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English Dutch Dictionary
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punishable punishment punish punitive punk punk rock pun pupil puppet pup puppy purchase purchaser purchasing pure purge purity purple purpose purse pursue pursuit push button push put away put down put forward put in place put in put off put on put-on put out put putting put together put up put up with puzzle puzzling pyramid python quad quadruple quads quail quaint quake qualification qualifications qualified qualifier qualify qualitative quality quantify quantitative quantity quantum quarantine quarry quarterly quarter quartet quart quartz queen queer query questionable question about questioning questionnaire question quest queue quick quiet quill quilted quilt quintessential quit quits quiver quiz quota quotation quote rabbi


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After playing Fable for quite some time now I've come across some frustrating gameplay functions and how ridiculously time consuming or awkward it makes me feel when I play.
I'll start off with one of the most recent rants I've collected; One of the lead characters 'Walter' is carrying a torch through an underground cave system which leads to be extinguished. I like this element of gameplay as it's creating a claustrophobic reaction to the user, however when I can produce fire from my hands with magic I don't want to be sitting through a 2 minute cut scene where Walter is voilently trying to re-egnite his torch while I'm sitting in the background mashing B in attempts to aid the poor fellow.
Growing up playing PS2 games in my early teens manual saving became a very useful habit, whereas in Fable 3 (because I play xbox) the only way I can save is to press the home button, exit out and navigate save from that point. There's no other way (of which I can find) to access the game menu/options!
Remember back in Fable 2, you recieved one of those fantastic quests where a character would ask you to lead them to another town. Yeah those were fun times and easy money, Fable 3 makes me extremely uncomfortable during these quests. I don't see the need to 'hold hands' during these travels, sure it offers us a little emotional incentive towards our fellow man however when I'm a grown man holding another grown mans hand prancing through a forest there's not much else that can lead the imagination. I'm not against gay relationships or homophobic but does it need to look so camp in the game? So far my royal career seems very… fabulous.
I may point out in the 'wasting time' area that interacting with the NPCs seems so uneccessary, I loved in Fable 2 that I could interact and make emotions quickly and easily without hyperlinking into a seperate interface.
All that being said I do like playing the game, most of what I look for in RPG's is always buying random junk to make my house pretty or upgrading my stats and weapons to 1 hit wonder everything that comes infront of my path. I never played the first Fable however the 3rd is not living up to the expectations I had after playing the second unfortunately.
I expect that whatever is in Peter Molyneux's head is much more adventurous and the potential to be absolutely fantastic but he doesn't have the power to express it in words or design for the rest of us to witness.

subset: commoncrawl


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So all we see really is, Organics, Plastics and Inert Materials. The organic materials include all of the food waste, garden trimmings, scrap paper and cardboard. The plastic materials include all of the plastics remains otherwise not recycled. The inert fraction, which we take out, includes all of highly recyclable metals and minerals that we send back to recycling – like aluminum cans, metal pieces and glass bottles, that can be better served by recyclers within these particular materials segments.
Waste collection trucks pick up the household waste and delivers it to a Transfer station or Recycling center. At the center, all the highly valuable materials that can be recycled, like certain plastics, paper, cardboard, and metals are extracted for sale. The waste left over, known as 'Residual Waste', including organics, dirty plastics, paper, cardboard, and diapers are then delivered to a UBQ facility instead of being disposed of in a landfill dump or burned in an incinerator.
When the residual waste arrives at the UBQ facility, it is pre-sorted and screened to ensure there are no additional materials that can be recycled. We particularly focus on inert and abrasive materials like metals and glass. This inert fraction is sent back to the MRF.
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UBQ makes sure to leverage every kilo of solid material input and output, putting it all to good use. In our processing steps we remove the recyclable inert materials and send them back to the recyclers while we use all the rest to convert it into our up-cycled bio-based UBQ Material.
By investing in and building an in-house waste screening and processing waste division, UBQ has been able to test and control all parameters of the incoming residual waste feedstock. This has enabled us to ensure that the UBQ Process can handle seemingly varying levels of different material fractions within the residual household waste streams.
So whether the waste is coming in the summer or winter, high income or low income neighborhoods, in different cities or countries, UBQ has a system in place to handle and mange it all.
UBQ has developed an internal quality control system to be able to test the input and output materials on every step of its processing stages. This enables us to confidently support our materials adhere to the approvals and certifications required by prospective customers.
UBQ has an extensive intellectual property portfolio of provisional and granted patents worldwide focused primarily on our innovative process (Method) and our sustainable material (Composition of Matter). This includes granted patents in Europe, Eurasia, USA, China, India, Canada, Singapore, Israel and Japan to mention a few. We are committed to our long-term R&D efforts aiming to expand our IP and know-how base while focusing on new developments and solutions to the waste and materials sectors.


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SAMJ: South African Medical Journal
versión On-line ISSN 2078-5135
versión impresa ISSN 0256-9574
SAMJ, S. Afr. med. j. vol.104 no.5 Cape Town may. 2014
Reliability and accuracy of the South African Triage Scale when used by nurses in the emergency department of Timergara Hospital, Pakistan
M K DalwaiI, II; M TwomeyIII; J MaikereIV; S SaidV; M WakeeVI; J-P JemmyVII; P VallesVII; K Tayler-SmithVIII; L WallisIX; R ZachariahIX
IMB ChB. Médecins Sans Frontières, Pakistan
IIMB ChB. Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
IIIBSc, PhD. Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
IVMB ChB, FCS, PhD. Médecins Sans Frontières, Pakistan
VBSc (Nursing) Médecins Sans Frontières, Pakistan
VIMB ChB. Ministry of Health, Islamabad, Pakistan
VIIMB ChB. Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg
VIIIMédecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg
IXMB ChB, FCEM, PhD. Division of Emergency Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
XMB ChB. Médecins Sans Frontières, Medical Department (Operational Research), Operational Centre, Brussels, Belgium, MSF-Luxembourg (LuxOR), Luxembourg
BACKGROUND: Triage is one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality. However, in low- and middle-income countries this strategy is underused, under-resourced and poorly researched.
OBJECTIVE: To assess the inter- and intra-rater reliability and accuracy of nurse triage ratings when using the South African Triage Scale (SATS) in an emergency department (ED) in Timergara, Pakistan.
METHODS: Fifteen ED nurses assigned triage ratings to a set of 42 reference vignettes (written case reports of ED patients) under classroom conditions. Inter-rater reliability was assessed by comparing these triage ratings; intra-rater reliability was assessed by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings. Accuracy of the nurse ratings was measured against the reference standard.
RESULTS: Inter-rater reliability was substantial (intraclass correlation coefficient 0.77; 95% confidence interval (CI) 0.69 - 0.85). The intrarater agreement was also high with 87% exact agreement (95% CI 67 - 100) and 100% agreement allowing for a one-level discrepancy in triage ratings. Overall, the SATS had high specificity (97%) and moderate sensitivity (70%). Across all acuity levels the proportion of over-triage did not exceed the acceptable threshold of 30 - 50%. Under-triage was acceptable for all except emergency cases (66%).
CONCLUSION: ED nurses in Pakistan can reliably use the SATS to assign triage acuity ratings. While the tool is accurate for 'very urgent' and 'routine' cases, importantly, it may under-triage 'emergency' cases requiring immediate attention. Approaches that will improve accuracy and validity are discussed.
With the increase in urbanisation and violent conflicts, together with the growing burden of chronic non-communicable diseases in many low- and middle-income countries (LMICs), there is an increased burden on emergency healthcare services.[1] In many LMICs, one of the main challenges facing emergency services is the capacity to deal with high patient loads.[2] The process of 'triage' is one way of addressing this challenge, since it optimises the allocation and use of existing resources.
Triage is the process of sorting critically ill patients who need immediate lifesaving interventions from patients who need medical attention but can safely wait to be seen.[3] Triage aims to determine a patient's 'acuity level' - i.e. how urgently they require medical attention. Triage is recognised as being one of the core requirements for the provision of effective emergency care and has been shown to reduce patient mortality.[4] However, in LMICs this strategy is underused, under-resourced and poorly researched.
The South African Triage Scale (SATS) was developed in 2004 for pre- and in-hospital emergency units throughout South Africa (SA).[5] It was specifically designed to be used by nursing assistants and as such was intended to serve as a coping measure to address medical staff shortages and limited resources - challenges that are commonplace in SA, as in other LMICs.[6]
In 2011, Médecins Sans Frontières (MSF), an international medical humanitarian organisation, implemented the SATS in Timergara Hospital (TH) in the rural district of Lower Dir in the province of Khyber Pakhtunkhwa (KPK), Pakistan. MSF had been working at this hospital alongside the Pakistan Ministry of Health to improve emergency healthcare for the population. Against a backdrop of limited resources, overstretched staff and the absence of a standardised triage system, MSF implemented the SATS with good preliminary results.[7]
The SATS has been assessed extensively in SA and implemented in several LMIC settings.[8,9] However, a more formal assessment of the SATS in a LMIC setting outside sub-Saharan Africa has not yet been undertaken.
The two most common measures for assessing a triage scale are reliability and validity. Reliability is the extent to which the triage scale yields the same result on repeated assessments of the same patient. Inter-rater reliability determines whether there is variability between different staff rating the same patient, while intra-rater reliability assesses the variability for one member of staff re-triaging the same patient. Validity has been defined as indicating how closely an acuity rating assigned using the triage scale is to the true acuity of that patient.[10] However, limitations exist when trying to validate triage scales in any setting, owing to lack of a gold standard. As such, validity has been assessed using surrogate markers such as hospital admission, discharge and resource utilisation.[11] In LMICs, however, the use of these surrogate markers is difficult owing to poor record keeping, varying levels of clinical skills and limited resources. Previous studies in LMICs have instead attempted to assess the validity of a triage scale by comparing the triage ratings assigned by emergency department (ED) staff for a series of simulated cases against those obtained from an expert panel based on the panel's expert opinion.[12] For the purpose of this study, we will refer to this methodology and use a set of 42 reference vignettes as a reference standard against which accuracy is measured.[13]
This study therefore aimed to determine the reliability (inter- and intra-rater) and accuracy of the adult version of the SATS when used by ED nurses in TH, Pakistan.
Study design
This was a cross-sectional study using a set of 42 reference vignettes (short, written, clinical case reports of ED patients) as a proxy for live ED cases.
TH is situated in the predominantly rural district of Lower Dir in the KPK province of Pakistan. It is the only district hospital in Lower Dir, serving an estimated population of 1.8 million. The ED has an estimated annual caseload of ~48 000 patients, comprising both adults and children. The caseload is largely made up of medical emergencies (typically respiratory infection, cardiac disease and gastrointestinal illness) and trauma (most often road traffic accidents).
SATS and its use in the TH ED
The SATS uses a physiologically based composite scoring system, the Triage Early Warning Score, together with a list of discriminators, with which to triage patients into one of five colour-coded groups according to their degree of urgency for medical attention. The colour categories are as follows: (i) red, 'emergency' (to be seen immediately); (ii) orange, 'very urgent' (to be seen within 10 min); (iii) yellow, 'urgent' (to be seen within 60 min); (iv) green, 'routine' (to be seen within 240 min, i.e. minor injuries/ illness); and (v) black, 'dead'.
The SATS was introduced in the TH ED in June 2011. All ED staff received a 1-hour structured training course, which was carried out by the expatriate ED doctor. It involved explaining patient flow in the ED together with each step of the triage algorithm and the composite physiological score where each vital sign is not seen in isolation but rather as a composite part of an early warning score. Each discriminator was explained using common local ED examples.
Using the SATS, triage was routinely undertaken by two triage nurses during each work shift. Once triaged, 'red' and 'orange' patients were seen by the MSF team (a national doctor, three nurses and an expatriate doctor) in the resuscitation room, while 'yellow' and 'green' patients were seen by the national casualty medical officers in a room adjacent to the ED. At the time of the study, 23 nurses were on the ED rota and carrying out triage.
Study population
The study included all nurses at TH who fulfilled the following inclusion criteria: (i) those who had received training in the SATS and had at least 1 month's experience performing patient triage using this tool; and (ii) those who agreed to participate in the study. As the study attempted to recruit all nurses fulfilling the above criteria, it was not necessary to calculate the required sample size.
Data collection
Under classroom conditions, nurses participating in the study were required to assign one of four priority categories to the set of 42 reference vignettes according to the SATS acuity levels of 'emergency', 'very urgent', 'urgent' and 'routine'. The vignettes had been collected and validated in a previous study and were based on real ED cases from a secondary hospital in SA.[13] The type and spectrum of patient presentations captured in these vignettes closely mirrored the sort of cases presenting at the TH ED. The vignettes included information on patient gender, age, presenting complaint, mode of arrival to the ED, and vital signs. Some vignettes also included information from additional investigations such as blood glucose test and haemoglobin, as done at the time of triage. For the purpose of this study, the vignettes were translated from English into Urdu, the national language of Pakistan. This was carried out by a professional translator and ratified by a local bilingual doctor to ensure the correct medical terminology.
Inter-rater reliability was measured by comparing the different nurse triage ratings for the 42 vignettes, while intra-rater reliability was measured by asking the nurses to re-triage 10 random vignettes from the original set of 42 vignettes and comparing these duplicate ratings.
The accuracy of nurse triage ratings for the 42 vignettes was measured by comparing their ratings with the acuity ratings assigned to the same set of vignettes by an international expert panel. The panel of 18 experts, made up of emergency medicine physicians and emergency nurses from developing and developed countries, were chosen from countries where triage scales were already established and validated or being established and validated. They had already independently reviewed the vignettes used in the current study, and via a modified Delphi technique, obtained consensus on 'true' acuity level for each vignette. They assigned an acuity level based on their expert opinion rather than through the application of the SATS. The acuity levels that they assigned had to fall into one of four categories to mirror the SATS categories of 'emergency', 'very urgent', 'urgent' and 'routine'.
Data analysis
In accordance with the Guidelines for Reporting Reliability and Agreement Studies (GRRAS), inter-rater reliability was assessed using the unweighted, linearly weighted and quadratically weighted κ (QWK) statistic, as well as the intraclass correlation coefficient (ICC).[14] The QWK is commonly used when reporting on reliability studies because it takes into account the degree of disagreement. A weighted κ uses maximum weights at two opposite ends of the scale and is therefore identical to the ICC.[10] Whereas the unweighted and linear weighted κ is not commonly used in triage literature, it has been reported in this case to follow the GRRAS for easy comparisons between other studies.[14] Point estimate values for QWK and ICC were graded using the Landis and Koch classification system as follows: 0.0 - 0.20 - slight agreement; 0.21 - 0.40 - fair agreement; 0.41 - 0.60 - moderate agreement; 0.61 - 0.80 - substantial agreement; and 0.81 - 1.00 - almost perfect agreement.[10] Intra-rater reliability was assessed by calculating the percentage of exact agreement and also the percentage of agreement allowing for one level of discrepancy in the triage ratings.
The accuracy of the nurse triage ratings was assessed by calculating the sensitivity, specificity, and associated over-/under-triage relative to the experts' triage ratings. Over- and under-triage were interpreted using an accepted range for average under-triage of not more than 5 - 10% and an associated average over-triage rate of 30 - 50%; these are the ranges considered acceptable by the American College of Surgeons Committee on Trauma.[7] Data were analysed using STATA (version 9.2).[15]
Ethics approval
Ethics approval was obtained from the MSF Ethics Review Board, Geneva, Switzerland, and the Human Research Ethics Committee, University of Cape Town, as well as the Pakistan Bioethics Review Board. Informed consent was obtained from all nurses participating in the study.
Characteristics of the study population
Of a total of 23 nurses carrying out triage, 20 met the study inclusion criteria and were invited to participate in the study. Fifteen of these nurses agreed to participate, while five declined due to scheduling conflicts and transport issues. The convenience sample therefore represented 75% of all eligible triage nurses.
Reliability of nurse triage ratings
A total of 780 ratings were obtained for analysis, consisting of 15 nurses assigning ratings for 42 vignettes (n=630) and the same 15 nurses assigning ratings for the 10 duplicate vignettes (n=150). Table 1 summarises the different reliability measures calculated to assess inter- and intra-rater reliability. Inter-rater reliability, as measured by the ICC and QWK, was substantial. Similarly, the level of exact intra-rater agreement among the nurses in our study was almost perfect (87%; 95% confidence interval (CI) 67 - 100), and there was 100% agreement when allowing for a one-level discrepancy in triage ratings.
Accuracy of nurse triage ratings
Table 2 summarises the accuracy of the nurse acuity ratings using the SATS, compared with the expert panel ratings of the vignettes. Overall, the SATS demonstrated a high level of specificity (97%) and a moderate level of sensitivity (70%). Broken down by acuity level, the SATS showed the highest sensitivity (93%) for 'very urgent' cases. However, the level of sensitivity for 'emergency' cases was exceptionally low (34%). Across all acuity levels, over-triage rates did not exceed the acceptable threshold of 30 - 50%. Similarly, for 'very urgent', 'urgent' and 'routine' cases, under-triage rates were below the acceptable threshold (5 - 10%). However, for emergency cases, the rate of under-triage was exceptionally high (66%), although almost all of these mis-triaged cases were only under-triaged by one acuity level, being rated as 'very urgent'.
This is the first study to assess the reliability and accuracy of nurse triage ratings using the SATS in a resource-poor Asian setting.[7] Nurse ratings using this triage scale demonstrated good inter- and intra-rater reliability and acceptable accuracy for 'very urgent' and 'routine' cases. However, nearly two-thirds of 'emergency' cases were under-triaged as 'very urgent', which warrants attention.
Supported by study findings from Botswana and SA,[6,8] our study demonstrates that after minimal formal training, the SATS can be applied reliably by nursing staff in an ED in Pakistan. However, there are concerns about the accuracy of these ratings. In our study, the degree of accuracy of the nurse triage ratings using the SATS was acceptable for 'very urgent' and 'routine' cases, but not for 'urgent' and 'emergency' cases. In particular, a high proportion of emergency cases were under-triaged, which mirrors the findings from a study in SA evaluating the validity of the SATS.[13] The under-triage of 'emergency' cases may be reflected inaccurately on account of several study biases which we discuss below. Alternatively, it may be that this is really the case. If so, this could either be because nursing staff are applying the SATS inaccurately, or because the SATS is poorly constructed to accurately identify true emergency cases. We suspect that staff inaccuracy is not to blame, as regular audits of the SATS in Pakistan together with the findings from a previous study have shown a high level of staff accuracy.[13]
If the construct of the SATS itself is responsible for the under-triage of 'emergency' cases, this needs further investigation. The clinical implications of under-triage of 'emergency' cases in our setting are negligible as almost all of the 'under-triaged' emergency cases were rated as 'very urgent', and in the context of TH all 'emergency' and 'very urgent' patients are seen by the same cadre of healthcare workers in the same area and within the same timeframe. Although we do not have data to substantiate this, a 10-minute delay linked to misclassification of 'emergency' to 'very urgent' cases is unlikely to have clinical implications. Nonetheless, in a setting where there are clear distinctions between the ways in which 'emergency' and 'very urgent' patients are managed, under-triage in this way needs to be avoided, as it may be associated with poorer outcomes (i.e. a higher risk of mortality, worsening morbidity and additional medical complications). This makes the case for ensuring that any assessment of the SATS is context specific.
Study limitations
A number of study limitations and various methodological issues related to assessing the validity of a triage tool have been brought to our attention by this study.
First, while there is no universally accepted time period recommended between assessments for inter- and intra-rater reliability, 2 - 14 days has been suggested.[10] Owing to ED staff time constraints, we conducted the intra-rater assessments immediately after the inter-rater assessment; this may have led to a recall bias in the response ratings.
Second, although the vignettes were paper based, in the absence of non-verbal patient cues and contextual information, raters' triage decisions may have been affected. That said, a previous study comparing the use of paper-based cases with live ED patients as a way of assessing the inter-rater reliability of a triage tool showed an acceptable level of agreement between the two methods.[16] The main benefits of using paper-based vignettes over real ED cases in LMIC settings is that they provide a cost-effective, time-saving, non-invasive and culturally acceptable way of undertaking this type of study.
Third, the written vignettes were based on ED cases seen in SA, not in the TH ED in Pakistan. In the study by Twomey et al.,[13] a set of vignettes ratified by a modified Delphi technique are proposed as a set of reference standard vignettes. Using these vignettes in Pakistan was deemed appropriate due to the following: (i) SA and Pakistan are both LMIC settings; (ii) the two settings have similar rates of trauma (66 trauma presentations per 1 000 patients in SA and 41/1 000 in Pakistan);[17,18] and (iii) the reference vignettes depict similar case presentations. However, the epidemiological pattern of disease is different. In future studies like this, it would seem important to develop specific reference vignettes based on ED cases seen in the actual study setting. This would ensure the use of a better reference standard of comparison adapted to the study context.
Fourth, when comparing nurse acuity ratings using the SATS to acuity ratings assigned by the expert panel, we cannot be sure whether an identified discrepancy between the two was: (i) because the nursing staff were not applying the SATS accurately; or (ii) because the SATS had poor construct validity - in other words did not measure what it purports to. As indicated earlier, we suspect that staff inaccuracy did not account for many of the observed discrepancies in this study. However, in future studies assessing the validity of a triage tool, it would be more appropriate to compare the ratings by several SATS experts (using the SATS) to the expert panel ratings (reference standard). This would help to control for the issue of staff error.
Finally, as in other studies, our reference standard was an expert panel that assigned acuity ratings to a series of paper vignettes according to their expert opinion. Almost all of these experts were based in high-income rather than LMIC settings and as such their opinion of 'true' patient acuity level may not have fully reflected the reality as in LMIC settings like Pakistan - they may have tended to over-rate patient acuity, especially at the higher end of the triage spectrum. In conjunction with this, it has been reported that nurses tend to under-rate patient acuity when using paper-based vignettes over live cases.[16] In our particular study, these two factors may have contributed to the under-triage of emergency cases that was reported.
Our study shows that the SATS can be used reliably by nurses in an ED in Pakistan. Our results suggest that the SATS is accurate for very urgent and routine cases but, importantly, may 'under-triage' 'emergency' cases. Although this is unlikely to influence patient outcomes in TH, there may be serious implications in other settings and it therefore merits specific investigation and correction.
Acknowledgements. We are grateful to the Pakistani Ministry of Health for their collaboration, and we are particularly grateful to the staff in the field for their hard work. The MSF project in TH, Pakistan, is funded by MSF-Operational Centre Brussels.
1. Van Rooyen M, Venugopal R, Greenough PG. International humanitarian assistance: Where do emergency physicians belong? Emerg Med Clin North Am 2005;23(1):115-131. [http://dx.doi.org/10.1016/j.emc.2004.09.006] [ Links ]
2. Hodkinson PW, Wallis LA. Emergency medicine in the developing world: A Delphi study. Acad Emerg Med 2010;17(7):765-774. [http://dx.doi.org/10.1111/j.1553-2712.2010.00791.x] [ Links ]
3. Horne S, Vassallo J, Read J, Ball S. UK triage - an improved tool for an evolving threat. Injury 2013;44(1):23-28. [http://dx.doi.org/10.1016/j.injury.2011.10.005] [ Links ]
4. Robison JA, Ahmad ZP, Nosek CA, et al. Decreased pediatric hospital mortality after an intervention to improve emergency care in Lilongwe, Malawi. Pediatrics 2012;130(3):e676-e682. [http://dx.doi.org/10.1542/peds.2012-0026] [ Links ]
5. Emergency Medicine Society of South Africa. The South African Triage Scale (SATS). http://emssa.org.za/sats/ (accessed 11 March 2014). [ Links ]
6. Twomey M, Wallis LA, Thompson ML, Myers JE. The South African Triage Scale (adult version) provides valid acuity ratings when used by doctors and enrolled nursing assistants. African Journal of Emergency Medicine 20123(1):3-12. [http://dx.doi.org/10.1016/j.afjem.2011.08.014] [ Links ]
7. Dalwai M, Tayler-Smith K. Implementation of a triage score system in an emergency room in Timergara, Pakistan. Public Health Action 2013;3(1):43-45. [http://dx.doi.org/10.5588/pha.12.0083] [ Links ]
8. Twomey M, Mullan PC, Torrey SB, Wallis L, Kestler A. The Princess Marina Hospital accident and emergency triage scale provides highly reliable triage acuity ratings. Emerg Med J 2012;29(8):650-653. [http://dx.doi.org/10.1136/emermed-2011-200503] [ Links ]
9. Harrison H-L, Raghunath N, Twomey M. Emergency triage, assessment and treatment at a district hospital in Malawi. Emerg Med J 2012;29(11):924-925. [http://dx.doi.org/10.1136/emermed-2011-200472] [ Links ]
10. Streiner D, Norman G. Health Measurement Scales. A Practical Guide to Their Development and Use. 4th ed. New York: Oxford University Press, 2008. [ Links ]
11. Twomey M, Wallis LA, Myers JE. Limitations in validating emergency department triage scales. Emerg Med J 2007;24(7):477-479. [http://dx.doi.org/10.1136/emj.2007.046383] [ Links ]
12. Olofsson P, Gellerstedt M, Carlstróm ED. Manchester Triage in Sweden - interrater reliability and accuracy. Int Emerg Nurs 2009;17(3):143-148. [http://dx.doi.org/10.1016/j.ienj.2008.11.008] [ Links ]
13. Twomey M, Wallis L, Myers J. Evaluating the construct of triage acuity against a set of reference vignettes developed via modified Delphi method. Emerg Med J 2013. [http://dx.doi.org/10.1136/emermed-2013-202352] [ Links ]
14. Kottner J, Audigé L, Brorson S, et al. Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed. J Clin Epidemiol 2011;64(1):96-106. [http://dx.doi.org/10.1016/j.jclinepi.2010.03.002] [ Links ]
15. StataCorp. 2005. Stata Statistical Software: Release 9. College Station, TX: StataCorp LP. [ Links ]
16. Worster A, Sardo A, Eva K, Fernandes CMB, Upadhye S. Triage tool inter-rater reliability: A comparison of live versus paper case scenarios. J Emerg Nurs 2007;33(4):319-323. [http://dx.doi.org/10.1016/j.jen.2006.12.016] [ Links ]
17. Wallis LA, Twomey M. Workload and casemix in Cape Town emergency departments. S Afr Med J 2007;97(12):1276-1280. [ Links ]
18. Nasrullah M, Xiang H. The epidemic of injuries in Pakistan - a neglected problem. J Pak Med Assoc 2008;58(8):420-421. [ Links ]
Corresponding author:
M K Dalwai
Accepted 7 January 2014.


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Power Flushing
Power Flush removes the build up of sludge and contaminants in your central heating system boilers, radiators and pipes. Gradually this heating sludge will build up and block pipes and radiators. This will obviously effect the efficiency of your central heating system as it will prevent heat from distributed around your house, which will cost you more money in higher heating bills and can cause serious long term damage to the internal parts of your boiler.
Our experienced heating engineers can work with any central heating system type or make and can ensure that once your system is power flushed it will be working better and more efficiently.


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today is the second day into my adventure of being a real person. i only have two more days left of this before my brother comes home to ruin it (probably with a wolf spider clinging to the back of his shirt), so i better milk this for all it's worth.
my second day as a real adult went like this, and i'm honestly going to try not to start tomorrow's blog all like, "my third day as a real adult went like this" because that just gets boring, and nobody cares about my day. i don't even care about my day. well, i do. sort of. anyway. depicting my second but first FULL day as a real person and how utterly irresponsible i was about it: go.
so last night i had this majorly intense dream that i was dying of leukemia. i have never had leukemia. i do not know anyone who's had leukemia, unless it was when they were really little and just don't like to talk about it. but i woke up legitimately afraid that i had leukemia. i feel like i can have this fear and i can have this dream because i've been spending the past four months researching leukemia, specificially the ALL (that's acute lymphoblastic leukemia) kind, and it's easy to go undetected. normally my leukemia research simply makes me terrifically depressed, but when you have a dream that you're dying of it, well, it gets even more depressing and personal.
i'm not sure why i just wrote a pargraph about my leukemia dream. the most important part of what was SUPPOSED to be in that paragraph was this: i set my alarm for the PM instead of the AM. my alarm going off at quarter till seven at night is not going to get me up for work in time. but alas, my leukemia dream saved me! it was very very important in my dream that i had to go get some super special leukemia test at six forty-four in the morning, and lo and behold, i woke up for the test expecting kanye west and i was greeted by silence and the shaky fear that i actually had leukemia.
this ties in with work. maddie, the head coach of the team (i'm the assistant head coach) and i were the only ones coaching this morning because our other assistant coach is in new jersey and our other other assistant coach only works evenings. maddie had been up all night with her other job and was jazzed on energy drinks, and i'd gotten about three hours of sleep, all of which was leukemia intensive. i was up writing my book, which happens to be about leukemia, (well, it's a major theme) and julia, one of the twelve year olds that maddie was working with, was interested in why maddie and i were so completely strung out.
i told her i was up writing a book. when she asked what it was about, i said, "depressing things and dysfunctionality."
she looked me dead in the eye, gave me a gigantic grin and said, "i wrote a book once. it was about macaroni and cheese."
i don't think i've ever laughed so hard in my life. when i got home from work, i tweeted it. it was just that good. i wish you could hear her say it. and see her face. it was terrific.
i told myself i was going to nap for an hour after work, shower, eat lunch, and then head to my second spanish class, the one that's smack in the middle of the afternoon (twelve thirty to three.) instead i ended up calling my physical therapist to reschedule three appointments (it was the most adult thing i've done all day) and then i enjoyed the fact that i have stolen my friend's hulu plus password.
hulu plus is going to suck away my life and make me fail my spanish exam. and keep me from blogging. oh hulu plus. i have access to all seven seasons of grey's anatomy. guess who's going to watch all of it by the end of the summer? that's right. you can guess.
mi clase de espanol was fantastic compared to last term's. the room is smaller, warmer, and the teacher is straight out of espana. lucky for me, my spanish parter from my first class is in this class, and we spent a good ten minutes conversing in spanish and feeling pretty badass about it. i had figured that this class would take absolutely forever because it's in the middle of the afternoon, but it went by extremely quickly. and i had kanye west in my head. that might've helped.
i learned a new exercise in physical therapy. it's not really as exciting as one would think. not exciting enough to blog about.
when i got home at four forty-five, i said, "i'll eat at five thirty, write some more of my book, and then i'll go to my coach's meeting and then to work." out loud. when i'm home alone, i need to hear my own voice.
well this is what actually happened: i watched grey's anatomy until six thirty, fixed a ten minute dinner, and then realized that i had a coach's meeting in eight minutes. i had completely forgotten. while i was running around trying to locate my flip flop and my frog towel (our team mascot is the frog) i began to have a minor asthma attack. and i got a beautiful book idea that would just have to wait.
the adult things i did today were these.
i managed to get myself out of bed on time without setting my alarm.
i watered the plants.
i remembered to bring in the mail and the paper... after dinner.
i actually put my dishes in the dishwasher in a timely manner.
i cleaned my bathroom.
i actually opened my mail that was addressed to me.
the things i am not proud of doing were these.
watching grey's anatomy for a god awful amount of time. at least three hours.
belting out hey soul sister in the shower.
getting completely distracted by that weird taxidermy museum closing when i should've been paying attention to what my kids were swimming.
not sleeping very much.
setting my alarm for the incorrect time.
actually thinking i had leukemia for twenty whole minutes. (seriously. the entire time i was muching on my mini wheats i was having a mini panic attack.)
eating mini wheats while driving.
i've had a decently productive day. but i think that being a real person doesn't mean that you're one hundred percent productive and you don't get distracted by the idea of having every episode of grey's anatomy free for your viewing enjoyment when you have a free moment.
real people procrastinate and get distracted too. if they didn't, they wouldn't be people.
i'm a person. a dysfunctional person. but a person.


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The CVCC Baseball Team is searching for a team manager for the 2012-2013 season. The successful candidate will receive a scholarship that includes a full tuition waiver, a full fee waiver, and books.
The selected candidate must posses background in baseball in some capacity as either a high school baseball player or team manager. Please note that this is not a roster position. You will not be a playing member of the baseball team nor will it lead to a roster position.
Duties included with this position are as followed, but not limited to:
- Laundering of uniforms
- Statistical recording and maintenance
- Game and Practice Field Set up
- Attendance to every practice and game
- Equipment Inventory
- Other Duties as assigned
Anyone that is interested in applying for this position should email Coach Adam Thomas at email@example.com. The subject line should be titled BASEBALL MANAGER. Include in your email the following information:
- Name
- Contact #
- High School
- A brief description of your baseball background
- Why you feel you would be a good fit for our program and for this position
- 2 References including name and contact #


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The Burbank City Council invites residents to one of three upcoming forums to gather public input in the search for a permanent city manager.
I began serving as your interim city manager on Dec. 3. One of my assignments has been to help guide the city while City Council searches for a permanent replacement.
The city manager is a very important position in city government. He/she is responsible for the city's day-to-day administrative operations while supervising all departments in carrying out the policies set by City Council. In Burbank, that means overseeing a staff of more than 1,400 and a 2012-13 total budget of over $635 million.
While we don't expect you to know the intricacies of the job, we would like to hear what qualities and experience you would look for in someone who will essentially be the chief executive officer of the city. Your comments will be incorporated into the overall evaluation of potential candidates.
The executive search firm Peckham and McKenney has scheduled three forums in which it will seek community feedback by interviewing interested groups and the general public.
All three forums will be held in Room 104 of the City's Community Services Building, 150 N. Third Street, at the following dates and times: Tuesday, Feb. 19, 2 to 3:30 p.m. and 4 to 5:30 p.m., as well as Thursday, Feb. 21, 4:30 to 6 p.m.
For those who would like to offer feedback and cannot attend the forum, please contact (818) 238-5840.
Ken Pulskamp
Burbank Interim City Manager


text: Perhaps the best way to describe Ceinwen (pronounced ""Kine'-wen") is that she is a musical and multi-cultural virtuoso. A naturally gifted musician, she is blessed with an exquisite voice with only ½ year of training. She has studied Chinese folksong for ½ year, piano for 5 years, violin for 2 years, flute for 3 years, and played autoharp since 1995. She has sung first soprano in a multitude of choirs, including the Bach Choir for 15 years, the Mendelssohn Choir for 1 year, the Pittsburgh Camerata for 20 years, the Pittsburgh Oratorio Society for 25 years and the Latin- American Choir since 2001. She has soloed for the Bach Choir and the Camerata, and has sung in the Community of Reconciliation choir since 1976, and has been a Church Organist for 1 year. Ceinwen is also active as a music teacher. She has taught music to children with learning disabilities for 7 years and piano for 5 years. She is on the faculty at Calliope House for Elementary Voice. She is also a UPMC Folk Singing Volunteer. Fluent in Chinese, Russian, Spanish, French, German, Polish and Portuguese as well as English, Ceinwen holds a B.A. in Russian from Stanford University in 1966, has studied Russian and Chinese for 1 year at the Graduate School at the University of Warsaw in 1967, and went on to receive an M.A.T. from Harvard in 1968 and a Certificate in Math from Duquesne University in 1974. She is retired from teraching Russian, Chinese, and Humanities at the Pittsburgh Gifted Center. Ceinwen's creativity takes many forms. Every Halloween, she can be seen wearing an elaborate costume of her own design and making. She hails from the Chicago area.


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Thailand's Prime Minister Prayut Chan-o-cha has spoken out to describe his vision of a more organised setup for both Pattaya and Jomtien Beaches which includes separate zones for different activities.
Following the PM's visit to Pattaya for the International Fleet Review he has instructed city officials to bring the beaches more in line with national approaches to law and order.
He said that Jomtien Beach should be a model of good balance combing tourist attractions and activities saying "I've been to beaches overseas and think if a beach is too empty, it feels lifeless."
The PM wants the beaches to have different areas for different activities to that they cater for all types of tourist saying "officials should arrange appropriate zones so that visitors can choose to either sit and drink beer, play sport or shop."
Apparently the Prime Minister must be unaware of city official's recent decision to ban the sale of alcohol on the beaches here in Pattaya and Jomtien.
He went on to warn that there shouldn't be too many shops in place however like what has become normal and many other beaches across the kingdom.
Space should be used sensibly so that areas can be put in place for people who want to take part in commercial activities without disturbing those who wish for a quiet, peaceful day at the beach.
Source: The Nation
Content: Love Pattaya Thailand


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Social networking is nothing new, but Facebook has managed to make itself pretty popular, particularly among more mature users who don't want to walk into a website filled with teenage angst and ROFLcopters all over the place.
It became a great site for college students to connect and an even better place to find people that you haven't seen in years. As a result, many people became addicted to Facebook. For bloggers and website owners, it also has the advantage of helping you increase RSS subscribers too.
For these and other reasons, Facebook is arguably even more popular than MySpace. You could even say that some people take Facebook too far. Well, the honeymoon period is over. Or at least that's what a couple of studies seem to be indicating.
I was reading the local newspaper yesterday and there was a story in there about how the number of people logging on to Facebook in the United Kingdom dropped by 400,000 between December and January. Going further, Kaan Yigit of Solutions Research Group says that the growth rate of the social networking site has "slowed considerably in Canada over the past few months." Yigit attributes this to "Facebook fatigue" and getting tired of the site is more of a phenomenon with users over the age of 40.
Is Facebook suffering a slow and painful death? There are several factors that may be playing into its eventual demise.
- Rising Fears: As Facebook becomes more commercial, people are starting to get more concerned about how they're going to use all that personal information. You'd be amazed how much Facebook knows about you.
- Stupid Applications: Part of the reason why many people chose Facebook over MySpace was because the former has a much cleaner interface than the latter. As more of those applications find their way into profile pages, the distinction of "cleanliness" becomes a little more muddled.
- Rise of Twitter: I haven't signed up for it yet, but it seems like Twitter is the new Facebook. At least among the more tech-savvy blogger-type.
- Standard Boredom: We have short attention spans and unless you're stellar and/or continue to offer something new, people will leave for newer (and not necessarily greener) pastures. This ties in with Twitter.
How about you? Does Facebook still interest you or have you moved on? I'm still on there and it's mostly because so many people I know are on there. If it wasn't for Facebook, I wouldn't have been informed of at least two weddings and one childbirth.


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$379,900 - 3,148 sqft - 3 beds/3.5 baths
Enjoy lagoon and golf views from this 3 bedroom and 3.5 bath home located in Long Cove Club. This light and bright home features expansive decking, a private swimming pool, bonus room and a 2-car garage. The master bedroom is on the main floor and the master bathroom has 2 full baths. New roof in 2017 and new driveway in 2016.


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Horseback Riding
Join Snowy Springs Outfitters for a 1/2 day or Full Day trail ride into the Bob Marshall Wilderness. Rides go during rain or shine for that authentic Montana experience. Reservations are required. All levels of riders are welcome. Minimum age of 6 years old.
Trail rides are available Monday, Wednesday, and Fridays during the peak season months. Transportation is included. Snowy Creek will pick up you up at the Inn.
|1/2 day Trail Ride
|4-5 hours
|Full Day Trail Ride
|8-9 hours
**It is recommended that guests bring a variety of clothing layers, snacks, and good closed-toed shoes.
For more information or to book your horseback riding adventure please contact Snowy Springs Outfitters at 406‑888‑5700 or visit them on the web at www.snowsprings.com
Wild River Adventures
The Middle and North Fork of the Flathead River are two of Montana's wildest rivers which are a part of our adventure trips. These rivers form the southern and western boundaries of Glacier National Park. They are protected as Wild and Scenic rivers, insuring that they will remain free flowing and untamed. These glacial fed waters rank as some of the cleanest rivers in the world.
There are several different trips to choose from. You can book a Whitewater Raft Trip, choosing from a half day whitewater, full day whitewater (lunch on the river), evening dinner whitewater, sport raft wild side, half day inflatable kayak, full day inflatable kayak, two day raft or a custom multi day raft trip (whitewater or scenic, Middle Fork or North Fork). There is also a Scenic Raft Trip where you can book a half day scenic, full day scenic (lunch on the river) or evening dinner scenic trip.
Wild River will pick up our guests on Wednesdays and Fridays. Rental cars are also available onsite at the Izaak Walton with rates starting at $99 per day.
For more information or to book your rafting adventure please contact Wild River Adventures at 1-80-700-7056 or visit them on the web at http://www.riverwild.com/
Glacier Ziplines
Glacier Zipline is located just west of Glacier National Park, approx 35 minutes from the Izaak Walton Inn. They offer spectacular views of the Flathead River, Great Northern Railway and the Badrock Canyon.
Glacier Ziplines offers an 8 Zipline Canopy Tour, plus a lowering Zipline. There is no hiking involved! Once you have completed the full tour you will have ziplined approx. one mile of cable.
Transportation is required. Rental cars are available on site at the Izaak Walton Inn with rates starting at just $99.
For more information or to book your zipline tour please contact Glacier Ziplines at 406‑888‑5700 or visit them on the web at www.glacier-ziplines.com
Apgar Outdoor Rentals
http://www.eddiescafegifts.com/eddies-rentals/ for more information.
Montana Fishing Trips
Montana is home to some of the best fly fishing creeks, rivers and lakes on the planet. Wether you are a seasoned fisherman or a novice in need of instruction, let us assist you with planning a fishing trip you will remember. Half day and full day fishing trips are available.
Contact Wild River for more information or to book your fishing trip.
If you would prefer a solo fishing trip, there are several public access points to the Middle Fork of the Flathead River, some within walking distances of the Inn.
Glacier Park's Red Bus Tours
The famous Red Bus Jammer Tours are available for trips departing from Apgar Village, the West Entrance of the Park and the East Entrance of the Park, plus several other locations in and around Glacier National Park. The Red Bus Tours are a fun way to experience the wonder of the park as well as learn more of it's history.
There are several different trips to chose from. For more information or to book your Red Bus Tour please contact Glacier National Park Red Bus Tours at 1-800-299-0396 or visit them on the web at http://www.nationalparkcentralreservations.com/activity/red-bus-tours
Guests are responsible for their own transportation. Rental cars are available at the Izaak Walton with rates starting at $99 per day.


text:
Hello everyone, am back to show you yet more from the Fit-mesh Event. I have an outfit from Att-Miss Flamenco in three different colors for you to see today..with the Event running from the 1st to 22nd of November you only have a couple more days to grab these gorgeous dresses ~ let me show you right away ~
Is this purple not gorgeous and so rich looking ~ with the one just off the shoulder strap that gives you a very sultry look ~ this is a dress to wear out when you want to make that statement of "look at me" as you do the Tango or any other fast paced dancing…
The front is showing those gorgeous legs off as your partner whips you around the dance floor doing the Flamengo that dance you just love to watch others take part in ~ in this show stopping orange you will make all eyes on you
Another bold print that will not let you become a wallflower ~ you will be pulled out onto the dance floor to show off all those great moves ~ as we all know in SL everyone can be a first rate dancer and this is the dress to wear when you and your dance partner decide to show off the moves ~ Would like to say a BIG thank you to the designers for letting show their items to you and to you out there for taking the time to read it… will be back with more to show you soon but in the meantime …Take care Till Next Time ~ Hugs Dena ♥
Lumae :: Eyelashes // Longer
.:Glamorize:. Tango Lips – Sugarberry
:{WS}: Kawaii Blush – Tomato (R-RO)
ATT-MISS FLAMENCO-Maitreya-RIGGED mesh SKIRT-ORANGE/POPPY/PURPLE
Izzie's – 50's Pearl Necklace orange,green and tahiti
Magika – Drive
Maitreya Mesh Body – Lara V3.5
Slink Avatar Enhancement Feet High
Slink Avatar Enhancement Hands Casual
Glam Affair – Amberly – India
* Inkheart * – Hades Eyes – Toxic Green
Shot on location at Starr's studio using poses from Nantra Rosie's


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Professional Negligence
When employment disputes arise you will need the best advice. There are often technical legal questions and if a claim arises the time limits to lodge a case are short, usually only 3 months. If you are defending a claim, there are also strict time limits and a need to comply with strict Tribunal rules and procedures.
When you receive employment advice from a representative you trust that they will get it right, but things do not always work out as you would hope or expect. Sadly, a negative outcome can be because the representative has been negligent, meaning that your case fails or if you are an individual you did not receive the correct level of compensation. This could include a low value settlement or you might have been advised to sign a Settlement Agreement for a very low figure.
As a business you might believe that in defending a claim your interests were not protected, so that you end up with a Tribunal Judgment against you and no doubt a substantial bill.
EAD Solicitors are experts in employment law and understand how an employment dispute should be dealt with. We pursue and defend claims, and we are best placed to consider if the correct work has been done.
If you believe that you are the victim of professional negligence on an employment or contract dispute contact EAD for advice. We might not be able to reverse what went wrong, but we may be able to secure a financial remedy for your losses.
Contact EAD for an initial free discussion or interview:-
Tel: 0151 735 1000
Email: email@example.com
- About employment law at EAD
- Funding your employment law work
- Testimonials from EAD clients
- Employment law areas covered
- EAD and individual clients
- Settlement Agreements Advice
- Employment Tribunals
- Advocacy Services
- Protective award claims
- Training events
- Professional and regulatory cases
- Dispute resolution and procedural advice
- Professional negligence
- Ecclesiastical law
EAD's Employment Law News
On the morning of 7 February 2018 the Government announced proposals to address issues derived from the Taylor report, which was published during 2017. Taylor addressed issues relevant to modern workplaces and also modern work practices, which included the... more »
Over many years, my guess is that we have all come across cases when organisations have refused to tell us something or to disclose a particular document. When challenged, a common answer has been that it is not permitted... more »
Shareholders' Agreements: An Overview
An analogy can be made between shareholders' agreements and umbrellas; you only tend get them when it's raining and we do, of course, live in England!
When starting a new business, entering into a joint venture or re-structuring an... more »
Employment Law
What others say about us
Extremely happy with the outcome of my Personal Injury Claim and can only thank Paul McCarthy and his team at EAD Solicitors and also Tim Trotman my barrister arranged by EAD, for all their work and efforts on my behalf. As such I would highly recommend EAD to anyone in need of their service. Once again thanks to all involved.
Brodie Martin, Merseyside
Excellent, very professional, approachable when I needed advice. I would just like to say thank you to your staff.Robert Adams, West Midlands


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Right, I recently got an android and I'm going to make a tutorial that will be extremely easy to understand. (Hopefully). There shall be no trouble with the gba-bios.bin as I found a beyond helpful application that can help us with that. Hope this tutorial will help somebody.
Step 1: On your android phone go to this link, open it up and install it.http://www.appsapk.com/wp-content/up...1/GameBoid.apk
Step 2: Go to this link also on your android phone, this will install the gba-bios.bin on your sdcard for you, no trouble!
It should look like this once installed.
Make sure to select Game Boy Advance Bios, and browse somewhere you will remember such as sdcard. Next, click Generate BIOS Files.
Step 4: Open up the Gameboid emulator, it will ask for a bios file. Search for the bios file you just installed, hit gba-bios.bin and voila.
Step 5: Next you shall want some roms. You will be needing AndroZip to unzip the files containing the gba roms once you have downloaded them.
Download here. https://play.google.com/store/apps/d...RyZXNvdXJjZSJd
Step 6: Search for a good rom site such as romulation.net, or whatever you feel. Download the file and open it. It will give you to options: Complete this operation using AndroZip or Gameboid. Click AndroZip. It will say 'Unpacking RAR'.
Step 7: It may extract the GBA to a folder named AndroZip. If this is the case open up your regular file manager, in sdcard locate AndroZip, hold down touch on the rom you just unpacked and click move. Move it to your desired location. I tend to create a folder named 'GBA ROMs'.
Step 8: Re-open gameboid, select the rom you just downloaded! Have fun.
Here are some screenshots I took on my android.
Pokémon ftw!
Additional notes about Gameboid:
There are cheat options, fast forward options and more.
Hope this tutorial was somewhat useful.


text:
Germany is heading for a presidential election in September this year. Angela Merkel, the incumbent president is facing German Social Democrat (SPD) candidate Martin Schultz during the coming election.
Merkel is hosting a summit of leaders from 20 Greedy Nations (G20) in Hamburg on July 7-8, 20117. Ahead of that summit, she is also hosting a meeting of the European leaders who will take part in the summit later on Thursday at the chancellery in Berlin. "We cannot expect easy discussions on climate change at the G20 summit. Our differences with the US are clear," said Merkel.
Earlier, Donald Trump had blasted Germany for not living up to its NATO contribution, as well as pressing for trade equity between the two nations when it comes to automobile exports.
On the weekend, Schultz slammed Merkel for not standing up to US president Trump.
"Should we be making concessions to Trump, Erdogan and Putin? NO," said Schultz.
Germany's powerful Jewish Lobby (Israel-German Congress) has thrown its weight behind Angela Merkel, who is the most popular European leader in Israel.
Martin Schultz (Jew), former president European Parliament was hooted by several Israeli Knesset members in February 2014 over mentioning Jewish water racism against Palestinian. After tirelessly reiterating his commitment to the Zionist entity and promising that a boycott of it will never take place. But he did make the antisemitic statement by mentioning: "The Palestinians in the West Bank don't have the same access to water as Israelis."
Zionist racist MKs refused to accept the truth that Schultz was representing the European Union and was not German Chancellor, US president, French president or British prime minister David Cameron or Canadian prime minister Stephen Harper for that matter, ready to suck Netanyahu's bottom.
On February 14, 2014, Martin Schultz in an Op-Ed for Israeli newspaper Ha'aretz said: For me the new Germany exists only in order to ensure the existence of the state of Israel and the Jewish people.
In November 2015, as president of the European Parliament Martin Schultz during his meeting with Iranian president Hassan Rouhani in Tehran praised Iran's efforts to bring stability in the region.


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Across the country there are different rules, regulations, and thoughts for academy riders wearing helmets. In most places it is a matter of personal preference, while others areas have led the way with regulations to keep our beginning riders safe.
With many young riders at Carousel competing in 10 and under and eight and under academy classes, it was quite surprising to see several of them without helmets. Fortunately things went relatively smoothly but it could easily have been disastrous.
The outdoor ring used was enormous and even at a full sprint, anyone trying to get to a horse and rider at the opposite end would have had quite a long trip. In addition, horses entered and left the ring through the same gate, which meant that riders were waiting to go in as horses were coming out which was at times confusing.
Carousel Horse Show was the first time this season that some horse and rider teams competed. Coupled with the fact that many teams were new, an outdoor ring can sometimes make even the best and most broke horse feel "their oats." The instructors who put academy riders in the ring did a great job of keeping children and horses safe, however.
Should it be mandatory that helmets be worn in the academy division across the country? It is an issue that has supporters on both sides, and in some parts of the country helmets are mandatory. In North and South Carolina for example, all academy riders aged 10 and under are required to wear helmets at all American Saddlebred Association of the Carolinas-sanctioned horse shows, according to ASAC officer Betsy Boone.
The absence or wearing of helmets, which are not required in Arizona, represented a personal choice by parents or trainers or both. The wearing of helmets or lack thereof, had nothing to do with the Carousel Horse Show but it did bring to the attention of many that the issue does exist, as they watched young riders walk, trot and even canter around the big ring.
Whether the rule changes or not, and whether they wore a helmet or not, lots of young riders enjoyed the Arizona sunshine and the enthusiastic crowd cheering them on and represented a bright future for the industry for many years to come.
If you are not already registered for the Saddle Horse Report, you can register here.


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The 2019 Parish Council was sworn in immediately following the conclusion of Divine Liturgy on Sunday, January 13, 2019. Those members who will serve throughout the upcoming year gathered before the Royal Gates, placed their hands upon the Holy Gospel and recited the Affirmation of Office administered by Presiding Priest, Father Christopher Xanthos.
"I do solemnly affirm that I will uphold the dogmas, teachings, traditions, holy canons, discipline, worship and moral principles of the Orthodox Christian Church, as well as the Charter and Regulations of the GOA, and that I will fulfill faithfully and sincerely the duties and obligations required of a member of the Parish Council. So help me God."
The 2019 Parish Council:
President - Sam Galeotos
Vice-President - Christine Pappas
Treasurer - Tim Joannides
Secretary - Jim Haefele
Member - Tina Marquardt
Member - Jamie Pullos
Member - Steve Zaharas


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Communicating Through Music - Music for All
The current data confirm that MIV and nPVI are associated with emotional communication in music and speech, but the extent to which these attributes are actually used by listeners for decoding has yet to be determined. Evidence does suggest that listeners are able to perceive differences in nPVI (Hannon, ) and unpublished work in our lab suggests that participants can differentiate levels of MIV. However, the extent to which these attributes aid listeners in decoding emotion is uncertain.
Communicating Through Music Thursday, ..
and cultural emotion communication in music | Music Psychology
1: : How do people communicate using music?
2: : Music and meaning, ambiguity and evolution
3: : Music and conversation
Cognition, Representation and Communication
4: : Musical cognition: defining constraints on musical communication
5: : From mimesis to catharsis: expression, perception and induction of emotion in music
6: : Representation, cognition and musical communication: invented notation in children's musical communication
7: : How the conventions of music notation shape musical perception and performance
Embodied Communication
8: : Rhythm, human temporality and brain function
9: : Musical companionship, musical community: music therapy and the process and value of musical communication
10: : Bodily communication in musical performance
11: : Singing as communication
Communication in Learning and Education
12: : Musical communication and chnildren's communities of musical practice
13: : Musical communication between adults and young children
14: : Pedagogical communication in the music classroom
Cultural Contexts of Communication
15: : Talking about music: a vehicle for identity development
16: : Hippies vs hip-hop heads: an exploration of music's ability to communicate an alternative political agenda from the perspective of two divergent musical genres
17: : Communication in Indian raga performance
18: : The role of music communication in cinema
19: : Musical communication in commercial contexts
The Importance of Communication in Music
Participants in Nordoff-Robbins music therapy between the age of 2 and 12 diagnosed with autism spectrum disorder will receive 30-minute sessions of individual music therapy weekly over the course of a 9-month clinical year. The Vineland-II is administered to children's parents or guardians upon intake and upon completion of the clinical year. In keeping with standard Nordoff-Robbins clinical practice, all therapy sessions will be video recorded, with the written consent of children's parents or guardians. Selected therapy sessions from different points in the course of therapy (i.e., upon intake, at the mid-point of the clinical year, and toward the end of the clinical year) are rated with respect to children's social reciprocity, mirroring, and emotional attunement, using an observation instrument adapted from the Individualized Music Therapy Assessment Profile (IMTAP) and the Music Therapy Communication and Social Interaction scale (MTCSI). Observable behaviors rated in music therapy sessions may involve, for example, the matching of dynamics, tempo, or timbre; responsive imitation of rhythmic patterns or melodic phrases; or mirroring of movements, gestures, and affect. Extent of improvement on the Communication and Socialization domains of the Vineland will be assessed using within groups repeated measures analysis of variance. In addition, we are examining whether changes on the Vineland are correlated with changes observed in children's communicative interaction within music therapy sessions over time.


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2 Timothy 3:16-17
'All Scripture is inspired by God and is useful to teach us what is true and to make us realise what is wrong in our lives. It straightens us out and teaches us to do what is right. It is God's way of preparing us in every way, fully equipped for every good thing God wants us to do.' (NLT)
So you're reading your Bible and you reach Leviticus. For those of you who haven't read it, this is how it goes.... '..when the priest goes into the house, if there is mildew on the walls that is green or red and goes up the wall, then the priest must close up the house for 7 days..' (Leviticus 14.37) And yet the Bible says that all Scripture is useful..?!
Here's 2 stories if you're sitting comfortably..
Derek Prince (a Bible teacher) recalls hearing how a person had become a Christian through hearing endless lists of people and their ancestors - like for example through Genesis. The man was convinced because someone had recorded so many names so accurately.
The other story is of how a tribe became Christians. They make medicine by spitting on their hands and using mud. In John 9.1-12, Jesus heals a blind man by spitting on the floor and rubbing wet mud on the man's eyes. The tribe were so amazed that this Jesus healed that they were saved.
2 Timothy 3.16 in Practice
The things that Paul writes to Timothy in this passage are written in light of the whole of chapter 3 of 2 Timothy. The chapter is about the 'last days' when there will be much trouble, selfishness, evil and ungodliness. Paul is warning Timothy and us that we must know and follow the Bible if we are to stand against these troubles. So how can we do this..
1. Believe the Bible is the Word of God and therefore powerful - Hebrews 4.12 says the Word of God is sharper than a double-edged sword. There is real power in speaking the Bible out loud.
2. We must let the Bible teach us - in Matthew 7.29 we see Jesus teaching with authority to the amazement of his captivated audience. We need to let God's Word have this effect in our lives.
3. The Bible shows us what is wrong in our lives. Psalm 119.105 says God's Word is like a lamp for our feet and light for our path. Make sure you live a life walking only in the light of the Bible. Don't step outside if you can - it's there for our good.
4. The Bible is also there to correct us - in Galatians 2.11-14, Paul recounts how he challenged Peter (the leader of the Apostles). The Bible is there to challenge us and set us back on the right way. Our job is to listen and obey.
5. The Bible is there to encourage us - many people have favourite Bible verses. One God has continually encouraged me with is Galatians 6.9 - don't get tired of doing good for if you keep going and don't give up, you will reap a harvest of eternal life in due time.
The application of this
1. How well do you know your Bible?
(Learn 2 Tim 3:16-17)
2. Do you know how to read and use The Bible?
(What do you read? How does God speak? Where do you go for help?)
3. Do you know what it means to let the Bible encourage you?
(Read Joshua 1:9. Read Hebrews 13:5. Read Matthew 6:33).
4. Do you listen to The Bible and let it correct you? Do you put it into practice?
(Hebrews 12, Romans 12, Romans 8).
5. If you don't know your Bible, God won't be able to use you as he could...
How can you change this? (Open up for discussion).
Some questions to look at
How well do you know your Bible?
Do you know how to read and use The Bible?
Do you know what it means to let the Bible encourage you?
Do you listen to The Bible and let it correct you?
Do you put it into practice?
If you don't know your Bible, God won't be able to use you as he could. How to change this?