Summary Points {#sec001a}
==============

-   Ebola hemorrhagic fever, or Ebola virus disease (EVD), has emerged in the last year as a global threat and humanitarian disaster for the affected countries of West Africa and has also come to the United States (US) and Europe.

-   The treatment of the first and three subsequent US patients outside of Africa at Emory University provided a number of challenges, as well as strategic and tactical lessons that included detailed planning and team work across multiple academic and health care units, emphasizing biosafety, the importance of institutional communications, addressing unanticipated challenges such as waste management, and the logistics of working closely with governmental agencies and outside collaborators.

-   In providing effective care for individuals, the value of mobilizing a diverse health and academic community to work collaboratively to addressing a global threat is emphasized. This includes dissemination of best practice information; providing education and training about EVD; expansion of new knowledge about the clinical course, complications, and pathogenesis of EVD; the creation of new institutional forums, and engagement in the broader policy and equity issues of contagious health threats.

Ebola hemorrhagic fever, or Ebola virus disease (EVD), is caused by a highly contagious group of enveloped, single-stranded, negative-sense RNA viruses of the family Filoviridae. The disease has historically carried 53%--88% mortality \[[@pmed.1001857.ref001]--[@pmed.1001857.ref003]\]. In December 2013, what has now become the largest and most devastating Ebola outbreak ever recorded, caused by a new strain of the Zaire species (*Zaire ebolavirus*), began in Meliandou, Guinea, West Africa and soon enveloped neighboring Sierra Leone and Liberia, with cases also in Nigeria, Senegal, and Mali \[[@pmed.1001857.ref001]--[@pmed.1001857.ref005]\]. WHO (World Health Organization)/CDC (United States Centers for Disease Control and Prevention) reports 27,550 cases and 11,235 deaths in the three principal countries as of June 28, 2015 \[[@pmed.1001857.ref006]\], which may be an underestimation of at least a factor of 2.

On August 2 and 5, 2014, two medical missionaries who developed EVD in late July while working at Eternal Love Winning Africa (ELWA) hospital in Liberia were evacuated from Monrovia by a specially designed air ambulance to Emory University Hospital (EUH) \[[@pmed.1001857.ref007]\]. Until August 2, 2014, EVD had not been seen or treated in humans outside of Africa. The initial call for help for these missionaries came to our institution on July 30 and would mobilize multiple resources at Emory University, in particular those of the academic medical center, EUH, Emory Healthcare, and the Robert W. Woodruff Health Sciences Center, the faculty, nurses, staff, and leadership of these units, and our communications and other Emory University support teams. The successful treatment and discharge of these first two patients by August 21, 2014, was only the first chapter of the impact of this outbreak on Emory, the US, Europe, and the global community. At least 25 individuals have now been treated outside of Africa (US: 11, Europe: 14, with five deaths). The US, Europe, and the rest of the world can expect to continue to be touched by this epidemic and by future communicable disease outbreaks.

The strategic and tactical lessons and challenges presented by providing care for the first and subsequent US EVD patients at Emory University provide an opportunity to share lessons that may help others. Specific clinical and immunological features and diagnostic and detailed management issues of the patients at Emory are reported separately \[[@pmed.1001857.ref007]--[@pmed.1001857.ref011]\]. It is very important to acknowledge the tremendous inequity between EVD care available in our academic medical center versus sites in West Africa. This disparity, illustrated by this outbreak, will require much future work to address.

Background {#sec001}
==========

EUH is the flagship clinical care facility for Emory Healthcare, staffed by 1,221 Emory School of Medicine faculty physicians, with over 3,600 employees, 25,300 admissions, and 157,000 outpatient visits annually. The hospital has one of the highest case-mix indexes (a measure of complexity of illness treated) among the University Healthsystem Consortium (UHC)-ranked facilities. Emory had established strong programs in health care delivery, quality, infectious diseases (ID), infection control and biosafety, immunology, vaccines, and public health that were important to its ability to respond to this series of events.

The Serious Communicable Diseases Unit (SCDU) ([Fig 1](#pmed.1001857.g001){ref-type="fig"}, [Box 1](#pmed.1001857.box002){ref-type="boxed-text"}) of EUH is a special isolation unit. This unit was designed and constructed in 2002 following the 2001 anthrax bioterrorism event but was also created, given the global connectivity of Atlanta and its institutions, to address naturally acquired, highly communicable emerging infectious diseases such as EVD. The unit was built and set up in close collaboration with and with financial support from the adjacent CDC to provide care for CDC scientists and staff who have contracted highly communicable infectious diseases in laboratory settings or while traveling abroad.

![The SCDU.\
(1) The private patient rooms resemble intensive care unit (ICU) rooms, with adjustable beds, intravenous (IV) fluid drips and monitors. Procedures a patient could need, from mechanical ventilation to hemodialysis, can be performed in the unit. (2) Medical staff who are providing direct patient care use a locker room to change into full-body protective suits and masks, which shield them from blood and bodily fluids. (3) Family members are able to speak with patients through glass windows in the unit; patients have access to phones and laptop computers. The windows also allow observation of procedures and detection of contamination events. (4) A dedicated laboratory that has the capacity to perform blood counts, routine chemistries, blood gas measurements, urinalysis, and tests for a variety of infectious agents was built specifically for use with the isolation unit. (5) All liquid waste is disinfected and flushed, and disposable waste is autoclaved and incinerated. At the peak of the Ebola patient's illness, up to 40 bags a day of medical waste were produced. *Image credit: Emory University; illustrator: Damien Scogin; licensed under a Creative Commons Attribution 4.0 International License*.](pmed.1001857.g001){#pmed.1001857.g001}

Box 1. The SCDU {#sec002}
---------------

-   The SCDU was designed ([Fig 1](#pmed.1001857.g001){ref-type="fig"}) to provide an extraordinarily high level of clinical isolation with more enhanced capacities than are normally provided to isolate patients in many hospital settings. The unit has a special outside entrance for emergency use and is separated from patient care areas in order to not impact other clinical services. It was the first of three such high-level civilian facilities in the US.

-   The SCDU was constructed (purposely to provide rapid isolation, security, flexibility, and access to special resources) within the EUH clinical research unit. The clinical research unit has been in existence for some 60 years and supports clinical research through the National Institutes of Health (NIH)-funded Clinical and Translational Science Awards (CTSA) program. The SCDU offers on-call, highly trained staff operating under standardized, ready-to-go protocols for providing care for patients infected with highly communicable contagious diseases.

-   While not necessary for treatment of EVD, the isolation rooms feature negative pressure air handling, 20 air changes per hour, with laminar flow and high-efficiency particulate air (HEPA)-filtering completed before the air is 100% exhausted outside of the hospital (no recirculation). General and intensive care can be provided. The SCDU was activated on two previous occasions. The first was in 2003 for a CDC worker with concern for having been infected with severe acute respiratory syndrome (SARS) in Hong Kong, China. The second was in 2005 for a CDC employee in Angola with potential Marburg virus hemorrhagic fever. While unit activation has been infrequent, intensive training in this unit to maintain a state of readiness has been continuous for well over a decade, including detailed preparation for transport of patients and the training of nurses and physicians.

-   A virtual tour of the SCDU and videos addressing many of the most frequently asked questions, together with access to all SCDU policies and standard operating procedures (SOPs), are available on the Emory education web site: [www.emoryhealthcare.org/ebolaprep](http://www.emoryhealthcare.org/ebolaprep) \[[@pmed.1001857.ref011]\].

The ID program at EUH was built to provide expertise in hospital epidemiology, antimicrobial management, transplant infectious diseases, and clinical microbiology. For over a decade, Emory University was an active member of the NIH Research Centers of Excellence (RCE) in Biodefense and was the site for the biosafety training program for select pathogens of the Southeast Regional Center of Excellence for Emerging Infections and Biodefense (SERCEB) RCE. This particular program provided invaluable expertise, equipment, and support for the EVD effort. Emory ID and Emory Healthcare (EHC) also created the TravelWell clinic, an outpatient clinic available for assessment and evaluation of pre- and post-travelers and supporting major Atlanta corporations and the CDC. Emory's TravelWell is part of a 57-site worldwide travel network (GeoSentinel) with a 10-year database of 3,000 entries of those who either had returned ill following travel to Liberia, Sierra Leone, Guinea, or Nigeria or had just emigrated from one of those countries.

The Decision to Accept EVD Patients into the SCDU {#sec003}
=================================================

The request for medical care for the initial patients came from the missionary organizations Samaritan's Purse and Serving in Mission (SIM) USA and from the patients themselves. The decision was coordinated through the US State Department and the CDC. EUH and EHC leadership made the decision to accept the patients---a decision made quickly but not lightly. The decision was based on the need, confidence in the overall preparedness of EUH, and the more than a decade plus of training and preparation to address highly communicable diseases at EUH ([Box 2](#pmed.1001857.box003){ref-type="boxed-text"} and [Box 3](#pmed.1001857.box004){ref-type="boxed-text"}). Importantly, as an academic medical center and research institution, the decisions were also based upon what we might learn in treating these patients (e.g., advancing knowledge about human health) and how such knowledge could be applied to the current outbreak.

Box 2. SCDU Preparation and Operations {#sec004}
--------------------------------------

-   The SCDU medical team is led by the SCDU director, an ID trained physician who has spearheaded for over a decade efforts in establishing the protocols, training, education, and operations of the unit in conjunction with the CDC. Three other faculty members of the Department of Medicine, four additional ID physicians, two pathologists, five medical technologists, and 21 critical care nurses also support the unit.

-   An SCDU unit director, clinical nurse specialist, and team coordinator handle logistics, organize training sessions, determine supply needs, and establish nursing schedules. Nurses provide care in 4-hour stretches to minimize donning and doffing of personal protective equipment. The overall effort has directly involved over 125 staff and support personnel.

-   During the care and treatment of EVD patients, there were daily communications between the SCDU medical team and the CDC's Division of High-Consequence Pathogens and Pathology (DHCPP), the Division of Healthcare Quality Promotion, and the Emergency Operations Center for Ebola established at CDC, and with the US Food and Drug Administration (FDA) and other US federal agencies, as well as frequent communications with other academic units, industry, and providers in West Africa.

-   The primary focus of training was on biosafety for all individuals who provided direct care or handled body fluids. All of these individuals received mandatory education and training, followed by strict competency verification before medical or nursing staffs were permitted to provide care for these patients.

-   Effective and assertive communication was central to the safety of the SCDU team. Use of the buddy system was an essential element of the focus on individual and colleague safety. Because communication was so important, the team developed rules to govern direct patient care communication as well as within daily team huddles. These rules were reviewed each morning during the daily huddle and served as a platform to empower all members of the team, regardless of role, to facilitate communication and to maintain strict SOPs.

Box 3. The SCDU Support Teams {#sec005}
-----------------------------

-   The hospital support team was led by the CEO of EUH. The chief medical and nursing officers of EHC and EUH, and in particular the vice president of operations of EUH, were also heavily involved in leading the support efforts. During the care and treatment of the EVD patients, an operations team of key administrators and nursing and physician leadership met twice a day. Despite the extensive preplanning, opportunities to refine and improve both clinical and operations were noted, and all aspects of the hospital services were involved. Pharmacy, environmental services, engineering/facilities support, and pastoral care/counseling were especially important.

-   Other ID faculty, including a pediatric ID specialist with experience in EVD, provided support for the frontline medical team. Periodic conference calls focused on support, therapeutic options in treating patients, and issues of postexposure prophylaxis, vaccines, surge planning, protocol development, and discussions of research as it related to EVD. To facilitate the necessary availability of SCDU dedicated ID providers, alternate faculty were recruited to cover the regular duties of the SCDU physicians. ID support also included contacting key national and international research leaders in EVD; evaluating, contacting, and obtaining, through outside groups, experimental vaccines and new drugs for Ebola; and communicating with the CDC, FDA, NIH, and other federal agencies, other university partners, and biotech/industry contacts, all of which were essential in the effort.

-   The Emory Environmental Health and Safety Office (EHSO) was engaged immediately after the call for ongoing support. While clinical care settings are very different from those of labs, EHSO staff included individuals with expertise in training on Biosafety Level BSL 3 and 4 laboratory safety, which was helpful in translating to our clinical care situation. Conversations were conducted by EHSO with other national biosafety leaders in EVD. (See "[Biosafety](#sec007){ref-type="sec"}.")

-   The SCDU team was also supported by the Department of Emergency Medicine and the Emory Office of Critical Event Preparedness and Response focusing on the complexity of patient transport and emergency care. They worked closely before and during the event with Phoenix Air Group, the air ambulance transport service, and the Grady Hospital Ambulance service. Critical Care established a 24/7 Medical Intensive Care Unit (MICU) attending coverage for critical care management issues including airway management and line placement issues. Other subspecialties, such as renal medicine, were required on a case-by-case basis. The location of the SCDU away from other patient care units of EUH significantly reduced the impact on our other health care delivery and patient operations. DHCPP at CDC provided critical help to the unit for viral loads, specialized assays, and other support.

Special Challenges of Addressing EVD {#sec006}
====================================

Biosafety {#sec007}
---------

Different outside perspectives and guidance were initially provided about the level of biosafety needed for EVD. Ebola viruses have a very low infectious dose, 1--10 aerosolized organisms, in nonhuman primate models \[[@pmed.1001857.ref012]\] and can reach extremely high levels in blood (up to 10^10^ RNA copies per ml of serum \[[@pmed.1001857.ref013]\]), stool, sweat, and other body secretions. Exposure of health care workers to infected body fluids via emesis, sweat, urine, saliva, diarrhea, or blood is a significant concern. There was also initial concern that this strain was not behaving epidemiologically as expected and the personal protective equipment (PPE) guidelines in Africa were not fully effective in prevention of transmission. Further, we had to demonstrate our ability to safely manage these patients.

To achieve the lowest risk to health care personnel, the highest level of biosafety was initially employed. This included MAXAIR powered air-purifying respirators (PAPRs), fluid-resistant body suits along with cover aprons, double gloves and shoe covers, and wiping down all surfaces with US Environmental Protection Agency (EPA)-registered disinfectants (no spraying) when doffing PPE. Other key biosafety SOPs developed were autoclaving within the unit for waste management, followed by disposal of regulated medical waste off-site after it had been autoclaved; decontamination; and handling of laboratory samples and waste. The consequences of transmission stressed the need for the highest level of biosafety.

The importance of the EHSO office in reinforcing the prior training of personnel and monitoring the clinical staff for consistency and adherence to biosafety from training sessions to practices in real-time clinical care cannot be overemphasized. This included how to "don and doff" impermeable fluid-resistant body suits, proper use of PAPRs, coordination of the disposal of waste, and the handling and transport of lab samples. EHSO also helped prepare and support the team psychologically, challenging them with spills and other incidents to practice remaining calm in the face of potential unexpected occurrences. Team engagement demonstrated the importance of melding the philosophies of clinical treatment/practice and biocontainment/biosafety. Feedback from frontline physicians, nurses, and hospital staff highlighted the contributions of EHSO to the effort and the value of the EHSO biodefense education and training expertise.

Waste Management {#sec008}
----------------

Waste management for EVD is a significant hurdle. EVD results in copious amounts of vomit and diarrhea with up to 10 liters of fluid lost by patients each day. Up to 40 large "bags" per day of regulated medical waste were generated by our first two patients. A large-capacity autoclave was mobilized, with postautoclaved waste stored in 32-gallon leak-proof rubber waste containers in the SCDU until removal and incineration. All waste in toilets was disinfected with an EPA-registered disinfectant before flushing. Importantly, no traces of Ebola RNA on \"high-touch surfaces\" such as beds and bathrooms were detected during active care or after patient discharge prior to terminal decontamination with vaporized hydrogen peroxide.

Communications {#sec009}
--------------

Guiding principles for communications included consistent messaging and protecting patient privacy while educating the public. Internal communications with a focus on transparency and education, within the bounds of confidentiality of medical information and protecting our patients' privacy, were vital. These included meetings with EUH hospital leadership and staff to address concerns, frequent emails and other communications with all faculty and staff at EHC and Emory, making sure instructions/checklists were in place, and facilitating the dissemination of protocols. To avoid unauthorized access to electronic medical records, a chart-warning flag was implemented. Confidentiality of medical information regulations were repeatedly stressed to all medical staff, residents, and fellows.

In external communications and interface with the media, the Emory communications teams tirelessly addressed media logistics, developed web and social media material, worked closely with governmental and nongovernmental external groups, developed talking points, and prepared the hospital and SCDU teams for communications venues. To maximize our preparedness and to address national concerns, press conferences and media interviews were conducted, and an EVD Questions and Answers document was developed and posted. The story exploded in broadcast print and social media. Over 84,000 media stories have been written linking Emory and Ebola. Emory communications created an Emory Healthcare Ebola Preparedness Protocols website ([www.emoryhealthcare.org/ebolaprep](http://www.emoryhealthcare.org/ebolaprep)) \[[@pmed.1001857.ref011]\] to make our clinical and biosafety protocols and other information widely available to the public. To date, 20,267 registrants have downloaded these educational materials.

Addressing a Surge of Cases of Possible Ebola {#sec010}
---------------------------------------------

The admissions heightened Ebola and other bio-threat concerns both locally and nationally. Questions about potential EVD patients began to occur immediately in our health care system and throughout the US. We developed and disseminated flow diagrams, algorithms, and SOPs \[[@pmed.1001857.ref011]\] for evaluating patients in emergency rooms and other health care provider settings where EVD was a consideration. CDC guidelines as they became available and current EVD articles were also disseminated. Our teams engaged local, regional, state, and national health care groups, and guidance was provided to questions about travelers from the region coming to Emory, to airlines flying to West Africa, and to multinational corporations based in West Africa. Travelers' diarrhea with fever and malaria are the problems most commonly encountered by travellers to West Africa. However, yellow fever along with Lassa fever, endemic in West Africa as well, can cause similar symptoms to those of Ebola. Typhoid and less frequently diseases such as dengue and other viral syndromes can cause such signs/symptoms, though not usually as severe. The intersection of the seasonal influenza epidemic with returning CDC workers from West Africa further amplified the evaluations of febrile episodes. Timely initial screening---with establishment of contact and droplet precautions early while the risk assessment, including an extensive travel history and the evaluation of exposure risk and symptoms, was continued---was emphasized. Policies and procedures for the continuing care of our discharged patients were also developed \[[@pmed.1001857.ref011]\].

Disseminating Knowledge: Education and Training {#sec011}
-----------------------------------------------

As noted, a highly trained group of faculty, nurses, biosafety support, and other providers staff the EUH SCDU. While no trainees (e.g., fellows, residents, or students) served on the direct care team, trainees benefitted from the experience of the unit and clinical experience with EVD through conferences and other education venues (e.g., Public Health Grand Rounds and ID seminars). An EVD "Micro Vignette" and other educational materials were developed for resident and fellow education. Further, ID and other specialty fellows have been integrated into the management planning for EVD patients, educated on the broader policies and procedures of the unit, are involved with the development of protocols for the management of Ebola patients who present to the Emergency Department (ED) or other clinical settings, and are educated about the collective experiences in treating the patients. In addition, a Massive Open Online Course (MOOC) "Ebola at Emory: Patients to Populations" has been launched \[[@pmed.1001857.ref014]\], an EBOLA Academic Learning Community was established, and other efforts to educate and support graduate and undergraduate student activities were undertaken. Emory faculty and staff also actively participate in national education and training efforts, including multiple presentations at national meetings, engagement in training forums sponsored by the CDC and the US Department of Health and Human Services (HHS), writing publications and communications, and conducting press conferences. Fifty-five US hospitals, including many in academic medical centers, have now been designated as Ebola treatment centers.

Generating New Knowledge {#sec012}
------------------------

Work was initiated to better understand EVD pathogenesis and therapeutic options \[[@pmed.1001857.ref007]--[@pmed.1001857.ref011],[@pmed.1001857.ref015]--[@pmed.1001857.ref019]\], including optimal patient management, fluid and electrolyte replacement, and dialysis \[[@pmed.1001857.ref007]--[@pmed.1001857.ref008]\]; evaluation of concomitant infections (e.g., malaria or Lassa fever); levels of EVD viremia, monitoring viral RNA in body sites \[[@pmed.1001857.ref019]\] and environmental samples; tracking EVD specific immune responses \[[@pmed.1001857.ref017]\]; evaluation of available investigational drugs and their safety, risks, and benefits; options for immune therapy (monoclonal antibodies \[mAbs\], convalescent sera) and available supplies; available investigational vaccines \[[@pmed.1001857.ref002],[@pmed.1001857.ref018]\], best practices in clinical operational management; and postexposure prophylaxis. In addition, the generation of new knowledge about EVD biosafety, infection control, and waste management has resulted from this event. These activities have now expanded as a broader institutional effort that includes new drug discovery for EVD, generation of human Ebola mAbs, expanded study of EVD glycobiology, focus on biomarkers as correlates of clinical EVD outcome, work on the ecology and the emergence of EVD and other tropical-associated zoonoses, clinical trials of Ebola vaccine, and modeling the spread and control of EVD in West Africa. This work required close coordination with and the support of the Emory Institutional Review Board (IRB), collaboration with the FDA, establishment of emergency investigational new drugs (INDs), and work with drug and biologic manufacturers and with multiple other governmental agencies. These and other EVD research and scholarly projects generated by the decision continue at Emory.

The event also led to broad faculty engagement across all parts of the institution through the creation of an Emory Ebola Task Force and Ebola Faculty and Community Discussion Forum \[[@pmed.1001857.ref020]\]. The Task Force includes leaders from across the campus and is directed at facilitating cross-cutting institutional initiatives such as EVD research, education and training activities, input into public policy issues around EVD, development of an institutional travel policy to West Africa, establishing procedures for trainee involvement in Ebola care, and the support of the humanitarian, research and control efforts in West Africa.

Conclusions {#sec013}
===========

EVD has arrived in North America and Europe and impacted us globally. Academic medical centers can be expected to be at the frontline to address EVD and other highly communicable infectious agents in the future. Our experience ([Box 4](#pmed.1001857.box005){ref-type="boxed-text"}) with EVD emphasized prepared infrastructure and coordination of clinical care, hospital and emergency operations, transportation, infection control, biocontainment, communications, and education and training initiatives. Unanticipated major challenges can be expected. The importance of detailed planning, preparedness, and team work across multiple academic and health care units, the emphasis on biosafety, key partnerships with environmental health and safety and institutional communications, and working closely with governmental agencies and outside collaborators to manage these threats is highlighted.

Box 4. Key Lessons and Recommendations {#sec014}
--------------------------------------

-   Communicable infectious diseases will continue to be global threats to human health and have the potential to cause repeated humanitarian disasters.

-   Our experience as an academic health center with EVD emphasized the importance of preparation, communications, and implementation: Coordination, detailed planning, and teamwork across governmental, nongovernmental, academic, and health care unitsPreparedness in training, biosafety, surveillance, and communications Environmental Health and Safety as a key support team memberEvaluation of provider competency in biosafety Donning and doffing of PPEWaste management protocolsDecontamination and containment protocolsSpecimen handling for diagnostic testingAn organizational structure to solve unanticipated challenges and the logistics of working closely togetherThe rapid dissemination of best practice informationProviding education forums and frequent educational communications (both internal and external) around disease transmission and riskConsistent messaging and protecting patient privacy while educating the publicExpanding new knowledge about the clinical course, complications and pathogenesis, diagnosis, treatment, and preventionEngagement in the broader policy issues of global health care inequities

The institutional experience, while providing the opportunity to effectively care for these individuals, has led to best practice information and the education and training of others, created key academic, governmental, and community partnerships, expanded research programs in EVD, and resulted in the development and communication of new knowledge about this emerging disease. Mobilizing our diverse academic community to work collaboratively on this global problem is also an important long-term outcome.

The authors wish to thank and recognize the key contributions of Emory faculty and staff, the Woodruff Health Sciences Center, Emory University Hospital and Emory Healthcare, and especially the SCDU Team \[[@pmed.1001857.ref007]\], the SCD Unit Coordinator, Emory Healthcare Nursing Services, Emory Medical Laboratories, Emory University and Woodruff Health Sciences Center Communications and Public Affairs, Emory Environmental Health and Safety Office, the Emory Ebola Task Force and other key Emory leaders, the CDC and other US federal and Georgia partners, Samaritan's Purse and SIM USA, and the patients themselves in this effort. We also thank Dianne Watson for excellent administrative support.

**Provenance:** Not commissioned; externally peer reviewed

BSL

:   biosafety level

CDC

:   US Centers for Disease Control and Prevention

CTSA

:   NIH Clinical and Translational Science Awards

DHCPP

:   Division of High-Consequence Pathogens and Pathology

ED

:   Emergency Department

EHC

:   Emory Healthcare

EHSO

:   Environmental Health and Safety Office

ELWA

:   Eternal Love Winning Africa

EPA

:   US Environmental Protection Agency

EUH

:   Emory University Hospital

EVD

:   Ebola virus disease

FDA

:   US Food and Drug Administration

HEPA

:   high-efficiency particulate air

ICU

:   intensive care unit

HHS

:   US Department of Health and Human Services

ID

:   infectious diseases

IND

:   investigational new drug

IRB

:   Institutional Review Board

IV

:   intravenous

mAbs

:   monoclonal antibodies

MICU

:   medical intensive care unit

MOOC

:   Massive Open Online Course

NIH

:   National Institutes of Health

PAPR

:   powered air-purifying respirator

PPE

:   personal protective equipment

RCE

:   Research Centers of Excellence

SARS

:   severe acute respiratory syndrome

SCDU

:   Serious Communicable Disease Unit

SERCEB

:   Southeast Regional Center of Excellence for Emerging Infections and Biodefence

SIM USA

:   Serving in Mission USA

SOP

:   standard operating procedure

UHC

:   University Healthsystem Consortium; WHO, World Health Organization

[^1]: The authors have declared that no competing interests exist.

[^2]: Contributed to the writing of the manuscript: DSS BSR BDG NRF MMF CPL JTF. Wrote the first draft of the manuscript: DSS. Agree with the manuscript's results and conclusions: DSS BSR BDG NRF MMF CPL JTF. All authors have read, and confirm that they meet, ICMJE criteria for authorship.


"Delay is natural to a writer. He is like a surfer—he bides his time. Waits for the perfect wave on which to ride in. He waits for the surge (of emotion? of strength? of courage?) that will carry him along." (E.B. White, The Paris Review Interviews, 1969)

10.12.2010

Tomorrow marks the beginning of my 39th trip around the sun. Lots of you reading this have made many of these trips, and I'm hoping to learn a thing or two from your amazing journeys over the next few orbits. In fact, I have to say that what I feel most strongly about this impending arc across the solar system comes from what I have gotten from my interconnectedness with others. During the past 38 years, friends and family have entered and exited my life. Many have taken more than they have given in the immediate term, but I can't think of anybody who has not taught me an important lesson. I'm not a big believer in a cosmic orderer--at least not in any way that can't elude our best-formulated control schemes--but I do believe in the power of absorbing the lessons available to us.

This past year, the entrance of three young Sudanese Americans has transformed our house and our understanding of the world. At the start of the year, my partner and I faced the completion of a very long journey. When our friends opened their hearts and lives to their friend and his three young, lovely children, our dreams were transformed. By the time the year ended, we found ourselves constantly re-configuring mental models of our small community to make space for these children and everyone else in the village who wanted to help out. Even though we aren't the primary caretakers in these kids' lives (and probably not even secondary), we have found ourselves trying to become less selfish to help them and the many people taking on the extra parenting. The persistent pull of these kids helped pull me and my partner from the cascading traumas brought about by two floods, the forgotten death anniversary of my father, the end of a 17-year academic journey, the purchase of our first new house (and its subsequent remodeling), physical injury, and a cancer scare. When I was overwhelmed at times, my partner would remind me to think about these kids and the other kids in the world who live on the edges of war and colonialism. We know nothing of trouble.

It's easy to get caught up in my own goals as an academic. Sometimes, the game of success is the only game that I feel like I can win; hell, sometimes it's the only game I understand. It's only the persistent ethical draw of eleven years with my best friend and lover that pulls me out of an institutional orbit to see the larger picture of what we can mean to others, especially when the culture gives you no instructions on how to connect with the young and vulnerable when you aren't biologically connected. It's hard to love people when acts of love are interpreted as selfish at best, dangerous at worst. It helps to have a life partner who is an old pro at giving without leaving traces. Being there for friends and strangers means you have to be courageous. You can't give while looking over your shoulder. The blows will come, but love gives you strength and courage that help you ignore them.

At times, the courage that comes from love has manifests as a willingness to grab opportunities. We're walking towards spending time in Africa next year. I'm hoping to help grow the arts community during a time of scarcity. Sport is hoping to continue and expand her work with vulnerable women. We're also looking at ways of aligning our professional careers more closely with our ethical bent. I want to be a better teacher. A better researcher. A better friend. A better person. These things all require an uncomfortable amount of truth-telling; something I'm not always willing to do. As a rhetorical scholar, I'm always aware of the means of persuasion, but this does little to help me change the world in deeply ethical ways. Sometimes you have to risk looking like a jackass to fulfill your calling. It's painful, but ultimately necessary.

Being more comfortable in my own skin has meant rubbing some people the wrong way, but it has also meant making deeper friendships. You can't please everybody, but that's O.K. Everybody who I have met in my life has played some sort of important role. As I take this trip around the sun again, know that I'm taking a little piece of you with me, that I'm trying to be a little less me and little more of those kids. You have all taught me something I needed to learn. If you have read this far, I'm sure that you have somehow helped me get to where I need to go in my journey. Thank you.


According to former President Bill Clinton bugs could hold the answer to fighting the childhood obesity epidemic and to stemming the rising tide of Americans developing type 2 diabetes and other chronic diseases related to poor nutrition.

Clinton did not tout bugs as a solution because they are an emerging, sustainable source of lean protein or a novel baking ingredient that can improve the health profile of popular items such as chips, cookies or snack bars as marketed by several startups. Rather, Clinton told attendees at the Partnership for a Healthier America’s Summit in Washington, DC, last week that bugs’ can help fend off preventable, diet-related diseases simply by providing a model for cooperation to achieve a shared goal.

Clinton said that he came to this conclusion in part by watching the not one, but two, ant farms that were given to him as gifts from his staff, and from Edward O. Wilson’s The Social Conquest of Earth.

Describing Wilson’s slim volume as “the most important political book that no one reads as a political book,” Clinton explained that Wilson argues that of all the species that inhabited earth, the most successful ones that ever lived, as defined by enduring multiple threats to their existence, are ants, termites, bees and people.

While these are ‘’not the biggest or strongest” of the species, Clinton said Wilson attributes their survival to their ability to find “ways to work together and solve common problems for stronger futures.”

And this is exactly what people need to do again to fight the obesity epidemic and other diet-related chronic diseases, Clinton said.

He acknowledged that this approach “is never as interesting as a knock-down, blood-on-the floor fight,” and is not as emotionally satisfying as “good old-fashioned name-calling,” or the tribalism that is growing in America, but, he said, “the truth is that in the world we live in, creative cooperation involving diverse partnerships with people who live different lives and know different things are the best mechanism for solving complex social problems.”

For support, he pointed to the agreement the Alliance for a Healthier Generation brokered with the American Beverage Association – to very different groups, with different individual goals – to reduce sugar consumption from drinks served in schools.

The arrangement resulted in a 90% reduction in calories from drinks in schools in part because it respected the individual needs of each partner.

“I never ask anybody to lose money, I say, because it’s not sustainable. I said, ‘Can you find a way to make money in a different way?’ And they did. They basically got all the full-sugar drinks out of the schools and went to fruit-flavored waters and smaller portions of milk, smaller portions of juice,” Clinton said.

He also lauded Former First Lady Michelle Obama’s Let’s Move campaign, the Partnership for a Healthier America and all the companies that have made commitments to PHA for similarly working together to achieve a common goal of reducing childhood obesity.

And while he celebrated the successes these partnerships have reached so far, he asked companies and public health advocates at the Summit to take the next step.

“We can do this in a big way,” he said, noting, for example, “we are now working with the beverage industry to reduce total consumption of calories from beverages nationally by people of all ages everywhere by 20% by 2025.”

He also took a step back from the food, beverage and public health arena to note that legislators in Washington could also learn from this approach.

He explained: “When Michelle Obama asked our foundation to help with what she was doing, and I realized they were calling the campaign ‘Let’s Move’ – not ‘Move Away,’ ‘Let’s Move’ – I thought, maybe we should make that the national motto and put in on the Capitol and the White House: Do something. Do it.”

And while Clinton noted he could “make 50 jokes out this,” he said he wouldn’t because he didn’t want attendees to lose sight of the true message “that inclusion, diversity and creative cooperation lead to better results.”

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According to former President Bill Clinton bugs could hold the answer to fighting the childhood obesity epidemic and to stemming the rising tide of Americans developing type 2 diabetes and other chronic diseases related to poor nutrition.


Sydney Lea

Sydney Lea is an American poet, novelist, essayist, editor, and professor, and is the Poet Laureate of Vermont. His most recent book is A Little Wildness: Some Notes on Rambling (Storyline Press, 2006), and he has a ninth collection of poetry, Young of the Year, now out from Four Way Books. He has taught for the Master of Arts in Liberal Studies program at Dartmouth College, and at Yale University, Wesleyan University, Vermont College, Middlebury College, Franklin University Switzerland, and the National Hungarian University.  He founded New England Review in 1977 and edited it till 1989. His work has appeared in literary journals and magazines including The New Yorker, The Atlantic, The New Republic, The New York Times, Sports Illustrated, Virginia Quarterly Review. He is one of 25 poets featured in the highly influential 1996 anthology, Rebel Angels: 25 Poets of the New Formalism. He lives in Newbury, Vermont.  His work "Mudtime" has been set as a long form song cycle for voice and string quartet by the composer Joseph Hallman which the poet described as "a high point of my term as poet laureate. It's been so refreshing and so different, a great shot in the arm.",.  It was premiered in 2014 by Hallman's long term collaborator, Abigail Haynes-Lennox and the 802 Quartet at the Vermont College of Fine Arts.

Honors and awards
 2011 appointed Poet Laureate of Vermont
 2001 Pulitzer Prize finalist for Pursuit of a Wound
 1998 Poets' Prize, for To the Bone: New and Selected Poems
 1992 Fulbright Scholarship
 1987 Guggenheim Fellowship
 1985 Rockefeller Foundation Fellowship

Published works
Full-Length Poetry Collections

Novels
   1st edition Scribner's 1989

Essay Collections

   1st edition

Anthology Publications

Anthologies Edited

References

External links
Author's Website
"Interview With Poet Sydney Lea", Poetic Asides, August 11, 2009
 Poems: "Mudtime In the County", Virginia quarterly Review, Autumn 1995
 Poems: "Canary Weather", Virginia quarterly Review, Autumn 1995
 Poems: "Children, Singing", The Atlantic, December 2003
 Essay: "The Death Of A Hunting Dog", Sports Illustrated, December 02, 1991

Category:Poets Laureate of Vermont
Category:Year of birth missing (living people)
Category:Living people
Category:Wesleyan University faculty
Category:Novelists from Vermont
Category:20th-century American novelists
Category:American male novelists
Category:American essayists
Category:Guggenheim Fellows
Category:Fulbright Scholars
Category:Rockefeller Fellows
Category:The New Yorker people
Category:People from Newbury, Vermont
Category:20th-century American poets
Category:American male poets
Category:American male essayists
Category:Novelists from Connecticut


Identical twins with mental retardation, dysarthria, progressive spastic paraplegia, and brachydactyly type E: a new syndrome or variant of Fitzsimmons-Guilbert syndrome?
We report on concordantly affected female identical twins with mental retardation, dysarthria, progressive spastic paraplegia, and brachydactyly type E. The most similar condition reported is the syndrome described by Fitzsimmons and Guilbert in uniovular twins characterized by progressive spastic paraplegia, dysarthria, brachydactyly type E, and cone-shaped epiphyses. During the last 11 years a report of only one other patient with this syndrome has been published; hence, its phenotypic delineation may be only partial. Although our patients might expand the phenotypic spectrum of this syndrome, they may represent a new disorder.


This blog is for discussion of everything judicial: nominees, judges, the confirmation process, judicial philosophy, court decisions, constitutional issues, judicial activism. The views expressed here are those of the individual bloggers and do not necessarily represent the views of the Committee for Justice.

February 04, 2008

Judges – McCain's nominees and a pay raise

Here are two pieces on judges that are notable for their “Nixon goes to China” viewpoint.

Conservatives’ concerns about the type of judges John McCain would appoint as president have become prominent of late. And we too have some doubts. But consider today’s Wall Street Journal op-ed on judicial appointments by Professor Steven Calabresi – Chairman and co-founder of the conservative Federalist Society – and his similarly-minded colleague Professor John Mcginnis. The conservatives who care most about the appointment of constitutionalist judges greatly admire both men, so their view that “John McCain is the best option to preserve the ongoing restoration of constitutional government” carries a lot of credibility.

Calabresi and Mcginnis argue that

“[McCain] is by far the most electable Republican candidate remaining in the race, and based on his record is as likely to appoint judges committed to constitutionalism as Mitt Romney, a candidate for whom we also have great respect. . . . For other kinds of issues, it may be argued that it is better to lose with the perfect candidate than to win with an imperfect one. . . . The judiciary is different. . . . Even if a more perfect candidate were somehow elected in 2012, he would not be able to undo the damage, especially to the Supreme Court.”

The second piece evinces the breadth of support for giving federal judges a much needed pay raise. Even the liberal New York Timesis on board. Hours before the Senate Judiciary Committee approved a 29% pay raise at the end of last week, the Times editorialized that “the case for a substantial increase is a strong one,” especially in light of the nearly 25% decline in judges’ real wages since 1969. The Times cited Chief Justice Roberts’s observation that the decline “has left federal trial judges . . . earning about the same as (and in some cases less than) first-year lawyers at firms in major cities.” The House Judiciary Committee approved a similar bill in December.


498 N.W.2d 413 (1993)
Hosien KALELL, Appellant,
v.
Rodney R. PETERSEN and Betty J. Petersen, Appellees.
No. 92-475.
Court of Appeals of Iowa.
February 2, 1993.
*414 Robert D. Houghton and Douglas R. Oelschlaeger of Shuttleworth & Ingersoll, P.C., Cedar Rapids, for appellant.
Brad J. Brady of Crawford, Sullivan, Read, Roemerman & Brady, P.C., Cedar Rapids, for appellees.
Heard by DONIELSON, P.J., and SACKETT, J., and KEEFE, Senior Judge.[*]
KEEFE, Senior Judge.
On June 15, 1987, Rodney Petersen began the process of removing a limb from a tree in his back yard. He tied a rope onto the limb and fastened the other end of the rope to his truck. While Petersen was pulling on the limb, Hosien Kalell entered Petersen's backyard unannounced and grabbed the rope that connected the limb to the truck. Thereafter, a portion of the limb broke loose from the tree and struck Kalell in the head.
Within minutes, Kalell was taken to the hospital. He developed a blood clot in his brain. Dr. James LaMorgese performed brain surgery upon Kalell to remove the blood clot. Kalell remained in the hospital until July 25, 1987. Dr. LaMorgese released him to return to work on December 1, 1987.
At the time of the accident, Kalell was sixty years old. He was employed as a manufacturer's representative for Kar Products. His net income from this employment was about $575 per month. Kalell testified that he planned to work until age seventy.
On December 17, 1987, Kalell filed suit against Rodney and Betty Petersen. Kalell alleged that, as a result of the Petersens' negligence in taking down the tree limb, he suffered permanent physical impairments and disabilities. The district court directed a verdict for Betty Petersen, and she is not a party to this appeal. After trial, the jury entered a verdict which assessed fifty percent of the fault to each party. Kalell's damages were found to be $59,856.41. He was thus awarded fifty percent of that amount, $29,928.21. After the district court entered judgment on the jury's verdict, Kalell filed a motion for new *415 trial on the issue of damages. The district court overruled the motion. Kalell now appeals.
Kalell contends that the trial court abused its discretion in two areas: (1) in overruling his motion for new trial on the ground the award of damages was insufficient and inadequate; and (2) in overruling his motion in limine to exclude evidence of his prior marriage dissolutions, bankruptcies, late filing of tax returns and expenditures of money on items other than medical charges or prosthetic devices. The court will consider these in the reverse order.

I. Motion in Limine.
Prior to trial Kalell filed a motion in limine addressing the four types of evidence mentioned above. The motion also addressed a fifth type of evidence concerning an Act of God. This motion was resisted by defendant. A hearing was held by the trial judge. The judge originally stated he would reserve ruling on prior dissolutions and bankruptcies until the evidence developed. He overruled the motion as it pertained to filing of late tax returns, other expenditures of money, and Act of God. Kalell's attorney insisted on receiving a clear ruling so he would know how to handle voir dire and his opening statement. The trial judge then stated he would make a clear-cut ruling and denied the entire motion.
In the case of Shawhan v. Polk County, the supreme court stated:
Plaintiffs objected to this evidence, raising the issues of whether it was relevant, see Iowa R.Evid. 401, 402, and if so whether its probative value was outweighed by the potential for unfair prejudice if allowed, see Iowa R.Evid. 403. We must decide whether the trial court abused its discretion in admitting this evidence and, if it did err, whether substantial rights of the plaintiffs were affected, see Iowa R.Evid. 103(a).
Evidence is relevant when it has "any tendency to make the existence of any fact that is of consequence to the determination of the action more probable or less probable than it would be without the evidence." Iowa R.Evid. 401. However, even relevant evidence is not admissible "if its probative value is substantially outweighed by the danger of unfair prejudice." Iowa R.Evid. 403. Issues of relevancy and prejudice are matters normally left to the discretion of the trial court; we reverse the trial court only when we find a clear abuse of that discretion.
420 N.W.2d 808, 809 (Iowa 1988).
In the trial of this case, every item of damages, except special damages, was hotly contested by Petersen. Kalell's attorney either introduced or did not object to the introduction by Petersen of items covered by the motion in limine.
The general rule, as stated in State v. Harlow, 325 N.W.2d 90, 91 (Iowa 1982), is that the granting or rejecting of a motion in limine is not reversible error. The error occurs, if at all, when the matter is presented at trial. Id. An objection should then be made in order to preserve error. Id. The court further stated in Harlow:
We have recognized an exception to this rule, however, and have said a defendant need not renew his objections at trial if the prior ruling amounts to an unequivocal holding concerning the issue raised.
Id. See also Reyes v. Missouri Pacific Railroad Co., 589 F.2d 791, 793 (5th Cir. 1979); Berg v. Des Moines General Hospital Co., 456 N.W.2d 173, 177-178 (Iowa 1990).
Apparently no evidence of an Act of God was presented by either party. Thus, this issue is not significant to our determination and will not be considered further by this court.
At trial, Kalell presented evidence about his marriages, bankruptcy, failure to pay child support, and filing of late tax returnsthe matters which had been the subject of the motion in limine. Kalell introduced his tax returns for 1978 through 1987 as evidence of lost income and earning capacity. Kalell had not filed any of these returns prior to the accident, but filed them as late returns in 1988.
*416 Petersen argued the fact that the returns were filed late was relevant to the question of the accuracy of the returns. Petersen also argued that the evidence of Kalell's expenditures of money on items other than medical charges related to Kalell's claims that he was unable to participate in social events or enjoy life. During the trial Kalell failed to object to the introduction of evidence concerning any of the matters raised in the motion in limine.
We find the evidence comes under the exception in Harlow because the trial court made an unequivocal ruling to exclude the evidence. Kalell's introduction of the evidence and failure to object to such evidence was not a waiver of his objections under the motion in limine. But the evidence was also relevant and its probative value substantially outweighed the danger of prejudice against Kalell.
We conclude the trial court did not abuse its discretion in allowing the evidence. We affirm on this issue.

II. Motion for New Trial.
Kalell next contends the trial court erred by refusing to grant a new trial based on his claims the award of damages was insufficient and inadequate. Again, we review for the trial court's abuse of discretion. See Kiner v. Reliance Insurance Co., 463 N.W.2d 9, 13 (Iowa 1990); Iowa R.App.P. 14(f)(3).
The jury found both plaintiff and defendant fifty percent negligent in this case. That issue was not appealed by either party. The jury awarded Kalell $59,856.41. His medical expenses were $37,388.14. Therefore, he received $22,468.27 for all elements of damage other than his medical bills. Kalell has not cited any cases where the Iowa courts reversed a verdict awarding that large an amount beyond special damages.
In Witte v. Vogt, the supreme court ruled:
An inadequate award merits a new trial as much as an excessive one. We review this question to correct an abuse of discretion. Thus, when the verdict is manifestly inadequate, we consider the refusal of the district court to grant a new trial an abuse of discretion that is subject to reversal. The question of whether damages in a particular case are inadequate turns on the particular facts of that case. If uncontroverted facts show that the amount of the verdict bears no reasonable relationship to the loss suffered, the verdict is inadequate.
443 N.W.2d 715, 716 (Iowa 1989) (citations omitted).
Also, in Cowan v. Flannery, the court stated:
It is not for us to invade the province of the jury. In fact a verdict will not be set aside or altered unless it is, (1) flagrantly excessive or inadequate; or (2) so out of reason as to shock the conscience or sense of justice; or (3) raises a presumption it is the result of passion, prejudice or other ulterior motives; or (4) is lacking in evidential support.
If the verdict has support in the evidence the others will hardly arise, if it lacks support they may all arise. The real question in most cases, and here, is the amount and sufficiency of evidence to support the award made. Certainly where the verdict is within a reasonable range as indicated by the evidence the courts should not interfere with what is primarily a jury question.
461 N.W.2d 155, 158 (Iowa 1990).
When we apply the principles set out in these cases, we find the trial court did not abuse its discretion in denying the motion for new trial. We find the jury verdict is sufficient and adequate.
One unusual element in this case must be addressed by the court. In Petersen's brief and in Kalell's oral argument to this court, we were informed that Kalell received payments in excess of $100,000 from nonparties to this action before trial. The $100,000 is subject to a right of subrogation by the payor from any award of damages to Kalell. Kalell's attorney argued to this court that we should consider this out-of-court payment as an indication the jury verdict was inadequate. The jury was not informed of these payments and no instructions *417 were given by the trial court as to their effect. Kalell's attorney admitted during argument that Kalell would have to receive a jury verdict in excess of $200,000 before he would receive any damages himself.
This argument is specious and improper. We will not consider any fact that is not in the trial record in deciding this case.
In summary, we conclude the trial court did not err in overruling plaintiff's motion in limine or allowing the introduction of evidence covered by said motion. Also, the trial court did not err in failing to grant a new trial based on an inadequate and insufficient jury verdict on damages. We affirm the trial court in all respects.
AFFIRMED.
DONIELSON, P.J., concurs.
SACKETT, J., specially concurs without opinion.
NOTES
[*]  Senior Judge from the 1st Judicial District serving on this court by order of the Iowa Supreme Court.


Last week, the 2016 Los Angeles Jewish Film Festival (LAJFF) concluded its weeklong series of screenings here on the L.A. Westside. It’s always a special time when the LAJFF comes to town, because when else are you going to see Jews in Beverly Hills? I didn”t attend any movie screenings (I was too cheap to buy a ticket), but I did attend one of the after-parties, as it was held just a few blocks from where I live. The movie chosen by the Chosen to open the festival wasn”t technically a movie, but an episode of the hit Israeli TV series False Flag. In Israel, the series is titled Kfulim, or “Doubles.” The opening-night gala screening was cosponsored by the Consulate General of Israel.

At the after-party, I paced my drinking well enough to speak coherently with some of the attendees. I asked several of the people associated with the series to explain the name change. Why not call it Doubles here in the U.S.? I received basically the same answer every time I posed the question. In America, claiming that something is a “false flag” is the newest conspiracy craze. It’s a hot, trendy buzzword among American conspiracy buffs (including conspiracy “celebrities” like Jesse Ventura, Steven Seagal, and Exene Cervenka). After the Umpqua Community College mass shooting last year, the local sheriff who investigated the crime turned out to be a false flag enthusiast. Following the San Bernardino massacre last December, attorneys for the family of the killers suggested that it was all a false flag setup.

False flag mania has now reached the point where the producers of a massively popular, high-profile Israeli TV series think the term is hip and familiar enough to garner their show attention and success in the U.S. There was a small air of condescension among some of the people with whom I spoke, a sense of (and I”m paraphrasing here) “if the goyim want to believe every Muslim act of terror is a false flag, we might as well profit from it.” Truth be told, I share that condescension. I wrote disdainfully about false flag conspiracy theorizing over a year ago, and after my experience at the LAJFF after-party, I thought it might be edifying to revisit the topic.

First off, it’s important to get an understanding of the definition of “false flag” among the conspiracy-minded. Initially, the term had a fairly simple meaning. It’s an operation designed to hide the true identity of the perpetrators of a crime while at the same time framing an innocent person or entity. Soldiers from country A dress in the uniforms of country B and carry out atrocities to make country B look bad. That has happened, no question. In fact, it’s an age-old war tactic, although so is claiming that something was a false flag when it wasn”t (country B actually does commit an atrocity and tries to weasel out of it by claiming, “No, it was people from country A wearing our uniforms! We wuz framed”).

Thanks to a dynamic partnership between trolls and lunatics, “false flag” has transmogrified into something very different these days. Now it is used to refer to fake events, hoaxes that were completely staged. “Crimes” (mass shootings, bombings, etc.) that involve no actual crime and no real victims. The “perpetrators” are all conspirators and the victims are all “crisis actors.”

Not only did Sandy Hook never happen, there is no Sandy Hook. Obama faked a town called Newtown and a school called Sandy Hook. Thousands of average people were hired to portray residents, neighbors, students, and administrators, and every member of the media was bribed to play along. There was no gunman, no victims. And of course, not one of the pretenders”not even the small children”has ever betrayed the secret (because we all know that 6-year-olds are the world’s best secret-keepers). Bataclan never happened. The Boston Marathon bombing and the Brussels airport attack? Never happened. The Santa Barbara mass shooting? Aurora? Roanoke? Charleston? San Bernardino? Fake, fake, fake. Crisis actors and stage blood.

“False flaggots reach their conclusions first, and interpret the evidence to support what they”ve already decided to be true.”

I”ve had several prominent false flaggots tell me that I was an “inspiration” for this lunacy during my Holocaust revisionist years. “You”re the one who taught me, man, to, like, examine film clips and photos for tiny clues to expose hoaxes!” I hear that more times than I”d like to say, so permit me to set the record straight: If you think my work poring over documents and taking a magnifier to historical ruins is in any way equal to what false flag nutjobs do these days, you”ve completely missed the point of my work. Please stop giving me credit, and, while you”re at it, stop sending me so many damn friend requests.

As a way of trying to make karmic amends for any role I might have played in encouraging false flag mania, I”ll outline just a few reasons why this kind of thinking is sloppy, wrong, and counterproductive.

To begin with, none of the celebrated false flag experts can point to a single provable example of a thousand people staging a crime scene and keeping it secret. In a widely disseminated piece, found on just about every false flag site in existence, detailing 56 “government admitted” false flags, not one example involves actors pretending that a crime or war atrocity occurred. There is not one single example of a faked incident in which the victims were playacting. The closest thing on the list is the case of an Italian cop who cut his own jacket in order to claim he was stabbed (and this was not a “government” crime; the cop was prosecuted for lying). All of the other examples are of genuine crimes that were, in some cases, falsely blamed on an innocent person or entity. And some of those examples aren”t really false flags at all.

The list includes the Katyn Forest massacre. That wasn”t a “false flag.” The Soviets invaded the eastern half of Poland. They rounded up Polish nationals and killed them. They committed the crime as themselves, as Soviets; they didn”t pretend to be anyone else. When the Nazis discovered the bodies, the Soviets panicked and said, “We didn”t do it. The Germans found the bodies; they must”ve done it!” (In international law, this argument is known as the “He Who Smelt It” defense.) Saying “I didn”t do it” isn”t a “false flag”; the Soviets simply lied. The list also claims that the Reichstag fire was a “false flag.” That’s sheer pseudohistory. Very few historians still believe that the Nazis were behind the fire; most agree that communist agitator Marinus van der Lubbe was the sole arsonist.

If there’s zero proof for previous “playacted” mass crimes, there’s an equal paucity of evidence that they”re suddenly, for some reason, happening every month now. False flaggots are incompetent when it comes to evidence because they work backwards; they reach their conclusions first, and interpret the evidence to support what they”ve already decided to be true. This is the exact opposite of everything I tried to impart as a revisionist historian. Having decided in advance that an event is a false flag, they look for rationalizations, a way to claim that a particular piece of evidence supports their conclusion, even if the claim contradicts one they made a week ago.

With Sandy Hook, a false flag was declared because one of the grieving fathers didn”t seem “sad enough.” Conversely, with the Santa Barbara shooting, the proof of a false flag was that one of the grieving fathers was grieving too much! When Aurora’s James Holmes was captured alive, that was proof of a false flag (“how suspicious; normally those guys are killed or kill themselves”). When Sandy Hook’s Adam Lanza killed himself, that was proof of a false flag (“how convenient; now they don”t have to bring him to trial”). The lack of blood next to a Charlie Hebdo massacre victim was proof of a false flag (“there should be free-flowing blood!”), whereas the abundance of free-flowing blood in the aftermath of the Santa Barbara shooting was evidence of a false flag (“it’s red paint; real blood would have clotted instead of flowed!”). Santa Barbara shooter Elliot Rodger’s vast history of social-media posts was evidence of a false flag (“what 22-year-old has that many online videos?”), whereas Adam Lanza’s lack of social-media posts was proof of a false flag (“what 21-year-old has that few online videos?”).

Speaking of Lanza, another “proof” is that he was supposedly too small to adequately handle a firearm. The San Bernardino killer’s family attorney mirrored this sentiment when calling false flag in the case of female shooter Tashfeen Malik: “She’s probably about 90 pounds, so it’s unlikely she could even carry a weapon or wear some type of a vest or do any of this. It just doesn”t make sense for these two to be able to act like some kind of Bonnie and Clyde or something.”

Too petite to be like Bonnie Parker? Parker was 4-foot-10, 90 pounds. But what are facts to a false flaggot? After the Boston Marathon and Brussels airport bombings, flaggots claimed that scenes of victims with their clothing torn by the explosions were proof of a false flag. “Look at those pants”they look like they were shredded with scissors! Only a “sheeple” could believe that a bomb can blow off clothes but not the skin underneath.” Now, you can show a loon like that the footage of a man in China standing next to an exploding manhole and getting his clothes neatly blown off while his white undershirt stays intact, but they”ll just accuse you of being part of the conspiracy (hell, they”ll probably claim that the Chinese faked the manhole explosion just to trick “em). I have one false flaggot among my Facebook friends who used the “pants blown away” argument to declare the Brussels attack a fake, only”a month later”to post photos of what he agreed was a real terrorist attack, the ANC’s 1983 Church Street bombing in South Africa. And guess what? Those photos show a victim with his pants similarly blown away.


A review of analgesic compounds used in food animals in the United States.
Extralabel drug use for pain relief in the United States is regulated under the Animal Medicinal Drug Use Clarification Act. Agents that may provide analgesia in livestock include local anesthetics, nonsteroidal antiinflammatory drugs, opioids, α2-agonists, and N-methyl-d-aspartate receptor antagonists. The challenges associated with providing pain relief in food animals and the salient pharmacokinetic and pharmacodynamic features of the analgesic compounds that could potentially be used in livestock are reviewed. The potential use of novel agents such as bicarbonate, magnesium, ethanol, and gabapentin to augment analgesia is also discussed.


Having reverted to an elementary for the 2005-06 school year, Ivywild School will have more space. Principal Libby Bailey
hopes to take advantage of that situation to enhance her school logistically while providing usage opportunities for the
neighborhood, she said in a recent interview.
The logistic move is to relocate all her grades to the main floor of the building. When the school had grades 6-8, there were also
kindergarten and first-grade classrooms on the lower floor.
“We're also trying to get a preschool,” added Bailey, who just completed her first year as Ivywild principal. “It will be at the
south end of the building and have its own entrance.”
Another goal is to convert the empty downstairs into a community center, creating adult uses for those classrooms. “Hopefully
we can have ESL (English as a Second Language), parenting classes and GED (general educational development),” she said.
Possible tenants for the center would be the Boys and Girls Club, City Parks, or the YMCA. A model for her plan includes the
intergenerational center, built into the side of West Middle School, which offers various classes, services and community
programs days and evenings.
“The overall push is to get more parents involved, so they'll feel comfortable coming to the building and become more active,”
Bailey said.
An in-depth District 11 study a year ago identified Ivywild as underutilized, and suggested that it be closed to save district
money. The Board of Education has since given Ivywild a reprieve, but Bailey agrees that her building ought to be “more viable,”
as she put it. Other potential benefits from her community center plans will be bringing more money into the school and
“improving the impression the community has of the Ivywild area,” she said.


After weeks of rumours, it’s now official: Louis Beland-Goyette has joined the Halifax Wanderers.

The 24-year-old midfielder was one of Valour FC’s shining stars from a fairly rough 2019 campaign that saw them finish last place in the spring and fifth in the fall, and had even captained the Winnipeg-based side on occasion. Now under contract with the Halifax Wanderers, he’ll be suiting up against his old club later this year.

The former Montreal Impact man was a standout player in the Canadian Premier League‘s inaugural season, suiting up for for the Winnipeg-based outlet 23 times in all prior to picking up a knock against York9 FC on his birthday. The move is a significant coup for the Wanderers, with Beland-Goyette stating in an official Halifax Wanderers press release that the packed stadium atmosphere at Wanderers Grounds was a key draw for the league’s second-ever intra-league transfer:

The city, the stadium, and fans are wonderful. Halifax is one of the top places you want to play in the league. A big part of my decision was what I saw last year. It’s a passionate club with passionate fans and that’s what you want. I hope I can bring success to this club because the fans deserve it, so I hope to bring joy and passion for them. Louis Beland-Goyette

Having a full stadium located in downtown Halifax has provided what may be the league’s best atmosphere, and beyond helping convince the club’s newest signing to call it home, it even has Toronto FC players hoping for a trip to Halifax in the Canadian Championship.

The move will see Beland-Goyette reunited with companions Chrisnovic N’sa and Alessandro Riggi, both of whom he played alongside during his time with the Montreal Impact and its now-defunct USL affiliate, FC Montreal. The familiar faces were yet another draw to the east coast club for Beland-Goyette.

I was really happy for Chrisno that he got the chance to play so much, and Riggi and I played a lot for FC Montreal together and I love him as an attacking player. Louis Beland-Goyette

Riggi has stated that he wants to make the fans at Wanderers Grounds go ‘ooh’, and pairing him up alongside Louis Beland-Goyette sounds like a promising way to make that happen. All-in-all, it appears to be a great gain for Halifax Wanderers, and a great loss for Valour FC.

Halifax Wanderers head coach Stephen Hart is in the midst of a near-total squad overhaul, having parted ways with the majority of his squad after it limped to a last-place finish in 2019’s fall season. Hart has been quick to bring in new additions, which include the aforementioned Alessandro Riggi along with even more domestic talent in the form of Omar Kreim, Aboubacar Sissoko, and Ibrahima Sanoh.

The former Canadian national team coach had kept a close eye on Beland-Goyette throughout the inaugural campaign, and was evidently impressed with what he saw:

He had a very good season last year and he is clean on the ball. He keeps the ball moving and keeps a team in possession but also has the ability to hit creative passes long and short and I thought that was something we needed. Now we have a variety of options in how we can shape the midfield and we have depth and balance now. When we played Valour I like that he was always available for the ball and he is definitely one of the top midfielders in the league. Stephen Hart

Beland-Goyette becomes the twelfth signing for the east coast club ahead of the 2020 Canadian Premier League season. This offseason, Club President Derek Martin had stated that the Wanderers will find itself less rushed to make its signings, indicating that the rest of the maximum-23-player roster may not be filled out till closer to the season’s launch.

To that end, Jamaican international Alex Marshall has told Northern Tribune that he’ll be joining the Wanderers, though the club has yet to make any official announcement regarding the 21-year-old left winger. Hart hadn’t instilled his preferred tactical philosophies in the inaugural campaign, but it looks like 2020 will now see him able to deploy a much more attack-oriented side that ought to help reduce the number of draws the club obtained last season.

With Valour FC having only re-signed three players so far and rumours pouring in about potentially even more key players departing, head coach Rob Gale will likely find himself with even more roster spaces to fill after Beland-Goyette, though he recently stated that fans will see at least half of the inaugural roster returning.

Details of Louis Beland-Goyette’s contract with the Wanderers, including its length or financial compensation, was not disclosed by the club.

Source: Halifax Wanderers


COMPILE_DEPS = CORE_DEPS + NETTY + [
    "//providers/lldpcommon:onos-providers-lldpcommon",
]

BUNDLES = [
    "//providers/lldpcommon:onos-providers-lldpcommon",
    "//providers/netcfglinks:onos-providers-netcfglinks",
]

osgi_jar_with_tests(
    test_deps = TEST_ADAPTERS,
    deps = COMPILE_DEPS,
)

onos_app(
    app_name = "org.onosproject.netcfglinksprovider",
    category = "Provider",
    description = "Allows operator to prescribe information about known infrastructure links and " +
                  "their state using the network configuration subsystem. Such information takes precedence " +
                  "over information discovered through other link discovery providers.",
    included_bundles = BUNDLES,
    title = "Network Config Link Provider",
    url = "http://onosproject.org",
)


The ability for tokens and cryptocurrencies to be interchanged with one another in a convenient manner without the complexity of going through exchanges will go a long way towards the mainstream adoption of the emerging technology.

Compared with the already established fiat ecosystem where currencies of different nations can be easily interchanged and applied almost without blinking an eye, different cryptocurrencies appear to still exist exclusively in their unique circles. This situation makes it cumbersome, since users are indirectly compelled to maintain several wallets simultaneously in other to function well within the cryptocurrency ecosystem.

Fixing the bottlenecks

In a time where the digital world is evolving into Internet of Value (IoV), any development that encourages the easy transfer of value represents a move with the trend, and a campaign for effective communication.

In its present state, cryptofinance is experiencing a lot of technical bottlenecks primarily because of the absence of effective interaction between blockchains. As already mentioned above, these blockchains exist as exclusive entities which makes it difficult for value to be moved across them easily. This is one of the reasons why exchanges exist and provide an avenue for such interactions.

A blockchain for blockchains

The creation of Fusion as a blockchain that will enable interaction between other independent blockchains will eventually enhance the activities of the crypto ecosystem, while relieving exchanges of the unnecessary traffic that befall them most of the time.

This innovation is designed to to serve as a general infrastructure / backbone for the future world of cryptofinance by enabling cross-token / cross-chain abilities (Transactions, Smart Contracts, and other high level applications involving different tokens). This interaction solves the existing problems of interoperability, scalability and usability within the cryptocurrency ecosystem.

The inclusive cryptofinance platform that is created by Fusion will utilize distributed network nodes to control various types of tokens’ private keys and, in this way, it connects various values by establishing a control and management layer on top of all types of blockchains. At the same time, it becomes feasible to build cross blockchain smart contracts. In order to further expand

interoperability and scalability, Fusion will also provide interfaces for centralized organizations and off-chain data sources.

Enhancing relationships

Founded and led by DJ Qian, a superstar Chinese entrepreneur formerly behind Quantum and VeChain, Fusion will use token mechanisms and a foundation to continually foster all kinds of communities such as technical communities, college communities, user communities, investment communities, node participant communities, central organizations, and data source

Providers. Apparently, like the name implies, this innovation is primarily about connectivity and the enhancement of proper relationships and communication between independent entities of the same ecosystem.

This innovation adopts a hybrid Proof-Of-Stake (POS) and Proof-Of-Work consensus mechanism, making it way faster and more scalable in comparison to other solutions within the industry.