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This week-long backpack will explore almost the entire length of Forbidden Canyon. The canyon is initially broad and gentle, and we will enjoy the canyon's many shallow pools and small waterfalls, pausing as we wish for a brief and welcome swim. As we descend farther, the canyon deepens and narrows as it squeezes between Cummings Mesa and Navajo Mountain. With thousand-foot cliffs on both sides of the middle and lower canyon, we will cross and re-cross an inner canyon with near vertical walls and frequent pour-offs, often using a hand-line for assistance. One of these crossings will require a 40-foot roped descent or rappel (no experience required). We will admire the canyon's pools, now deep and dark, and will wade -- or, less likely, swim -- through one of these.

Except for the last day, the entire hike is cross-country and off-trail. Depending on our precise route, we may see cliff dwellings, pictographs, and long-abandoned Navajo hogans, and we will have two or three layover days to explore the slickrock domelands high above the canyon. The hike ends at Rainbow Bridge, one of the world's largest natural bridges, where we board a National Park Service concession boat for a 2.5-hour trip on Lake Powell back to Page.

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This seven-day hike begins at the rim of Forbidden Canyon on Black Brush Flat, southwest of Navajo Mountain. Navajo friends will provide transport from Page to the starting point. The leader will provide detailed information regarding the meeting location and the Navajo transport. The transport is not part of the trip, and the cost, approximately $75 each, is not included in the trip fee. The day-to-day itinerary will depend on the weather and canyon conditions, the group's progress descending the canyon, and the interest of trip participants

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This seven-day hike begins at the rim of Forbidden Canyon on Black Brush Flat, southwest of Navajo Mountain. Navajo friends will provide transport from Page to the starting point. The leader will provide detailed information regarding the meeting location and the Navajo transport. The transport is not part of the trip, and the cost, approximately $75 each, is not included in the trip fee. The day-to-day itinerary will depend on the weather and canyon conditions, the group's progress descending the canyon, and the interest of trip participants.

Day 1: After a 2.5-hour road trip from Page to Navajo Mountain, we begin our adventure with an easy descent on a rarely used Navajo stock trail. We will camp beside a large deep-blue pool that's suitable for swimming.

Day 1:

Day 2: On this layover day, we will explore the upper end of Forbidden Canyon, possibly climbing out of the canyon on a sheepherder's trail to the top of Cumming's Mesa or visiting a remote cliff-dwellers ruin.

Day 2:

Days 3-5: The terrain will become increasingly challenging as we descend Forbidden Canyon. Depending on our progress, we may have opportunities for side trips out of the canyon.

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The Occupational Safety and Health Administration ’s (OSHA) focus this week is on its National Safety Stand-Down, taking place from May 7-11. National Safety Stand-Down is a voluntary event to encourage companies to talk about safety with their employees, especially about fall hazards and fall prevention.

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Helping to raise the profile of the National Safety Stand-Down and encouraging companies in our industry to participate is just one of the many ways we partner with OSHA to promote the health and safety of workers. Be sure to check out our Alliance page for more information on other ways we work with OSHA.

OSHA’s National Safety Stand-Down is a combined effort from OSHA, the National Institute for Occupational Safety and Health and CPWR–The Center for Construction Research and Training , aimed at raising awareness of fall hazards. Falls from heights are still the leading cause of death in the private construction industry and lack of proper fall protection is the most frequently cited violation by OSHA. While the event primarily references the construction industry, workers in any industry are susceptible to fall hazards.

Any workplace can hold a stand-down by taking a break to reinforce the importance of fall prevention. If fall hazards aren’t a major risk for a particular company, they can still use the opportunity to talk about other hazards they face, ways employees can protect themselves from those hazards and the company’s safety policies and goals. It can also be an opportunity for employees to talk to management about fall hazards and other potential job hazards they see.

Last year marked the fourth annual Stand-Down with nearly 150 free public events reaching more than 1 million workers. By continuing to reach workers and employers, OSHA aims to raise awareness and decrease the number of fall-related injuries and fatalities. Participation is not limited to the construction industry, and no business is too small to participate. In previous years, many non-construction employers held Stand-Downs.

Council for Relationships’ Online Therapy service launches this summer! This service is intended for PA residents who can’t come to one of our offices for in-person therapy. Stay tuned for more information.

Introducing July’s featured therapist, Caitlin Rice, MSS, LCSW. Learn more about Caitlin in our interview on the blog!

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Council for Relationships is a nonprofit organization with amission tohelp people from all walks of life improve their important relationships by providing exemplary therapy, educating and training clinicians in the family systems approach, and advancing the behavioral health field through research.

More than 60 therapists and psychiatrists at 10offices and community-based locations in the Greater Philadelphia Area provide counseling to individuals, couples, and families. More than 50 clinical interns provide counseling on a sliding fee scale through CFR’s clinician education programs.

We are committed to providing quality therapy services to all regardless of ability to pay. We operate on a sliding fee scale and one-third of our clients receive counseling services at low- or no-fee.

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Hepatitis B surface antigen (HBsAg) may be detected in the presence of acute or chronic hepatitis B virus (HBV) infection [ 281 ]; it indicates that the person is infectious. In acute infection, its appearance predates clinical symptoms by 4 weeks and it remains detectable for 1–6 weeks. The tests for detecting hepatitis B and D disease are primarily serologic and molecular ( Table 62 ). Care providers should check with the laboratory on the minimum volumes of blood needed, as some molecular platforms require more blood than others.

Table 62.

Laboratory Diagnosis of Hepatitis B and D Viruses

Abbreviations: EDTA, ethylenediaminetetraacetic acid; IgG, immunoglobulin G; IgM, immunoglobulin M; NAAT, nucleic acid amplification test; PPT, plasma preparation tube; RT, room temperature; SST, serum separator tube.

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Table 62.

Laboratory Diagnosis of Hepatitis B and D Viruses

Abbreviations: EDTA, ethylenediaminetetraacetic acid; IgG, immunoglobulin G; IgM, immunoglobulin M; NAAT, nucleic acid amplification test; PPT, plasma preparation tube; RT, room temperature; SST, serum separator tube.

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The presence of hepatitis B surface antibody (HBsAb) indicates recovery from and immunity to HBV infection, as a result of either natural infection or vaccination. In most patients with self-limited acute HBV infection, HBsAg and HBsAb are not detectable simultaneously in serum or plasma.

Hepatitis B core (HBc) IgM antibody appears during acute or recent HBV infection and remains detectable for about 6 months. A serologic “window” occurs when HBsAg disappears and HBsAb is undetectable. During this “window” period, infection can be diagnosed by detecting HBc IgM antibody.

HBc total antibodies appear at the onset of symptoms of acute hepatitis B infection and persist for life. Their presence indicates acute (positive HBc IgM antibodies), recent (both HBc IgM and HBc total antibodies), or previous (positive HBc total antibodies but negative HBc IgM antibody) HBV infection. There is currently no commercially available test for HBc IgG antibody in serum or plasma.

A chronic HBV carrier state is defined by persistence of HBsAg for at least 6 months. In patients with chronic hepatitis B, the presence of hepatitis B e antigen (HBeAg) in serum or plasma is a marker of high viral replication levels in the liver. Loss of HBeAg and emergence of antibody to HBeAg (ie, HBe antibody) is usually associated with improvement of underlying hepatitis and a reduction in the risk of hepatocellular carcinoma and cirrhosis. Alternatively, disappearance of HBeAg may denote the emergence of a precore mutant virus; high concentrations of HBsAg and HBV DNA, in the absence of HBeAg and presence of HBe antibody, suggest the presence of a HBV precore mutant virus. Hepatitis B viral DNA is present in serum or plasma in acute and chronic hepatitis B infection [ 282 ]. Quantification of HBV DNA in serum or plasma may be included in the initial evaluation and management of chronic hepatitis B infection, especially when the serologic test results are inconclusive or when deciding treatment initiation and monitoring a patient’s response to therapy. Other molecular laboratory tests used in the diagnosis and management of chronic hepatitis B infection have been reviewed and include assays for determining viral genotype, detection of genotypic drug resistance mutations, and core promoter/precore mutations [ 282 ].

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