF8 character and then search for all combinations. Yet, at least the grep I tried doesn't do that.
Are there implementations of grep or other text find tools that can do this properly?

A: I resolved this issue with a regex engine (PCRE2).
Basically, I convert, using my own written code, the user's search string into all possible UTF-8 and UTF-16 representations, and then combine them all into a single regex expression, as alternatives, and taking care to escape any character as necessary (e.g. the 00 bytes of UTF-16 chars are encoded as \x00).
The nature of regex, which builds a decision tree, makes the search then quite fast.
That lets me scan any binary file for the search string, no matter in which format it's encoded in the file.
Since I needed this feature in one of my own programs, I should have mentioned that programming solutions were also welcome (and then it'd have better belonged on the StackOverflow site).

redpajama_set_name: RedPajamaStackExchange


I was there when Enigma was first introduced to North America in 1991. I was 18 at the time, and very obsessed with music already. But Enigma was like nothing I had ever heard before. It was like hearing my own emotions played in song. Over the years, as I evolved, so did the music of Enigma. It was as if it was joined to my soul, reflecting my deepest self as I journeyed from young man into to parenthood. So, as the Enigma album that bears my favorite number is about to be given to the world, I reflect upon just how much the music is as much a part of me as the sound of my voice. While most of my most special moments with Enigma happened in the early 1990s (which are listed here), I still feel overcome with contentment when I listen. But when I think of the music, I envision a circle of people dancing with joy, because a circle of joy is what life is supposed to be.


Review of Environmental Factors REFs are often prepared to consider the potential impacts on the natural environment as a result of a development or activity.
Arbor Ecological has prepared REFs for consideration by local councils, e.g. Lismore, Ballina and Richmond Valley Councils; and State Government agencies, e.g. Office of Environment and Heritage OEH. Our impact assessments are guided by legislation and present the findings of site assessments and expert studies. They address relevant matters such as potential for significant impacts on threatened species and endangered ecological communities.
Details are also outlined on stakeholder consultation, environmental safeguards, mitigation measures, alternative activities and any required approvals. Assessments of significance, previously 7-part test & 8-part test of significance, are conducted as required under the NSW Biodiversity Conservation Act 2016.
Click on the photos below for more information on our Review of Environmental Factors REF projects, or to discuss your project requirements please Contact Us.


"Summer fallow and in-crop weed management programs in sugarcane (Sacch" by Luke Moss Etheredge, Jr.
In fallowed sugarcane fields, perennial weeds and sugarcane regrowth must be controlled to maximize productivity of sugarcane in the first production year. Isopropylamine salt of glyphosate applied in April at 1.68 kg ai/ha to 15 cm sugarcane provided 85% control 28 d after treatment (DAT). Control of sugarcane 56 DAT with isopropylamine and potassium salt formulations of glyphosate averaged 83% for 1.12 kg/ha. Bermudagrass control with glyphosate at 1.12 kg/ha was 86% 40 DAT and increased to 98% with a sequential application at 1.12 kg/ha. In comparing various combinations of tillage and glyphosate in summer fallow programs, bermudagrass ground cover was 37% in November for tillage alone compared to no more than 7% ground cover for the tillage/glyphosate and no-tillage/glyphosate programs. Perennial weed control was greater when glyphosate replaced a tillage operation. Purple nutsedge tubers were planted in 26.5 L pots with a surface area of 0.093m2 at densities of 0, 1, 2, 4, 8, and 16 tubers/pot along with a single node cutting of 'LCP 85-384' sugarcane to evaluate interference. At 64 days after planting, both purple nutsedge shoot and root (including tubers) dry weight increased as initial tuber density increased. Based on sugarcane shoot dry weight, critical weed density was four nutsedge tubers/pot. Using root dry weight, critical weed density was one nutsedge tuber/pot. The sugarcane variety 'L 97-128' was more competitive with purple nutsedge than LCP 85-384, 'Ho 95-988', and 'HoCP 96-540'. In a shade response study, 30% shade reduced nutsedge shoot dry weight 75% compared with full sunlight. Field studies were conducted to evaluate purple and yellow nutsedge control in sugarcane with herbicides applied postemergence (POST) in September around 5 weeks after planting. Halosulfuron at 53.0 or 70.6 g/ha averaged 80% 4 weeks after treatment (WAT) and 77% 6 WAT. Control with the trifloxysulfuron at 15.7 g ai/ha was no more than 71% 6 WAT. Injury to sugarcane was not observed 6 WAT for either herbicide. In April of the following year, nutsedge control with the halosulfuron treatments averaged 74% compared with 44% for the trifloxysulfuron treatments, but sugarcane shoot population did not differ.
Etheredge, Jr., Luke Moss, "Summer fallow and in-crop weed management programs in sugarcane (Saccharum spp. hybrids): control of perennial weeds and purple nutsedge (Cyperus rotundus L.) interference" (2007). LSU Doctoral Dissertations. 3306.


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Nutrient recovery from urban wastewaters by cultivation of microalgae in continuous reactors
Written by Dott. Ing. Elena Barbera, Prof. Alberto Bertucco - Department of Industrial Engineering, University of Padua - Padua -Italy
The growing demand for fresh water, together with the drive towards reducing environmental impacts, imposes the need to develop "green" and cost-effective wastewater treatment processes. From this point of view, biological treatment processes using activated sludge have seen an increasing development. However, some critical aspects of this process are still to be resolved, including the reduction of nutrients such as nitrogen and phosphorus, which often require additional stages characterized by chemical or physical treatments, with consequent increase in costs and environmental impacts. An alternative that has aroused great interest in the scientific community in recent years is represented by the use of microalgae in wastewater treatment. This alternative is particularly interesting in view of the development of a circular economy, aimed at the recovery and valorisation of waste. In fact, these organisms are particularly efficient in the assimilation of nitrogen and phosphorus, that are accumulated in the biomass, which can then be valorized in a wide variety of sectors (from energy, to the production of high-value compounds).
In this work, the performances of a process of microalgae continuous cultivation in urban wastewater are evaluated, in terms of biomass productivity and nutrient consumption (N, P and COD). In particular, Chlorella protothecoides was grown in wastewater sampled downstream of the primary treatment of two different plants, respectively in Vicenza and Padova [1]. The experimental results conducted in the laboratory at a light intensity of 100 μmol m-2 s-1 and with continuous insufflation of air enriched in CO2 (5% v/v, 1 L h-1), at different hydraulic retention times (HRT = 0.64 - 1.97 d), showed an efficient abatement of N and P, with consumption ranging between 70-80% and 85-95% respectively (Figure 1). On the other hand, the COD content was unchanged, suggesting a purely autotrophic microalgae growth. The biomass productivity resulted between 0.4 - 0.6 g L-1 d-1. In this context, a possible process scheme could include a microalgae cultivation tank downstream of the primary treatment for the removal of nitrogen and phosphorus, followed by the activated sludge tank for the removal of the COD.
This process scheme, however, has some disadvantages, linked on one side to the aeration of both tanks to provide CO2 to microalgae and O2 to bacteria, while on the other to the need for high surfaces to allow sufficient light availability to guarantee an efficient growth of the photosynthetic organisms.
Recently, the idea of growing microalgae and bacteria in the same reactor, in a consortium, has gained a lot of interest. The use of algae-bacteria consortia allows, in principle, to obtain the simultaneous abatement of N, P and organic carbon in a single stage, exploiting the synergy between these organisms given by the reciprocal gaseous exchange: oxygen produced by microalgae from photosynthesis is exploited by bacteria for their growth, which in turn produces the CO2 needed for the former. In this way, operating costs related to the aeration of the tanks (which represent the major contribution in the energy balance of the whole process) would be cut down.
Also the limitation related to the need of large surfaces to allow an efficient use of light can in some way be moderated, considering the ability of some microalgae (including C. protothecoides) to grow according to a mixotrophic metabolism, that is by the simultaneous use of light and assimilation of organic carbon as sources of energy for growth. The regulation of this metabolism is influenced by many factors, including the availability of CO2 which, when present in excess, favors the photosynthetic growth path [1, 2], and the availability of light. The effect of this last variable on the abatement of N, P and COD of a consortium consisting of C. protothecoides and a bacterial inoculum coming from activated sludge (Montebello Vicentino) was therefore studied in continuous reactors, operated at different HRT values (1.6 - 4 d). In particular, two different light intensities were tested, respectively 50 and 150 μmol m-2 s-1 [3]. The results show that at lower light intensity, nutrient removal was generally more efficient (Figure 2). In particular, for residence times lower than 2.5 d, microalgae were washed out from the system, due to their lower growth rate compared to bacteria. This is reflected in a modest consumption of N and P. For longer residence times however, the algal biomass concentration was higher at 50 μmol m-2 s-1 compared to the case at higher light.
These results suggest that low light can have a positive effect in an urban wastewater treatment plant where microalgae are applied together with bacteria. Thanks to the mixotrophic metabolism, in fact, a smaller surface would be necessary, allowing a simultaneous removal of N, P and organic carbon in a single stage of the process. This encourages and promotes the development and implementation of microalgae for the recovery of nutrients from wastewater.
Figure 2. N e P consumption in urban wasteaters at different HRT. PD and VI indicate wastewaters sampled from Padova and Vicenza, respectively [1] .
Ramos Tercero EA, Sforza E, Morandini M, Bertucco A (2014) Cultivation of Chlorella protothecoides with Urban Wastewater in Continuous Photobioreactor: Biomass Productivity and Nutrient Removal. Appl Biochem Biotechnol 172:1470–1485. doi: 10.1007/s12010-013-0629-9
Sforza E, Cipriani R, Morosinotto T, et al. (2012) Excess CO2 supply inhibits mixotrophic growth of Chlorella protothecoides and Nannochloropsis salina. Bioresour Technol 104:523–529. doi: 10.1016/j.biortech.2011.10.025
Pastore M, Santaeufemia S, Bertucco A, Sforza E (2018) Light intensity affects the mixotrophic carbon exploitation in Chlorella protothecoides: consequences on microalgae-bacteria based wastewater treatment. Water Sci Technol 78:1762–1771.
Circular Economy Nitrogen Phosphorus Wastewater treatment


text:
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obj-m := module_parameter.o

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all:
	$(MAKE) -C $(KDIR) M=$(shell pwd) modules

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redpajama_set_name: RedPajamaGithub


DUNLOP Couplings are an essential part of the transmission of power process, where two rotating shafts can be joined together at their ends, whilst allowing for misalignment and/or movement.
HRC spider element and L-jaw couplings are flexible and are used to connect two shafts together for the purpose of transmitting power. They are used in a variety of industrial drive applications .
HRC are used in more heavy duty than a jaw coupling, which is used in more lighter duty transmission.


text:
Virgin Galactic Spaceplane Makes First Powered Flight Since Deadly 2014 Disaster
Filed to:Virgin galactic
Today's flight was the 12th for the VSS Unity, and its first powered flight.
Photo: Virgin Galactic
Earlier today, the VSS Unity went supersonic during crewed tests, reaching speeds of 1,220 miles per hour. It's the first powered flight of Virgin Galactic's new SpaceShipTwo aircraft, and the first flight since the 2014 disaster in which a pilot was killed and a co-pilot severely injured.
After detaching from the carrier mothership VMS Eve, and gliding above the Mojave Air and Space Port in California, the VSS Unity fired its rocket engines for about 30 seconds, attaining a maximum speed of Mach 1.6. The experimental spaceplane, with its crew of two, landed shortly thereafter at around 12:05 pm ET, according to Virgin Galactic. Though just a test, it's an important milestone for the Richard Branson-led company, which aims to eventually offer suborbital flights to space tourists.
Back on October 31, 2014, Unity's predecessor, the VSS Enterprise, crashed, killing the pilot and badly injuring the co-pilot, who survived by deploying his parachute. An official investigation found that the craft's braking system had been deployed prematurely by the co-pilot, resulting in the "in-flight anomaly." All ensuing flight tests were canceled as Virgin Galactic worked to remedy the various deficiencies, both procedural and mechanical.
Two years ago, the private company introduced an updated version of the spaceplane that would replace the destroyed SpaceShipTwo craft. The Enterprise was built by aircraft developer Scaled Composites, but the updated version was manufactured by The Spaceship Company, a California-based subsidiary of Virgin Galactic.
The VSS Unity, named by the late physicist Stephen Hawking, had been undergoing engine and gliding tests over the past several months. Today's successful test, with pilots Mark Stucky and Dave Mackay at the helm, means the company can continue to move forward with its plans.
Eventually, Virgin Galactic would like to have a fleet of these SpaceShipTwo suborbital spaceplanes, each capable of carrying paying customers 68 miles above the Earth's surface—a full six miles higher than the so-called Kármán line, which is conventionally used to mark the edge of space—and back. The estimated price tag for a single trip will be $250,000, but the spaceplane could also be used to carry science equipment and measuring devices to high altitudes for NASA and other organizations.
[CNBC]
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Richard Branson Announces New Space Company, Tries Pulling a Reverse Musk™
The FCC Just Gave SpaceX the Go-Ahead to Build a Space Internet


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We have been in business for many years, and our business started because we are toy collectors of old and new Toys.
We at Rhineshill wanted to share our collection with others. We offer quality service and merchandise to our customers.
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We offer fast shipping and quality merchandise.
Feel free to look us over and if you like what you see we will gladly see that you get it. Or if you are looking for something special then drop us a line and We might have it or know where to get it for you.
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We offer fast shipping and great customer service all with a smile. If you have certain toys that you are looking for drop us a line and we might have it or know someone who does. Here at Rhineshill toys & Collectibles your viewing and shopping experiences with us will always be fun and enjoyable. Your satisfaction is our personal business when it come to giving you toys from back in the days and today.


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Following deals with Russia, Turkey now expands military cooperation with China
Metin Gurcan August 3, 2018
Both China and Turkey are determined to develop their cooperation in the defense and security sectors.
REUTERS/Roman Pilipey
Chinese Foreign Minister Wang Yi (R) shakes hands with Turkish Foreign Minister Mevlut Cavusoglu during their meeting at Diaoyutai State Guesthouse in Beijing, China, Aug. 3, 2017.
When the Chinese military attache stationed in Turkey said on July 28 that cooperation between the Turkish and Chinese militaries will produce "fruitful results," his words didn't escape the notice of defense circles. Speaking at a ceremony marking the 91st anniversary of the founding of the People's Liberation Army (PLA) of China, held at the Chinese Embassy in Ankara, Brig. Gen. Chen Qingsong also congratulated Turkish President Recep Tayyip Erdogan on his election victory in the June 24 polls and said his re-election will help to strengthen the ties between the two countries. The attendance of several high-level diplomats and politicians and Turkish Armed Forces commanders at the ceremony was also remarkable.
The attache, who said the PLA is actively participating in United Nations peace operations, noted that more than 37,000 Chinese military personnel had taken part in various peace operations worldwide in the past 28 years. He stressed that as a permanent member of the UN Security Council, China is the country that has provided the largest number of troops and the second top financial contributor to these operations.
As for China-Turkey relations, Chen said Erdogan had recently met with his Chinese counterpart, Xi Jinping, on the sidelines of the BRICS summit held in Johannesburg, South Africa, and that the two leaders frequently talk on the phone.
"Relations of the two countries are developing favorably. Turkey's central corridor strategy that aims at linking Europe to Central Asia and to Afghanistan, Pakistan and China matches with China's Belt and Road initiative," he said.
According to Turkish diplomatic sources speaking to Al-Monitor, during the meeting in Johannesburg, Turkish and Chinese officials discussed how to strengthen cooperation between the two countries in the defense and security sectors.
Frequent visits and talks between the two sides indicate that both countries desire to expand their economic, security and defense ties. The latest visit was on July 26 when a Chinese military delegation headed by Maj. Gen. Licun Zhou, the political commissar for the Joint Warfare Institute of the PLA at National Defense University, visited the Turkish National Defense University.
The number of high-level meetings between the Chinese and Turkish militaries will increase in the coming months, the same sources added. According to the sources, the discussions will cover boosting cooperation in professional military education, military training, the defense industry, terrorism, intelligence sharing, robotic systems, artificial intelligence and cyberwarfare. Also, there will be some joint projects in which Turkish and Chinese engineers work together to boost defense cooperation.
In May 2018, a large number of Chinese officers attended the Ephesus 2018 military exercise held in Izmir as observers. The sources said officers were particularly interested in new military technologies displayed by the Turkish Armed Forces during the maneuver.
According to Altay Atli, a Turkish expert on the Asia-Pacific region who is a scholar at the Istanbul Policy Center at Sabanci University in Istanbul, China should be considered among the top economic partners for Turkey.
"China is the second largest economy in the world, which is now projecting its economic power to the rest of the world through the Belt and Road Initiative. At the moment, China is the largest source of Turkey's trade deficit and current account deficit," Atli told Al-Monitor. "However, what is important here is expectations for the future. Turkey expects, and rightfully so, to have China as a major source of investment and technology for its own economy. On the other hand, Turkey is important for China, too, because it is located right at the heart of the Belt and Road Initiative. So it is a case of mutual benefits, and both sides are eager to develop this further into the future," he added.
Yet according to Atli, merely trade will not be enough for sustainable and productive cooperation between the two countries. "The two countries have to build on it and transform their relationship into a multidimensional collaboration structure. Both sides want a strategic partnership, and for this, economics alone is not enough. Security and military cooperation, including cooperation in the defense industry, can help Turkey and China both to effectively address their common issues of security concerns such as terrorism and strengthen the basis of their relationship."
Atli also noted that Turkish-Chinese cooperation on the military field is not a brand-new development. "In 2010, both air forces conducted a joint exercise called the 'Anatolian Eagle,' and defense industry cooperation has been going on since the late 1990s — albeit at a more modest scale compared with Turkey's cooperation in this field with NATO allies," he said.
Atli said he expects more comprehensive cooperation between the two sides in the defense and security fields in the coming months and years.
It is clear that the international society will witness more intense military cooperation between Ankara and Beijing in the coming months. The question now is: How will this development be perceived by Western countries, particularly by Washington at a time when the Donald Trump administration is upping the ante in the trade war against China and at a time when Turkey's growing ties with Russia have already caused significant irritation in Western capitals?"
Found in: Defense/Security cooperation
Metin Gurcan is a columnist for Al-Monitor's Turkey Pulse. He served in Afghanistan, Kazakhstan, Kyrgyzstan and Iraq as a Turkish military adviser from 2002 to 2008. After resigning from the military, he became an Istanbul-based independent security analyst. Gurcan obtained his PhD in 2016 with a dissertation on changes in the Turkish military over the preceding decade. He has published extensively in Turkish and foreign academic journals, and his book "What Went Wrong in Afghanistan: Understanding Counterinsurgency in Tribalized, Rural, Muslim Environments" was published in August 2016. On Twitter: @Metin4020
Iran's next moves depend on US
Erdogan vows to defend Tripoli government after Libya talks fail
Turkey edges toward Islamic law with new finance rules
Anti-Turkey alliance grows as Ankara sends troops to Libya
Tunisia goes into 'diplomatic coma'
Could fragile cease-fire lead to peace in Libya?
Libya conflict


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Sunnyvale, CA is around 915 miles W of Laramie.
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Saint Louis, MO is around 837 miles E of Laramie.
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Arlington, WA is around 934 miles NW of Laramie.
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THE EVENT INDUSTRY 2022 – SUSTAINABILITY
In this fifth and final insight into the future of the event industry, KSS Associate Director Debbie Power considers the important topic of sustainable design with a designer's approach to delivering a successful strategy.
Sustainability should always be at the forefront of our perspective and approach. Reduction in travel during COVID has made us reflect on its necessity and we have all enjoyed the cleaner air during that period. However, the measures required to manage COVID in our venues often conflict with our sustainability aims, from the widespread use of plastic-based materials for testing and PPE kit, to the instant appearance of acrylic screens and protective coverings, which although not mandated, are widely used as people are familiar with them and appreciate that their welfare is being considered.
Guests are increasingly demanding more ethical and sustainable experiences and venues are already responding with sustainable systems, strategies and polices.
The role of designers is to ensure that the proposed processes can be delivered. If disposable or re-usable cups are discarded within general waste because of a lack signage or unclear communication, all the best intention becomes no more than an empty gesture.
Our clients enjoy working with us because we understand the micro level detail as well as the big picture concepts. From developing clear communication signage to creating bespoke bin apertures to suit the recycling strategy, these details prompt guests to consider their action and choices. We strive to make our environments intuitive, clearly navigable and a joy to explore.
To make a sustainable impact we need to be thinking more deeply about how we can minimise our overall impact on the complete design process.
With buildings contributing around 49% of the worlds carbon, or over 180 million tonnes per year, in very simple terms we need to build less, and maximise the use of our existing building stock. Once a new building is complete the carbon budget is spent, so we need to build projects to last. We must design for durability, longevity and increase design life through flexibility.
For the two recent developments of Liverpool FC's Main Stand and Twickenham's East Stand we developed bold extensions that seamlessly knitted into the existing buildings. Our careful, thoughtful, and practical designs ensured both were constructed without disruption to play.
We should always question what can be re-used and recycled. Predominately our hospitality projects are refurbishments, which by their nature are more sustainable because we are bringing old stock up to current standards, extending building life and ensuring we are building clever and designing efficiently.
At Brighton & Hove Albion FC last summer we relaunched the 1901 Club at the American Express Community Stadium, this was an impactful but considered stadium-wide refurbishment, transforming nine premium lounges with new finishes and furniture throughout. Existing bars were refurbished and reclad, but we retained the original ceilings and lighting from when we designed the spaces over a decade ago. The ceilings were designed to be timeless as they were inspired by the Club's locality, they were built with longevity and with our creativity we could successfully reinvent the spaces within some of the existing parameters.
We can ensure designs are built to last, for durability and operationally, and more importantly because ultimately it is more sustainable.
Debbie Power Associate Director
EVENT INDUSTRY 2022 – TECHNOLOGY AND EXPERIENCE
1901 Club relaunches at The Amex


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Trump Directs FDA To Look Into Malaria Drug To Treat Coronavirus
By Stephanie Sandoval
The president said he has instructed the FDA to look into whether chloroquine is effective in treating the coronavirus.
During a press briefing Thursday, President Donald Trump said he told the FDA to look into whether a decadesold anti-malarial drug can be used to treat the coronavirus.
President Trump said the U.S. could make this drug available by prescription "almost immediately."
The drug in question is called chloroquine. Some scientists have suggested it could be used to treat the coronavirus. It'll undergo a clinical trial to see if it's effective.
"That's a drug that the president has directed us to take a closer look at as to whether an expanded use approach to that could be done to actually see if that benefits patients," FDA Commissioner Stephen Hahn said.
But Hahn also said it's important to "not provide false hope."
The drug has not been approved to treat the coronavirus. It's only been approved to treat malaria and an arthritis condition, according to the FDA commissioner.
The World Health Organization has said there's no proof yet that the drug can treat the virus.
On Thursday, Bayer, a pharmaceutical company, said it's donating 3 million tablets of Resochin, made out of chloroquine phosphate, to government agencies to potentially treat COVID-19. Resochin is used to treat malaria and autoimmune diseases. The drug has not been approved in the U.S., but the company said it's working with "appropriate agencies on an Emergency Use Authorization."
Other drugs are also being tested around the world. Remdesivir, an antiviral drug, is under clinical trials in the U.S. and China.
And scientists are also working on a vaccine. The National Institutes of Health announced Monday a phase one clinical trial for a potential vaccine has begun and that the first participant has received it. Different doses will be tested on 45 healthy adult volunteers. But public health officials have said getting a vaccine ready for widespread use could take up to 18 months.