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6. Bar Codes - Nifty 50

Bar Codes

Bar codes, those dizzying combinations of 30 lines and 29 spaces, are on everything from chewing gum to soft drinks, from books and newspapers, to airline luggage tags and penguins.

Information gleaned from bar codes now helps supermarket chains, bookstores, airlines and many other industries determinewhat products are marketed and, sometimes more important, how, to whom and for what price goods are sold.

Bar codes are also used to help detect and determine consumer buying trends, literally the "why" behind consumer choices. It is estimated more than 100,000 grocery store items alone have bar codes.

Scientists even tag penguins in Antarctica with bar codes to help make data gathering faster and more precise, providing help in research into migration and endangered species.

Latest advances

NSF funding helped play a crucial role -- both earlier and more recently -- in the development of bar codes. In the early 1990s, research in computer vision conducted at the State University of New York-Stony Brook led to major advances in algorithms for bar code readers. That research led to commercial development of a new product line of barcode readers that has been described as a revolutionary advance, enabling bar-code readers to operate under messy situations and adverse conditions.

Work continues on developing two-dimensional bar codes, which will enable far greater amounts of information to be represented in a very compact form. NSF helped fund bar-code research in the 1970s, which helped to perfect the accuracy of the scanners that read bar codes.

Credit must also be given to private industry for its work in development and implementation of bar codes and scanners.

The first bar codes were used at a supermarket in Troy, OH, in 1974, and the scanners that read the bar code were considered large, loud and clumsy. Now scanners are small, hand held, unobtrusive, quiet and quick; they are used everywhere from stores and post offices to hospitals and by researchers in the field.

Original publication date: April 2000

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At North Shore Honda near Long Island, we offer an extensive inventory of pre-owned vehicles that will have you driving confidently off our lot. As a proud partner with Edmunds, our Honda dealership is pleased to pass on the several pre-owned perks that come with this partnership. Get the most for your money with our Edmunds pre-owned perks!

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Pre-owned perks are just one of the things that sets us apart from other dealers. When you shop at our Honda dealership, you'll always experience exceptional customer service with our incredible sales team. After you've found the pre-owned car of your dreams, you can benefit from our perks. As an Edmund's Premiere Dealer, we are able to offer customers that purchase a pre-owned vehicle from us a:

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When you're ready to take advantage of these pre-owned perks, simply shop for our vehicles on the Edmunds website and click on special offers or visit our dealership where we can sign you up for these pre-owned perks right away.

If you have any questions about our pre-owned perks, don't hesitate to contact us at our Long Island area dealership today.

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Online Continuing Education

OCEAN Online Continuing Education

As part of NPO and the Oregon Nurses Association's ongoing efforts to best serve our members and every nurse in Oregon, we are excited to present OCEAN (Oregon Continuing Education Activities for Nurses) online continuing education.

This new learning environment provides continuing education (CE) opportunities to ONA members and nurses across the region, in a convenient and user-friendly format.

OCEAN courses will be self-paced, independent learning modules, that cover a broad range of topics and encompass all levels of nursing practice. In addition to offering educational nursing content that is conveniently accessible 24 hours a day, OCEAN will house each learner’s CE history for easy access and retrieval. Additionally, future OCEAN courses may include live webinars and other learning activities.

Most OCEAN CE courses will be provided free to NPO/ONA members while non-member pricing is based on the number of CNE contact hours associated with each course. Occasionally, some courses will require a fee for members or an increased rate for non-members because the content is specialized or licensed through another organization.

Click here to learn more and to access the OCEAN Online Continuing Education System

Other Educational Resources

Announcing 2 Free CE Programs for Oregon NPs

The Nurse Practitioner Healthcare Foundation is pleased to offer NPO access to two free online CE programs related to “Opioid Prescribing: Safe Practice, Changing Lives.” You’ll learn guidelines for patient selection and assessment of risks associated with opioid use for long-term management of chronic pain, initiation and modification of ER/LA opioid therapy, ongoing monitoring, as well as patient and caregiver education. Alan Agins, PhD, Jody Agins, MSN, FNP-BC, and Wendy Wright, MS, FNP present the content in an interesting and dynamic format, including practical clinical content as well as illustrative case studies. These programs provide up to 5 hours of ANCC credit. Register now and become part of the solution to the opioid epidemic, a national healthcare crisis.

Have you checked out Medscape?

Unique Nurse Practitioner and other provider health care information, news, CE options, Conferences, Resource Centers, Journals & References, Experts & Viewpoints. New Users: FREE Registration!

Hepatitis Web Study

The site was designed for health care workers who provide clinical care to persons with viral hepatitis, and is a companion site to the HIV Web Study site:

Funded by a federal grant from the Division of Viral Hepatitis in the Centers for Disease Control and Prevention, this site features:

  • Fourteen interactive, clinically-relevant case studies, each with a discussion, high quality illustrations and graphics, and links, that highlight and illustrate key recommendations from national guidelines;
  • Free continuing education credits, including an easy way to print CME/CNE documentation and an electronic CE tracker;
  • Numerous high quality figures that the user can easily download into Power Point slides;
  • Reference linked to Pub Med abstracts, Federal Guidelines sites, and/or CDC MMWR documents;

Please visit the site and feel free to share it with your colleagues! Return visits are encouraged as the site will be updated on an ongoing basis and will continue to be expanded.

Free Prescribing Reference Available to NPs

The Nurse Practitioner Prescribing Reference, a quarterly publication, is an up-to-date guide to commonly prescribed pharmaceuticals, as well as certain over-the-counter products. It provides an easily accessible reminder of basic information useful to review when prescribing medications, such as specific indications for use, dosage and a checklist of precautions, interactions and adverse drug reactions. Contact 1-617-923-8519 to request an application for a free subscription if you don't already receive this booklet.

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Dietary Supplements and Bioavailability: Suppliers Improve Ingredient Bioavailability

January 27, 2011

Bioavailability is especially important for curcumin, which is notoriously difficult for the body to absorb. Standard curcumin is unstable at intestinal pH levels, resulting in rapid degradation. In addition, studies have shown that regular curcumin has a poor pharmacokinetic profile for oral absorption, a high rate of metabolic conjugation and reduction, as well as a tendency to be rapidly eliminated from the body, says Indena S.p.A. (Milan, Italy).

Tomatoes for Type 2 Diabetes?

December 13, 2010

Iranian researchers witnessed a supportive effect of tomatoes on several blood markers in type 2 diabetes patients.


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Advocacy Day

New York ACEP's annual Advocacy Day will be held Tuesday, March 3 from 10:30 am-4:00 pm at One Commerce Plaza, Suite 402 in Albany.

Each year, emergency physicians make a greater and more lasting impression during Advocacy Day in Albany. After a briefing on current issues to prepare you for the face-to-face meetings, we will head to the Capitol to meet with legislators and staff to discuss pressing issues facing emergency medicine and our patients. These visits serve many purposes including educating legislators on emergency medicine issues, seeking support for specific bills or legislative initiatives and showing appreciation for past support.

New York ACEP will schedule your Advocacy Day visits with key legislators and staff, so there is no need for you to contact your legislators' offices. Each attendee will be part of a leadership team comprised of colleagues and a New York ACEP lobbyist based on geographic location. During the briefing you will receive a hard copy of the schedule and position statements on specific issues and bills.

We will begin arranging legislative appointments in February. If you would like to attend, please contact New York ACEP by e-mail (This email address is being protected from spambots. You need JavaScript enabled to view it.) or phone (585-872-2417) no later than February 10, 2020.

With your involvement in Advocacy Day, New York ACEP can continue its work for a better political environment for our specialty and our patients.

New York ACEP Lobby Day
Tuesday, March 3, 2020
Reid, McNally & Savage
MSSNY Conference Room
One Commerce Plaza, Suite 402
Albany, NY 12210
10:30-11:30 am Lobby Day Briefing
11:30 -12:00 pm Lunch
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NYC - The Official Guide

Say “Chi-KEE-toe,” kind of like the banana. It’s not as hard as it looks. The word means “little” in Euskera, the Basque language. And it’s not every day you find such wonderful, passionately made Basque food outside of Spain. This simple, tiled cubbyhole (28 seats) in Chelsea has a wide-ranging tapas menu, good for sharing along with some earthy Spanish wine. Chef Alex Raij and her Bilbao-born husband, Eder Montero, gained a following at the nearby Tia Pol and El Quinto Pino, and have branched out on their own, creating a completely new menu here. There are little sandwiches of Basque tuna with piquillo oil and sweet onions; blistered peppers with sea salt; crispy, creamy croquettes; and legendary Basque salt cod poached in olive oil, among many other treats.

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Lessons From the Big Branch Tragedy

It is still not known what set off the West Virginia mine explosion that killed 29 workers  the nation’s worst mining disaster in four decades. What is clear is that federal oversight of the industry must be greatly strengthened.

The first task is to reform the Mine Safety and Health Administration. Its powers are limited. It has been remarkably forgiving of bad actors. And even when it uncovers serious, repeated violations, its cumbersome, industry-friendly appeals process makes shutting down a mine virtually impossible.

The Upper Big Branch mine, where the explosion occurred, is a case in point. According to a 2007 agency letter to the Massey Energy Company, the mine’s owner, Upper Big Branch had incurred 204 safety violations just in the previous two years. Disturbingly, the agency soon pronounced itself satisfied that Massey had addressed the problems. But in the past two years, the mine has been cited repeatedly for safety violations, many of them serious, and some involving improper ventilation.

These alarming numbers should have given the agency sufficient ammunition to prove a “pattern” of violations, a necessary precondition for shutting the operation. But the agency’s procedures prevent it from taking decisive action until the appeals process runs its course, and industry has become remarkably adept at prolonging legal challenges for months or years.

Federal officials say the backlog has been holding up strong enforcement action  including shutdowns  against 48 mines, one of which is the Massey mine.

Strengthening the agency means strengthening the Mine Safety and Health Act of 1977. Regulators lack subpoena power, a basic investigatory tool. Violations of safety standards that lead to deaths are mere misdemeanors. The agency also needs more inspectors and administrative judges to deal with the appeals backlog.

Representative George Miller, the California Democrat who leads the House Education and Labor Committee, is eager to begin addressing these deficiencies, as is his Senate counterpart, Tom Harkin, an Iowa Democrat. Both are scheduled to hold hearings.

After the Sago mine disaster in 2006, Washington increased inspections but did not fundamentally reform the system. This time the chances look better. Joseph Main, the boss of the Mine Safety and Health Administration, is a former union official and a far cry from the industry enablers who dominated the place under the Bush administration. He and his superior, Labor Secretary Hilda Solis, are planning to meet with President Obama on Thursday to discuss ways to guard against similar disasters.

Meantime, public anger is at a high pitch, even among West Virginians who rely heavily on coal mining for their livelihoods. West Virginia’s governor, Joe Manchin III, has now appointed his own investigative panel.

No one should underestimate industry’s capacity to resist. The time to fight this battle is now, before the tragedy at Upper Big Branch, like so many other mining disasters, recedes from the public consciousness.


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N.B.A. Star Kobe Bryant Dies in California Helicopter Crash

The retired N.B.A. star, 41, and his daughter Gianna were among nine people in a helicopter that crashed near Calabasas, Calif. A college baseball coach and his wife and daughter were also killed.

Fans and Friends Mourn Kobe Bryant After Helicopter Crash

The retired N.B.A. star, 41, was among the passengers in a helicopter that went down in Calabasas, Calif.

“We’re all feeling crazy sadness right now because earlier today Los Angeles, America and the whole wide world lost a hero, and we’re literally standing here heartbroken in the house that Kobe Bryant built.” “Tonight is for Kobe —” [singing] “Kobe, my thoughts are with you. Absolutely rest in peace, young man — this loss is, it’s just hard to comprehend.” “He was just such a wonderful kid. But more than that, has turned into a wonderful adult man.” “Everything I do, I do it for him, obviously — really close friend, and this season’s for him.” Crowd: “Kobe, Kobe, Kobe, Kobe, Kobe, Kobe.” Announcer: “The N.B.A and the game of basketball will mourn this loss together. Please join us in a moment of silence for Kobe Bryant. Rest in peace, Mamba.”

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The retired N.B.A. star, 41, was among the passengers in a helicopter that went down in Calabasas, Calif.CreditCredit...Hannah Yoon for The New York Times

The retired Los Angeles Lakers star Kobe Bryant, 41, and his daughter Gianna died in a helicopter crash near Calabasas, Calif., on Sunday.

Sources: Flight path from Flightradar24

By The New York Times

Bryant was among the passengers traveling onboard the helicopter. Nine people died in the crash, including the pilot, said Alex Villanueva, the Los Angeles County sheriff, during a news conference.

The National Transportation Safety Board said it sent a team to California on Sunday evening.

Daryl Osby, the Los Angeles County fire chief, said the crash site was difficult to access and that firefighters had to hike to the area.

It was not immediately clear how many passengers the helicopter was approved to transport, and fire officials said it was not immediately clear whether the helicopter was overloaded.

The N.B.A. sent a confirmation of Bryant’s and Gianna’s deaths to all teams and league employees Sunday afternoon, according to two people familiar with the document.

The other victims of the crash included John Altobelli, a longtime baseball coach at Orange Coast College, a junior college in Costa Mesa. Calif., as well as Altobelli’s wife, Keri, and daughter Alyssa, university officials said.

Sheriff Alex Villanueva of Los Angeles County said the helicopter went down in an area with “very rough terrain,” and that even emergency officials had found it dangerous to reach during daylight on Sunday. The debris field, the sheriff said, was roughly 100 yards in each direction.

The local authorities did not immediately release the identities of the people who were aboard the helicopter, including Bryant, and the chief medical examiner for Los Angeles County, Dr. Jonathan R. Lucas, said it could take several days to recover the bodies from the crash site.

“We will be doing our work thoroughly, quickly and with the utmost compassion,” Lucas said. “We’re doing everything we can to confirm identifications and give closure to the families involved.”

Credit...Chris Carlson/Associated Press

Outside the Mamba Sports Academy in Thousand Oaks, Calif., fans laid flowers and lit candles at an impromptu memorial for their star. The gym had handwritten signs on the door: Closed.

A few dozen people, adults of all ages, stood huddled in silence around the memorial of several jerseys, candles, dozens of bouquets, Sports Illustrated magazines with Bryant on the cover, and a Lakers flag. Written on one bouquet was “We love you Kobe and Gigi.” Another card, the shape of a Lakers basketball, read, “The day we lost a legend: 1-26-20 Thank you for being a role model for me and for others.”

Bryant was on his way to the academy to coach his daughter when the helicopter crashed, according to two law enforcement officials who spoke on condition of anonymity because they were not authorized to divulge details of the ongoing investigations.

The academy was hosting the Mamba Cup Tournament Series, a series of tournaments for boys and girls basketball teams from the third through eighth grades. All the games were canceled after the news of Bryant’s death became public.

Momentarily, a few fans wearing Laker jerseys started chanting “Ko-be! Ko-be!” and then stopped.

Eddie Lugo, 21, placed a throwback No. 8 jersey and candles on the memorial. He wore a blue throwback jersey backward, so that Bryant’s name faced forward.

“I was walking my dog meeting up with my buddy, complimenting my buddy on all the Laker gear, actually, when one of my best friends called,” Lugo said. “We were all just mind blown, we thought it was fake.”

Drafted to the N.B.A. directly out of high school in 1996, Bryant was named an All-Star in 18 of his 20 seasons for the Lakers and helped lead the team to five championships. His hypercompetitive nature led to occasional public disagreements with coaches and other players, but his commitment to winning was never questioned.

The winner of the N.B.A.’s Most Valuable Player Award for the 2007-8 season, and the N.B.A. finals M.V.P. in both 2009 and 2010, Bryant showed a rare commitment to success on both ends of the court, with a résumé that included two scoring titles — and an 81-point game in 2006 that is the second-highest single-game total in N.B.A. history — along with 12 appearances on the league’s All-Defense team. He also thrived on the international stage, where he won gold medals for U.S.A. Basketball in the 2008 and 2012 Olympics.

In 2016, after various injuries had taken their toll on the longtime superstar, he proved to have one more highlight in him, scoring 60 points in his final game while leading the last-place Lakers to a surprising win over the Utah Jazz.

Off the court, Bryant’s legacy was far more complicated. He was arrested in 2003 after a sexual assault complaint was filed against him in Colorado. A 19-year-old hotel employee claimed that Bryant, who was working to rehabilitate his knee following surgery, had raped her. The legal case against Bryant was eventually dropped, and a civil suit was settled privately out of court, but Bryant publicly apologized for the incident.

“Although I truly believe this encounter between us was consensual, I recognize now that she did not and does not view this incident the same way I did,” he said in his statement. “After months of reviewing discovery, listening to her attorney, and even her testimony in person, I now understand how she feels that she did not consent to this encounter.”

In retirement, Bryant became something of a champion for women’s sports and expanded his purview, winning an Academy Award in 2018 for his animated short film “Dear Basketball” while also creating the web series “Detail” for ESPN in which he analyzed current players.

“My heart can take the pounding / My mind can handle the grind / But my body knows it’s time to say goodbye,” he wrote in “Dear Basketball,” the poem that he wrote to announce his retirement that was the basis for the short film.

He was scheduled to headline the 2020 N.B.A. Hall of Fame nominees.

The fans who gathered at Staples Center represented the ethnic and racial diversity of Bryant’s professional city.

Leo Márquez, 7, placed a candle at the memorial, his eyes filling with tears. He couldn’t get the words out to explain why he was there.

“He wanted to come because he always watched Kobe on TV with his dad,” said his mother, Alejandra Márquez.

Adam Jackman, 18, a University of Southern California student from New York City, walked from the university to the arena.

“I’m here for the impact that Kobe had on the city of L.A., not just on the court but in the community,” he said. “This is the best place to be with the city as it tries to heal.”

Joe Rivas, 28, a registered nurse, was on a gym treadmill in the town of Cerritos when the news of Bryant’s death flashed on the television.

“The whole place froze,” Rivas said. “It sucked the air out of the room. I couldn’t believe it. I grew up with Kobe. He is my favorite player of all time.”

Rivas said he couldn’t finish his workout. He changed and jumped in his car to drive 25 miles to Staples Center, where he had watched Bryant play his last game in April 2016.

“He was not a perfect man but we all have our faults,” said Rivas, who donned a No. 24 jersey. “It’s beyond basketball.”

Among the other victims of the crash was John Altobelli, 56, a longtime baseball coach at Orange Coast College, a junior college in Costa Mesa. Calif. “This is a tremendous loss for our campus community,” said Angelica Suarez, the president of Orange Coast College, in a statement.

Juan Gutierrez, a spokesman for Orange Coast College, said that Altobelli’s wife, Keri, and daughter Alyssa also died in the crash.

Last year, Altobelli led the Pirates to the California Community College baseball state championship, their fourth state title under Altobelli. He was named one of the American Baseball Coaches Association coaches of the year.

Among the players Altobelli coached was Mets All-Star infielder, Jeff McNeil, in the summer Cape Cod Baseball League. “He took a chance on me, kept me the whole summer,” McNeil told ESPN. “Him taking that chance on me, having me on his team, got me drafted.”

To those who played against him, he was a tenacious competitor who won their respect. Many who came after him said he inspired them to pick up the game.

Tributes from other athletes rolled in on Sunday, as Bryant’s friends and rivals shared what he meant to them. Shaquille O’Neal, who won three titles with Bryant on the Lakers, said he would hug Bryant’s children “like they were my own.”

Michael Jordan said in a statement that he spoke to Bryant often and that he was “like a little brother to me.” Dwyane Wade, the former Miami Heat star, said on Instagram that Bryant “was who I chased” and that it was “one of the saddest days in my lifetime.”

Top athletes in other sports shared in the grief. Neymar Jr., the Brazilian soccer star, held up the number 24 with his fingers and pressed his hands together in a prayer motion after scoring a penalty kick for Paris Saint-Germain. Nick Kyrgios wore a yellow No. 8 Bryant jersey as he walked on court for his blockbuster match against the top-seeded Rafael Nadal at the Australian Open. Naomi Osaka thanked Bryant “for caring and checking up on me after my hard losses.”

Colin Kaepernick, the former N.F.L. quarterback whose kneeling during the national anthem in protest of racism and police brutality inspired a number of athletes to speak out publicly, sat with Bryant last August at the United States Open in the support box for Osaka. He said on Twitter that he would remember Bryant as a “basketball legend, a father & a man.”

Tiger Woods said that he heard cries of “do it for Mamba” from the gallery as he finished his final round of the Farmers Insurance Open at Torrey Pines in San Diego, but he didn’t understand why. Then Woods’s caddie, Joe LaCava, broke the news of Bryant’s death as the two walked from the 18th green to hand in his card. Woods could be heard on the CBS broadcast replying, “Excuse me?” to LaCava before he stepped into the clubhouse.

“It’s a shocker to everyone and I’m unbelievably sad,” Woods said in an interview shortly after. “One of the more tragic days, I think, well, for me, the reality is just kind of setting in because I was just told probably about five minutes ago.

Woods, 44, and Bryant shared a friendship that dated back to their meteoric rise to the top of their respective sports during the mid-1990s and spanned adversities and scandals as both navigated fame, marriage, parenthood and injuries. When asked what he would remember about his friend, Woods said: “The fire. He burned so competitively hot. And desire to win. He brought it each and every night on both ends of the floor.”

The Italian Basketball Federation said on Monday that it would hold a moment of silence in every game this week for Bryant, who lived in Italy from ages 6 to 13 while his father played professional basketball there.

Bryant was fluent in Italian, and once said it would be a “dream” to play for the country, but in 2011, when an Italian team, Virtus Bologna, offered him a one-year contract during the N.B.A. lockout, the deal fell through, The Associated Press reported.

“It’s a small but heartfelt and deserved gesture to honor the life and memory of Kobe Bryant, an absolute champion who always had Italy in his heart,” the federation said in a statement. Bryant, the statement said, “was and will always be linked to our country.”

Teams across the N.B.A. started their Sunday night games by purposely running the shot clock out, taking 24- and 8-second violations in honor of the numbers Bryant wore.

In a number of games, the team winning the opening tip opted to dribble out the 24-second clock or keep the ball in the backcourt for an 8-second violation, followed by the other team returning the gesture. Bryant changed his jersey number to 24 from 8 in 2006.

Fans in the arenas rose for standing ovations, some chanting “Ko-be.” Players and coaches joined in the applause.

The tributes could also be seen in games between New York and Brooklyn, Indiana and Portland, New Orleans and Boston, San Antonio and Toronto, Atlanta and Washington, and Orlando and the Los Angeles Clippers.

At the arena where Bryant put his stamp on the Lakers and the N.B.A., his death cast a pall over a typically ebullient event: the Grammy Awards.

The show’s host, Alicia Keys, paid tribute to Bryant during the opening of the CBS broadcast, performing “It’s So Hard to Say Goodbye to Yesterday” with the R&B group that made the song popular, Boyz II Men.

“Here we are, together on music’s biggest night celebrating the artists that do it best, but to be honest with you we’re all feeling crazy sadness right now because earlier today Los Angeles, America and the whole wide world lost a hero,” Keys said. “And we’re literally standing here heartbroken in the house that Kobe Bryant built.”

A spotlight shined on Bryant’s retired No. 8 and No. 24 jerseys up in the rafters of the Staples Center.

The music industry’s top stars mourned Bryant leading up to the show, from Taylor Swift to Demi Lovato and John Legend.

“In Staples Arena, where Kobe created so many memories for all of us, preparing to pay tribute to another brilliant man we lost too soon, Nipsey Hussle,” John Legend wrote on Twitter. “Life can be so brutal and senseless sometimes.”

The grief over Bryant’s death extended from coast to coast, with his high school alma mater, near Philadelphia, becoming the scene of a spontaneous shrine.

“I was heartbroken,” said Jasmine Strong, 29, who was visiting from Brooklyn and decided to visit Lower Merion High School, where fans brought flowers and other tributes after Bryant’s death. “I’m lost for words.”

She had charted Bryant’s professional career from its start: when he was 17, fresh out of Lower Merion, where he had led the basketball team to a state title in 1996.

“Aces Nation has lost its heartbeat,” Gregg Downer, who coached Bryant, said in a statement.

Indeed, others with ties to the school flocked to the campus on Sunday as word of Bryant’s death spread.

Brittany Ferro, 30, said she had also gone to Lower Merion and had been moved to come with two friends and her newborn son after she learned of Bryant’s death during dinner.

“We were very upset so we wanted to come and pay our respects,” she said. “He was one of the best of his times and he was admired by a lot of people.”

Bryant was a standout at Lower Merion, where he helped to elevate the basketball program to extraordinary heights. Bryant, who dominated the court from any position, was a draw — plenty would say the central draw in the mid-1990s.

“It was quite a treat to watch a future superstar,” said Rob Wilson, who still lives in Lower Merion Township and recalled taking his son to watch the adolescent Bryant play.

Soon after Bryant was drafted, he walked into a local diner while Wilson and his son were there.

“I remember him coming into Ruby’s and pointing him out and saying, ‘That guy’s a future superstar in the N.B.A., right here in our little Ruby’s,” Wilson recalled. “I was very touched by the fact that he was not being swarmed.”

Gov. Tom Wolf of Pennsylvania said the state would “never forget our time as Kobe’s home.”

“At Lower Merion HS, he captured our hearts and the attention of the world,” the governor wrote on Twitter. “He truly shined and brought pride to our state.”

Gianna Bryant had more than a blue blood basketball lineage. Her father often spoke proudly of her development as a player.

The 13-year-old, whose nickname was Gigi, was “hellbent” on playing for the University of Connecticut and in the W.N.B.A., her father told The Los Angeles Times last year.

The father and daughter sat courtside last March during UConn’s senior day rout of the University of Houston, which the Huskies’ coach Geno Auriemma acknowledged caused some nerves for his players.

“Kobe was a little bit of a distraction,” Auriemma said at the time. “We were hoping he would just send Gigi, his daughter, and him stay home so he wouldn’t cause that distraction but we couldn’t arrange that.”

The elder Bryant was asked about his daughter picking up the game by SNY at the time.

“I watch the game through my daughter’s eyes,” Bryant said.

Kobe Bryant was one of the first guests to appear on Auriemma’s Holding Court with Geno Auriemma podcast in December 2017.

Auriemma shared Philadelphia roots with Bryant and played against Bryant’s father, Joe Bryant, in a summer league game once, he said. The coach was born in Italy, which is where Kobe Bryant lived from age 6 to 13 while his father played professional basketball there.

“Then your Italian is way better than mine,” Auriemma said on the podcast.

Three American presidents spoke out on Sunday after Bryant’s death, a remarkable display of public grief.

President Trump said that Bryant was “just getting started in life,” even after a career that forever marked him as one of basketball’s greats.

“He loved his family so much, and had such strong passion for the future,” the president wrote on Twitter. “The loss of his beautiful daughter, Gianna, makes this moment even more devastating.”

Former President Barack Obama, a noted basketball fan, posted on Twitter that Bryant was “a legend on the court and just getting started in what would have been just as meaningful a second act.”

The death of Bryant’s daughter, the former president added, “is even more heartbreaking to us as parents.”

Bryant and Obama had crossed paths over the years, with Obama welcoming the Lakers to the White House and, at another point, with the president and Bryant appearing alongside each other at a community service event.

In 2016, Obama even appeared to mimic Bryant’s “Mamba out” moment at Staples Center. Obama, making the final appearance of his presidency at the White House Correspondents’ Association dinner, closed his speech with “Obama out” and dropped the microphone.

Former President Bill Clinton, who was in the White House when Bryant ascended to the N.B.A., and his wife, former Secretary of State Hillary Clinton, extolled how Bryant “brought excitement and joy to basketball fans not just in Los Angeles, but all over the U.S. and around the world.”

“Kobe Bryant,” the Clintons added, “lived a very large life in a very short time.”

Though Bryant never played for the Mavericks, Dallas announced on Twitter that “the number 24 will never again be worn by a Dallas Maverick.”

The Lakers retired both of Bryant’s jersey numbers -— 8 and 24 — in 2017. Donovan Mitchell, who plays for the Utah Jazz, proposed the league go a step further, retiring the number for all teams.

The N.B.A. has never retired a number across the league, but there is precedent in other major American sports leagues. Major League Baseball retired Jackie Robinson’s 42 in 1997, and the National Hockey League retired Wayne Gretzky’s 99 in 2000.

Twelve players currently wear 24, including Buddy Hield of the Sacramento Kings and Lauri Markkanen of the Chicago Bulls.

The National Transportation Safety Board said a team of 18 people would be immediately involved in its investigation, and that officials were expected to arrive in California from Washington late on Sunday.

“Our team will be looking at the history of the pilot and whatever crew was on board,” said Jennifer Homendy, a member of the board. “We’ll be looking at maintenance records of the helicopter. We will be looking at records of the owner and operator of the helicopter and a number of other things.”

N.T.S.B. investigations can stretch for months.

Homendy said federal officials were trying to learn the precise configuration of the downed helicopter — a crucial clue in determining the cause of the crash.

Adam Silver, the N.B.A. commissioner, quickly hailed Bryant as “one of the most extraordinary players in the history of our game.”

“For 20 seasons, Kobe showed us what is possible when remarkable talent blends with an absolute devotion to winning,” Silver said, adding that Bryant would “be remembered most for inspiring people around the world to pick up a basketball and compete to the very best of their ability.”

Indeed, Silver, who led the N.B.A. in the final years of Bryant’s career, was certain to note how Bryant had taught Gianna, his daughter who also died in the crash. Silver said the longtime star was “generous with the wisdom he acquired and saw it as his mission to share it with future generations of players, taking special delight in passing down his love of the game to Gianna.”

Bryant was associated with Nike for nearly his entire career. The company, which signed him to a $40 million contract in 2003, said in a statement that it was “devastated by today’s tragic news.”

“We extend our deepest sympathies to those closest to Kobe, especially his family and friends,” the statement said. “He was one of the greatest athletes of his generation and has had an immeasurable impact on the world of sport and the community of basketball. He was a beloved member of the Nike family. We will miss him greatly. Mamba forever.”

Bryant wore the first in his initial line of signature shoes during the 2005-2006 N.B.A. season, including the game in which he scored 81 points in January 2006.

In 2011, the company supported his introduction of the nickname The Black Mamba, releasing a commercial in which he was pitched an idea for an action film by the director Robert Rodriguez. And when Bryant was set to retire, the company christened April 13 “Mamba Day.”

The media coverage of Bryant’s death spanned the globe, but a BBC clip package showing highlights of the Lakers superstar LeBron James instead of Bryant was widely mocked and criticized on Twitter.

The clip package showed James passing Bryant on the career scoring list in a road loss to the Philadelphia 76ers on Saturday night while a BBC newscaster rattled off Bryant’s achievements.

The segment began with a still photo of Bryant with his daughter Gianna seated courtside at a basketball game.

Paul Royall, a BBC editor, apologized on Twitter, for what he said was a human error.

“In tonight’s coverage of the death of Kobe Bryant on #BBCNewsTen we mistakenly used pictures of LeBron James in one section of the report,” he wrote. “We apologise for this human error which fell below our usual standards on the programme.”

Some 200 people had huddled together near the foggy Calabasas at the foot of the hill closest to the crash. Several people were wearing Kobe gear and had basketballs.

Paolo Santos, 27, had looked forward to catching a glimpse of his childhood idol at the Lakers game on Tuesday. “I’ve been watching him since I was a kid,” Santos said. “My stomach just hurts.”

“He’s a figure. He’s a legend. He brought L.A. back. He’s an L.A. icon,” he said. “He was a competitor. His drive, shooting in the gym at 4 in the morning. He’s what everyone wants to be.”

Philip Gordon, 45 of Winnetka, who was wearing a Kobe bathrobe over a Kobe jersey, Kobe shoes and socks, said he was watching the NFL Pro Bowl when he heard the news. “It’s so surreal,” he said.

“For 20 years I looked up to him. I became a fan of his as a person. It’s a huge loss for the city. He’s an icon beyond any Laker. We love Magic, we love Kareem, but Kobe transcends generations.”

Over in Echo Park Lake, joggers ran past residents of the cluster of tents on the lake’s northwest corner who were gathering around a table of donated food.

One man joined them and asked if the others had heard the news about Kobe Bryant. Immediately, expressions of disbelief rang out.

“No way!” someone said, punctuated with an expletive.

The man insisted it was true.

But slowly the reality set in.

Davon Brown, 29, wearing Lakers purple warm-up pants and a matching knitted beanie, said he moved to Southern California from New York years ago to play basketball. He saw Bryant as an example both on the court and off.

“He was way beyond” Michael Jordan, he said. “He was more omnipresent.” His game, Brown said, was more like dance.

Basketball, Brown said, has been a lifesaving force for him. And Bryant represented a powerful ethos.

“He had a killer instinct,” he said. “That self-love, that confidence transmutes into play.”

On Saturday, the current Los Angeles Lakers star LeBron James surpassed Bryant on the league’s all-time scoring list in a game against the Philadelphia 76ers.

Bryant congratulated James in a tweet, with a hashtag, #33644, referring to the number of points James had scored to surpass Bryant’s career total of 33,643 points. Before Saturday, Bryant had stood third only to Kareem Abdul-Jabbar and Karl Malone on the list of career points scored.

After the game, James, who joined the Lakers in 2018, spoke at length about what Bryant meant to him, to the team and to the league.

“He had zero flaws offensively,” James said.

James described his long history with Bryant — how he had admired Bryant’s ability to go from high school to the N.B.A., how the two had met in Philadelphia where Bryant had insisted upon the value of hard work. Later, Bryant gave a high-school age James a pair of his signature shoes, which James wore in a game even though they were the wrong size.

“I’m happy just to be in any conversation with Kobe Bean Bryant, one of the all-time greatest basketball players to ever play,” James said. “One of the all time greatest Lakers. The man has two jerseys hanging up in Staples Center. It’s just crazy.”

Reporting was contributed by Jennifer Medina, Neil Vigdor, Marc Stein, Louis Keene, Jill Cowan, Miriam Jordan, Mihir Zaveri, Jon Hurdle, Rachel Abrams, Benjamin Hoffman, Jonah Engel Bromwich and Daniel Victor.


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#Muse40for40: Lisa Nishimura (2018)

We’re counting down the 40 days to NYWIFT’s 40th Anniversary Muse Awards with a look at some of our favorite honorees, all women of vision and achievement who have contributed to the film and television industry. Join us as we look back at #Muse40for40, and buy your tickets for the Muse Awards on Tuesday, December 10th at nywift.org/muse!

#31: Lisa Nishimura

By Kathryn O’Kane

13-year Netflix veteran Lisa Nishimura was the VP of Original Documentary and Comedy Programming when we honored her at 2018; just three months later, she was named the head of Independent Film and Documentary Programming. In 2017, she was named one of the 100 most powerful women in entertainment by The Hollywood Reporter.

Under her leadership, Netflix has provided a global platform for critically acclaimed documentary work including Making a Murderer; Wild Wild Country; Chef’s Table; Icarus; What Happened, Miss Simone?; 13th; White Helmets and Salt Fat Acid Heat. In addition, her team has produced global stand-up comedy specials including Hannah Gadsby’s Nanette and Ali Wong’s Baby Cobra and Hard Knock Wife as well as work from the likes of Jerry Seinfeld, Dave Chappelle, and Amy Schumer, with forthcoming specials from Ellen DeGeneres and Chris Rock. The current slate of films including Reversing Roe, Shirkers and Quincy, showcases Netflix’s commitment to female documentarians and compelling storytelling.

“I think this is the very reason why I absolutely love and feel so privileged to do the work I do. I get to support incredible storytellers — documentarians, comics – true creators who are the brilliant social commentators of our day.” – Lisa Nishimura at the 2018 Muse Awards

busyk Kathryn O'Kane is a producer/director with over fifteen years of diverse experience in television, advertising and web media. She is honored to serve on the NYWIFT Board of Directors, which supports the careers of women in the Entertainment Industry. Kathryn has crafted narratives as diverse as “Mission Juno,” which documents NASA’s probe to Jupiter, "Master Class," the award-winning10-part flagship series for the Oprah Winfrey Network OWN, and "San Quentin Film School," a six-part documentary series for Discovery Channel following nine prisoners during the first ever film production class in prison. Having started her career supporting democratic initiatives in Latin America, Kathryn has always maintained a love for international travel and politics, and she looks forward to bridging cultural differences through art and story telling. Learn more at www.busyk.com.

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Do you want to apply for funding for a co-production? Use this form to apply to the Co-Production Development Fund.

Please note that our application forms are writable pdf’s. You must download and save them to your computer before you can type into them (right click, then save as). Many browsers, including Chrome and Firefox, will automatically open these documents in a ‘preview’ form that will not allow you to type into them or will not allow you to save what you have written.

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Physical plastic sim cards could soon be a thing of the past.

Apple and Samsung are in talks with the rest of the global telecommunications industry to launch new electronic sim cards, a move which could see the conventional plastic sim relegated to the past, the Financial Times has reported.

The two smartphone titans are in talks with the GSM association - which represents hundreds of phone carriers worldwide - and a standard e-sim which would be embedded in future phones is reportedly close to being announced and could be seen in the next generation iPhone.

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Hitching NZ up to disruptive tech's cart
Apple Watch: New Zealand release date announced?

The move would give consumers the option to change phone providers without having to take out a conventional sim and replace it with a new one.

Apple has launched its own sim cards in the latest generation iPads, but it is only supported by selected carriers in the UK and US.

Although Apple is yet to announce any partnerships with New Zealand carriers, Apple users here are able to choose a cellular data plan without the need to buy a physical sim when travelling overseas.


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Tuesday, 25 February, 2020, 9:16 PM
latest Four killed in Laxmipur road crash       Bangladesh beat Zimbabwe by innings and 106 runs
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AL MP Mannan passes away

Published : Saturday, 18 January, 2020 at 9:58 AM  Count : 390
Observer Correspondent

AL MP Mannan passes away

AL MP Mannan passes away

Abdul Mannan, lawmaker of Bagura-1 constituency, passed away at a hospital in Dhaka on Saturday morning.

The Awami League leader breathed his last around 8:15am at Labaid Hospital where he had been undergoing treatment, Motiur Rahman Moti, personal assistant of Mannan, confirmed this.

Mannan, the former organising secretary of the party, was taken to the hospital around 10:15pm on Thursday after he suffered a cardiac arrest. He was put on life support around 11pm following deterioration of his condition.

The first namaz-e-janaza for the AL leader will be held on the South Plaza of Jatiya Sangsad around 10 am on Monday.

He will be buried at his village home in  Sariakandi upazila of Bagura after second janaza.

Abdul Mannan was elected lawmaker thrice from the same constituency in 2008, 2014 and 2018.

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3rd FUNDO Edition

Meet the winning projects of the Ocean Conservation Fund

Oceanário de Lisboa and Oceano Azul Foundation announced today the three winning projects of the third edition of the “Ocean Conservation FUND”, under the theme “Marine Invertebrates. Protecting at sea, the future on Earth ”, with a total funding of 150 thousand euros.

From the 16 valid applications, the jury of national and international conservation experts selected the projects:
| DEEPbaseline which will be dedicated to the conservation of deep corals and sponges, all along the coast of mainland Portugal;
| COACH, which intends to create a shellfish cooperative in the Ria de Aveiro to dedicate itself to the conservation and management of cockles;
| The Selvagens ’LImpet Project whose objective is to decipher, through genetic studies, whether the Selvagens Giant Lapa is unique to these islands, and define conservation strategies for this species.

Learn more here.


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July 26, 2017

 We are proud to have assisted in the setup for this 1300 Gallon Monster Cold water System for the SF Giants at AT&T Park. This was created by ATM and will be featured on Animal Planet's Tanked, airing October 9th. It was 2 grueling days and Nights to handle the 150+ animals, setup, plumb and fill the tank, all while on camera.

Unfortunately, I didnt have the entire Ocean Treasures Crew in this final picture with Brett and Wayde of ATM, but at least you can see one of our techs, Carlos Carranza and myself in the picture below.

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ODL - Aker BP exercises the first 12 month option for Deepsea Nordkapp

Aker BP has today exercised the first 12 month option for Deepsea Nordkapp under the Contract entered into between the parties in April 2018. The first 12 month option shall commence after expiry of the two year firm period in May 2021.

The approximate contract value for the firm scope is USD 128 million (excluding any integrated services). In addition, a performance bonus will be applicable.

Simen Lieungh, CEO Odfjell Drilling AS, says: “We are very pleased to see Aker BP’s continued commitment to the Alliance Agreement between the parties and Odfjell Drilling is equally committed to delivering our very best performance on Deepsea Nordkapp.”

For further queries, please contact:
Eirik Knudsen, VP Corporate Finance & Investor Relations
+47 934 59 173

Aberdeen, United Kingdom
18 December 2019
Odfjell Drilling Ltd.


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BALITHERM IONIT is an environmentally-friendly technology to maximise the performance and reliability of large components. BALITHERM IONIT creates very hard, wear-resistant component surfaces. High corrosion resistance, thermal stability and first-class tribological properties are ensured. BALITHERM IONIT offers protection against micropitting as well as high tooth root strength and flank load bearing. Due to the low processing temperature, there is very little to no warpage in the component, which results in improved sliding properties and less noise development. No hard fine processing is required. No poisonous gases or chemicals are used. Moreover, BALITHERM IONIT is an excellent substitute for hard chromium plating.


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Downers Grove Medical Office

Downers Grove Gastroenterologist- Downers Grove Gastroenterologist Office

Comfort and convenience are the hallmarks of Dr. John Smith 's office operations. To ensure your convenience, below is the information you need about our hours, location, appointment scheduling, insurance acceptance and billing.

Officite Gastroenterologist Office
3010 Highland Parkway Suite 625
Downers Grove, IL 60515

Office Hours
Monday: 9:00 AM - 5:00 PM
Tuesday: 9:00 AM - 5:00 PM
Wednesday:  9:00 AM - 5:00 PM
Thursday: 9:00 AM - 5:00 PM
Friday: 9:00 AM - 5:00 PM
Saturday: Closed
Sunday: Closed

We know you have many choices when choosing a Gastroenterologist in Downers Grove, IL so we have made requesting an appointment a simple and convenient process via our Web site. If, for any reason you cannot keep a scheduled appointment, or will be delayed, please call us as soon as possible.

Insurance and Billing

Please contact our office to verify acceptance of your insurance plan. Qualifications for insurance coverage may differ due to the uniqueness of each procedure. We are happy to file insurance for your reimbursement as long as you are free to choose your own gastroenterologist.

Payment Options

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The goal of Mayes County Health Department is to use their knowledge to recognize and prevent communicable diseases, such as food and waterborne illness, sexually transmitted diseases, tuberculosis and childhood diseases.

              Wash Your Hands

Sexually Transmitted Diseases:

• Confidential care and treatment

• Laboratory tests

• Disease investigation and follow-up of contacts

Tuberculosis Control

• Skin testing and sputum evaluation

• Disease investigation and follow-up of contacts

• Drugs dispensed for treatment of TB infection and preventive therapy

Communicable Disease:

• Disease investigation and follow-up of  contacts

• Prevention and treatment

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Registered nurses and sanitarians are always available to investigate outbreaks as they occur. In most circumstances, these professionals work as a local team with consultation from the state epidemiologists to address community problems.

Disease Reporting

Please call (918) 825-4224, or e-mail to report your problem. Your call will be returned by a nurse.

The Acute Disease Service Epi-on-call is available 24-hours/7-days a week at (405) 271-4060, for communicable disease consultations and reporting of diseases and outbreaks.

For more information on disease reporting, visit the Oklahoma State Department of Health Acute Disease Service, utilizing the following link: http://www.ok.gov/health/Disease,_Prevention,_Preparedness/Acute_Disease_Service/Disease_Reporting/index.html

Communicable diseases spread from one person to another or from an animal to a person. The spread often happens via airborne viruses or bacteria, but also through blood or other bodily fluid. The terms infectious and contagious are also used to describe communicable disease.

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Joan Dabney Clickner

A big thank you to Dr. Kramer who is not only very professional and kind, but also intuitive. She urged aspirating a spot on our boxer which had not changed in years, and it turned out to be cancerous. She removed the tissue promptly, and the wound looks perfect — such care in the stitches! She even tried to make sure the brindle stripes would still look right when she sewed up the incision. We’ve been clients for almost 13 years and are always impressed with every aspect of the hospital, from the receptionists to the techs to the veterinarians.

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Strange Cat Behaviors Explained

strange cat behavior

There’s no denying that cats are excellent companions, but sometimes they do something that leaves you scratching your head in total confusion. If you’re used to dogs, cats’ social interactions and the way they communicate can be very confusing. Yet it’s these special behaviors, like affectionate head-butting and their penchant for cardboard boxes, that make us love them so much.

To help you better understand your elusive feline, we rounded up a few cat behaviors that people commonly consider mysterious. You’ll find that many of these habits aren’t weird at all for cats — they’re normal.

Head-Butts You
When your kitty butts you with his head, it’s his way of saying, “Greetings, I trust you and feel safe.” It’s also one of his methods of sharing facial pheromones with you. Behaviorists actually call this curious behavior “bunting.” If your kitty doesn’t bunt, it’s nothing to worry about — he just might not be the head-butting type.

Kneads You
Does your kitty “make biscuits”? Probably she’s content and happy, trying to alleviate anxiety or wants to mark you with her scent. The instinctive behavior begins shortly after birth, when kittens move their paws against their mother’s mammary glands to stimulate milk flow. If your kitten continues kneading as an adult, sit back and enjoy the massage.

Loves Boxes and Other Small Spaces
There are plenty of spacious and comfortable places your cat could sleep: your bed, the couch, a chair or even a plush pet bed placed on the floor just for him. So why does kitty choose an uncomfortable bathroom sink or small cubbyhole? Small spaces make cats feel more safe and secure. In the wild, felines need to be stealthy to survive, so sleeping in the middle of a wide-open field makes them susceptible to larger predators. Hiding in a small den, on the other hand, makes it more difficult for predators to find them.

Ignores You
Like people, cats sometimes just need quiet “alone” time. When your cat is acting like he needs some space, let him have it. He’ll feel safer with you because he knows you respect that need. By allowing your cat to have his alone time, you’re setting the stage for him to come seek you out for some cuddles and lap time.

Source: VetStreet

Personal, Professional, Passionate Care for Your Pets


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Beginners' Yoga Workshop at Om Studios

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Om Studios in Monterey presents a Beginners' Yoga Workshop taught by Michael Simpson on Saturday, February 1, 11am-1pm. This is the perfect opportunity to begin or to re-establish a yoga practice.

The workshop will provide an introduction to breath, alignment, and movement - the foundation of a safe, accessible, and sustainable yoga practice. Yoga postures will be reviewed to address individual needs and concerns with modifications provided as needed.

Develop the foundational skill and knowledge to move with greater ease in your body and mind both on and off the yoga mat. Fee is $55. Space is limited to 12 students - please register online. Each student receives three free yoga classes to support and inspire the continuation of their practice

Michael Simpson is a 500-hour registered yoga teacher with 10 years of teaching experience. She has studied and practiced various styles of yoga over the past 16 years and recently completed 250 hours of therapeutic yoga training. Michael's goal in teaching is to make yoga a safe, accessible and sustainable practice to all of her students in order that they can enjoy a lifetime of practice.

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J Barthelow Classen

University of Maryland 3637 Rockdale Road, Manchester, MD 21102, USA

J Barthelow Classen is currently working at University of Maryland, USA . The research interest of the scientist is Medicinal Chemistry . He is serving as an honorary reviewer for Journal of Molecular and Genetic Medicine and has authored of several research articles/books related to Biomedical Sciences.

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Virology, Immunology, Molecular Biology, Genetics, Genomics


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Patrizia Landi

Fondazione Toscana Gabriele Monasterio, Italy

Her international experience includes various programs, contributions and participation in different countries for diverse fields of study. Her research interests reflect in her wide range of publications in various national and international journals.

Research Interest

Coronary anteriography, Stress echocardiography, Cardiovascular stress, internal medicine, Cardiovascular surgery.

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Q Fever Osteomyelitis - Donand#195;and#162;and#194;and#8364;and#194;and#8482;t Treat the Scan | OMICS International
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Journal of Medical Microbiology & Diagnosis

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Q Fever Osteomyelitis - DonÃ¢Â€Â™t Treat the Scan

Thomas J Marrie*

Department of Medicine, Dean Faculty of Medicine Dalhousie University, Canada

*Corresponding Author:
Thomas J Marrie
Department of Medicine Dalhousie University
5849 University Avenue, Halifax, Nova Scotia, Canada
Tel: 902 494 8099
Fax: 902 494 7119
E-mail: [email protected]

Received date: December 23, 2014; Accepted date: February 22, 2015; Published date: February 24, 2015

Citation: Marrie TJ (2015) Q Fever Osteomyelitis - Don’t Treat the Scan. J Med Microb Diagn 4:178. doi: 10.4172/2161-0703.1000178

Copyright: © 2015 Marrie TJ. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Medical Microbiology & Diagnosis

Q fever is an infection caused by the micro-organism Coxiella burnetii [1]. It is a zoonosis with an extensive animal reservoir and it occurs in two forms acute and chronic [1]. The former consists of a variety of presentations including mainly self-limited febrile illness, pneumonia, hepatitis, and the latter endocarditis, endovascular infection and osteomyelitis [1-3]. There is very little clinical experience with Q fever osteomyelitis. This case report illustrates some of the difficulties encountered in managing such a patient.

Case Report

This 49 year old male school bus driver and hobby goat farmer became ill on March 4, 2004 with fever, headache, sore throat, cough, myalgias, anorexia and vomiting. Twelve days later he was admitted to his local hospital with a diagnosis of fever of unknown origin. Investigations here included negative blood cultures, elevated liver function tests and a normal chest radiograph. He remained febrile with daily temperatures of 38.5 to 39°C. On the 10 hospital day, 22nd day of his illness, he was transferred to a hospital in Edmonton. There a history of attendance at the delivery of pregnant goats in February was obtained and it was also noted that his daughter and wife had a febrile illness at about the same time as the onset of his illness. With this history antibody titres for C. burnetii infection were obtained and were consistent with recent infection with a phase II antibody titre of 1:2048 and a phase 1 titre of 1:512. Meantime he had been undergoing a workup for fever of unknown origin and computed tomographic scan of his abdomen showed splenomegaly with an infarct. A Gallium scan showed an area of focal uptake in the distal right tibia, although the radiographs of this area were normal (Figure 1). An MRI showed bone marrow edema consistent with early osteomyelitis (Figure 2). By now his fever had resolved and tjm saw him in consultation and recommended therapy for Q fever osteomyelitis. At this point he wanted to wait and see if his infection would resolve without therapy. He had increasing antibody titres on followup visits (Figure 3) and therapy with ciprofloxacin and rifampin was started with a subsequent decrease in antibody titres. He had severe symptoms of esophageal reflux trigged by these medications and he wished to stop therapy. Figure 3 shows the time course of his antibody titres and his subsequent treatment regime of doxycycline and hydroxychloroquine. These medications also resulted in a number of side effects and adherence was difficult and they were discontinued in March 2007 and then restarted December 2007 until November 2008. At that time his antibody titres were 1:128 and 1:512 for phase 1 and phase II respectively. As of March 2014 the antibody titres were 1:128 and 1:256 for phase 1 and II.

Figure 1: Radiographs of both distal tibia and fibulae (right) are normal and Gallium scan showing focal area of upatake (left) distal right tibia.

Figure 2: MRI distal right tibia showing marrow edema.

Figure 3: Serial antibody titres (reciprocal) phase 1 and phase II Coxiella burnetii.

Figure 4: Follow-up MRI’s of distal right tibia in February and July 2005 showing evolution to chronic change with sequestrum formation.

A follow up MRI of the distal tibia in December 2009 was essentially unchanged from previously and was interpreted as consistent with chronic osteomyelitis.

Merhei et al. noted that up to 2012 only 20 cases of Q fever osteomyelitis had been reported [3]. Spondylodiscitis was present in 8 patients; long bones were involved in 6, hip prosthesis in 2, wrist in 2 and one each, talus and sacrum/ilieum. In some instances Q fever vertebral osteomyelitis is secondary to contiguous infection of an aortic graft [4]. The diagnosis is often delayed as exemplified by three pediatric cases reported by Noursi and colleagues [5]. The diagnosis is usually made serologically but in a few cases C. burnetii has been cultured from biopsy specimens of bone or from wound drainage. Amplification of C. burnetii DNA from specimens has been another diagnostic test [3].

Coxiella burnetii exists in two antigenic phases-phase I and phase II [6]. A variety of tests are available to detect antibodies to these antigens but the best one is the indirect immunofluorescence test [7]. In general in acute Q fever phase II antibodies are much higher than phase 1 antibodies while the reverse is true in chronic Q fever. Until recently most cases of chronic Q fever meant endocarditis or vascular graft infection and a phase 1 IgG antibody titer of 1:800 or greater by immunofluorescence was said to be diagnostic of Q fever endocarditis [8]. Our patient never had phased I titres higher than phase II but he did have a phase I titre of >1:800.

Our patient differs from most of the cases in the literature in that he had osteomyelitis diagnosed during the acute phase of his illness. At that time he had bone marrow edema and if treatment had been started early there might have been resolution of the bone infection without going on to a more chronic phase with sequestrum formation. The treatment of choice for chronic Q fever is a combination of doxycycline and hydrochloroquine for 18 months for patients with native valve endocarditis [9]. We used the same strategy in treating our patient with osteomyelitis. The challenge then was when to stop therapy as the MRI changes persisted. Clinically however he had no bone pain or tenderness and antibody levels were stable. Therapy was discontinued in March 2008 after almost four years of on again off again treatment. Six years later there has been no recurrence of his osteomyelitis.

Q fever osteomyelitis is an uncommon complication of a not uncommon infection in many countries. As more experience is gained with its management guidelines for treatment can be developed.

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Kristi Rosa
Published: Tuesday, Jan 22, 2019

Brandon Weckbaugh, MD

Brandon Weckbaugh, MD

The treatment landscape of non–small cell lung cancer (NSCLC) continues to expand with potential biomarkers that are under investigation, as well as novel agents that could potentially target them. What was once a major area of unmet need has experienced an explosion of new research, said Brandon Weckbaugh, MD.

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OncLive: What drugs have recently been approved for some emerging biomarkers in NSCLC?

Weckbaugh: Previously, this was an area of unmet need with actionable mutations in NSCLC. But more recently, there have been a couple of new drugs approved, which are targeted for some of these mutations. To take NTRK as an example, there are 2 drugs that have [shown promise]—entrectinib and larotrectinib. These have shown very good efficacy and responsiveness for patients with NTRK-mutated NSCLC, which is important because NTRK is mutually exclusive with other oncogenic drivers. This is why I say this is an area of unmet need for targetable therapies.

Could you discuss tumor mutational burden (TMB) and how it’s being investigated as a potential biomarker?

Previously, when we were diagnosing metastatic NSCLC, one of the markers to check was PD-1/PD-L1 expression of the tumor. There have been times when that has been a little bit frustrating, as it is not a perfect predictor of how the patient is going to respond to therapy. By using TMB, the theory was that this would increase the immunogenicity of the patient's tumors.
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