Hai An

Hai An


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Hai An Steam Frigate

The Hai An was one of the largest warships built in China before the 1930s, and was a three-masted steam frigate that had a rather undistinguished career.

She was built at the Kiangnan dockyard, and was launched in 1872. Her sister ship, the Yu-yuen, followed in 1873. Both ships were three-masted frigates, with a single funnel and a top speed of 12 knots. They carried a mixed armament, with two 9in muzzle loading guns carried on the upper deck and either twenty-four 70pdrs or twenty-five 56pdr Krupp guns carried in a traditional broadside position on the main deck.

The two ships were the largest warships to be built in China until the cruiser Ping Hai in the 1930s, but by the time they were launched they were already out of date. In addition they were built form inferior pine, and were said to have begun decaying very soon after being built. Although they were considered to be attractive looking ships they weren't very seaworthy.

After she entered service the Hai An was used as a training vessel. During the undeclared war against France of 1884 she was moved to Shanghai for possible use as a blockship. She was filled with stones and anchored close to the bar of the Whangpoo River. The French decided not to risk an attack on Shanghai, where the numerous foreign concessions made fighting difficult. After the end of the fighting the Hai An was towed back to her normal base, suggesting that she was already effectively unseaworthy. Her eventual fate is unclear, but she was probably scrapped a few years after the confrontation with the French.

Displacement

2,630t

Top Speed

12kts

Length

300ft

Width

42ft

Armaments as built

Two 9in guns
Twenty four 70pdr guns

Armament after refit

Two 8.2in Krupp guns
Four 5.9in and twenty 4.7in Krupp guns

Crew complement

372

Launched

24 May 1872


Control of Health-Care--Associated Infections, 1961--2011

Corresponding author: Richard E. Dixon, MD, Regional Medical Director Health Net of California, Inc., 11971 Foundation Place Rancho Cordova, CA 95670 Telephone: 916-935-1941 Fax 800-258-3506 E-mail: [email protected]

Introduction

For centuries, hospitals have been known as dangerous places. In 1847, Ignaz Semmelweis presented evidence that childbed fever was spread from person to person on the unclean hands of health-care workers (1). Semmelweis's findings did not immediately improve sanitary conditions in hospitals, but surgeons gradually adopted aseptic and antiseptic techniques and became leading innovators of techniques to reduce patients' susceptibility to postoperative infections. Concerns about the spread of infection by air, water, and contaminated surfaces gradually changed practices in hospitals, making them safer. During the 1950s, epidemic penicillin-resistant Staphylococcus aureus infections, especially in hospital nurseries, captured the public's attention and highlighted the importance of techniques to prevent hospital-acquired infections, now also referred to as health-care--associated infections (HAIs i.e., nosocomial infections) (2). By the mid-20th century, some surgeons, microbiologists, and infectious disease physicians had focused their studies on the epidemiology and control of HAIs (3,4). From the efforts of these pioneers grew the notion that hospitals had the ability---and the obligation---to prevent HAIs.

By the 1960s, hospital-based infection control efforts had been established in scattered hospitals throughout the United States. The number of hospitals with HAI control programs increased substantially during the 1970s, and HAI control programs were established in virtually every U.S. hospital by the early 1990s. The remarkable spread and adoption of programs designed to prevent and control HAIs hold valuable lessons about the ways that other public health initiatives can be designed, developed, and implemented. This report traces the strategic and tactical steps used to bring about a major public health success: the ubiquity of formal established infection control programs in virtually all U.S. hospitals and expanding into other health-care settings.

Developing the Public Health Model for Hospital Infection Control

By the late 1950s and early 1960s, a small proportion of hospitals had begun to implement programs designed to understand and control HAIs. The pioneering leaders of those efforts were located mostly in large, academic medical centers, not in public health agencies. Although state, local, and federal public health agencies were sporadically called on to provide epidemiologic or laboratory support to investigate particular problems, they did not consider hospitals as communities needing ongoing public health resources. Nor did hospitals routinely see themselves as communities needing such assistance. During the 1950s and even afterwards, many hospitals saw themselves as "the doctor's workshop" and their roles as providers of space and personnel to support practicing physicians. In most communities, a hospital was perceived as good because doctors who practiced there were perceived as good, not because the hospital's outcomes were better than its competitors'. Focused on patients and doctors as individuals, most hospitals neither tracked nor had systems in place designed to improve their overall outcomes public health--based and population-based principles often were not important management priorities. The nosocomial staphylococcal epidemics of the 1950s began to change those attitudes.

History did not record who first understood---or when it was first recognized---that hospitals are discrete communities in which public health principles could be used to prevent and control HAIs. But by the 1960s, hospital-based clinicians and CDC epidemiologists clearly were beginning to apply a public health model to HAIs. That model was built around systematic surveillance to identify HAIs ongoing analysis of surveillance data to recognize potential problems application of epidemic investigation techniques to epidemic and endemic HAIs and implementation of hospitalwide interventions to protect patients, staff, and visitors who seemed to be at particular risk.

One might assume that the public health system would have managed the public health approach to HAIs. It did not. Instead, a different approach evolved. Hospitals built and managed their own infection control programs. The historical record is murky as to why infection control programs became the responsibility of hospitals, rather than local, state, or national public health agencies. Although many exceptions certainly existed, hospitals generally did not work closely with their local health departments, and when they did interact, the health departments were sometimes seen to be regulators, not colleagues. A perception at the time was that most health departments had little interest in the hospitals' clinical activities.

Given the absence of a tradition of collaboration between community hospitals and local health departments, two of CDC's first public health research and development activities were embedded in hospitals themselves. One was a national network of hospitals that volunteered to conduct HAI surveillance by using CDC methods and to report those data to CDC each month. That voluntary surveillance system, the National Nosocomial Infection Surveillance program, has changed over the years but remains active as the National Healthcare Safety Network (NHSN http://www.cdc.gov/nhsn/) and continues to provide information about the changing patterns of HAIs.

The second of CDC's research projects also was located in community hospitals, and it profoundly affected the evolution of infection control programs. The Comprehensive Hospital Infections Project (CHIP) was begun in 1965 (5). Eight community hospitals, which were located in different cities across the country, participated in the project. Those hospitals served as the laboratories where surveillance and control techniques were developed. CDC funded those activities, and Atlanta-based CDC staff actively collaborated in the research. Physician and nurse epidemiologists, along with CDC microbiologists, visited CHIP hospitals regularly and conducted studies to learn the epidemiology of HAIs. CHIP studies helped to define how HAIs could be identified and distinguished from community-acquired infections. Hospital staff and CDC epidemiologists explored what data were needed to improve practices and how those data should be analyzed and reported. That direct field epidemiology experience gave CDC important insights into the ways that community hospitals worked. The close interactions with the hospitals undoubtedly helped CDC develop unique recommendations that were credible to hospitals and practical for them to use.

CDC's decision to use community hospitals for some of its early research was a strategic one. Most hospital inpatients were---and still are---treated in community hospitals. Although CDC staff interacted closely and shared ideas with leading infectious disease experts in the United States and Europe, CDC's involvement with community hospitals made the resulting infection control models and techniques more likely to be appropriate for use in the kinds of institutions where most patients get hospital care.

Promoting the Public Health Model to All U.S. Hospitals

As the infection control community developed confidence in the value of infection control programs, the next task was to assist other hospitals to adopt them voluntarily. Two barriers were obvious. First, hospitals were not required to have such programs, so the value of the activities had to be promoted to hospital administrators and clinical staffs. Because they recognized such programs as advantageous to the hospital and its patients, many hospitals voluntarily adopted and paid for such programs.

The second problem posed a larger challenge. Because local and state health departments did not have the resources to place their personnel in every hospital needing an infection control program, where would the trained infection control specialists come from? Existing hospital personnel had to be recruited and trained to use entirely new public health and epidemiologic skills.

The new jobs were often filled by existing staff nurses and laboratorians who built new careers as infection control practitioners (ICPs). The ICPs usually were supervised by hospital epidemiologists---typically physicians selected from the existing medical staff, such as pathologists or infectious disease--trained physicians. These doctoral-level program directors often were hired to provide this service part time, and many volunteered to serve without pay. Both positions---ICP and hospital epidemiologist---were newly created positions, and at the time, few ICPs or hospital epidemiologists had more than cursory formal training in epidemiology or any other public health discipline.

Training for these new careers often took place informally, on the job, by networking with colleagues in other hospitals, and by taking brief training courses. Many of the pioneer infection control programs were staffed by practitioners who had either attended a week-long training course conducted at CDC or had been trained by another practitioner who had been trained at CDC. As a result, the knowledge and attitudes of the earliest infection control staff had considerable uniformity. Those pioneers soon became the leaders of their new fields and naturally became the teachers and consultants for new practitioners. The public health model became an unofficial standard of practice it focused on active prospective surveillance, data analysis, and reporting, and it emphasized prevention programs that relied on the education of hospital staff about infection control techniques.

Although using existing hospital staff and retraining them for their new jobs provided many advantages, this practice also had unanticipated disadvantages. Few infection control pioneers brought investigative experience to their new positions. As a result, when problems were discovered by surveillance, instead of basing interventions on locally acquired epidemiological and laboratory evidence, often they were based merely on established guidelines and recommendations that seemed logically to make the most sense. The evidence base for many of those guidelines was not strong, however, because effectiveness studies of intervention programs had rarely been conducted.

Infection Control Becomes a Profession

The rapid growth and acceptance of infection control programs was undoubtedly stimulated by the new career possibilities offered by the emerging infection control field. Staff nurses, microbiologists, pathologists, and infectious disease clinicians were eager to become part of a field that provided new skills and offered new opportunities. The professionalization of infection control practice was strengthened when, in 1972, infection control practitioners formed a professional society, the Association of Practitioners in Infection Control (APIC, now the Association for Professionals in Infection Control and Epidemiology). APIC was formed to provide practitioners with continuing professional interaction, education, and growth. A certifying program based on practitioners' education, experience, and test scores followed in 1980, further establishing infection control as an attractive career.

The hospital epidemiologists followed soon afterwards in forming their own professional society, the Society of Hospital Epidemiologists of America (SHEA), now The Society for Healthcare Epidemiology of America. Its initial membership requirements allowed only physicians to join, and physician infectious disease subspecialists accounted for most of its early members. Only several years after its founding were nonphysician epidemiologists, sanitarians, microbiologists, and other doctoral-level practitioners able to join SHEA. The doctoral-level societies were also divided. Surgeons interested in hospital-acquired infections formed their own society: the Surgical Infection Society (SIS). SIS, like the other professional associations, has expanded membership to other categories of physicians, nurses, and others with an interest in surgical infections. SIS, SHEA, and APIC have not merged, although they have developed collegial working relationships and have important collaborations.

Although the development of trained professional cadres of infection control experts in every hospital seems to be an obvious benefit, it must be asked whether infection control would have been more innovative and might have advanced faster if the practitioners of the new careers had welcomed other disciplines and other kinds of expertise into the field earlier. Would that have promoted innovation? Would it have led to faster development of an evidence base for infection control? Perhaps so. Public health officials need also to consider this question as they develop and deploy new approaches to public health practice.

Transforming Infection Control from Movement to Mandate

By the late 1970s, the infection control field was well established. It had strong presences in hospitals across the country, organized work forces, a coherent model that guided the field's activities, and a rapidly expanding body of scientific publications. A decade earlier, during the late 1960s and early 1970s, however, that degree of success was not certain. During the early 1970s, the hospital infection control movement faced the same challenges as many other public health initiatives have before it: how to increase adoption by more communities and how to convert a good idea into a virtual mandate for action.

By the mid-1970s, HAIs were recognized as a major threat associated with medical care. Despite the increasing public and professional concern about HAIs, it became apparent during the mid-1970s that not all hospitals were adopting infection control programs. CDC had ready access to national professional societies, health-care trade associations, accrediting organizations, and regulatory agencies, but infection control programs, although encouraged, were not mandated. Some hospitals had no programs at all. Other hospitals had programs, but no requirement existed to ensure they were properly staffed, well structured, or effective. The absence of a requirement that hospitals have effective infection control programs to protect the public was due, in part, to the fact that the evidence for the effectiveness of the public health model for infection control programs was mostly only anecdotal. It had a compelling story it seemed like a good thing to do but it was not evidence based.

CDC determined that a rigorous scientific assessment of the effectiveness of infection control programs would be necessary to propel widespread adoption of hospital-based programs. That decision led to the Study on the Effectiveness of Nosocomial Infection Control (SENIC), a rigorous assessment of infection control effectiveness that compared outcomes in hospitals with and without CDC-style infection control programs (6). The study was designed to determine whether infection control programs using CDC-recommended practices actually reduced the risks from HAIs. To conduct the study, 338 U.S. hospitals were randomly selected and were stratified by geography, inpatient bed capacity, and teaching status. Approximately half of the study hospitals had established infection surveillance and control programs. When that study showed that hospitals with infection control programs had significantly lower rates of HAIs than did hospitals without such programs (7), expectations for hospital programs changed. With strong scientific evidence supporting the value of such programs, accrediting organizations such as the Joint Commission on Accreditation of Hospitals (now The Joint Commission) mandated that accredited hospitals have infection control programs similar to those recommended by CDC and the professional organizations of hospital epidemiologists and infection control practitioners. The Joint Commission made this an accreditation requirement in 1976 (8).

The SENIC study converted a movement into a mandate. Although it is widely agreed that new treatment interventions for individual patients should be tested in rigorous clinical trials, such trials are much less common for large population-based interventions. The design and conduct of assessments for population-based interventions can be difficult scientifically, legally, and ethically. They also can be expensive, and often no commercial company is interested enough to sponsor such studies. As a result, SENIC-style studies are rarely conducted by public health agencies.

Beyond its revolutionary effect on infection control practices in hospitals, the SENIC study served as an example that rigorously conducted public health research can change the credibility and acceptability of public health interventions and can speed adoption of important programs. It established how, when a public health problem is important enough, a scientifically rigorous population-based assessment can be used to propel the implementation of effective programs. In the future, public health programs are likely to face ever-greater demands for proof of worth and more competition for support, and more SENIC-style studies may be needed.

Hospital Epidemiology in the New Century

CDC continues to play an important role in HAI prevention research. CDC's Division of Healthcare Quality Promotion (DHQP) has substantial expertise in HAI control, stemming in part from decades of experience in HAI epidemiologic investigations. That, along with its central role in the public health infrastructure, gives CDC a unique opportunity and responsibility to guide and support research that directly addresses the knowledge gaps most relevant to the public health.

In addition to the important research contributions that arise directly from the core activities of outbreak investigation, laboratory support, and HAI surveillance, CDC dedicates funds for innovative extramural HAI prevention research through its Prevention Epicenter Program. DHQP began the Prevention Epicenters Program in 1997 as a way to work directly with academic partners to address important scientific questions about the prevention of health-care--associated infections, antibiotic resistance, and other adverse events associated with health care. Through a collaborative funding mechanism, DHQP staff work closely with a network of academic centers to foster research on the epidemiology and prevention of HAI, with an emphasis on multicenter collaborative research projects. The program has provided a unique forum in which leaders in health-care epidemiology can collaborate with each other and with CDC to pursue innovative research endeavors that bring into alignment both academic and public health research goals and objectives and create important synergies that might not be possible for a single academic center or without the benefit of cross-fertilization of ideas between academic and public health experts.

Research conducted through the Epicenters program has produced valuable contributions to the field and to the mission of DHQP. The program has resulted in approximately 150 peer-reviewed publications that cover a broad array of topics relevant to HAI prevention, including the epidemiology of infections caused by multidrug-resistant organisms and Clostridium difficile development and testing of novel prevention strategies, such as the use of chlorhexidine bathing to prevent bloodstream infections and pathogen transmission among intensive-care unit patients and development of novel HAI surveillance strategies that are helping to shape the future of HAI surveillance through the National Healthcare Safety Network. CDC should seek to maintain an active participatory role in HAI research.

As CDC plans its research agenda, another lesson taught by the development of infection control as a public health discipline should be remembered: sometimes public health agencies need to actually conduct research, not just fund it. CDC's credibility obtained through its own research was an essential factor in its ability to promote infection control programs. Working in hospitals, collecting data, and conducting field studies alongside hospital workers gave CDC a unique understanding of the challenges that hospital-based infection control personnel face. As a result, CDC recommendations were more likely to be useful and appropriate than they would have been had CDC simply funded others to do its research. Learning the subtleties of what did not work or what was impractical to implement was perhaps more important than learning what did work, and this was learned best by the agency conducting the research itself.

The landscape of infection control and health-care epidemiology began another dramatic shift with the publication of the Institute of Medicine (IOM) report, To Err is Human, in 1999 (9). This report revealed that thousands of patients in U.S. hospitals were injured or died each year because of medical errors---many of which might have been preventable. HAIs were recognized as a leading cause of these preventable harms. This report was followed by an influential series of investigative articles on health-care--associated infections published by the Chicago Tribune. These reports underscored the findings of the IOM report on the major public health effects of HAIs and criticized hospitals for failing to prevent these infections and keeping secret the scope of the problem. The IOM report and Chicago Tribune articles touched off an active debate about HAI prevention and spurred action by consumers and legislatures. In 2002, four states (Illinois, Florida, Missouri, and Pennsylvania) passed laws to mandate that health-care facilities report HAIs to the public. Proponents of the legislation argued that health-care facilities would finally begin to take real steps toward preventing HAIs if they had to disclose them more openly.

Public interest in HAIs reached an important tipping point in 2005--2006 with the publication of two studies about the prevention of central line--associated bloodstream infections (CLABSIs). One study was a collaboration between CDC and the Pittsburgh Regional Healthcare Initiative and the other a collaboration between researchers at Johns Hopkins University Hospital and the Michigan Hospital Association (10,11). Both studies brought together staff from a large number of intensive-care units who collaborated to reduce CLABSIs by implementing a relatively simple set of interventions. The results of the studies were striking and consistent. In each, CLABSIs were reduced by roughly 65%.

Increasing awareness of the scope of the HAI problem, coupled with the recognition that a substantial portion of these infections could be prevented, galvanized even more consumers and policy makers to take action. Many other state legislatures began to debate and pass laws to mandate the public reporting of HAIs. In recognition of the growing interest in so-called public reporting, CDC worked with the Healthcare Infection Control Practices Advisory Committee to develop recommendations to help guide future legislation (12). These laws have now become widespread. Twenty-eight states have passed legislation that requires the public reporting of one or more HAIs, and legislation is pending in others. Federal lawmakers also have taken up the HAI issue. In 2008, as part of the larger deficit-reduction act, Congress mandated that the Center for Medicare and Medicaid Services (CMS) stop giving hospitals increased payments for the care of patients with HAIs. CMS worked closely with CDC to identify HAIs that were "reasonably preventable" to support implementation of this requirement. In 2010, Congress incorporated HAI prevention into the Value Based Purchasing program of the Affordable Care Act. CMS has elected to implement the requirement by requiring national public reporting of HAIs, beginning with CLABSIs in 2011.

CDC is playing a central role in supporting legislative mandates on HAI reporting and prevention. Laws in 22 of the 28 states that require reporting of HAIs specifically stipulate that facilities use the CDC's NHSN as the platform for that reporting. Likewise, the new CMS mandate will require submission of data to NHSN. These requirements have led to a dramatic expansion in NHSN enrollment, from roughly 300 hospitals in 2006 to approximately 3,500 in 2010. Increasingly, state health departments, with support from CDC, are leading HAI prevention efforts. Their role in HAI prevention was recognized and greatly enhanced in 2009 with passage of the American Recovery and Reinvestment Act. That legislation included $50 million to support state-based HAI prevention efforts. American Recovery and Reinvestment Act funds were distributed through CDC's Epidemiology and Laboratory Capacity grant to support state efforts to build HAI infrastructure and expand surveillance and prevention efforts. CDC staff and experts are now supporting HAI prevention efforts in 49 funded states, the District of Columbia, and Puerto Rico. Specifically, CDC subject-matter experts are helping guide the expansion and validation of HAI surveillance data and the initiation and expansion of HAI prevention.

Conclusions

Efforts to prevent and control HAIs have led to profound changes in the ways that those infections are perceived and managed in the United States and abroad. Programs focused on preventing and controlling HAIs were rare in U.S. hospitals in the early 1970s now, they are present in virtually every hospital in the nation and in many hospitals abroad.

Among the main factors that led to this success was, most importantly, CDC's decision to use a rigorous scientific study, the SENIC study, to demonstrate that infection control programs were effective. This evidence obtained from SENIC converted infection control programs from being something worth doing into programs that must be implemented to reduce illness and death. Before SENIC, the evidence for the effectiveness of infection control programs was insufficient to make these programs mandatory. With evidence from SENIC, it was virtually impossible for hospitals to avoid implementing them.

CDC's ability to work with others to design and refine infection control programs was almost certainly aided by CDC's direct field experience investigating epidemics. Perhaps even more important was CDC's experience working directly with hospitals over a long period to design and test surveillance and control techniques. That first-hand field epidemiology helped CDC to learn how hospitals function and to design infection control programs that were practical and could be implemented.

CDC and other pioneers helped to define a new field (hospital epidemiology) and new professional disciplines (infection control and hospital epidemiology). When no training courses or job descriptions existed for those essential hospital workers, CDC provided the key early training and job-development resources used by a large proportion of infection control pioneers. Because of CDC's early dominance in defining the work of these new disciplines, CDC profoundly affected knowledge base, work activities, and extent of the practitioners' responsibilities.

Finally, hospital epidemiology was, for many years, a misleading title for a field that mainly focused on HAIs. As the patient safety movement has vividly shown, the opportunities for strong public health skills in hospitals extend far beyond mere infection control. CDC has the capacity to continue to support that effort and thereby help prevent the range of errors, omissions, and other preventable mishaps that still plague the organizations that should heal, not harm.


Bahá'u'lláh

One of the Báb's earliest and most ardent disciples was Mirza Hoseyn 'Ali Nuri, who had assumed the name of Bahá'u'lláh ("Glory of God") when he renounced his social standing and joined the Babis.

Bahá'u'lláh was arrested in 1852 and jailed in Tehran. During his imprisonment, he realized he was the prophet whose coming had been predicted by the Bab.

He was released in 1853 and exiled to Baghdad, where his leadership revived the Babi community. In 1863, shortly before being moved by the Ottoman government to Constantinople (now Istanbul, Turkey), Bahá'u'lláh declared to his fellow Babis that he was the messenger of God foretold by the Bab. An overwhelming majority of Babis acknowledged his claim and thenceforth became known as Bahá'ís.

Bahá'u'lláh was subsequently confined by the Ottomans in Adrianople (now Edirne, Turkey) and then exiled to Acre in Palestine (now 'Akko, Israel).


Hoi An Ancient Town

Hoi An Ancient Town is an exceptionally well-preserved example of a South-East Asian trading port dating from the 15th to the 19th century. Its buildings and its street plan reflect the influences, both indigenous and foreign, that have combined to produce this unique heritage site.

Description is available under license CC-BY-SA IGO 3.0

Vieille ville de Hoi An

Hoi An constitue un exemple exceptionnellement bien préservé d'une cité qui fut un port marchand d'Asie du Sud-Est du XV e au XIX e siècle. Ses bâtiments et la disposition de ses rues reflètent les traditions autochtones aussi bien que les influences étrangères, qui ont donné naissance à ce vestige unique.

Description is available under license CC-BY-SA IGO 3.0

مدينة هوي - آن القديمة

تجسد مدينة هوي- آن مثالاً سليماً لمدينة شكلت مرفأ تجارياً جنوب شرق آسيا من القرن الخامس عشر ولغاية القرن التاسع عشر. وتعكس أبنيتها وتصميم شوارعها التقاليد المحلية والتأثيرات الخارجية التي أدّت الى نشوء هذا الأثر الفريد.

source: UNESCO/ERI
Description is available under license CC-BY-SA IGO 3.0

source: UNESCO/ERI
Description is available under license CC-BY-SA IGO 3.0

Исторический город Хойан

Исторический город Хойан – это пример исключительно хорошо сохранившегося торгового порта в Юго-Восточной Азии, относящегося к периоду XV-XIX вв. Его застройка и планировка сложились под воздействием как местных традиций, так и пришлых культур, в результате чего и сформировался этот уникальный объект наследия.

source: UNESCO/ERI
Description is available under license CC-BY-SA IGO 3.0

Ciudad vieja de Hoi An

Hoi An constituye un ejemplo excepcional de lo que fue una ciudad portuaria mercantil del Asia Sudoriental entre los siglos XV y XIX. Sus edificios y el trazado de sus calles son un fiel reflejo de la combinación de estilos arquitectónicos, autóctonos y extranjeros, que ha dado su fisionomía singular a este sitio único en su género.

source: UNESCO/ERI
Description is available under license CC-BY-SA IGO 3.0

古都ホイアン
Oude stad Hoi An

De oude stad Hoi An is een bijzonder voorbeeld van een traditionele handelshaven in Zuidoost-Azië die volledig en uitzonderlijk goed bewaard is gebleven. Het merendeel van de gebouwen is gebouwd in de traditionele 19e en 20e-eeuwse bouwstijl. Zowel de gebouwen als het stratenplan weerspiegelen inheemse en buitenlandse invloeden. De stad kent veel religieuze gebouwen zoals pagodes, tempels en vergaderhuizen, ontstaan door toedoen van de havengemeenschap in Hoi An. De traditionele levensstijl, godsdienst en (culturele) gewoonten zijn bewaard gebleven en veel festivals vinden nog steeds jaarlijks plaats.

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Outstanding Universal Value

Brief synthesis

Hoi An Ancient town is located in Viet Nam’s central Quang Nam Province, on the north bank near the mouth of the Thu Bon River. The inscribed property comprises 30 ha and it has a buffer zone of 280 ha. It is an exceptionally well-preserved example of a small-scale trading port active the 15th to 19th centuries which traded widely, both with the countries of Southeast and East Asia and with the rest of the world. Its decline in the later 19th century ensured that it has retained its traditional urban tissue to a remarkable degree.

The town reflects a fusion of indigenous and foreign cultures (principally Chinese and Japanese with later European influences) that combined to produce this unique survival.

The town comprises a well-preserved complex of 1,107 timber frame buildings, with brick or wooden walls, which include architectural monuments, commercial and domestic vernacular structures, notably an open market and a ferry quay, and religious buildings such as pagodas and family cult houses. The houses are tiled and the wooden components are carved with traditional motifs. They are arranged side-by-side in tight, unbroken rows along narrow pedestrian streets. There is also the fine wooden Japanese bridge, with a pagoda on it, dating from the 18th century. The original street plan, which developed as the town became a port, remains. It comprises a grid of streets with one axis parallel to the river and the other axis of streets and alleys set at right angles to it. Typically, the buildings front the streets for convenient customer access while the backs of the buildings open to the river allowing easy loading and off-loading of goods from boats.

The surviving wooden structures and street plan are original and intact and together present a traditional townscape of the 17th and 18th centuries, the survival of which is unique in the region. The town continues to this day to be occupied and function as a trading port and centre of commerce. The living heritage reflecting the diverse communities of the indigenous inhabitants of the town, as well as foreigners, has also been preserved and continues to be passed on. Hoi An Ancient Town remains an exceptionally well-preserved example of a Far Eastern port.

Criterion (ii): Hoi An is an outstanding material manifestation of the fusion of cultures over time in an international commercial port.

Criterion (v): Hoi An is an exceptionally well-preserved example of a traditional Asian trading port.

Hoi An Ancient Town has retained its original form and function as an outstanding example of a well-preserved traditional South East Asian trading port and commercial centre. It remains complete as a homogenous complex of traditional wooden buildings, with the original organically developed street plan, within the town’s original river/seacoast setting.

These original cultural and historic features demonstrate the town’s outstanding universal value and are present, well-preserved, and evident within the boundary of the inscribed property, even while it continues to be occupied and function as a trading port, as well as a popular tourism destination. As a result of this economic stagnation since the 19 th century, it has not suffered from development and there has not been pressure to replace the older wooden buildings with new ones in modern materials. This has ensured that the town has retained its traditional urban tissue and is preserved in a remarkably intact state.

Authenticity

Hoi An Ancient Town has retained its traditional wooden architecture and townscape in terms of plot size, materials, façade and roof line. Its original street plan, with buildings backing on to the river, with its infrastructure of quays, canals and bridges in its original setting, also remains. The historic landscape setting is also intact, consisting of a coastal environment of river, seashore, dunes and islands.

Because most of the buildings were constructed in wood it is necessary for them to be repaired at intervals, and so many buildings with basic structures from the 17th and 18th centuries were renewed in the 19th century, using traditional methods of repair. There is currently no pressure to replace older buildings with new ones in modern materials such as concrete and corrugated iron.

Protection and management requirements

Hoi An Ancient Town was classified as a National Cultural Heritage Site in 1985 and subsequently as a Special National Cultural Heritage Site under the Cultural Heritage Law of 2001 amended in 2009. The entire town is State property and is effectively protected by a number of relevant national laws and governmental decisions, such as: the Cultural Heritage Law (2001, amended 2009) and the Tourism Law (2005). The 1997 Hoi An Town Statute defines in regulations that are implemented by the Hoi An Center for Monuments Management and Preservation, the responsible agency of the People’s Committee for the management of the property. Day-to-day management involves collaboration with various stakeholders, to maintain the authenticity and integrity of the property and to monitor socio-economic activities within and adjacent to the property. The capacity of the professional staff has been and continues to be developed by many domestic and international training courses. Revenue from entrance tickets is invested directly in the management, preservation and promotion of the property. Management and preservation are further strengthened through master planning and action plans at the local level. There are also regular restoration and conservation programmes.

Multi-disciplinary research conducted by teams of international and national scholars has informed the conservation and interpretation of the town’s heritage. This research is on-going. Within the property boundary, the landscape, the townscape, the architecture and all material cultural artifacts are preserved.

A Management Plan was implemented at the time of nomination of the property, and is being kept up to date and reviewed as required by UNESCO to ensure that it remains effective.

The buffer zone is managed to protect the property from external threats. The potential adverse effects to the property caused by annual flooding and urbanization are being effectively controlled with the active participation of all authorities and the local community.

The Master Plan for the Hoi An Ancient town conservation, restoration and promotion together with the city and tourism development was approved by Prime Minister on 12 January 2012, covered the period until 2025.

Long-term management should aim to promote improvement in the living conditions for local residents. As tourism increases a strategy to manage it within the parameters of the site will be required. Strategies to deal with adverse effects of the climate are being developed and should be included in the Management Plan.

In the future, it is an aim to link the Hoi An Ancient Town with the adjacent UNESCO Cu Lao Cham Biosphere Reserve and to build Hoi An into a community integrating ecology, culture and tourism.


The Move to Shelter Island

Built in 1953 and originally one of several Christian’s Hut locations, the iconic Bali Hai Restaurant on San Diego’s Shelter Island is one of the oldest classic mid-century Tiki establishments still thriving. It became Bali Hai in 1954, with owner Tom Ham eventually gaining total control of the operations, then passing it along to his family after his death in 1973.


HAI History

The Harvard AIDS Institute was established in 1988 by Harvard University President Derek Bok and Harvard School of Public Health (HSPH) Dean Harvey Fineberg. Initial seed funding for HAI was provided by the office of the President Bok and the offices of the Dean of HSPH and the Dean of Harvard Medical School (HMS). Additional seed funding came from Professor Max Essex’s and HSPH patent royalties for the widely-used HIV-blood screening test that was developed from the research conducted by Essex and his colleague, Dr. Tun-Hou Lee.

Max Essex was named Chair of HAI and has been so every since. HAI focused on innovative, cutting edge research concerning the pathogenesis of the AIDS virus and the dynamics of the epidemic.

As the number of AIDS cases continued to escalate disproportionately in Africa and other resource scarce settings, HAI directed its research efforts toward developing prevention and treatment strategies to stem the epidemic in these regions. International partnerships were created with on-the-ground efforts with specific countries affected by the epidemic, including Thailand, Senegal, Botswana, Nigeria, Tanzania, and South Africa.

Official opening of the BHP headquarters in 2001

In 1996, HAI partnered with Botswana’s Ministry of Health to form the Botswana Harvard AIDS Institute Partnership (BHP). In 2001, at a ceremony on World AIDS Day, the BHP officially opened its state-of-the-art laboratory and headquarters on the grounds of Princess Marina Hospital in Gaborone, the capital of Botswana.

In 2004, the Harvard AIDS Institute changed its name to the Harvard School of Public Health AIDS Initiative to better reflect the the base of activity at the School of Public Health. In 2015, HAI officially became the Harvard T.H. Chan School of Public Health AIDS Initiative as the School changed its name to honor a generous gift from the Chan family.

Today, Max Essex and other scientists at HAI who helped pioneer the field of HIV research continue their efforts, working side-by-side with students and colleagues from the U.S . and around the world.


How to View, Search and Delete History in Safari

Go to History > Show All History at the top of the browser to view your Safari history. All of your recently visited sites are listed on a single page, sorted by day. For the mobile app, tap the bookmarks icon on the bottom and then the clock icon at the top.

Look through your Safari history from the History page. Start typing into the text box at the top of the page, and the results populate instantly.

To delete single search history items from Safari, locate what you want to remove and right-click it to find the Delete option. You can delete an entire day's worth of history, too.

Mobile Safari users can selectively delete history items by swiping to the left and then tapping Delete.

To delete all search history in Safari, use the Clear History button on the History page. Choose how much to remove — the last hour, today, today and yesterday, or all history — and then choose Clear History.

The Safari app lets you delete all your history, too, via the Clear button on the bottom of the History page.


Start Your Museum CMS Selection Process with a Needs Assessment

Bringing Your Stories to Life

While the information in any history must be curated, organized, and shared&ndashcontent development and storytelling is about framing and communicating your narrative in a professional and meaningful way.

Making History Engaging and Profitable

Providing you with the comprehensive historical research that you need to move forward with development, restoration, and adaptive reuse projects involving historic properties

Detectives for the Most Challenging Research Questions

Providing discreet and time-sensitive historical research, data, and analysis to law firms in support of complex legal matters, regulatory compliance, and public relations.

Bringing Order Out of Chaos

Your organization knows how quickly electronic records and historical materials can accumulate into a formidable web of information that requires substantial resource investments to untangle.

“HAI was recommended to me by University of MD, which houses our union archives. Best recommendation I ever received. Everyone’s needs are somewhat ‘custom’ we’re all a little different in the projects we are trying to grow. HAI met EVERY need that I had many of those were needs that I was unaware of until our relationship began. I would recommend HAI 100%.”

Robert Welch Director of Operations, United Brotherhood of Carpenters “The new installation is absolutely gorgeous. It has a wonderful layered look with images, graphics, text, objects – so engaging it just pulls you along.”

Bernadette Rogoff Curator of Museum Collections, Monmouth County Historical Association, (regarding HAI’s work on the Monmouth Battlefield State Park Visitor Center) “HAI’s planning, collaboration, and processing work was pivotal to our archives initiative. HAI’s archivists worked with us every step of the way. They ensured that an amazing collection of women religious stayed out of the backlog and became research ready to the public.”

Nadia Nasr Head of Archives & Special Collections, University Library, Santa Clara University "HAI provides the highest quality archival services and responsive collaboration to our University Library team. We can turn to HAI for innovative brainstorming and on the ground project support. What began in 2016 as a specific archives processing engagement has grown into a long-standing, collaborative partnership.”

Cate Rudowsky, PhD Dean of Libraries, Texas A&M University-Corpus Christi "HAI is a valuable partner in our efforts to preserve and share our archives and history with Baylor School’s current, past, and prospective students, families, and community members. We now have a real plan for safeguarding our historical archives and creating digital immersive experiences that create modern, meaningful connections with our school.”

Emmie Treadwell Director of Strategic Initiatives, Baylor School – Chattanooga, TN

Office Locations

HAI Headquarters:
300 N. Stonestreet Avenue
Rockville, MD 20850
Phone: 301.279.9697
Email: [email protected]

Satellite Offices:
• New York, NY
• Orlando, FL
• Los Angeles, CA


Hai An - History

With support from the Rose Community Foundation, we will be able to launch Witness to History—a new, online platform for learning with updated, digitized curriculum offering free access to teachers throughout the state to aid in Holocaust education. This website will be a free resource for educators and students and supports Colorado's newly legislated statewide education mandate for Holocaust and Genocide Studies in Colorado Public Schools (HB20-1336).

The website will present narrative profiles of Holocaust survivors who made Colorado their home. Their stories will be integrated into an interactive chronological timeline of the Holocaust and interactive maps keyed to events in the survivors' narratives. Drawing on archival materials and first-hand testimony, content will be mapped to existing lesson plans and the Colorado educational standards now in development under the new educational mandate.

Support for Witness to History

The Holocaust Awareness Institute at the Center for Judaic Studies in the College of Arts, Humanities & Social Sciences at the University of Denver is honored and thrilled to announce award of a $25,000 grant from the Rose Community Foundation to support our website project, Witness to History: Holocaust Education Today.

Founded in 1995, Rose Community Foundation strives to advance inclusive, engaged and equitable greater Denver communities through values-driven philanthropy. The Foundation envisions a thriving region strengthened by its diversity and generosity, and utilizes grantmaking, advocacy, donor engagement and community leadership to advance this aspiration.

We are so appreciative to the Rose Community Foundation for this support!


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