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Environmental Directory

Environmental Directory

Welcome to NaturesList.org environmental directory. All sites are validated by human editors in order to bring you only the best environmental resources, both regional and worldwide.



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Alternative Energy News
added: 7/13/2009
Alternative Energy News and directory

CAERAN - Natural Products for a Natural Lifestyle
added: 7/14/2008
Caring And Environmentally Responsible And Nurturing organization. (C.A.E.R.A.N.) Canadian Manufacturer and Retailer of natural, environmentally responsible products: CAERAN biodegradable and eco-friendly household cleaners and laundry liquids, personal care, mineral cosmetics, and hair care. Retailer of the LiceMeister Comb, E•Zyme Sport equipment deodorizer and therapeutic grade essential oils.

Organic Trade Association
added: 7/14/2008
Organic Trade Association (OTA) is a membership-based business association that focuses on the organic business community in North America. OTA's mission is to promote and protect the growth of organic trade to benefit the environment, farmers, the public and the economy.

Environmental Career
added: 6/8/2007
Environmental Career Center's environmental and natural resources job listing and career information site: jobs, books, career news, live career conferences

Got2BeGreen
added: 5/15/2007
Got2BeGreen offers simple everyday tips to changing our current lifestyle and displays examples of how small efforts can make a big impact on the world of tomorrow.
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NEW CATFISH PICTURE: "Picky," Elusive Hatchlings Born




Normally shy and secretive, a male twig catfish takes center stage as he watches over his eggs at Washington, D.C.'s Smithsonian National Zoo—behavior that, in the wild, would help keep the fish-to-be from becoming a predator's lunch.
Earlier this month, one of the zoo's female twig catfish had laid between 30 and 60 eggs on the glass wall of her aquarium—which in the wild would be any open vertical surface. Her breeding partner—seen above with his pebble-like progeny—took over to guard the eggs until they hatched on November 12.
Zoo staff will carefully track the development of the newborns, since scientists haven't had much success raising twig catfish newborns in the past. The juveniles are picky eaters and, once hatched, can be hard to find even in a zoo tank, noted Vincent Rico, assistant curator for the zoo's Amazonia exhibit.
Twig catfish are native to the Amazon, Orinoco, and Paraná rivers of South America.
Scientists don't know how many twig catfish live in the wild, because the tiny, slim fish look remarkably like submerged plant debris, making them difficult to spot. (See related pictures of the world's largest catfish in Thailand.)
Wild female twig catfish lay their eggs on surfaces covered with algae, the food of choice for newly hatched fry. Adult twig catfish also munch on algae as well as the fallen plant matter they use for camouflage.
At the zoo, newborn twig catfish nibble on blanched kale, shelled peas, and sometimes the low-protein, low-fat gel the zoo feeds their parents, Rico said.
In addition to the new arrivals, ten adult twig catfish currently live at the National Zoo, although the youngsters and their parents are not in public tanks.

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"Darwin" Tortoises "Make" Video




One of the most iconic animals of the Galapagos Islands is the Giant Tortoise. Charles Darwin wrote of this tortoise in his famed report, Origin of Species, published 150 years ago this month. The differences between the tortoises from island to island were instrumental for Darwins development of his theory of natural selection. And while Darwin used a notebook for his observations toward explaining his theory of evolution, research tools have gone through their own evolution. Recently, scientists have begun using one of those modern innovations to study the natural behavior of wild Galapagos Tortoises. the cutting-edge technology of the National Geographic Crittercam. As famous as these animals are, surprisingly little is actually known about their day to day behavior. And while it might seem simple to attach a camera to a slow moving tortoise, the Crittercam team ran into plenty of obstacles. 
 
 
These creatures are used to bulldozing their way through low-lying vines and branches. And with their strength, when the camera mount gets snared on a branch, the mount gives way before the tortoise gives up. Crittercam inventor Greg Marshall and Associate Kyler Abernathy were invited to the Galapagos Darwin Research Station by Dr. Steve Blake of the Max Planck Institute. Blake is coordinating a research partnership with the Galapagos National Park and the Charles Darwin Foundation. The researchers are conducting extensive studies of the behavior of Galapagos tortoises in the wild all in the efforts toward conservation of the species. SOUNDBITE: Stephen Blake, Max Planck Institute This tortoise was around when Lincoln was alive probably. And to have the ultra-high tech of the Crittercam meet a 150-year-old animal is quite something. And to get this real-time video on a poorly understood and poorly known animal is just fabulous. Blakes team has outfitted several tortoises with GPS monitoring devices. But location is only one part of observation. The Crittercam will provide much needed data on what the tortoises are actually doing as they roam. Harvested for meat and oil beginning in the 18th century, and preyed upon by introduced predators, the tortoises suffered a steep decline in numbers. Today, several of the living Galapagos tortoise species are listed as endangered and all are under strict protection. This video was recorded from the back of a tortoise called Lolo on Santa Cruz Island in May of this year. The Crittercam team hopes to return soon with an improved camera system that can survive scrapes in the wild, and help in the survival of this threatened species. 



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Environmental conference aims to protect rare species

Environmental conference aims to protect rare species




HA NOI — More than two dozens of Viet Nam’s environmental police gather this week in Ha Noi for four days of training on wildlife trade enforcement.
The training, led by German CITES experts, will focus on the regulations, implementation and enforcement of CITES (the Convention on International Trade in Endangered Species of Wild Fauna and Flora), the primary international agreement regulating trade in wildlife and wildlife products.
The workshop is one of two being conducted by the Greater Mekong office of TRAFFIC, the wildlife trade monitoring network, in co-operation with the German CITES Management Authority.
The training will be held in Ha Noi for environmental officers from northern Viet Nam, while the second will take place on November 30 to December 3 in HCM City for officers from southern provinces.
Both workshops are sponsored by the German Ministry for Environment and the Federal Agency for Nature Conservation (BFN) and will include a field trip to nearby wildlife centres and farms to give trainees hands-on experience in animal identification and CITES compliance.
In Viet Nam, as in other parts of Southeast Asia, the illicit wildlife trade has pushed species such as tigers, Asian elephants, Javan rhinoceros and hawksbill turtles to the brink of extinction, and caused a sharp decline in wild populations of many others.
Although relatively new, the Department of Environmental Police has shown an ever-increasing commitment to ending wildlife trafficking since its inception in 2007. It has expanded to a force of nearly 1,000 officers stationed around the country, and has been increasingly more active in investigating and seizing illegal wildlife products.
The growing frequency of wildlife seizures by authorities indicates an improved understanding of illegal trafficking and CITES regulations, thanks in part to two previous training sessions conducted by TRAFFIC in 2008.
According to Nguyen Dao Ngoc Van, senior project officer with TRAFFIC Greater Mekong Programme, such results are encouraging for Viet Nam’s CITES enforcement efforts.
"When the environmental police were first created, officers didn’t know which plants and animals were protected. Now we see the evidence of the effectiveness of the training in providing the technical skills and knowledge necessary to monitor and confiscate illegal wildlife," said Van.
The training takes place over the next two weeks and will include an element of capacity building for the environmental police. A selection of the 50 workshop participants will be taught how to lead their own training sessions for other officers in their units, thereby ensure the long-term sustainability of CITES enforcement in Viet Nam.
"It is the quickest way for Viet Nam’s environmental police to familiarise its officers with basic CITES knowledge," said lead trainer Franz Bohmer, who has more than two decades experience conducting CITES training. — VNS

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Images of the H1N1 Influenza Virus

The images below of the newly identified H1N1 influenza virus were taken in the CDC Influenza Laboratory.

Image of H1N1 influenza virusDownload 72 dpi JPEG image:



Graphical Representations of a Generic Influenza Virus


These images provide a 3D graphical representation of the biology and structure of a generic influenza virus, and are not specific to the 2009 H1N1 virus. Available for download in 72 dpi.

General structure and biology of influenza viruses

3D View - Full Available in these background colors Posted November 25, 2009
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General structure and biology of influenza viruses

3D View - Full Sliced Available in these background colors Posted November 25, 2009
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General structure and biology of influenza viruses

3D View - Full Sliced w/Key Available in these background colors Posted November 25, 2009
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Related Images


CDC developed PCR diagnostic test to detect novel H1N1 virus.

CDC-developed PCR diagnostic test to detect novel H1N1 virus. Photo by Greg Sykes, ATCCDownload 72 dpi JPEG image:

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Questions & Answers about 2009 H1N1 Flu In The News

2009 H1N1 and Seasonal Influenza Infections and Invasive Pneumococcal Disease




Some of CDC's Active Bacterial Core surveillance (ABCs) sites have seen an increase in serious cases of pneumococcal disease coincident with increases in influenza-associated hospitalizations. CDC has been working with state and local public health officials in Colorado for example concerning its ABCs site in the Denver Metro area to collect additional data on pneumococcal disease cases.
There is good evidence that 2009 H1N1 influenza may be responsible for this increase in invasive pneumococcal disease (IPD) cases in the Denver Metro area. (5-year average number of cases in October, ~20; total number in October 2009, 58).
The increase in IPD cases in the Denver Metro area is primarily among younger adults with 36 out of 58 (62%) cases occurred among 20-59 year olds. In a typical non-pandemic year, most IPD cases occur among persons 65 years of age and older.
What occurred in Denver is likely an indicator of what is happening in other parts of the country.  Data shown below is preliminary and subject to change upon further investigation.
For more information on preventing pneumococcal infections secondary to seasonal and 2009 H1N1 influenza: http://www.cdc.gov/h1n1flu/vaccination/public/public_pneumococcal.htm.

2009 H1N1 Influenza Vaccination Safety

How many adverse event reports among people who received 2009 H1N1 vaccine have been reported to CDC?
As of November 20, 2009, the CDC Vaccine Adverse Event Reporting System (VAERS) had received 3,182 adverse event reports following 2009 monovalent H1N1 vaccination. The vast majority (94%) of adverse events reported to VAERS after receiving the 2009 monovalent H1N1 vaccine have not been serious (e.g., they encompass things like soreness at the vaccine injection site). CDC and FDA will be providing weekly updates on our vaccine safety monitoring activities in an effort to better characterize data that are being viewed publicly through the Vaccine Adverse Event Reporting System (VAERS; and CDC’s website, WONDER (http://wonder.cdc.gov/vaers.html). 
How does 2009 H1N1 vaccine safety compare to seasonal flu vaccine safety?
The number of serious health events reported after H1N1 vaccination is very similar to the number of reports that typically follow seasonal influenza vaccines. Additionally, no new or unusual events or pattern of adverse events have emerged.
How many Guillain-Barré syndrome (GBS) cases have been reported after 2009 H1N1 vaccination?
We know there has been interest in Guillain-Barré syndrome (GBS). CDC employs three vaccine monitoring systems that will alert us quickly should any indications of GBS-related issues arise, including: Vaccine Adverse Event Reporting System (VAERS), Vaccine Safety Datalink (VSD), and a collaboration in 10 states to look actively look for cases of GBS regardless of vaccination. To date, there are no indications of GBS-related problems with the 2009 H1N1 vaccine. It is important to note that each week in the United States, about 80-160 cases of GBS occur in the general population - regardless of vaccination.  For more information about GBS: http://www.cdc.gov/h1n1flu/vaccination/factsheet_gbs.htm.
How is the government monitoring H1N1 vaccine safety?


The Federal government has a robust vaccine safety monitoring program that has been enhanced further to ensure 2009 H1N1 vaccine safety.

Reports of Changes to the 2009 H1N1 Virus

November 24, 2009 6:00 PM ET

Have changes to the 2009 H1N1 virus been reported?
The majority of 2009 H1N1 viruses tested by CDC and the other three World Health Organization (WHO) Collaborating Centres located around the world are similar and have changed relatively little since April 2009 when the 2009 H1N1 virus was first detected. However, there have been occasional reports of small changes in the genes of some virus samples collected from some people infected with 2009 H1N1 in several countries.
What are these changes to the 2009 H1N1 virus and what are the implications for public health?
The changes to the 2009 H1N1 virus that have been reported out of Norway, and that WHO has reported as being detected occasionally in viral isolates in other countries, are scientifically known as D222G and D222N changes. The public health implications of these changes are currently being studied by CDC and WHO scientists. At this time, these changes appear to occur sporadically and spontaneously. No links between the small number of patients infected with 2009 H1N1 virus with these changes have been found, and viruses with these changes do not appear to be spreading to other people. Although further investigation is underway, there is no evidence that these changes in the 2009 H1N1 virus have lead to an unusual increase in the number of 2009 H1N1 infections or to a greater number of severe or fatal cases. Worldwide, these changes have been found in mild cases of 2009 H1N1 illness as well as severe cases of illness that have resulted in death. As a result, the public health significance of this finding remains unclear.
Will the 2009 H1N1 vaccine still protect against these viruses?
According to CDC and WHO experts, the 2009 H1N1 vaccine remains well matched with the 2009 H1N1 viruses that contain these small changes. There is no reason to think that the 2009 H1N1 vaccine will be less effective against these viruses based on the area of the influenza virus where these changes have occurred.
Will antiviral drugs work against the 2009 H1N1 viruses that have these changes?
The D222G and D222N changes found in these 2009 H1N1 isolates are not associated with resistance to oseltamivir or any other influenza antiviral medication.
Which countries have reported finding 2009 H1N1 viruses with these changes?
A recent report from the Norwegian Institute of Public Health described a change in the 2009 H1N1 virus (D222G) found in the first two people in Norway who died from 2009 H1N1 as well as an additional Norwegian patient with severe influenza illness. This D222G change was not found in the virus samples isolated from other people who died in Norway of 2009 H1N1 related causes. Norwegian scientists have analyzed samples from more than 70 patients infected with 2009 H1N1, and no additional viral isolates containing these changes have been found.
In addition to Norway, CDC has received sporadic reports of these changes found in viral isolates from Australia, Brazil, China, Japan, Mexico, Saudi Arabia, Ukraine, Uruguay and the United States.

2009 H1N1 Hospitalizations in People with Asthma November 4, 2009

What does CDC know about hospitalizations among people with asthma who get 2009 H1N1 flu?
People with asthma are at higher risk for serious complications from influenza (flu), including 2009 H1N1 flu. This can place people with asthma at higher risk of hospitalization when they have 2009 H1N1 flu. CDC monitors 2009-H1N1 related hospitalizations, including among people with asthma, through the Emerging Infections Program (EIP).
What is the Emerging Infections Program (EIP)?
The EIP Influenza Project conducts surveillance for laboratory-confirmed influenza (flu) related hospitalizations in children (persons younger than 18 years) and adults in 62 counties covering 13 metropolitan areas of 10 states (for more information see the overview of influenza surveillance in the United States). Cases are identified by reviewing hospital laboratory and admission databases and infection control logs for children and adults with a documented positive influenza test* conducted as a part of routine patient care. EIP estimated hospitalization rates are reported every week during the flu season.
*Tests used by EIP to confirm influenza infection include viral culture, direct/indirect fluorescent antibody assay (DFA/IFA), real-time reverse transcriptase polymerase chain reaction (rRT-PCR), or a commercial rapid antigen test.
What percentage of people hospitalized with 2009 H1N1 flu have asthma?
According to Emerging Infections Program (EIP) data collected from April 15 through October 27, 2009, 32% of people hospitalized with 2009 H1N1 had asthma. Among adults hospitalized with 2009 H1N1, 30% had asthma, whereas 35% of hospitalized children with 2009 H1N1 had asthma.
What percentage of people hospitalized with asthma and 2009 H1N1 are admitted to an Intensive Care Unit (ICU)?
According to Emerging Infections Program (EIP) data collected from April 15 - October 27, 2009, 21% of hospitalized adults with asthma and a 2009 H1N1 infection and 18% of hospitalized children with asthma and a 2009 H1N1 infection were admitted to an ICU. No significant differences in the number of ICU admissions were noted between 2009 H1N1 infected people hospitalized with or without asthma.

2009 H1N1 Hospitalizations by Age Group

October 20, 2009 What percentage of hospitalizations for 2009 H1N1 flu occur in different age groups in the United States?
The percentage of hospitalizations for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 4,958 laboratory-confirmed 2009 H1N1 hospitalizations to CDC. The percentage of 2009 H1N1 related hospitalizations that occurred among those 0 to 4 years old was 19%; among those 5 years to 18 years was 25%; among people 19 years to 24 years was 9%; among those 25 years to 49 years was 24%; among people 50 to 64 years was 15%; and among people 65 years and older was 7%. For a graphical representation of this data, please see the chart below.
Percentage of hospitalizations for 2009 H1N1 flu that occur in different age groups
What percentage of deaths for 2009 H1N1 flu occur in different age groups in the United States?
The percentage of deaths for 2009 H1N1 flu in the United States varies by age group. From August 30, 2009 through October 10, 2009, states reported 292 laboratory-confirmed 2009 H1N1 deaths to CDC. The percentage of 2009 H1N1 related deaths that occurred among people 0 years to 4 years was 3%; among those 5 years to 18 years was 14%; among people 19 to 24 years was 7%; among people 25 to 49 years was 33%; among people 50-64 years was 32%; and among people 65 years and older was 12%. For a graphical representation of this data, please see the chart below.
Percentage of deaths for 2009 H1N1 flu that occur in different age groups.
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Origin of 2009 H1N1 Flu (Swine Flu): Questions and Answers




Where did the 2009 H1N1 flu virus come from?

The 2009 H1N1 influenza virus (referred to as “swine flu” early on) was first detected in people in the United States in April 2009. This virus was originally referred to as “swine flu” because laboratory testing showed that its gene segments were similar to influenza viruses that were most recently identified in and known to circulate among pigs. CDC believes that this virus resulted from reassortment, a process through which two or more influenza viruses can swap genetic information by infecting a single human or animal host. When reassortment does occur, the virus that emerges will have some gene segments from each of the infecting parent viruses and may have different characteristics than either of the parental viruses, just as children may exhibit unique characteristics that are like both of their parents. In this case, the reassortment appears most likely to have occurred between influenza viruses circulating in North American pig herds and among Eurasian pig herds.  Reassortment of influenza viruses can result in abrupt, major changes in influenza viruses, also known as “antigenic shift.” When shift happens, most people have little or no protection against the new influenza virus that results. For more information, see “How the Flu Virus can Shift: Drift for Shift.”

Why does CDC think this?

There are three primary reasons why experts from CDC and other public health research institutions around the world think 2009 H1N1 influenza resulted from reassortment of influenza viruses that occur naturally among pigs.
Reason One
The different gene segments of the 2009 H1N1 influenza virus are traceable to influenza viruses found in pigs. All influenza viruses have eight genes. Six of the eight genes found within the 2009 H1N1 influenza virus are associated with influenza viruses that regularly cause illness in pigs in North America. The remaining two genes of the 2009 H1N1 flu virus are associated with influenza viruses that previously were only known to be circulating among pigs from Eurasia.1, 2 The mixing of live pigs from Eurasia and North America through international trade or other means could have created the circumstances necessary for influenza viruses from North American and Eurasian pigs to mix. In fact, a 2009 study in Nature demonstrated that reassortant influenza viruses with genes from North American and Eurasian pigs were found in samples collected from pigs in Hong Kong as early as 2004.2*
*The reassortant influenza viruses found in Hong Kong from 2004 are different from the 2009 H1N1 influenza viruses that have caused human illness around the world today, but these viruses serve as an example of how reassortment can occur naturally among influenza viruses found in Eurasian and North American pigs.
Reason Two


Evidence suggests that the 2009 H1N1 influenza virus has existed and evolved in nature for some time prior to being detected in humans. There are laboratory techniques available for looking at how and at what speed influenza viruses evolve and change. This is related to a concept known as “molecular evolution.”  Evolution refers to small changes in influenza viruses that happen continually over time. Generally speaking, influenza viruses generate mutations by passing from one animal to another animal for several years and through virus replication in the animal host. These mutations are represented by changes in the nucleotides and amino acids found within influenza viruses. These small changes occur at a relatively stable rate in all influenza viruses. As a result, scientists can compare the number of mutations found within a new influenza virus with older, related influenza viruses to estimate the amount of time that it may have taken for one strain to evolve into a new strain of influenza virus.  Researchers at CDC used this molecular evolution method to determine that the 2009 H1N1 influenza virus likely evolved in nature – perhaps through circulation in an unknown animal host – for a number of years before being detected. At this time, CDC continues to monitor the 2009 H1N1 influenza virus for changes. Research so far suggests that the 2009 H1N1 influenza virus is changing at a normal rate as compared to other influenza viruses.
Reason Three
The 2009 H1N1 influenza virus does not have the adaptations that are typical of influenza viruses grown or created in laboratories. For example, the standard method of growing influenza virus in laboratories involves injecting the virus into fertilized chicken eggs. The 2009 H1N1 influenza virus lacks the properties associated with growth in eggs.

Have viruses similar to the 2009 H1N1 virus been seen before?

Prior to the discovery of the 2009 H1N1 influenza virus, this particular combination of gene segments from North American and Eurasian swine had never been detected before in a single influenza virus and this new virus is different from the influenza viruses that normally circulate in North American and Eurasian pigs. It is not known when reassortment occurred to create the 2009 H1N1 influenza virus.  Testing of the virus suggests that this reassortment event may have occurred years prior to the first reports of 2009 H1N1 influenza infection in people.1, 2 Scientists call 2009 H1N1 influenza a "quadruple reassortant" virus, because although each separate gene segment of the virus has been found in pigs previously, the individual gene segments of the virus originated from humans, birds, North American pigs and Eurasian pigs.

Why does the 2009 H1N1 flu virus have genes from humans, birds, and from pigs on different continents?

Pigs can be infected by influenza viruses found in birds and other animals as well as people.  Therefore, pigs represent a mixing vessel in which influenza viruses from different species can swap genes. For example, in a setting where people and animals are in close contact, pigs can be infected by influenza viruses found in pigs, poultry or humans – sometimes at the same time. For at least 80 years, influenza viruses known as “classical swine H1N1” viruses have circulated in North American pigs. However, in the late 1990s, a series of reassortment events occurred between influenza viruses found in pigs, humans and birds. As a result, swine influenza viruses with genes from humans, North American pigs and birds have existed in many parts of the world for around 10 years prior to 2009 H1N1 flu. Mixing of these “triple reassortant North American swine influenza viruses” with Eurasian swine viruses likely resulted in the 2009 H1N1 influenza virus.

Was the 2009 H1N1 flu virus created in a laboratory?

This is very unlikely. Each of the gene segments within the 2009 H1N1 influenza virus have been found in pigs for more than 10 years prior to the beginning of the 2009 H1N1 influenza outbreak.2  Pigs have long been considered a possible mixing vessel for influenza viruses that originate within pigs, birds and humans. In addition, a 2009 Nature study showed that reassortment between influenza viruses found in North American and Eurasia pigs had already occurred at least once naturally in the 5 years prior to the identification of 2009 H1N1 flu. Also, the 2009 H1N1 influenza virus does not have adaptations consistent with viruses grown in laboratories. For more information, see reasons 1, 2 and 3 above.

How often does reassortment of influenza viruses occur?

We know that reassortment occurs frequently in nature. Fortunately, reassortment rarely results in a virus with pandemic potential, though it has done so at least twice in the 20th century. The influenza viruses that caused the 1957 and 1968 pandemics contained a mixture of gene segments from human and avian influenza viruses.  What is clear from genetic analysis of the viruses that caused these past pandemics is that reassortment (gene swapping) occurred to produce novel influenza viruses that caused the pandemics.  In both of these cases, the new viruses that emerged showed major differences from the parent viruses.  However, not all viruses emerge directly from reassortment events. For example, the origins of the 1918 virus are not precisely known, but experts think it is likely that the 1918 virus may have resulted from a bird influenza virus directly infecting humans and pigs at about the same time without reassortment.

What can be done to identify influenza viruses circulating in animals that have pandemic potential?

The emergence of the 2009 H1N1 influenza virus in humans highlights the need for better surveillance of influenza viruses in pigs and other animals.  The mixing of influenza genes in pigs can result in the emergence of viruses with pandemic potential in humans. Improved surveillance of influenza in pigs and other animals may help to detect the emergence of influenza viruses with the potential to cause illness and spread among people, possibly resulting in a pandemic.  Early detection of such viruses can alert public health officials and aid in pandemic preparedness through the development of appropriate diagnostic tests and influenza vaccine candidate viruses, if necessary.

What scientific studies are available for additional information?

1. “Antigenic and Genetic Characteristics of the Early Isolates of Swine-Origin 2009 A (H1N1) Influenza Viruses Circulating in Humans” by Rebecca J. Garten & C. Todd Davis et al. Science. 325: no. 5937, pp. 197-201. (10 July 2009).
2. “Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic” by Gavin J.D. Smith et al. Nature. 459, 1122-1125. (25 June 2009).
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2009 H1N1 Influenza: Resources for Pharmacists

General Information for Pharmacists




CDC has issued recommendations for clinicians on the use of antiviral medications for the treatment and prevention of influenza for the 2009-2010 season. The Food and Drug Administration (FDA) has authorized emergency use of oseltamivir (Tamiflu_) and zanamivir (Relenza under certain circumstances not included in the FDA-approved uses or outside of the FDA-approved uses in response to the declaration of a public health emergency involving 2009 H1N1 influenza A virus made by the Secretary of Health and Human Services on April 26, 2009.  Additionally, FDA has recently issued an Emergency Use Authorization for the use of an unapproved (investigational) intravenous drug (peramivir) for the treatment of 2009 H1N1 influenza virus in certain hospitalized adult and pediatric patients. 
The current public health emergency has affected the nation’s pharmacists as a greater number of people than usual seek to fill prescriptions for influenza antiviral drugs or antibiotics to treat secondary infections, in addition to seeking advice on over-the-counter cough and cold medications. This may have an impact on supplies and availability of antiviral medications and other materials that may be needed to fill such prescriptions.

Antiviral Availability

At this time, CDC discussions with the antiviral supply chain (manufacturers, distributors and retailers) indicate that supplies of the Tamiflu® adult capsule formulation (75  mg) and pediatric capsule formulations (30 mg and 45 mg) and Relenza®  Inhalation Powder  are meeting current demand for these products. However, the FDA and Roche (maker of Tamiflu®) have determined that supplies of Tamiflu® Oral Suspension are limited.
Pharmacies should be aware of the importance of providing patients with these influenza medications as quickly as possible when they are prescribed.  Having product at the pharmacy store level, including doses of Tamiflu® and Relenza®, and supplies to compound Tamiflu® Oral Suspension, will be critical to ensure that patients needing treatment receive it as quickly as possible.
  • Limited Availability of Commercial Tamiflu® Oral Suspension
    Supplies of commercially-manufactured Tamiflu® Oral Suspension are limited.  In response to this, Tamiflu® Oral Suspension has been released from the CDC Strategic National Stockpile to enhance availability at state and local levels.  Some of these lots of suspension product have an expired date on the label. Under the emergency use authorization for Tamiflu® FDA has authorized the use of certain lots of expired Tamiflu®. Based on scientific review, FDA found that some Tamiflu® may be used past the expiration date printed on the package. If you want to look up the lot number for your Tamiflu to see if it has been authorized for use past its expiration date, please see the listing of antivirals at or nearing expiry.



    When local supplies of commercially-manufactured oral suspension are limited, physicians should consider infants and children less than one year of age or less than 33 lbs to be the highest priority for receiving the commercial suspension.
    • FDA: Information for Healthcare Professionals – Authorization of Use of Expired Tamiflu for Oral Suspension
  • Supply of Ingredients Needed to Compound Tamiflu® Oral Suspension
    Tamiflu® capsules (75 mg) may be compounded using either of two vehicles: Cherry Syrup (Humco) or Ora-Sweet SF (sugar-free) (Paddock Laboratories).  As of October 28, 2009, these products may be in short supply in some locations if there is increased demand for compounding an oral suspension from Tamiflu® 75 mg capsules.

    Humco reports that they have increased production of Cherry Syrup and that they are releasing new production weekly to wholesalers.  If pharmacists are having difficulty obtaining Humco Cherry Syrup, they may contact Humco directly to locate supplies at 1-800-662-3435.  Paddock Laboratories reports that they have increased production of Ora-Sweet SF and they are releasing new production daily to customers. 
    • FDA: Tamiflu Oral Suspension Shortage Information
CDC will provide additional information and updates regarding antiviral drug supplies as needed.

Antiviral Prescription and Dispensing Considerations

Oseltamivir (Tamiflu®)

    External Web Site Icon
  • Complete information for the Emergency Use Authorization for Tamiflu® is available from CDC.  
    • CDC: Emergency Use Authorization for Tamiflu®
  • Alternatives to Tamiflu® Oral Suspension for Pediatric Patients
    While commercially-manufactured Tamiflu® Oral Suspension (12 mg/mL) is the preferred product for pediatric and adult patients who have difficulty swallowing capsules or where lower doses are needed, this product may not be locally available.

    For patients who are less than one year old, there is one alternative:
    • a suspension compounded by a retail pharmacy (see links below)
    For children who are at least one year old there are two alternatives:
    • a suspension compounded by a retail pharmacy (see links below)
    • 30mg, 45mg, or 75 mg capsules, which may be mixed into a sweetened liquid by a caregiver if the child cannot swallow capsules (see links below).
  • Tamiflu® Oral Suspension Compounded by a Retail Pharmacy
    Compounding an oral suspension from Tamiflu® 75mg capsules as described in the FDA-approved manufacturer package insert  is an alternative when commercially-manufactured oral suspension formulation is not readily available. Tamiflu® 75 mg capsules may be compounded using either of two vehicles: Cherry Syrup (Humco) or Ora-Sweet SF (sugar-free) (Paddock Laboratories). Other supplies needed include mortar and pestle and a standard pharmacy bottle, such as an amber glass or amber polyethyleneterephthalate (PET) bottle.
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Sebelius Attends Opening of Cell-Based Influenza Vaccine Manufacturing Facility




 Sebelius Attends Opening of Cell-Based Influenza Vaccine Manufacturing Facility

Secretary Sebelius attended the opening of a new cell-based influenza vaccine manufacturing facility on Tuesday, November 24.  HHS helped support the development of the U.S. cell-based influenza vaccine manufacturing facility in Holly Springs, North Carolina through a public-private partnership with Novartis Vaccines and Diagnostics, Inc.  The facility is the first of its kind in the United States.
"The opening of Novartis's cell-based influenza manufacturing plant in Holly Springs, North Carolina is an important step forward in expanding our domestic influenza vaccine manufacturing capability," said Secretary Sebelius.  "Built upon financial support from HHS, this facility lays the cornerstone for a strong, flexible flu vaccine manufacturing infrastructure, and moves us down the path we have set to transform vaccine technologies that will support rapid, flexible and reliable approaches to influenza and other emerging threats. The completion of this plant is a significant investment for the U.S. and demonstrates the power of effective public-private partnerships."
Novartis expects the facility to be ready as early as 2011 to produce vaccine for emergency use in a situation such as a pandemic.  The plant is intended to be running at full-scale commercial production capacity in 2013 in order to provide substantial amounts of pandemic vaccine within 6 months of pandemic onset as well as provide flexible manufacturing capability for other vaccine needs.
Sebelius Attends Opening of Cell-Based Influenza Vaccine Manufacturing Facility

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Clarification on the Canadian Vaccine Situation




Clarification on the Canadian Vaccine Situation

According to recent news reports, the British-based vaccine manufacturer GSK has placed a voluntary hold on a single lot of H1N1 vaccine being used in Canada because of some reports of severe allergic reaction.  This vaccine is not a U.S.-licensed vaccine. We have seen no such increase in severe allergic reactions to any U.S.- licensed H1N1 vaccines in millions of doses given to date.  The GSK vaccine that was recently licensed in the U.S. has not yet been released for use, is not yet available, nor has it been distributed. Unlike the Canadian-licensed GSK vaccine, the U.S.-licensed GSK vaccine does not contain an adjuvant.  We are in close contact with Canadian officials and are monitoring the situation closely.

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INFLUENZA A (H1N1)




The situation in India : Since the declaration of the first H1N1 influenza case by Indian Health Ministry, 17 196 confirmed cases and 560 deaths have been reported in India as on 25th November 2009.


Precautionary measures:
H1N1 influenza is extremely contagious, but is usually not virulent. However, it does sometimes appear in a more severe form, which could necessitate hospitalization.
The following hygienic measures should be adopted:
- wash your hands regularly with soap and water or with an alcohol-based solution;
- regularly wipe surfaces that you touch (e.g. remote control or door knobs);
- cover your mouth and nose when you cough or sneeze;
- ensure that used tissues are thrown in dustbins;


- regularly ventilate the rooms you use and avoid contact with sick persons;
- limit visits to places of public gathering that are not ventilated;
- be careful about the most vulnerable persons, particularly children and frail persons.
H1N1 influenza symptoms:
- Its symptoms akin to those of seasonal flu, but similar to the latter, H1N1 influenza can aggravate other chronic underlying illnesses:
— fever higher than 38° C and exhaustion;
— two or more of the following symptoms: headache, cold, cough, stiffness or aches in limbs or joints.
What to do if you have these symptoms:
- consult a doctor, who will tell you whether you need to proceed to a mucus or blood test in one of the government hospitals designated by the Indian authorities;
- stay at home and restrict contact with others.
Incubation period:
The period between the moment a person gets infected and develops symptoms is between 1 to 7 days; in most cases, it appears that the incubation period is between 1 and 4 days.
When does one become contagious?
According to what is currently known, an infected person can pass on the infection to others from the day preceding the appearance of symptoms till seven days after their appearance. Children – particularly very young children – can remain contagious for longer.
Follow-up of the situation by the Government of India:
- New Guidelines for Screening, Testing, and Isolation for H1N1
Union Minister of Health and Family Welfare, Shri Ghulam Nabi Azad chaired a meeting late last night in connection with the various actions taken by the Government for containment and mitigation of H1N1 cases in India. The meeting lasted for more than five hours from 4.30 pm to 10.00 pm in Nirman Bhawan. The meeting was attended by various eminent experts from public and private hospitals/ organizations besides the senior officers of Health Ministry Directorate General of Health Services.
During the meeting various guidelines and protocols developed by the World Health Organization Geneva, Centre for Disease Prevention and Control, Atlanta, USA and National Health Service, United Kingdom were also discussed threadbare.
After long discussion with the experts the following guidelines for India were finalized.
In order to prevent and contain outbreak of Influenza-A H1N1 virus for screening, testing and isolation following guidelines are to be followed:
At first all individuals seeking consultations for flu like symptoms should be screened at healthcare facilities both Government and private or examined by a doctor and these will be categorized as under:
Category- A
* Patients with mild fever plus cough / sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir and should be treated for the symptoms mentioned above. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.
* No testing of the patient for H1N1 is required.
* Patients should confine themselves at home and avoid mixing up with public and high risk members in the family.
Category-B
(i) In addition to all the signs and symptoms mentioned under Category-A, if the patient has high grade fever and severe sore throat, may require home isolation and Oseltamivir;
(ii) In addition to all the signs and symptoms mentioned under Category-A, individuals having one or more of the following high risk conditions shall be treated with Oseltamivir:
• Children less than 5 years old;
• Pregnant women;
• Persons aged 65 years or older;
• Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS;
• Patients on long term cortisone therapy.
• No tests for H1N1 is required for Category-B (i) and (ii).
Category-C
In addition to the above signs and symptoms of Category-A and B, if the patient has one or more of the following:
• Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails;
• Irritability among small children, refusal to accept feed;
• Worsening of underlying chronic conditions.
All these patients mentioned above in Category-C require testing, immediate hospitalization and treatment.
These guidelines will be reviewed and revised from time to time as per need and on the basis of spread of the disease.
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H1n1 Virus Goes Global




People everywhere are trying to protect themselves against the swine fluFrom Europe to Asia to the Middle East, the 2009 H1N1 virus is spreading. The World Health Organization reports the virus has killed close to 6,000 people worldwide.

"I come home from the street, take the mask off, wash and iron it and make my children do so too," she said.

Hundreds of thousands of doses of Tamiflu, a treatment for H1N1 flu, have arrived in the Ukraine, which has reported a sudden outbreak, killing at least 22.

Ukrainian Prime Minister Yulia Tymoshenko met the plane on the tarmac.

"A large number of the most needed medicines to treat those people who have caught flu have been delivered today," said Yulia Tymoshenko. "It is Tamiflu. I have it in my hands…"

Ukraine's Prime Minister Yulia TymoshenkoThe government has closed schools, limited public gatherings and imposed travel restrictions with enforcement at the borders.

Health experts in Germany are also reporting an alarming rise in H1N1 cases. Most worrisome, many aren't travel-related but are developing inside the country.

German health officials are worried.

"If you want, you can say the wave has begun," said an official.

Health officials say that here in the U.S. an estimated 1,000 people have died from the H1N1 virus with roughly one million infected. Most of those cases have been tracked since September, the onset of the flu season here.

In China, because of slow global distribution of the vaccine, the government has produced its own. And it has launched a massive vaccination campaign. So have 16 other countries, including Japan and Israel.

In Afghanistan, many residents blame foreigners traveling to their country for at least two confirmed H1N1 deaths.

Health officials declared a state of emergency following those deaths.

Some Afghans blame foreigners traveling to their country for at least two confirmed H1N1 deaths"Whoever comes from abroad should be checked before entry, if they are well, they should be able to enter if not they should be deported," said an Afghan man.

Deporting sick travelers might not do the trick, says microbiologist Dr. Andrew Pekosz, since people can carry and pass H1N1 for up to a day before developing symptoms.



His advice to those with access to the vaccine: Get it now.

"The vaccine is safe when administered to a number of different populations and it also induces a very good immune response which should protect you from infection," said Andrew Pekosz.

He repeats that the best protection against catching and spreading H1N1 is good hygiene. Use a tissue or cover your mouth.

Health officials say to date more than 440,000 people around the world have been infected with H1N1. They say before the pandemic ends, 30 percent of the world's population may have been infected.
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Drug resistant H1N1 no major change in virus: WHO




GENEVA (Reuters) - Tamiflu resistance in some H1N1 patients with badly weakened immune systems does not seem to reflect a major change in the virus' susceptibility to the frontline drug, the World Health Organization said on Thursday.
Nine people in Britain and the United States developed a Tamiflu-resistant form of swine flu while being treated in hospital mainly for blood cancers, said WHO flu expert Keiji Fukuda.
"We don't know the full answer. But it is more likely that we are not seeing a change, a major shift in the epidemiology or in the properties of these viruses with regard to oseltamivir resistance," he told a weekly news conference.
He said Tamiflu, known generically as oseltamivir and made by Switzerland's Roche, was effective when used correctly and early.

About 75 cases of oseltamivir-resistant viruses have been reported worldwide in recent months, mostly isolated cases which have arisen after preventive treatment with the drug, he said.
"Right now we do not see any evidence of a large impact in immuno-compromised people with milder forms and we do not see a large impact in HIV-infected populations," he said.
FLU TO CONTINUE FOR WEEKS
Swine flu is expected to infect more people in the northern hemisphere in the next weeks before there is a downturn, but is less prevalent in the southern hemisphere, Fukuda said.
"... it's still too early to say whether we are seeing peaking of activity in the northern hemisphere. Again, we see differences on a country by country basis," he said.
H1N1 has killed at least 6,770 people, according to the WHO. Most people suffer mild symptoms and recover without special treatment.
Some serious side effects have occurred after inoculation, but mostly "we have seen that the serious events are not related to the pandemic vaccine," Fukuda said.
In Canada, six people had severe allergic reactions after vaccination, but all recovered. Canadian provinces have stopped using a particular batch of GlaxoSmithKline Plc vaccine.
"As we understand, none of this vaccine was distributed outside Canada," Fukuda said. "All of the unused doses of vaccine have been put on hold, that is they are not being used at this point while investigations go on."

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Chicago’s Great Culinary Middle Ground




PAUL KAHAN is one of Chicago’s best chefs, and his restaurants are reliable bellwethers for what’s going on in the city’s dining scene. When Blackbird, his first restaurant, opened 12 years ago, it presaged Chicago’s rebirth as one of the planet’s most dynamic restaurant cities — a promise fulfilled by restaurants like Alinea, Schwa and L20. Mr. Kahan followed Blackbird with Avec and the Publican, restaurants that are less formal, better suited to a city that needed less pomp and polish to go with good food.
A few weeks ago, Mr. Kahan opened a fourth restaurant, Big Star Taqueria and Bar, in what was once a mechanic’s garage. There’s country on the jukebox and a complement of tequila behind the bar, but the real draw is the tacos, including spit-roasted al pastor, which go for $2 apiece.
The extremes have long been the best places to eat in Chicago: the city is home to some of the world’s finest temples of haute gastronomy as well as its greatest collection of hot dog stands. But the middle ground — the world between the direct pleasure of a salty, snappy dog and the epic degustation menus at the city’s fanciest restaurants — has been a notable absence.
No more. In the past few years, a number of chefs and restaurateurs have taken on everyday foods, revisiting, revising and approaching them with care and, often, a twist or two.
Big Star isn’t the only news in the Mexican scene in Chicago; Rick Bayless — whose Topolobampo and Frontera Grill have reigned over the Chicago Mexican scene for 20 years — has just opened a third spot. He, too, went for the middle, opening Xoco (pronounced SHO-ko), a torta, soup and churros place that is primarily a lunch destination. The menu tops out at $12.50.
“I didn’t want to do tacos — we do those in Frontera,” Mr. Bayless said in a recent interview. “I wanted to bring street food flavors inside and offer them at a price point for other people that can’t afford to come to the other restaurants.”

Xoco has a casual vibe, like a cheerier, more colorful Chipotle Grill. A quick scan of the menu, though, makes it clear that there’s more to Xoco than meets the eye: there are headcheese tortas, drip coffee brewed to order and served in handsome glass Chemex pots, and a half-dozen more farm names than you usually encounter on a chain restaurant’s menu.
Tortas, Mexican sandwiches, are the specialty at lunch, and the selections cooked in the restaurant’s wood-burning oven are your best bet (the griddle-cooked tortas were too cheese-driven for me, though if a grilled cheese is what you’re shopping for, the griddle is the way to go). The pepito — an assemblage of short ribs, black beans, caramelized onions and pickled jalapeños — is as good as its ingredient list reads, with bread toasted to a wonderful crispness by the oven. The woodland mushroom torta is no mere concession to vegetarians; Mr. Bayless’s decades of mastering Mexican flavors have somehow imbued him with the power to turn a goat cheese, mushroom and arugula sandwich into a bold Mexican sandwich. (Maybe the secret is the three-chili salsa.)


Tortas are available after 11 a.m., and they come off the menu at 3 p.m. to make way for Mexican soups. But the restaurant actually opens at 7 a.m., serving a phenomenal rendition of a combination of foods I first learned about from the title of a Spanish-language textbook I read in the sixth grade: churros y chocolate. The churros are crisp and fresh, dense in the traditional fashion, rolled in a dirty snowfall of cinnamon sugar and served warm. The hot chocolate features freshly ground cacao beans, and the drinks are predictably killer. The Barcelona, one of Xoco’s options, is so thick you can stand your spoon up in it, and so rich with bittersweet chocolate flavor it could do double duty as a dessert.
It’s not just Mexican fare that’s getting pulled out into the spotlight: Michael Kornick, the chef of MK, which twice has been awarded three stars from The Chicago Sun-Times since it opened in 1998, recently opened DMK Burger Bar, where he is serving grass-fed beef, truffle fries and house-made sodas, including blood orange and cherry.
But it is Kuma’s Corner, which Matt Cain opened four years ago on the North Side, that has been attracting the most attention of late. It is notorious for the wait to get in (long; no reservations accepted), the music it plays (heavy metal), the bourbon on tap (um, bourbon on tap) and, most of all, its burgers.
The night I visited, the hostess — tattooed and pierced — was direct and chipper about the 60- to 90-minute wait. (On a Monday night, I should add.) She added my name to her list; my younger brother noticed that next to each name is a description to help her differentiate customers; I was “scruffy, odd.” Fair enough.
I DON’T know what I was expecting — guns? outlaw bikers? — but the restaurant, with its high ceilings and a pleasing corner location, didn’t end up all that threatening. Sure, there were drawings of half-naked female vampires on the walls, a scrawl reading “Die Emo Die” above the bar, and the incessant and propulsive fluttering of double-kick bass drums chugging under growled vocals on the sound system all night, but my girlfriend’s parents — not the target demographic, one assumes — described it afterward as “a hoot.”
And the burgers are good. Big 10-ounce patties are grilled reliably to temperature and served on soft pretzel buns. The buns aren’t chewy or intrusive, but they are strong enough to keep the burgers, however wildly they are dressed, together, and they add an alkaline tang that complements the beefiness of the burgers.
There are 20 or so options for topping combinations, most named after metal bands, each progressively crazier. The most popular and probably the best is the Kuma Burger: a fried egg, bacon and Cheddar. I am typically averse to such profligate assemblages, but there’s something special about Kuma’s particular combinations — not harmonious, exactly, more like the often cacophonous sounds of the heavy metal that fills the room, channeled into burger form.
For an atmosphere as quiet as Kuma’s is loud, head to Great Lake in Edgewater, on the far North Side. Lydia Esparza and Nick Lessins opened the place last year in a tiny space with a homey feel — a mishmash of modern furniture, a few seats and a set of shelves where they sell an assortment of products they like, including wooden knitting needles. (Mrs. Esparza designed showrooms for Herman Miller before plunging into Great Lake; Mr. Lessins worked in consulting.) Mrs. Esparza said that Mr. Lessins had been working on a pizza recipe at home for years and, at a certain point, the couple decided it was time to bring it to the people. The transition from unseasoned home cook to restaurant chef has, I contend, never gone as well for anyone as it has for Mr. Lessins. This summer, Alan Richman, the food writer for GQ, called the mortadella pie the best pizza in the country. Having not visited quite as many pizzerias as Mr. Richman, I can only say that Great Lake’s pies are the best pizzas I have ever eaten in my entire life.
They hew to no traditional style — neither Neapolitan nor Chicagoan nor New York. But the crusts have a perfectly irregular crumb, pleasing but not overly chewy, with a yeasty tang, and they are crisp enough to stand up to whatever Mr. Lessins tops them with. (Digression: Chicago pizza is commonly associated with the baked casserole that is deep-dish pizza, but the more prevalent style features a thin, cracker-crisp dough, cut into a grid, not wedges.)

The toppings at Great Lake are sourced with an aggressively local bent; Dante and Mona — two cheeses from the Wisconsin Sheep Dairy Cooperative — have supplanted pecorino and Parmesan, and the mozzarella is local and freshly made. Some of Mr. Lessins’s combinations look unappetizing on the menu and then turn out to be knee-weakeningly good. The heirloom squash and country ham combo, for example: razor-thin curls of squash baked into the cheese, with the ham (from Newsom’s, one of the country’s best purveyors) sliced prosciutto-thin and draped over the finished pie.
There are a few caveats: Great Lake has severely limited hours (Wednesday through Saturday at the moment, though Mrs. Esparza encourages diners to call ahead and see if they’ve changed), it is BYOB, the service can be profoundly slow (pizzas are baked to order, one at a time), and waits can be tremendous. None of these things would stop me from going back.
TOPPINGS
Prices are estimated for two people, not including taxes, tip or beverages.
Big Star Taqueria and Bar, 1531 North Damen Avenue; (773) 235-4039. Dinner, $15 to $18.
Xoco, 449 North Clark Street; (312) 334-3688; www.rickbayless.com/restaurants/xoco.html.
Lunch, $15.
Kuma’s Corner, 2900 West Belmont Avenue; (773) 604-8769; www.kumascorner.com. Dinner,
$12.
Great Lake, 1477 West Balmoral Avenue; (773) 334-9270. Dinner, $25. (Open Wednesday and Thursday 5 to 9 p.m. and Friday and Saturday,
5 to 10 p.m.)
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