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News Reports for May 2, 2012

by: NewsDiary

Sat Apr 28, 2012 at 23:44:04 PM EDT


Reminder: Please do not post whole articles, just snippets and links, and do not post articles from the Las Vegas Review-Journal. Thanks!

Australia
• Flu vaccine could save thousands of hospital visits (Link)

India
• Tamil Nadu: One more case of A (H1N1) (Link)
• Gujarat: 1 more tests positive to swine flu in Ahmedabad (Link)
• Madhya Pradesh: Woman tests positive for swine flu (Link)

Indonesia
• Coordinating Minister For People's Welfare: Menkes In A Coma (translated) (Snip) (Link)
• Indonesian child dies from H5N1 infection (Link)
• Indonesian Health Minister dies (Link)
• Safe Journey Mrs. Endang Rahayu Sedyaningsih (translated) (Link)

United States
• CIDRAP: US hospital antiviral prescribing for flu dropped in year after pandemic (Link)
• CIDRAP: Study finds substantial cost burden of flu in young kids (Link)

Research
Bird flu research from UW-Madison finally published (Link)
• NOVAVAX Launches Phase I Clinical Trial of A/H5N1 Influenza Vaccine Candidate (Link)

Commentary
• Recombinomics: Adaptation of Egypt H5N1 Toward Human Transmission (Link)
• Helen Branswell: Bird flu study: Three mutations might give virus ability to transmit to humans (Link)
• Laurie Garrett: Manmade H5N1 Paper Finally Published, And Worrying (Link)
• Science magazine: One of Two Hotly Debated H5N1 Papers Finally Published (Link)
• Discover Magazine: Behold The Forbidden Flu - A Loom Explainer (Link)
• Wired: Lab Security Standards Raise Chances of Mutant-Bird-Flu Catastrophe (Link)


• H (Link)

NewsDiary :: News Reports for May 2, 2012

News for May 1, 2012 is here.


Thanks to all of the newshounds!
Special thanks to the newshound volunteers who translate international stories - thanks for keeping us all informed!

Other useful links:
WHO A(H1N1) Site
WHO H5N1 human case totals, last updated April 12, 2012
Charts and Graphs on H5N1 from WHO
Google Flu Trends
CDC Weekly Influenza Summary
Map of seasonal influenza in the U.S.
CIDPC (Canada) Weekly FluWatch
UK RCGP Weekly Data on Communicable and Respiratory Diseases
Flu Wiki Main Page

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Coordinating Minister For People's Welfare: Menkes In A Coma
Shared by dbg of PFI:
http://www.antaranews.com/beri...

Tuesday, May 1, 2012 21:46 PM

Jakarta (ANTARA News) - Coordinating Minister for People's Welfare Agung Laksono said state Health Minister Endang Rahayu Sedyaningsih currently in a coma.

"It was sad because in a coma and had lost consciousness," said Coordinating Minister for People's Welfare (Welfare) Agung Laksono Baksyacaraka after opening the 2012 awards show in Sentul, West Java, on Tuesday night.

Agung explained, based on reports that he received is known that at present Minister of Health to use breathing apparatus to help.

"He had a malignant cancer that spread quickly," he said.

He also expects all Indonesian people to come pray for Minister of Health.

"We pray the best for the health minister," he said.

He also added, after being in the Sentul he would go straight to the RSCM to see Minister of Health.

"I would immediately go to the RSCM for direct review by Minister of Health state," he said.

Menkes lung cancer detected since October 2010.

Treatment that had been undertaken by the Minister of Health, among others, local radiation and surgical frozen, aim to treat cancer locally and increase endurance.

Three weeks ago, Minister of Health began receiving treatment at RSCM because he felt his pain.


I hate to hear this....
Health Misnister Endang was such a huge improvement over "bat-shit-crazy Supari".  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


[ Parent ]
Indonesian child dies from H5N1 infection
A 2-year-old Indonesian child has died from H5N1 avian flu, according to a translated Indonesian health ministry statement that appeared today on the FluTrackers infectious disease message board. The girl, from Riau province, got sick on Apr 17 and was treated at a private clinic a few days later, according to the statement. She was admitted to the hospital on Apr 21 and was transferred to a referral hospital on Apr 27, where she died that day. An investigation into the source of her infection revealed that she had been exposed to poultry; her parents sold quail eggs. If the girl's illness and death are confirmed by the World Health Organization (WHO), she will be listed as the country's 189th infection and its 157th death from H5N1. Also, the event would push the global H5N1 total to 603 cases and 356 deaths.

http://www.cidrap.umn.edu/cidr...

United we stand: Divided we fall
www.flunewsnetwork.com


And it also appeared on Fluwiki!
The story was found, translated and posted by bgw in MT. Good job bgw and thanks!

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


[ Parent ]
CIDRAP: US hospital antiviral prescribing for flu dropped in year after pandemic
Antiviral use among hospitalized patients dropped significantly nationwide during the 2010-11 flu season compared with during the pandemic the year before (Snip)

(Snip) they noted that data on antiviral use was available for 99% of hospitalized patients with lab-confirmed flu in both seasons. During the 2009 H1N1 pandemic, 2,341 (77%) of 3,047 children and 4,754 (82%) of 5,819 adults hospitalized with flu received antiviral treatment. In 2010-11 those percentages dropped to 56% and 77%, respectively, with 763 of 1,365 children and 3,600 of 4,675 adults hospitalized with flu receiving antivirals.

Both drops were statistically significant (Snip) The authors note that antiviral drugs are recommended for all hospitalized flu patients. http://www.cidrap.umn.edu/cidr...

Apr 27 Clin Infect Dis abstract: http://cid.oxfordjournals.org/...  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Australia: Flu vaccine could save thousands of hospital visits
More than 17,000 hospital admissions might have been avoided last year if the patients had been vaccinated, according to figures issued by the Australian Institute of Health and Welfare. Hospital statistics published by the institute show that there were 17,300 hospitalisations for vaccine-preventable conditions in 2010-11, including 165 cases in the ACT.

The majority of the cases - 12,790 nationally and 143 in the ACT - were for influenza or pneumonia.
(Snip)
Influenza Specialist Group Chairman Alan Hampson said the number of flu and pneumonia cases were probably under-recorded in hospital statistics because the diseases often led to other serious health problems. ''People actually suffer things such as myocardial infarction and stroke and kidney problems and the like as a follow-on from flu,'' he said.

Dr Hampson said many people in the medical community and the general public would also be surprised at how many deaths were influenza-related. ''Flu doesn't even rate on the death certificate. But if you actually do the analysis of what happens when flu is there, compared with not, you find that there's somewhere between 2000 to 3000 deaths per year on average due to influenza,'' he said.

''Doctors don't always see this and public health people don't always see this.'' Continued: http://www.brisbanetimes.com.a...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


India: One more case of A (H1N1) (Tamil Nadu)
A final year medical student of Madras Medical College tested positive for A (H1N1) influenza on Sunday, taking the total number of healthcare workers who have contracted the flu to 14. The infected healthcare workers include doctors, nurses and paramedical staff from MMC, Cancer Institute, Adyar, Sri Ramachandra Hospital, Porur and Government Kasturba Hospital, Triplicane.

The student, who was quarantined at the Rajiv Gandhi Government General Hospital, attached to MMC, had no travel history and there is no known source of contact as yet, hospital authorities said.

On Saturday, a priest from a temple in Manali in North Chennai was admitted to the hospital. According to hospital dean V. Kanagasabai, three patients are on treatment at the hospital and all of them are responding well to medication.

Director of Communicable Diseases Hospital, B. Mahalakshmi, said that given healthcare workers are constantly exposed to infections in their daily work, their immunity levels would be low. Health department officials maintain that those who have contracted the infection were probably not exposed to the virus during the 2009 epidemic. "This is herd immunity. While 60 to 70 per cent of the community would have developed immunity, the rest would not have been exposed, and so, they would have been infected," Dr. Mahalakshmi said. Continued: http://www.thehindu.com/news/c...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


1 more tests positive to swine flu in Ahmedabad (Gujarat)
One more patient in Sterling Hospital has tested positive for swine flu. The 55-year-old man, identified as Sureshchandra Jain, was brought from Rajasthan for treatment in the hospital. It was after he was brought here that it was confirmed that he was suffering from swine flu. Sources said he was admitted on Monday morning and his condition is reported to be stable.

Since the outbreak of the disease this year, Gujarat has recorded in all 11 cases. Of this, 6 were from the state and 5 from other states. "In all, 5 patients who came to Gujarat from elsewhere later tested positive for swine flue," said a health department official. It should be noted that of the 5 patients from outside, 4 are from Rajasthan while one was from Maharashtra.

Of the 6 cases reported from the state, 2 had succumbed to the disease, one in Ahmedabad and the other in Rajkot. Of the patients from outside, one had died. http://www.dnaindia.com/india/...

(Note: 27% CFR - 3 of the 11 confirmed cases died. India only counts laboratory confirmed cases so we don't know how many have really been infected or the true number of deaths.)  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


CIDRAP: Study finds substantial cost burden of flu in young kids
Family out-of-pocket and indirect costs of lab-confirmed flu in young children is substantial and higher than previously thought, according to a study in Vaccine. The study involved data from the 2003-04 flu season at CDC New Vaccine Surveillance Network sites in Rochester, N.Y., Nashville, Tenn., and Cincinnati, Ohio. Researchers based their cost estimates on 2009 dollars. They explored expense data from parents of 67 hospitalized children under age 5, 121 kids who were treated for flu in the emergency department (ED), and 92 who received outpatient care. The burden was greatest in the hospitalized group. Continued: http://www.cidrap.umn.edu/cidr...  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Adaptation of Egypt H5N1 Toward Human Transmission
Recombinomics Commentary

The National Laboratory for Veterinary Quality Control on Poultry Production has released twenty H5 poultry sequences (at Genbank) from samples largely collected in late 2011 / early 2012. All except A/chicken/Egypt/113Q/2011, which was collected on July 26, 2011 had the 3 BP deletion, S133del.  Thus, the deletion, which is a hallmark of clade 2.2.1 G, is in all samples collected in late 2011 or 2012.  This dominance of clade 2.2.1 G in poultry in Egypt matches the results reported for human isolates.

Although NAMRU-3 has not released H5 sequences from human cases in Egypt since 2010, all sequences after mid-2009 were clade 2.2.1 G.  Similarly, WHO phylogenetic trees of the withheld sequences from cases in 2011 were also clade 2.2.1 G, strongly suggesting that all 2011 human cases also had the 3BP deletion.

This sub-clade has also been noted for similarities with seasonal H1N1, raising concerns of adaptation to human transmission.  This adaptation was also seen in CDC studies on H5N1 transmission in a ferret model.  Their published studies used a 2006 egret isolate, A/egret/Egypt/1162/2006, which had N158D.  The CDC study demonstrated transmission without isolation of variants that arose via ferret transmission.  

Transmission studies by Kawaoka noted the selection of N158D in the clade 2.3.4 isolate, A/Vietnam/HN31604/2009, used in those studies.  Similarly, comments by Fouchier strongly suggested that N158D was also selected during passage in ferrets of a clade 2.1 isolate from Indonesia, A/Indonesia/5/2005.

(Big Snip)

Thus, the latest samples confirm the dominance of clade 2.2.1 G in poultry and human cases in Egypt, which has multiple changes associated with human adaptation and transmission, which is cause for concern.
http://www.recombinomics.com/N...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


US: Bird flu research from UW-Madison finally published
A paper on controversial avian H5N1 influenza research at the University of Wisconsin-Madison finally is being published in full this week in the journal Nature after touching off a months-long international debate over the value of preparedness vs. the risk of key details falling into the hands of terrorists.

The study, conducted by an international team of researchers led by the UW's Yoshihiro Kawaoka, shows that relatively few mutations in nature would enable the bird flu virus to be transmissible in mammals.
(Snip)
Because flu viruses in nature are constantly changing and easily swap genes with other flu viruses, the possibility of circulating H5N1 viruses hitting the right combination of mutations and becoming a much bigger threat to human health is greater than many experts believed, according to  Kawaoka, a professor of pathobiological sciences and leading expert on influenza in the UW-Madison School of Veterinary Medicine.

"By identifying mutations that facilitate transmission among mammals, those whose job it is to monitor viruses circulating in nature can look for these mutations so measures can be taken to effectively protect human health," Kawaoka said in a statement released this week by the university. The study by Kawaoka's group identified the mechanism by which the H5N1 virus transmits, a basic discovery that could aid in the development of countermeasures, and that contributes to the store of basic knowledge on influenza virus transmission, according to Kawaoka.

The work also may help governments in some countries justify the significant economic hardship imposed by the mass culling of poultry flocks when potentially dangerous mutations are identified in circulating H5N1 viruses, according to Kawaoka.

According to the UW news release:

Some viruses now circulating in nature require just four mutations to the hemagglutinin protein, which sits on the virus surface and enables it to bind to host cells, to become an even greater threat to human health, the UW research found. A subset of the mutations identified by Kawaoka's team has, in fact, already been detected in some viruses circulating in poultry flocks in Egypt and parts of Southeast Asia, underscoring the urgency of science-based surveillance, Kawaoka said.
Kawaoka cautions there may be other unknown mutations that also enable the virus to transmit in mammals. It's critical to continue research to identify additional mutations that have the same effect, and to understand how they work, he says.

Whether or not the H5N1 viruses currently circulating in the world could easily acquire the additional mutations needed to cause a pandemic is an open question, according to Kawaoka: "It is hard to predict. The additional mutations may emerge as the virus continues to circulate." Continued: http://www.jsonline.com/blogs/...


Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Branswell on publication of paper
Canadian Press via Winnipeg Free Press:Bird flu study: Three mutations might give virus ability to transmit to humans
A bird flu study that was blocked from publication for months after biosecurity experts questioned if it was unsafe to put it in the public domain has finally been published.

The work, conducted by a team led by influenza virologist Yoshihiro Kawaoka of the University of Wisconsin-Madison and the University of Tokyo, suggests that as few as three changes to the main gene on the surface of some H5N1 flu viruses might allow the virus to transmit efficiently among mammals - perhaps even humans.

Kawaoka and his team managed to create a hybrid virus that would transmit through the air, passing from infected to healthy ferrets, which were used in the experiment as a stand in for people. The newly transmissible virus needed four mutations in the surface gene, the hemagglutinin, which gives a flu virus the H portion of it name.


More...

[ Parent ]
Laurie Garrett on publication of paper
Manmade H5N1 Paper Finally Published, And Worrying
One of the two notorious manmade flu virus papers that spawned massive concerns regarding biosecurity was finally published today in Nature magazine. Extensively edited and rewritten by U.S. government reviewers, a vast number of scientific peers and the editors of Nature, the paper by University of Wisconsin's Dr. Yoshihiro Kawaoka offers genuine grounds for concern.


[ Parent ]
Science (the magazine) on publication of paper
One of Two Hotly Debated H5N1 Papers Finally Published
One of two influenza papers at the center of an intense, 6-month international debate has finally seen the light of day. Today, Nature published a controversial study in ferrets that shows how scientists can engineer an avian influenza strain to transmit between mammals through respiratory droplets such as those created by coughing or sneezing.


[ Parent ]
The Loom at Discover Magazine on publication of paper
Behold The Forbidden Flu: A Loom Explainer
Here, for your viewing pleasure, is a very important part of a very special flu virus. It may look like an ordinary protein, but in fact it's been at the center of a blazing debate about whether our increasing power to experiment on life could lead to a disaster. Not that long ago, in fact, a national security advisory board didn't even want you to see this. So feast your eyes.

You'll have to follow the link if you want to feast your eyes.

[ Parent ]
Yes, I've been hanging around Twitter again. n/t


[ Parent ]
LOL Well pogge, there are worse places to hang out at.


Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


[ Parent ]
Wired: Lab Security Standards Raise Chances of Mutant-Bird-Flu Catastrophe
Lab Security Standards Raise Chances of Mutant-Bird-Flu Catastrophe
Fears that bioterrorists could learn from controversial experiments that make H5N1 avian influenza more virulent have overshadowed a more pressing danger: accidental releases, laboratory infections and disgruntled workers.

Dozens of all-too-human mistakes have occurred in just the last decade inside high-security laboratories, and many experts say new H5N1 flu strains engineered to infect mammals have not been handled with the care required to minimize chances of unintentional catastrophe.

In fact, research on less-threatening pathogens is conducted at higher security levels than research on the new bird flu and other strains made artificially more virulent.



[ Parent ]
Riau boy: 157th bird flu fatality
Mustaqim Adamrah, The Jakarta Post, Jakarta | Wed, 05/02/2012 10:43 AM

A two-year old boy, identified only as MAF, died from bird flu last Friday in a state hospital in Riau, the Health Ministry has confirmed.

A ministry team has investigated the boy's neighborhood and found that he may have had contact with quails' eggs because his parents sold them, the ministry's directorate general for disease control and environmental health said in a press statement released on Tuesday night.

The boy, a resident of Siak in Pekanbaru, was brought to a private clinic on April 20 after developing a fever on April 17, the statement said.

He was then rushed to a private hospital on the night of April 20 because his condition had not improved, it said.

On April 21, he was treated in another hospital identified only as EB, where doctors reported the case to the Riau Health Agency's post command. He was referred to a state hospital, identified only as AA.

"[The boy's] condition deteriorated and he died on April 27 at 11:45 p.m. at Hospital AA," the statement said.

The total number of bird flu cases since 2005 now stands at 189, with 157 fatalities after the latest case.

Director general Dr. Tjandra Yoga Aditama has reported the latest case to the World Health Organization, the statement said.

http://www.thejakartapost.com/...

United we stand: Divided we fall
www.flunewsnetwork.com


NOVAVAX Launches Phase I Clinical Trial of A/H5N1 Influenza Vaccine Candidate
ROCKVILLE, Md., May 2, 2012 (GLOBE NEWSWIRE) -- Novavax, Inc. (Nasdaq:NVAX) announced today that it has begun enrollment in a Phase I clinical trial of its monovalent virus-like particle (VLP) vaccine candidate to prevent a potential pandemic disease due to A/H5N1 avian influenza viruses ("bird flu"). This randomized, observer-blind, dose-ranging, placebo-controlled trial is being conducted under the company's contract with the U.S. Department of Health and Human Services' Biomedical Advanced Research and Development Authority (HHS BARDA). The goal of the trial is to evaluate the safety of the VLP A/H5N1 avian influenza vaccine candidate Novavax is developing under the HHS BARDA contract and determine the vaccine's immunogenicity with and without the use of an undisclosed adjuvant ("Adjuvant 1").

The Phase I trial will enroll healthy adult subjects, each of whom will be randomized into one of six treatment groups including varying doses of A/H5N1 VLP vaccine, with or without Adjuvant 1, or placebo. The trial is being conducted in a stepwise manner, enrolling increasing number of subjects, until a target of approximately 333 subjects is reached. All subjects will be evaluated for safety and immunogenicity. Trial participants will receive two identical intramuscular injections at a 21-day interval (Day 0 and Day 21) with study follow-up approximately 13 months from the first dose.

Gregory Glenn, M.D., Novavax's Senior Vice President and Chief Medical Officer, stated: "This is an important trial because it will help determine the most appropriate dose for future studies of our avian influenza vaccine candidate, as indicated by the safety of the vaccine, and how closely the vaccine meets the immunogenicity criteria for an accelerated approval of a potential pandemic influenza vaccine set by the FDA's Center for Biologics Evaluation and Research. Continued: http://www.globenewswire.com/n...

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


India: Woman tests positive for swine flu (Madhya Pradesh)
Bhopal - A 27-year-old woman from Harda has tested positive for swine flu (Snip) The woman had given birth to a child sometime back but as her condition was not good, the doctors at Government Hamidia Hospital here suspected her to be suffering from swine flu and her samples were sent for testing to Jabalpur.

(Snip) she is now being treated for swine flu. (Snip) a total of 34 samples have been sent from Bhopal for testing and out of these two were found to be positive. http://www.deccanchronicle.com...  

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


Indonesian Health Minister dies
The Indonesian Health Minister, Endang Rahayu Sedyaningsih, has died of lung cancer, five days after she tendered her resignation.

She was 57.

The director of the Jakarta hospital, Professor Akmal Taher, said Mrs Endang will be buried tomorrow.

''Mrs Endang died at 11:41am from lung cancer, which had reached the last stage,'' he told reporters.

Last Thursday, she tendered her resignation to President Susilo Bambang Yudhoyono to concentrate on her medical treatment.

Yudhoyono it yet to appoint a successor and her duties are being taken over by her deputy and other related officials.

She had been Indonesia's health minister for more than two years.

http://www.radioaustralianews....

United we stand: Divided we fall
www.flunewsnetwork.com


Safe Journey Mrs. Endang Rahayu Sedyaningsih
url= Depkes [/url]

This is terribly sad and affects us all. She did a good job as Minister of Health. I hope her replacement is as competent.

Jakarta, May 2, 2012

Verily we belong to God, and to God we return. Has returned to the house of God the Minister of Health 2009 - 2014, dr. Endang Rahayu Sedyaningsih, MPH, Dr.PH, on Wednesday, May 2nd, 2012 at 11:41 pm at Cipto Mangunkusumo Hospital (RSCM), Jakarta.

Menkes away after battling lung cancer was detected in October 2010. Since then, Minister of Health to undergo treatment at home and abroad for about 1.5 years. Treatment undertaken, among others, local radiation and surgery to treat cancer frozen locally and increase endurance. During the treatment period, he remained the spirit of ministerial duties as Minister of Health.

Endang Rahayu Sedyaningsih was born in Jakarta, February 1, 1955. He successfully completed education at the Faculty of Medicine, University of Indonesia in 1979. Master's degree on Public Health and Doctor of Public Health obtained at Harvard University, the United States in 1992 and 1997.

From his marriage with dr. MJN Mamahit, Sp.OG, blessed with 2 sons and 1 daughter that is Arinanda Wailan Mamahit (M, 31), Awandha Raspati Mamahit (M, 27), and Rayinda Raumanen Mamahit (F, 21) and a daughter Sara Ratna Qanti (F, 30).

Endang Rahayu Sedyaningsih Enny familiarly called, began his career at the Department of Health since 1990. In 2004 was appointed as an officer with the rank of Researcher functional. On January 26, 2007, Endang believed to be the Head of Biomedical and Pharmaceutical Research and Development Center. Position as Associate researchers also carried on July 24, 2008. Since August 1, 2008, Endang was appointed Researcher at the Center for Bio Medical and Pharmaceutical. Dated October 21, 2009, President Susilo Bambang Yudhoyono gave the mandate as Minister of Health of the Period 2009-2014.

As a researcher, Endang Rahayu Sedyaningsih has twice won the award as the best article writer to-2 Research and Development Agency in 2000, Best Poster Presentation-3 in Asia Pacific to Conferensi-3 on Travel Health. When I became Minister of Health, Endang Rahayu Sedyaningsih Sulianti Award was awarded the award for his services in terms of disease prevention and health management

Many scientific papers that have been generated, including the Development Network of Virology and Epidemiology of Influenza in Indonesia (2007), Characteristics of cases of bird flu in Indonesia (July 2005-May 2006), and social and behavioral research studies related to sexually transmitted infections, HIV / AIDS in Indonesia (1997-2003).

The bodies of Mrs. Endang of RSCM will be taken and buried at the residence of Jl. Kingdom Education III, Block A 55, Duren Sawit IKIP Complex East Jakarta at 14.00 WIB. Furthermore, on Thursday (3/5) at 6:30 Kemenkes body sent to the office to get the memorial at 07:00 to 9:00 pm. Dispatched to its final resting bodies in the cemetery of San Diego Hills Karachi at 09.00 from the Ministry of Health.


Link to the above article:
http://www.depkes.go.id/index....

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


[ Parent ]
Please post new news stories to...
 
News Reports for May 3, 2012

Thank you!

Life is not measured by the number of breaths we take, but by the moments that take our breath away. --Unknown

     


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