text:
- Research article
- Open Access
- Open Peer Review
Elevation and cholera: an epidemiological spatial analysis of the cholera epidemic in Harare, Zimbabwe, 2008-2009
© Luque Fernandez et al; licensee BioMed Central Ltd. 2012
- Received: 25 October 2011
- Accepted: 18 June 2012
- Published: 18 June 2012
In highly populated African urban areas where access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions. This study aims to analyze the association between topographic elevation and the distribution of cholera cases in Harare during the cholera epidemic in 2008 and 2009.
We developed an ecological study using secondary data. First, we described attack rates by suburb and then calculated rate ratios using whole Harare as reference. We illustrated the average elevation and cholera cases by suburbs using geographical information. Finally, we estimated a generalized linear mixed model (under the assumption of a Poisson distribution) with an Empirical Bayesian approach to model the relation between the risk of cholera and the elevation in meters in Harare. We used a random intercept to allow for spatial correlation of neighboring suburbs.
This study identifies a spatial pattern of the distribution of cholera cases in the Harare epidemic, characterized by a lower cholera risk in the highest elevation suburbs of Harare. The generalized linear mixed model showed that for each 100 meters of increase in the topographical elevation, the cholera risk was 30% lower with a rate ratio of 0.70 (95% confidence interval=0.66-0.76). Sensitivity analysis confirmed the risk reduction with an overall estimate of the rate ratio between 20% and 40%.
This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Furthermore, elevation information, among other risk factors, could help to spatially orientate cholera control interventions during an epidemic.
- Cholera
- Generalize Linear Mixed Model
- Attack Rate
- Average Elevation
- Sewage Disposal
On the 20th of August 2008, an outbreak of 118 cases was declared at St. Mary's and Zenenga wards of Chitungwiza, a large urban centre on the outskirts of Harare [1, 2]. Vibrio Cholerae El Tor 01 was isolated from 18 (30%) of the 59 specimens submitted for examination, thus supporting the clinical evidence for an outbreak [3].
Following this initial outbreak in Chitungwiza, a second wave of infections was reported a few months later with numerous wards being affected and a rapid transmission of the infections to the whole city of Harare. This is one of the largest and most extensive outbreaks of cholera yet recorded in Zimbabwe affecting rural and urban areas [1–4].
In developing countries, cholera is closely related to poor environmental status and lack of basic infrastructure. In this respect, high population densities and poor access to safe water and proper sanitation, along with other environmental conditions, contribute to the spread of cholera in Africa [5–7]. There have been several environmental risk factors described, related to the origin of a cholera epidemic, such as sea surface temperature and more recently, air temperature and rainfall [8–15]. In highly populated African urban areas where the access to clean water is a challenge, water source contamination is one of the most cited risk factors in a cholera epidemic. During the rainy season, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns where shallow wells could easily become contaminated by excretes. In cholera endemic areas, spatial information about topographical elevation could help to guide preventive interventions.
In 1852, Farr hypothesized a causal relation between the cholera cases in the London epidemic and the elevation, indicating that there was an underlying "natural law" correlating infection with cholera inversely to elevation above high water. Farr stated that the elevation of the soil in London had a more constant relation with mortality from cholera than any other known element. In the same way, his contemporaneous colleague Snow, by mapping cholera deaths by elevation, found a correlation between higher elevations and reduced risk for cholera death [16, 17].
Since 1852 there is some evidence about the association between cholera and elevation, although there is no empirical data explaining this pattern [18–20]. Cholera appearance and epidemic magnitude are related to the local environment [21]. New findings explaining possible local ecological and environmental risk factors of cholera are of importance as they could be used to prevent and plan future cholera epidemic responses in endemic areas. Therefore, this study aims to analyze the association between topographic elevation and the distribution of cholera cases, in Harare during the cholera epidemic in 2008 and 2009.
We developed an ecological study using secondary data.
Data were drawn from the registry of cholera treatment centers (CTCs) and oral rehydration points (ORP) functioning during the cholera epidemic in Harare and Chitungwiza. Medecins Sans Frontieres, in collaboration with the Department of City Health of the Ministry of Health & Child Welfare, implemented and managed three CTCs, in the Budiriro Polyclinic, in the Beatrice Road Infectious Diseases Hospital and in the city of Chitungwiza. Ten ORPs were functioning in Harare city and one in Chitungwiza.
Data used in this study were the aggregated number of cholera cases by suburb of residence, topographic average elevation of each suburb in meters, and the distance in meters from suburbs' geometric centre to Chitungwiza (the epicenter of the epidemic).
Population figures by suburb were calculated from the official census of Harare and Chitungwiza, completed in 2002. To estimate the populations' figures at the time of the epidemic, we employed an average constant annual growth rate of 3%, as estimated by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat [22].
During the epidemic, a cholera case was defined as any patient presenting 3 or more liquid stools and/or vomiting for the last 24 hours [23].
We described the elevation by suburbs and distance of each suburb to the epicenter (Chitungwiza) in meters. Geographical information was integrated into the GIS database as vector polygons. Using ArcGIS 'zonal statistics' module, we measured for each polygon average ground elevation and the distance between each suburb centroid (geometric center of the polygon) to Chitungwiza.
To describe the outbreak, we calculated attack rates for each suburb, including 95% exact confidence intervals (CIs). We assumed that the attack rates follow a Poisson distribution [24, 25]. We then estimated rate ratios and their respective 95%CIs, taking the whole Harare rate as reference.
To describe the relation between the cholera cases and elevation, the Pearson's correlation coefficient (R) between the cholera rates and the mean elevation of each suburb was calculated. Then, a scatter plot was built to show the relation between the observed rates and the average elevation by suburb.
A generalized linear mixed model (under the assumption of a Poisson distribution) was used to model the relation between the risk of cholera by suburb and the elevation in meters of Harare: The model assumed a random intercept, with the number of cholera cases as the dependent variable, the log of the population figures by suburb as the offset, and the suburb's average elevation as the independent variable [24, 26].
The derived risk ratio of the model was interpreted as the cholera risk per 100 meters of increase in the elevation, taking into account overdispersion and spatial correlation of the data.
Finally, the predicted rates of cholera by suburb were derived from the model using an Empirical Bayesian estimation. This Empirical Bayesian approach consists of computing a weighted average between the raw rate for each suburb and the regional average, with weights proportional to the underlying population at risk [28]. Estimated rates were illustrated in a figure in order to show the relation between the predicted rates and the elevation in meters. Because of the random intercept, represented by the quintile variable (Q1 to Q5), predicted rates by suburbs were clustered in groups following the specification of the model.
A sensitivity analysis was developed to confirm the consistency of our findings, consisting of an iterative random selection of suburbs to build the cluster variable for the estimation of the random effect. The aim of this process was to estimate the variability of the coefficient of the elevation, taking our first estimation as reference and proving its consistency [29, 30].
For the GIS component of the analysis (mean elevation and distance to the epicenter), a recent (2008) high resolution satellite image of Harare was used. In order to assure a good integration with field surveys, the satellite image was geometrically corrected to fit a set of control points surveyed with a GPS. This image was used as a spatial reference for all GIS analysis. Information from the Harare's topographic map (Produced by the Surveyor General of Zimbabwe), was digitized on top of the satellite image using Arcview software. The elevation information was extracted from the SRTM database (a digital terrain model obtained from the Space Shuttle mission). In this database, ground elevation is provided for each 90x90 meter cell of the model. The extent of each urban district was integrated to the GIS database as vector polygons. Using ArcGIS 'zonal statistics' module, average ground elevation and the distance between each suburb centroid (geometric center of the polygon) to Chitungwiza were measured for each polygon.
The statistical software used for this study was Stata v.11.2 and the module ArcMAP of ArcGIS (ESRI, v. 9.2) software for spatial and geographical representation.
During this cholera outbreak, CTCs and ORPs in Harare and Chitungwiza registered and cared for 19,422 persons who met the case definition. The epidemiological description of the outbreak including the number of cases, attack rates and rate ratios by suburb is presented in Table 1. Suburbs with highest attack rates were located on the south western area of Harare, where overall, the average elevation is lower and the distance to the epicenter (Chitungwiza) is smaller (Table 1, Figure 1: 1A and 1B ).
Rate ratios and attack rates per 1,000 people by suburb in Harare, 2008-2009 (n= 19,422 cholera cases)
in meters
Distance to
in meters
Quintiles of the
distance to Chitungwiza
Attack rates
per 1,000 people
Rate ratios
90.3 (82.8-98.2)
7.00 (6.43-7.63)
74.6 (68.4-81.1)
5.79 (5.32-6.30)
23.2 (22.2-24.2)
1.80 (1.72-1.88)
23.2 (22.2-24.1)
1.80 (1.72-1.87)
Glen View-Glen Norah
19.6 (19.0-20.1)
1.52 (1.47-1.57)
16.9 (15.8-18.1)
1.31 (1.22-1.41)
12.3 (11.0-13.6)
0.95 (0.86-1.06)
11.5 (11.1-12.0)
0.89 (0.86-0.93)
10.7 (9.8-11.6)
0.83 (0.77-0.91)
10.0 (9.1-11.0)
0.78 (0.71-0.86)
9.8 (9.0-10.5)
0.76 (0.70-0.82)
City Centre
9.8 (8.1-11.6)
0.76 (0.63-0.90)
7.0 (6.4-7.4)
0.54 (0.50-0.58)
6.3 (5.9-6.7)
0.49 (0.46-0.53)
6.1 (5.2-7.1)
0.48 (0.41-0.55)
Mt. Pleasant
6.0 (4.1-8.4)
0.47 (0.33-0.65)
4.9 (3.5-6.5)
0.38 (0.29-0.51)
4.8 (3.7-6.1)
0.37 (0.29-0.48)
Milton Park
4.8 (2.9-7.3)
0.37 (0.24-0.57)
4.4 (3.2-5.8)
0.34 (0.26-0.46)
4.3 (3.2-5.4)
0.33 (0.26-0.42)
4.1 (2.7-5.9)
0.32 (0.22-0.46)
4.0 (3.0-5.5)
0.31 (0.23-0.42)
2.9 (1.9-4.1)
0.22 (0.16-0.32)
2.6 (1.5-4.2)
0.20 (0.13-0.33)
2.1 (1.4-3.0)
0.16 (0.12-0.23)
2.1 (1.1-3.7)
0.16 (0.09-0.29)
Warren Park
1.7 (1.4-2.1)
0.14 (0.11-0.16)
1.8 (0.9-3.2)
0.14 (0.08-0.25)
1.7 (0.7-3.2)
0.13 (0.06-0.26)
1.2 (0.7-1.6)
0.09 (0.06-0.13)
All Suburbs
12.9 (12.7-13.1)
This pattern of the spatial distribution of cholera cases correlates positively with the average elevation of Harare suburbs. The computed Pearson's correlation coefficient between the cholera observed rates and the mean elevation by suburb shows a significant negative relationship, which means that at higher elevation, the number of cholera cases was lower (R=−0.5; p-value < 0.001).
Taking into account the overdispersion and the spatial correlation, the modeled relationship between the risk of cholera and the average elevation shows the same pattern (lower elevation, higher risk), with higher rate ratios for the suburbs that are located nearest to the cholera epicenter (Chitungwiza, Figure 1B and Figure 2B). In Figure 2B, Q1-Q5 represent the quintiles of the distance of each suburb to Chitungwiza; hence, Q1 refers to the cluster of suburbs nearest to the epicenter, whereas Q5 refers to the cluster of suburbs which are most far away from the epicenter. Specifically, this refers to the results of our generalized linear mixed model which showed that an increase of 100 meters in elevation yields 30% lower cholera risk, with a rate ratio of 0.70; (95%CI = 0.66-0.76). The sensitivity analysis confirmed the risk reduction with the increase of the elevation with an overall estimate between 20% and 40% (rate ratios between 0.6 and 0.8).
This study shows a spatial pattern of the distribution of cholera cases during the epidemic in Harare. This pattern is characterized by an increase of cholera risk for each 100 meters of drop in elevation; lowest suburbs had the highest cholera risk.
During the cholera epidemic, Zimbabwe was in economic crisis: the health care systems had become dysfunctional, water supplies were irregular and sanitation systems had collapsed. The reason for this was a lack of maintenance of the system, with frequent power interruptions affecting pumping stations [31–34]. On the 1st of December 2008, problems with the main pumping station meant that, without prior warning, the water supply was shut off for Harare city, leaving large populations without access to potable water. By 2008, Chitungwiza, a large urban centre on the outskirts of Harare, had already been without an adequate water supply water for more than 2 years. People had to revert to using unprotected shallow wells that were at risk of contamination because of the dysfunctional sewer system [35]. Unprotected shallow wells could support the pattern founded between cholera risk and elevation; hence, at lower elevation, shallow wells could be contaminated easily by sewage disposal. During the rainy season, in high populated urban areas, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns [34].
A similar pattern could have happened in Haiti where the epicenter of the epidemic had been located in the Artibonite area, which is a plain where rivers and surface water have high risk of contamination compared with mountains, situation that reinforces the external validity of our finding [36, 37]. Water source contamination is one of the most cited risk factors in a cholera epidemic in all the regions of Africa; therefore, lower elevation (like plains and depressions) could facilitate contamination through surface water [38].
The diversity of regions affected by cholera epidemics during the last twenty years in Africa and the multiplicity of risk factors need to be highlighted; however, lack of water and sanitation facilities are the most common factors involved in the origin of an epidemic [38]. In any case, topographical elevation in densely populated urban areas should be considered a risk factor in endemic areas to plan cholera preventive activities linked with water and sanitation. Furthermore, elevation information could help to spatially prioritize cholera control interventions during an epidemic.
Our finding could be affected by the fact that data are based on estimated suburb population, and we recognize that the estimates may not reflect the real figures during the epidemic. However, we tried to take into account the natural average growth of the population to work with most realistic population estimates possible. The internal validity could be affected for data overdispersion and spatial correlation; however we used a mixed model with a random intercept based on a neighborhood variable which is defined via the distance to the epicenter. In introducing a random intercept, suburbs within a cluster are allowed to be dependent. Finally, to confirm whether the choice of our neighborhood cluster for the mixed effect was stable, a sensitivity analysis was developed fitting the model with many other choices of clusters specifying the dependency of suburbs (random choice, choice based on visual aspects and also a second hierarchy). Even though this methodological approach is not the classic way to account for spatial correlation, the standard errors of our estimations allow for suburbs correlation within each of the five groups (spatial correlation), relaxing the usual requirement that the observations are independent.
Our study focuses only on topographic elevation, but we have to highlight that there were other historical, geographical, social, and environmental risk factors previously published, that explained the spatial pattern of the Harare epidemic. Specifically, the fact that Tafara, a high elevated suburb, had high cholera rates, could be explained by the dynamics of population movement because there is a big concentration of bus stops and informal markets offering service to the travelers moving to Mozambique. Bus stops and informal markets, residential housing, water supplies and sewage disposal system were previously identified as risk factors related with the cholera epidemic in Harare, 2008-2009 [12]. Finally, we need to highlight that the risk of cholera by suburb cannot be attributed to one simple individual living in one specific suburb due to the ecological fallacy.
Despite that fact, and to our knowledge, this study could be the first attempt to model the relationship between cholera risk and elevation. Furthermore, the sensitivity analysis developed reinforces the validity of our final model confirming the inverse relationship between cholera risk and elevation.
In conclusion, it has been shown that the distribution of cholera cases by suburb in Harare during the outbreak of 2008-2009 followed an identifiable spatial pattern characterized by a lower cholera risk when the average elevation in meters by suburb increased by 100 meters. During the rainy season, in high populated urban areas, where there is either no sewage disposal or working sewer system, runoff of rains follows the slopes and gets into the lower parts of towns. This study highlights the importance of considering topographical elevation as a geographical and environmental risk factor in order to plan cholera preventive activities linked with water and sanitation in endemic areas. Further studies are needed to explore the link between elevation, water supplies and sewage disposal systems. The identification of this spatial pattern could guide public health action to orientate further preparedness interventions in Harare, aiming to prevent a new cholera epidemic.
We would like to thank Ariane Bauernfeind, Henry Gray and Dionioso Herrera Guibert for their collaboration and support.
Authors' Affiliations
- WHO: Cholera outbreak, Zimbabwe. Wkly Epidemiol Rec. 2009, 84: 50-52.Google Scholar
- WHO: Cholera, Zimbabwe–update. Wkly Epidemiol Rec. 2009, 84: 109-110.Google Scholar
- WHO: Outbreak news. Cholera, Zimbabwe. Wkly Epidemiol Rec. 2008, 83: 449-450.Google Scholar
- Bradley M, Shakespeare R, Ruwende A, Woolhouse ME, Mason E, Munatsi A: Epidemiological features of epidemic cholera (El Tor) in Zimbabwe. Trans R Soc Trop Med Hyg. 1996, 90: 378-382. 10.1016/S0035-9203(96)90512-X.View ArticlePubMedGoogle Scholar
- Hartley DM, Morris JG, Smith DL: Hyperinfectivity: A critical element in the ability of V. cholerae to cause epidemics?. PLoS Med. 2007, 3: 63-69.Google Scholar
- Talavera A, Perez EM: Is cholera disease associated with poverty?. J Infect Dev Ctries. 2009, 3: 408-411.View ArticlePubMedGoogle Scholar
- Zarocostas J: Cholera epidemic in Haiti is blamed on poor sanitation. BMJ. 2011, 342: d2944-10.1136/bmj.d2944.View ArticlePubMedGoogle Scholar
- Colwell RR, Huq A: Environmental reservoir of Vibrio cholerae: The causative agent of cholera. Ann N Acad Sci. 1994, 740: 44-54. 10.1111/j.1749-6632.1994.tb19852.x.View ArticleGoogle Scholar
- Huq A, Sack RB, Nizam A, Longini IM, Nair GB, Ali A, Morris Jr JG, Khan MNH, Siddique AK, Yunus M, Albert MJ, Sack DA, Colwell RR: Critical factors influencing the occurrence of Vibrio cholerae in the environment of Bangladesh. Appl Env Microbiol. 2005, 48: 420-424.Google Scholar
- Lipp EK, Huq A, Colwell RR: Effects of global climate on infectious disease: The cholera model. Clin Microbiol Rev. 2002, 15: 757-770. 10.1128/CMR.15.4.757-770.2002.View ArticlePubMedPubMed CentralGoogle Scholar
- Luque Fernandez MA, Bauernfeind A, Jimenez JD, Gil CL, El Omeiri N, Guibert DH: Influence of temperature and rainfall on the evolution of cholera epidemics in Lusaka, Zambia. Trans R Soc Trop Med Hyg. 2009, 103: 137-143. 10.1016/j.trstmh.2008.07.017.View ArticlePubMedGoogle Scholar
- Luque Fernandez MA, Mason PR, Gray H, Bauernfeind A, Fesselet JF, Maes P: Descriptive spatial analysis of the cholera epidemic 2008-2009 in Harare, Zimbabwe: a secondary data analysis. Trans R Soc Trop Med Hyg. 2011, 105: 38-45. 10.1016/j.trstmh.2010.10.001.View ArticlePubMedGoogle Scholar
- Mendelsohn J, Dawson T: Climate and cholera in KwaZulu-Natal, South Africa: The role of environmental factors and implications for epidemic preparedness. Int J Hygiene Env Health. 2008, 211: 156-162. 10.1016/j.ijheh.2006.12.002.View ArticleGoogle Scholar
- Pascual M, Bouma MJ, Dobson AP: Cholera and climate: Revisiting the quantitative evidence. Microbes Infect. 2002, 4: 237-245. 10.1016/S1286-4579(01)01533-7.View ArticlePubMedGoogle Scholar
- Tamplin ML, Gauzens AL, Huq A, Sack DA, Colwell RR: Attachment of Vibrio cholerae serogroup O1 to zooplankton and phytoplankton of Bangladesh waters. Appl Env Microbiol. 1990, 56: 1977-1980.Google Scholar
- Bingham P, Verlander NQ, Cheal MJ: John Snow, William Farr and the 1849 outbreak of cholera that affected London: a reworking of the data highlights the importance of the water supply. Public Health. 2004, 118: 387-394. 10.1016/j.puhe.2004.05.007.View ArticlePubMedGoogle Scholar
- Farr W: Influence of elevation on the fatality of cholera. J Stat Soc Lond. 1852, 15: 155-183. 10.2307/2338305.View ArticleGoogle Scholar
- Ali M, Emch M, Donnay JP, Yunus M, Sack RB: Identifying environmental risk factors for endemic cholera: a raster GIS approach. Health Place. 2002, 8: 201-210. 10.1016/S1353-8292(01)00043-0.View ArticlePubMedGoogle Scholar
- Chevallier E, Grand A, Azais JM: Spatial and temporal distribution of cholera in Ecuador between 1991 and 1996. Eur J Public Health. 2004, 14: 274-279. 10.1093/eurpub/14.3.274.View ArticlePubMedGoogle Scholar
- Olago D, Marshall M, Wandiga SO, Opondo M, Yanda PZ, Kanalawe R, Githeko AK, Downs T, Opere A, Kavumvuli R, Kirumira E, Ogallo L, Mugambi P, Apindi E, Githui F, Kathuri J, Olaka L, Sigalla R, Nanyunja R, Baguma T, Achola P: Climatic, socio-economic, and health factors affecting human vulnerability to cholera in the Lake Victoria basin, East Africa. Ambio. 2007, 36: 350-358. 10.1579/0044-7447(2007)36[350:CSAHFA]2.0.CO;2.View ArticlePubMedGoogle Scholar
- Emch M, Feldacker C, Yunus M, Streatfield PK, DinhThiem V, Canh do G, Ali M: Local environmental predictors of cholera in Bangladesh and Vietnam. Am J Trop Med Hyg. 2008, 78: 823-832.PubMedGoogle Scholar
- Population Division of the, Department of Economic & Social Affairs of the United Nations, Secretariat: World Population Prospects: The 2008 Revision. Available at: [http://www.un.org/esa/population/publications/wpp2008/wpp2008_highlights.pdf].,
- Bauernfeind A, Fesselet JF, Van Hep M, Le Saout E, CJ M: Cholera Guidelines. 2004, Medicins sans frontieres, Paris, FranceGoogle Scholar
- Dupont WD: Statistical modeling for biomedical researchers. A simple introduction to the analysis of complex data. 2004, Cambridge University Press, Cambridge, UKGoogle Scholar
- Fleiss JLL, Cho-Pai M: Statistical Methods for Rates and Proportions. 2003, Wiley, New York, USAView ArticleGoogle Scholar
- Hardin JW, Hilbe JM: Generalized linear models and extensions. 2007, Stata press, Texas, USAGoogle Scholar
- Ruiz-Moreno D, Pascual M, Emch M, Yunus M: Spatial clustering in the spatio-temporal dynamics of endemic cholera. BMC Infect Dis. 2010, 10: 51-10.1186/1471-2334-10-51.View ArticlePubMedPubMed CentralGoogle Scholar
- Rabe-Hesketh S, A S: Multilevel and Longitudinal Modeling Using Stata. 2008, Stata press, Texas, USAGoogle Scholar
- Richardson S: Methodological problems in health-environment ecological studies. C R Acad Sci III. 2000, 323: 611-616. 10.1016/S0764-4469(00)00162-1.View ArticlePubMedGoogle Scholar
- Severini TA: Measures of the sensitivity of regression estimates to the choice of estimator. J Am Stat Assoc. 1986, 91: 1651-1658.View ArticleGoogle Scholar
- Ncayiyana DJ: The Zimbabwe mayhem-how many people must die for the neighbours to act?. S Afr Med J. 2009, 99: 7-PubMedGoogle Scholar
- Truscott R: Zimbabwe appeals for medical aid as it declares state of emergency over cholera epidemic. BMJ. 2008, 337: a2942-10.1136/bmj.a2942.View ArticlePubMedGoogle Scholar
- Truscott R: Zimbabwe faces a 'major health disaster', as hospitals close. BMJ. 2008, 337: a2710-10.1136/bmj.a2710.View ArticlePubMedGoogle Scholar
- Zarocostas J: Aid organisations warn Zimbabwe's cholera crisis is far from over. BMJ. 2009, 338: b693-10.1136/bmj.b693.View ArticlePubMedGoogle Scholar
- Mason PR: Zimbabwe experiences: the worst epidemic of cholera in Africa. J Infect Dev Ctries. , 3: 148-151.Google Scholar
- CDC: Update: outbreak of cholera-Haiti. MMWR Morb Mortal Wkly Rep. 2010, 59: 1586-1590.Google Scholar
- WHO: Outbreak news. Cholera, Haiti - update. Wkly Epidemiol Rec. 2010, 85: 489-490.Google Scholar
- Griffith DC, Kelly-Hope LA, A MM: Review of reported cholera outbreaks worldwide, 1995-2005. Am J Trop Med Hyg. 2006, 75: 973-977.PubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/12/442/prepub
Pre-publication history
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


text:
Houston, Texas, January 9, 2018 - RJN GIS Manager Noelle Gaspard, P.E., GISP, CFM, will be presenting at the WEAT Conference on Wednesday, January 17, 2018, at the Embassy Suites by Hilton San Marcos Hotel Conference Center & Spa.
Details about this presentation are as follows-
Presentation Title: Utilizing Advanced Technologies for Mapping, Condition Assessment and Master Planning
Presenter: Noelle Gaspard, P.E., GISP, CFM, GIS Manager, RJN Group, Inc.
Date: Wednesday, January 17, 2018
Time: 9 AM to 9:30 AM
Location: Embassy Suites by Hilton San Marcos Hotel Conference Center & Spa, 1001 E. McCarty Lane, San Marcos, Texas
Description: This presentation provides an overview of the multi-year Stormwater System Televising, Mapping and Condition Assessment project initiated by the City of San Antonio in 2015, the Stormwater CCTV Master Plan development, and provides information about technologies used to complete the project.
Be sure to visit RJN at Booth 24 while you're at the conference!
To learn more about this conference, visit this website: www.weat.org

subset: commoncrawl


text:
Pricing Information
Each painting is an original work of art, no prints or reproductions are created or sold.
We aim to make pricing accessible to all, but each piece is unique and the price depends on a myriad of factors. A general range is €500 to €2,000 plus shipping and handling.
If you are interested in a specific work, please send us an email with the reference number. [When on the Gallery page, hover over or click on the image]
We strive to respond to all inquires within 24 hours. We look forward to hearing from you and thank you again for your interest.
How to Purchase
To make a purchase, please locate the reference number for the painting and send an email to firstname.lastname@example.com or call 385 98 164 5023.
Credit cards and electronic payments accepted.
We are happy to accept online payments through PayPal.
We ship internationally.
When we receive your address, we will give you a price quote for shipping and handling.


text:
1Ti 6:8 And having food and raiment let us be therewith content.
2Co 11:3 But I fear, lest by any means, as the serpent beguiled Eve through his subtilty, so your minds should be corrupted from the simplicity that is in Christ.
We Americans have nearly forgotten the simple life but much of it still exists in the villages we try to minister in here in Romania. Certainly the simplicity of materialism is evident and the verse above about contentment with food and raiment is exercised here. Racos village actually is ahead of much of America in certain aspects for instance notice photo # 5901 Fresh milk delivered to your door.
Poor children have to suffer without Saturday morning cartoons. They end up playing the games we all played 50 years ago Photo #5902 and playing with simple toys Photo # 5903 these kids are about to burst for the gospel of Jesus Christ they were waiting for us to come and tell them a story from the Bible. The boy in photo #5904 carried his brother and held him most of the time for the Bible story "He's not heavy he's my brother."
I have functioned in many capacities in churches over the years but I have never been a bus captain WELL looks like I got my chance in Photo #5905 you will see 21 from Budila debussing my bus and into church this past Sunday morning what a blessing. I am running now for president of the Womens Missionary Society another office I have never held.
We have filed a formal complaint to the police in Brasov because of their continual harassment notice Photo #5907 Daniel is preaching and once again here they come thank God they always end up going away but sometimes it really gets tricky how handle them this time we have every permit they have ever required (but according to the constitution we don't need any at all) and still they hassle us In Photo # 5906 three of our home grown missies helping us with tracts on a street meeting these are from left to right Alexandra, Bethany Ann Logan and Mary Bethany Sutek
With the artificial light of the European Union beginning to shine over the border into Eastern Europe and beginning to steal the attention of the souls created by our Lord and thus diminish the harvest He deserves, we confess a measure of frustration and disappointment. But souls are still being saved in areas where the true light of the gospel is unhindered by materialism and the false promise of a better existence in this life. Dan led a 51 year old man to the Lord on the street meeting we showed in the photos. A 21 year old who rode the bus in the photos was giving assurance and made a rededication and we thank the Good Lord for being about to do some profitable gleaning in these last days In Photo #5908 is a one of many beautiful scenes here of a ripened Poppy field back dropped by the magnificent Transylvania Alps.
Thank you for the ammunition of your prayers as we serve on the front lines of the eastern front.
Gerald Sutek
And the SWAT TEAM for Christ


text:
In a recent article by Deepak Chopra he writes:
When you know who you really are, you are able to manifest your deepest desires. You are able to experience abundance, joy, and fulfillment. Yet most people confuse their true identity with their self-image. They identify themselves with external things, including their possessions, titles, money, perceived status, and the opinion of others. This is known as object referral. By their very nature, objects change, so as long as you remain in a state of object referral, your life will feel unstable.
The opposite of object referral is self-referral or identifying with your inner self – the unchanging essence of your soul. In this state you have an internal sense of abiding happiness regardless of what is happening around you because you aren't identified with transient objects or events. Your true self is:
Connected to all that exists
Unlimited and unbounded
Infinitely creative
Fearless and willing to step into the unknown
Since your true self is an inseparable part of the field of pure potentiality, the intentions that you set from this level of your being are powerful. When you're established in your true self, you are able to harness the infinite organizing power of infinite intelligence to manifest your deepest desires.
After Reading this I was thinking, yes and how do we get from that place of object referral when we are constantly looking outside of ourselves for clues as to who we are at any given moment.
There are actually many ways to connect on a deeper level with ones-self and many of those ways are along the lines of finding things that are particular to you those things that in your most intimate moments with yourself you say to yourself, "I am really in love with this…."
However, our world or the world that we have created in this moment tends to be one that requires a lot of our attention like an unruly child that constantly begs for our attention, our lives have a way of requiring that we always think about what's next for us or what we have to do next.
With all this in mind my invitation for you this week is to find 5 or more minutes a day for you to just be with your self. Not doing anything just being. You can meditate if you want, if that is something that feels good to you or practice one yoga asana, but mostly just be… relax in a chair (no reading) lay down and let yourself really rest, tune in to your breath, imagine clouds above you and try to feel that movement in your own body or the gentle rocking of waves hitting the side of a boat.
Just something where you have an opportunity to tune into your true, pure, peaceful self; no attachments just you part of everything. Relax…
Om shanti


text:
I Don't Think We're In Middle-Earth Anymore - Part 1
"I highly doubt that's possible," she said to herself, sighing she leaned closer to the computer screen and read one last story.
"Whatcha doin'?" she heard her annoying little brother's voice from behind her.
"Typing," she said, finishing the story and bringing up the submit a story page, "Now go away!"
Her brother didn't leave, "Whatcha writing about?"
Rolling her eyes, Renee answered as patiently as she could, "Lord of the Rings."
"Oh," he replied excitedly, "I love that movie!"
"It was a book first," Renee said as she began to move her fingers over the keyboard, letting creativity flow out of her.
Her brother went on, "I love it when they fight! The elf dude-"
"Legolas," she corrected him.
"-When he uses his bow," her brother was unphased, "And when the humans use their swords to chop off pieces of the monsters!"
Renee put her face in her hands, "David," she said slowly, there was no use in reasoning with him, "Why don't you go pretend you're those guys and go chop something to pieces outside?"
David seemed to think this was a good idea, and left to get his weapons.
Renee went back to typing, not knowing what was soon going to happen, something that would change her life forever.


text:
A cute 3 bedroom, 2 bathroom house in Canyon Trails. Open Living. Generous Sized Bedrooms. Laundry Room with storage. 18'' Tile and NEW Carpet. Upgraded Lights and Fans. Newly painted inside and outside with epoxy painted garage floor. A 6,000 sq ft CORNER Lot. Backyard Landscaping with extended Patio. View Fence OVERLOOKS the Community Greenbelt and close to playground/park. HOA $80 month includes community pool and fitness center. BUY now as values increase with NEW Homes building in the area.
Listing courtesy of Homie. Selling Office: HomeSmart.
All information should be verified by the recipient and none is guaranteed as accurate by ARMLS. Copyright 2019 Arizona Regional Multiple Listing Service, Inc. All rights reserved.


text:
Hi all
I am just about to buy a house that has solid brick walls. I will be having a DPC installed (probably injection?) but the surveyor said something about recommending I had the walls insulated, and mentioned dry lining. Is this the best way to go about it, or are there easier/better ways, and if dry lining is the way to go, how?
I am probably going to have to DIY it, and many other things, as finding the huge deposit necessary these days have left me pretty much skint - Expect more posts from me on here as I find other bits wrong with the house!


text:
Beauteous. The entire series is great.
Thank you Owen. One day, when I'm rich and don't have to work any more, I'll set about painting the whole Abstracts series on canvas. Until that point I guess I'll just keep churning out the screen caps.
Your email address will not be published. Required fields are marked *
Name *
Email *
See more here: @llwchllwch


text:
Exclusive: Emmett Parka
I'm packing our new exclusive Emmett Parka for my winter ski trip to Jackson Hole. The grosgrain ribbon detail and detachable fur collar will look chic on the slopes!
December 13, 2017
I can't wait to dive into Tina Brown's "The Vanity Fair Diaries" over the holiday break. Her eight years at the top of the Vanity Fair masthead were legendary!


text:
Meet Rocky, part of the August release from DigiStamp Boutique. Isn't he the cutest? Today is probably the hottest day of the year here so he's here just in time! We can use all the cool and wintery thoughts we can get!
What a cute card!!
I adore this Lisa...the colours and papers are superb - one snazzy creation indeedy....fab sparkle too! xx


text:
Fiberglass is commonly used to make hot tubs. This material can be easily scratched, but it is very durable when it comes to holding a lot of weight. When you own a hot tub, it is crucial that you drain the hot tub regularly in order to clean the interior of the tub to cut down on algae, grime and build up and also to keep the filters clean and working. Cleaning a fiberglass hot tub isn't all that hard, and if you drain it first, you don't need any fancy cleaning equipment or cleaners.
Step 1
Drain the hot tub. This will get as much of the loose debris and dirt out of the tub as possible, which will make cleaning easier.
Step 2
Take out and rinse the filter with clean water, or replace the filter if it is disposable.
Step 3
Mix 1 cup of mild dish detergent with 2 gallons of warm water in the bucket and drop the sponge in. You want to use a non-abrasive sponge because abrasive surfaces can damage the fiberglass.
Step 4
Wring out most of the liquid from the sponge and scrub the interior of the hot tub. Scrub the lights if you have them and get into the hard to reach places. This is where a lot of grime and dirt can hide and accumulate.
Step 5
Rinse the interior with clean water (you can use a garden hose) and then drain the hot tub. Repeat until there are no soap bubbles left in the tub.
Step 6
Scrub the exterior of the hot tub to eliminate dirt, dust, grime and film. Rinse with clean water.
Step 7
Refill the hot tub and turn it on to heat up the water temperature. Replace the cover if desired.


text:
So here were my JULY GOALS
Now I'm not really sure how I feel about income reports, so instead I'm going to note down my goals for the month, just to put some out there, to look back at and monitor progress.
Also I would like to point out that obviously I don't rate success by Facebook or social media likes/followers etc as you could have 10000 followers but actually just have 500 specific targeted fans that are more engaged and effective, however I'm just using the data to measure and quantify my results and progress. So yer….
1. Mr Paul accounts
Its now time to file the accounts and this is my number 1 priority, it actually took up 99.9% of my head space in July BTW.
2. INSTAGRAM 6000 followers
3. TWITTER 2000 followers
4. 200 LIKES to my Facebook business page
( I feel a little apprehensive about growing this, I'm not sure why? I guess it's really putting yourself out there! It could be challenging and time-consuming, but I will give it a go)
6. 300 blog views
7. 3 blog posts ( ideally 4 )
8. Make an EMAIL opt in offer, promote and grow email list to 100
9. £1000 amazon sales
(quite a low month for sales, but just winding down a PL product and changing strategy as I'm about to become VAT registered)
10. Learn more about affiliate marketing and drop shipping
11. Read book, The book of titans
12. Save money. £500 from other sources of income
So how did I do ?
1. Accounts done! I have an amazing accountant, I also use Xero, I highly recommend!
Sign up for a free trial, I've tried a few different accounting applications and softwares and I find this is the best one for E-commerce, you can link it to your Amazon seller account. Its reasonable too at just £22 a month for the standard package which is fine for me.
WOW nearly at my 6000 goal, come on only 157 short? I'm pleased with this, my goal in August is for around 6500 and I'm going to have to really improve my content, so that's on my list of things to do.
How did I do it? I've been using a strategy for growing my Instagram account, mostly from this book
Also I'm no expert at Instagram but Jeremy McGilvrey certainly is, he is the man!He gives away so much great free content and amazing advice, check him out on Facebook, you can sign up to a free webinar web class here to learn more from him.
Including an amazing review from the lovely Tracey Catherine Hurst ( thank you so much for all your support Tracey)
44 , again I've been a little apprehensive about this, going to continue to add great content, but my mindset is holding me back with this. If you're thinking of starting a Facebook group Caitlyn Bacher is the go to, Caitlyn posts lots of amazing free content on Facebook and youtube.
Oh and you can join the group here please
Specifically if you are interested in selling on Amazon here in the UK.
6. 300 blog views
Sorry not a great picture, but 765 views, smashed it, not bad for 1 blog post in July, really going to try to build momentum now. I think I should try and double it for August. I've got some great ideas for posts.
7. Blog posts 3 (ideally 4)
oops just the 1 but I've been procrastinating and blaming my accounts, they really did take up all of my time and mindset, back on it for August ( this ones the first)
8. Opt in offer, grow email list to 100
Well I put together a Free guide ( help me out with this goal and sign up ta x )
The result?
67, quite pathetic,
300 in august! MUST TRY HARDER! I'm going to run a little Facebook ad I think?
9. £1000 amazon sales
Quite a low achievable amount, I'm just winding down sales as I'm coming up to being VAT registered, this is 1 private label product, I had around 100 left in stock. If you didn't know about my Amazon journey check this post out.
10.learn more about affiliate marketing and Drop Shipping
11. Book, the book of titans
Review coming soon, I loved Tim Ferris's first book The 4 hour work week.
12. Save £500 (from other sources of income)
- £71 music magpie, (sent an old phone in)
- £25 quidco,
- £75 eBay sales some old bits n pieces,
- £20 shpook
- £40 Facebook groups,
- £164 instagram posts!
£395 wahoooo! not too far off, super pleased with this. Going to try again in August, join me on my extra £500 challenge, comment below if you're in and we can check back on your progress? Also for a few ideas of ways to make additional income check out this post
So basically I didn't smash all of my goals I just nearly achieved most of them, quite happy with that!
Heres to an amazing August!


text: As would happen today with a story about a political scandal, the population was stirred and began the patriotic movements that could not be easily laminated because soldiers were mutinous. According to Center for Responsible Business, who has experience with these questions. The viceroy Baltasar Hidalgo de Cisneros, that shortly before, (15 July 1809 in Colonia del Sacramento, Uruguay today) had replaced Santiago de Liniers, rejected for being of French origin and possible ally to the Napoleonic, trying to stem the tide with a quick reflection. Cisneros issued 18 one side where demanded to calm people and loyalty to the Spanish Crown with the goal that not occur stormy events in the Rio de la Plata. At that time the viceroyalty was divided into eight municipalities: La Paz, Cochabamba, Charcas, Potosi, Paraguay, Salta, Cordoba and Buenos Aires, and four Governments subordinate to the direct authority of the viceroy: Montevideo, missions, Chiquitos and Moxos. The reading of the Royal Edict mobilized the Creoles, who had already analyzed information arrival in Europe, requesting the authorities to be allowed to perform an open Cabildo to treat the situation particularly. In this popular mobilization is where it starts and develops the military and political move that would end up forming the first Junta de Mayo as a provisional Government until they assume new authorities in the Iberian peninsula. Notable as the brigadier Cornelio Saavedra, born in the Bolivian territory and the Mariano Moreno Buenos Aires were enforcement officials hastily mature the air of freedom. Both were merchants, with the difference that Saavedra entered checkered military during the resistance and later recapture of Buenos Aires to the British invasions at the end of 1806, when he was appointed commander of the Corps of volunteers who formed the regiment of patricians, for being all born in America. Saavedra had a very important role during the years after the invasion, during week of May and in the first years of the emancipation of motherland mother.


text:
Miss Pop created cool, easy-breezy nail art for the hippies/models who walked the runway at Jeremy Scott's super colorful show.
Read more
Featured Products & Promotions | Advertisement
View Store
How big is the U.S. nail business? $7.3 billion. What's the average service price for a manicure? Dig into our decades' deep research archives.
View All
VietSalon is a Vietnamese-language magazine and the sister publication to NAILS. Click the link below to sign up for a FREE one-year subscription.
Subscribe to NAILS & SAVE!
Get a free preview issue and a Free Gift
Subscribe Today!


text:
Ron Gold
President & CEO
Marketing Works was launched in 2002 by noted New York communications professional, Ron Gold.
With connections to over 1,000 U.S. publications, we have the resources to get the word out effectively to the mass media, as well as to industry and local community news sources. Our experienced staff of writers, designers, and PR pros works one-on-one with clients to fine tune and spread their message through attention-getting press releases, media interviews, mailings, videos, social media, websites, and more—designed to capture attention and generate recognition. We constantly bring fresh ideas to our clients on ways to promote, market, and deliver their message to their target audience.
For over 30 years, Ron Gold has been a solid presence in the communications industry. He was General Manager at WALK 97.5 FM where he helped make it the number one radio station on Long Island — a status the station maintains to this day. He was also responsible for unveiling B103 FM, the top "oldies" radio station on Long Island.
After 25 years in radio, Ron left to start an advertising agency with his wife called Advertising Works. He launched Marketing Works in 2002, offering a full spectrum of marketing and public relations capabilities, with an emphasis on good old-fashioned customer service and a focus on serving the nonprofit field. In 2014, we launched The Nonprofit Voice, a weekly radio show that discusses the issues affecting the special needs and behavioral communities of Long Island. The show is broadcast live on Saturday mornings on Long Island News Radio 103.9 FM.
Ron believes in giving back to the community and has provided pro
bono material for the Huntington Breast Cancer Action Coalition and the
Long Island Advancement of Small Business, among others. He served on
the Board of Directors of the Suffolk County Police Athletic League and
was named "Man of Year" by the American Red Cross of Suffolk County.
Melissa Rose
Vice President
Melissa has always had a passion for working with people and has a keen eye for design. Her gentle, yet no nonsense approach has earned her the reputation of a results-getter who always has cutting-edge ideas. Melissa has always tended to gravitate to those beyond her years with great admiration for their devotion and expertise in the business community.
As Vice President at Marketing Works PR, Melissa assists over 15 clients throughout the tri-state area with their marketing, graphic design, and event planning needs. With a focus in the not-for-profit arena, Melissa helps her clients to fine tune their messaging, expand their media presence, reach new audiences, and enhance the profitability of their fundraising events.
Melissa has been recognized several times for her consummate leadership. She is extremely proud of the awards she received from Long Island Business News in 2012 as a Top 40 Under 40 recipient; 2012 Huntington Chamber of Commerce, Top 30 Business Professionals Under 30; and 2011 Public Relations Professionals of Long Island, Rising Star.
Melissa served on the Board of Directors of Public Relations Professionals of Long Island from 2007 to 2013 and as a member of Long Island Elite, from 2015 – 2017.
Melissa received her Bachelor of Arts Degree in Communication Studies concentrating in Public Relations from Wilkes University in Wilkes-Barre, PA, and she graduated Summa Cum Laude with a Master of Arts Degree in Communication Arts from New York Institute of Technology in 2006.


text:
Uber Soca Cruise
The 365 TV Network and Toronto Caribbean were Out and About for Ubersoca Cruise 2016 from Miami to Jamaica. Watch all of Priya Ali's interviews with the performers streaming right here.
Ubersoca Cruise is the first and only full cruise ship charter dedicated exclusively to soca music. This year, the cruise sails from Miami Florida to Cozumel Mexico from November 16th – 20th 2017 and features the best soca artists and DJs in the world. It all starts with the pre-cruise party in South Beach Miami Florida on November 15th 2017. Ubersoca Cruise is the largest soca festival at sea and is sure to be an experience beyond the music.


text:
Getting Ready for Baby (2 of 2) - La Jolla
Caring for your new baby
Caring for your new baby
This second session of a two-part class will help new parents gain skills for caring for their newborn.
The class is taught by a pediatrician and covers newborn care, appearance and characteristics. It is held on the campus of Scripps Memorial Hospital La Jolla in the Schaetzel Center.
Both parents are encouraged to attend.
Why do I need to register?
Pre-registration allows us to reserve your space and contact you in the event of a change in the time or location of a class or on the rare occasion that we have a class cancellation.
Please remember, we cannot guarantee accommodation for walk-in participation at our classes, screenings and programs and cannot be responsible for any inconvenience due to lack of registration.
- Scripps Memorial Hospital La Jolla
- La Jolla, CA 920379888 Genesee AvenueSchaetzel Center
|Thu, Nov 3rd, 2016 - Thu, Dec 1st, 2016
|6:30 pm - 8:30 pm
|Thursday, November 3rd, 2016
|6:30 pm - 8:30 pm
|Thursday, December 1st, 2016
|6:30 pm - 8:30 pm


text:
SAN FRANCISCO (CBS SF) — Half a million immigrants who applied for naturalization in the United States this year — hoping to vote in a national election in which immigration has been a dominant issue — aren't likely to be able to vote due to slow processing of applications.
It came as no surprise to the U.S. Citizenship and Immigration Services (USCIS) that 2016 would see a massive influx of applications for U.S. naturalization due to the upcoming national election. The White House Task Force on New Americans even launched a citizenship-awareness campaign to encourage the 8.8 million lawful permanent residents eligible for citizenship in the U.S. to apply.
USCIS officials also anticipated a major increase in applications due to a pending naturalization fee increase expected later this year. A similar increase occurred prior to the 2008 election.
"They should urgently redistribute pending cases to field offices with capacity and/or deploy supports to stressed offices," writes Tara Raghuveer in a report released Friday that describes how the slow application process, and resulting backlog, may cause voter disenfranchisement this election cycle.
Raghuveer, the deputy director of the National Partnership for New Americans, a coalition of 37 immigrant and refugee rights groups, said she was shocked to learn how few applications had been processed. She described the backlog as "absurd."
Many immigrant rights organizations rushed to get eligible immigrants in swing states to apply for naturalization early in the year to allow sufficient time for processing of the applications before states' voter registration deadlines.
Of the more than 500,000 applications pending nationwide, roughly a fifth of those applications are in California.
California's voter registration deadline for the upcoming election ends on October 24, so many potential California voters may not get their applications processed in time.
As of mid-September, San Francisco had over 16,000 U.S. citizen naturalization applications pending, more than any other USCIS field office in the state.
USCIS's San Francisco spokeswoman Sharon Rummery said pending applications in San Francisco can take up to seven months to process.
Raghuveer said California isn't nearly as troubling as Nevada, where some applicants who submitted their paperwork in January say they still haven't been able to meet with immigration officers.
Nevada is not keeping up with the increase in applications. California's backlog increased by only 30 percent while Nevada's backlog has almost doubled since 2015. Likewise, Florida has seen a backlog increase of almost 60 percent over last year.
USCIS officials in Nevada did not immediately respond to CBS San Francisco's inquiries regarding the cause of the backlogs in that state.
By Hannah Albarazi – Follow her on Twitter: @hannahalbarazi.
The liberal progressive democrats would love to get these people to vote for Hillary .
We have more than enough people in the U.S., close the doors already.
What did they expect? 7 months is about how long it takes for a passport, too. The feds have always been slow, on everything.
But it won't matter in California anyway…you can easily register to vote even if you're an illegal. Simply check the box for Citizen. They don't ask for proof of citizenship when you register. No one verifies that, no one cares. With so many illegals already voting, this state is a lock for Hillary.
Scary, sad and all so true.
It's been my experience that Hispanic people will lie right to
your face, and not blink an eye. I think it's just second nature to them.


text:
For those of you following, I'm beginning my Functional Wellness elimination phase this week. *If you want to follow more closely, I update instastories way more often :)*
For those of you not, my doctor believes I may have small intestine bacterial overgrowth (SIBO) and while I'm waiting on test results, I'm doing a strict elimination. I basically am eliminating all known dietary triggers so that I can set my body up for optimum detoxification and healing. I'm eliminating things like caffeine, dairy, gluten, alcohol, sugar, and wheat. I want to invite you on this journey with me, as I've said many times before! I guess I'm getting redundant. Oh well.
Here's the deal: Withdrawal sucks. Quitting things cold turkey is hard. You can taper and wean. It works. However, I know myself and if I give myself anything, I won't quit. Just one piece of candy turns into the whole bag. Just one sip of coke turns into the whole can. I don't know how to just a little bit.
Food is not the main issue though. Our health is built on so much more than food and medicine. We have to make sure that our lives are in balance and functioning. This means that each pillar of wellness needs attention. I want to use this week to introduce how to work on different areas of our lives. I'm going to be sharing tips on detoxing each area and replenishing each area.
I am an expert at a lot of things. I know how to wear a Ninja Turtle onesie while watching The Office. I am especially skilled at forgetting clothes in the washing machine and having to run it again. My skills for forgetting someone's name as soon as they tell it to me are unmatched. However, I am not an expert at any of the things I'm about to share with you. This is just my life, my story, and my crazy self trying to get healthy.
Anyway, I'm stupid excited for elimination week (by the way, that's what I'm calling it. Hey! I'll even make it a hashtag. #katiejoyhealthelimination wait. that sounds like I'm being murdered. I'll think of something) and I can't wait to share these things with you!
For now, if you want, you can go view my how to start post one & two to learn what I do to set the stage for an elimination.
What do you want to change in your life? What needs to be eliminated? What could be added? I'd love to hear from you!


text:
I was supposed to be teaching a class tonight. I taught last night. I have an event tomorrow night. I am leaving Friday on a 3-day weekend. Guess what's in my refrigerator? That's right. Nuttin'. And it's snowing REALLY hard. Ain't "nuttin" open tonight either to grab dinner. What to do? What to do?
Don't tell anyone, especially my husband, but there is RARELY a real reason to say "We need to go out/order in/eat cereal because there is nothing in the house to eat". If you keep a reasonably stocked pantry (and why shouldn't you?), have cheese on hand and some basics in the freezer, you can always put it together with pasta and have a great, hearty meal.
In the refrigerator, I found a random piece of green pepper(I can't remember what I used the rest for), a red pepper, a cherry pepper, a few black olives, a small packet of oregano, 4 mushrooms, a kind of sad-ish zucchini, some fresh mozzarella, a ½ package of shredded mozzarella, some Parmesan cheese, about 1 cup of milk and some butter. My husband's going to freak when he finds out I used the last of his precious milk-yes the old man drinks milk every day. Weird. In the freezer was a ½ lb. of ground beef left over from one of those huge Costco packages-I had sausage too, so I could have used that or I could have gone completely veg. In the pantry I had some onions(always), a jar of Rao Marinara Sauce(also always), a box of no-cook lasagna noodles(yep, always) and, of course, flour.
Here's what I did:
- I sliced the mushrooms fairly thin, cleaned and sliced the peppers into strips, peeled the zucchini, cut it in ½ and cut it into 1/4 " planks, sliced ½ of a large onion, tossed all the vegetables lightly in a bit of olive oil, spread them out on a sheet pan and roasted them at 350° for 30 minutes.
- I chopped up the fresh oregano and the olives and mixed them together.
- I sliced the fresh mozzarella
- I put the ground beef in a fry pan and cooked it until all the red was gone and drained any fat from the pan.
- I made a béchamel (https://www.kieffers.com/kieffers-cooking-blog/lasagna-bolognese-like-an-italian) from the butter, milk and flour and added Parmesan cheese.
Now everything was ready for the pan-a 9X9 square non-stick baking pan.
- First grease the pan, if it is not non-stick-be sure to get the sides.
- Lay down a film of Marinara Sauce
- Lay some pasta sheets over to cover
- Layer, the béchamel, veggies, meat, olives, cheeses and some sauce. Repeat. Top with a final layer of pasta and a nice layer of sauce. Top with more cheese, if you have it. I didn't.
- 5. Bake for about 1 hour at 350° until nice and bubbly.
Presto! Snow Day Lasagna.
Note: I could have used well-drained frozen spinach, sun dried or fresh tomatoes, any kind of fresh or frozen greens-escarole, broccoli or broccoli rabe, finely cut salami or pepperoni, canned tomatoes cooked with some aromatics and red wine in place of my jarred pasta sauce or thin sliced par cooked potatoes in place of the noodles. Be Creative. Just be careful not to "kitchen sink" the ingredients-stick with what actually goes together (forget that bok choy in the vegetable bin). But, hey it's a SNOW DAY. Anything goes!!


text:
Kabuki Reviews & Details
2913 S 38th St
(253) 472-4267
Kabuki is located at 2913 S 38th St in Tacoma near the intersection of S 38th St and S Junett St. Their menu consists of American dishes . Call (253) 472-4267 today!
- Cuisine:American
- Major Intersection:S 38Th St And S Junett St
What everyone says about Kabuki
Tell us more about Kabuki Tacoma!
Kabuki Reviews, Tacoma
Be the first to review Kabuki!


text:
It was originally planned to record 10 tracks in 10 days. But thanks to the amazing efficiency and unique work atmosphere that was created in the studio, at the end 15 tracks were recorded. 14 songs will be on the album. Discover what this exclusive 15th song is about.
When I received the album, after a quick listen I put the cd aside. Later on I played it again and start to get really jovious. The reason why the project is called Diversidad started to make sense.
Put 20 artists from different countries together regardless of the ethnicities, religions and social backgrounds with the challenge to make an album in 10 days is more than ambitious.
First, props to the organisation. Props also to the producers who manage to create an original and colourfull musical atmosphere for the mc's. The first track is the perfect introduction of the artists and the project. "I got it" with an all female collaboration and a banger production from Spike Miller set the level high for the boys to compete. Coming from different countries and having different styles, Melodee, Remi and Mariama manage to create a powerful energy around each other lines.
"Cookin in your pot" is the hypnotic track and club banger by excellence. The producers from Spain, Cookin' Soul are really living to their reputation. The production is minimalist and still you feel like hittin' the dancefloor and bust some moves. Good cookin' !!
"The anthem" with Rival, Nach, Marcus Price & GMB is the revenge of the boys on the girls. In my eyes it's mos definitely the next single. My 4 years old nephew, the first thing he does when he's visiting with his parents, is to put it on repete and start dancing and singing the hook along. No matter which language used he knows the track line for line.
You almost would say that the 4 mc's will be rapping together for years.
Diversidad, is not only an unique experience for the mc's an everyone involve in the project, it's also a good way to learn different languages. The only minipoint is that there's no translation to understand what the mc's are rhyming about.
For someone like me it's a always a pleasure to discover new artists. I didn't know most of the mc's and now I'm diggin to know more about them.
It's also a relief to see that the european Hip Hop is finally getting the spotlight he deserves.
What is more amazing during the whole album by seeing the videos now is the respect between all the artists. Egos are pushed aside and what is left is room for creativity and mutual love for rap music.
Altough the first Diversidad album was good this one set the tone very high. You can feel the hunger of each artists to get finally the national and international recognition they deserve.
It will be another challenge for the organisation to top this one.
Diversidad, is not only an unique experience, it is a one nation under the groove as well…
The Diversidad album will be released by Believe Digital on February 14, through a worldwide online distribution
and by V2/Munich Records on February 21 through a physical distribution in the Benelux. The album includes 14 tracks representing the highest level of contemporary European hip hop.
source: Diversidad


text:
BVM Solution makes versatile sites that pull in guests, give an awesome client encounter, and produce more activity and leads that transform into clients.
Look our done projects
Gambloo was developed by players for players. We want to give everyone the opportunity to win money playing video games.Visit Site
Talent Bid is an online job marketplace, working all over the world with clients in the entertainment industry. We connect directly with agencies, talent management companies, actors, and athletes worldwide.Visit Site
Our facilities, which offers comfort and modern equipment, and our strategically located Medical Centre, which is easily accessible.Visit Site
Every client is very important and look what people say about us
BVM Solutions delivered again an amazing rezult on a very complex task. We've been working with Raj for almost 3 years and he always delivered more than expected. On our UFC fight management project he manage to give us excellent results on very difficult tasks. We are looking forward to work with Raj and his team long term. Very highly recommended!!!
Simona Marian
Excellent Company. Did a greta job in solving all my wordpress problems and delivered good code. I would hire him again and can recommend him. Skilled and freiendly with gooo commuications.
This was an absolutely amazing job. Everything was completed at lightning fast speeds and with pristine quality. I also appreciated the professionalism shown. They sent visual status updates and were always available to communicate. I will most definitely continue to work with them and I would HIGHLY RECOMMEND their services to anyone looking for great quality work.
A pleasure to work with BVMSolution; A reliable and competent development co. – followed project specs very closely, and was extremely responsive to the queries. Would recommend and will hire again. Thanks
Very nice person to work with, and very fast!
They are having very knowledgeable in wordpress!
Went above and beyond to help me solve problems encountered. Am already planning on using them again.
No matter the size of your project, we'd love to hear from you!


text:
Amber Pasztor is already in jail for allegedly killing her two young children, and now police believe there may be a third victim.
Authorities in Fort Wayne, Indiana, issued an Amber Alert late on Monday for two young children they believed were kidnapped by 29-year-old Pasztor. The children — 7-year-old Liliana Hernandez and 6-year-old Rene Pasztor — were found dead on Monday night, leading police to charge Amber Pastzor with murder.
The mother allegedly murdered her two young children and then drove their bodies to a police officer's patrol car, ABC 7 in Chicago reported.
Police said Pasztor stopped the officer to inform him that there were two dead children in her car. The officer didn't know beforehand that the woman who stopped him was wanted for abducting two young kids.
"It's not a well traveled road, so people will stop and ask for directions," said Sgt. Chris Snyder of the Elkhart Police Department (via WNDU). "So he was taken a little off guard and caught a little bit surprised exactly with what happened when she told him what the nature of her stopping him was for."
Investigators said it made for a gruesome find.
"Anytime you have kids involved, that makes it a little bit harder," Snyder said. "A lot of it is unknown. A lot of it, for the officers, is the way our portion of this transpired. Again, not knowing a lot of the background, not knowing a lot other than the mere fact that there is a car parked behind our police station and there are two deceased young kids in there."
Reports have suggested there could still be another victim — 65-year-old Frank Macomber, who police believe may have been with Pasztor at the time the children were murdered. Police found the body of an older man on Tuesday but did not say how he died or disclose the deceased man's identity.
The arrest of Amber Pasztor generated interest not only in the Fort Wayne area but across the country. The Amber Alert after the children went missing described her as a "non-custodial mother" and noted that the children were believed to be "in extreme danger."
"The children were last seen at 6:21 am EDT in Fort Wayne, IN and are believed to be in extreme danger. Fort Wayne, Indiana is 125 miles north of Indianapolis, Indiana. Allen County Sheriff believes the children were likely abducted by their non-custodial mother Amber Pasztor a 29 year old white female, 5 feet, 6 inches tall, 250 lbs., with long blonde hair. Suspect vehicle is a Mercury, Mystique, Tan in color."
The case got a bit of national attention thanks to Nancy Grace, who tweeted pictures of the missing children and of Amber Pasztor on Monday in the hours before the children were found murdered.
Amber Pasztor has a long history of trouble with police, ABC 57 reported. There were reportedly warrants out for her arrest, including ones for violating a protective order and not complying with a previous sentence. Pasztor had been convicted of criminal trespassing in August and sentenced to 365 days in jail.
She was also charged with underage drinking in 2005 and in 2006 charged for drunk driving and causing bodily injury. Pasztor has a slew of other arrests, including three charges of battery between 2009 and 2010 and several charges of operating a motor vehicle without receiving a license.
There are still other details yet to emerge on the arrest of Amber Pasztor, including exactly how the children were murdered or whether she could face charges in the death of the older man whose body was found on Tuesday. Police are also unsure how Pasztor and the children ended up in Elkhart.
[Featured Image by Amber Pasztor/Facebook]


text:
Information in accordance with section 5 TMG Matthias Garten smavicon Best Business Presentations Pfützenstrasse 75a 64347 Griesheim
Contact Telephone: +49 6155 8444 0 Fax: +49 6155 8444 11 E-Mail: email@example.com Website: www.smavicon.com
Register entry Entry in Handelsregister Register Number: HRA 7152 Register Court: Amtsgericht Darmstadt
VAT number VAT indentification number in accorance with section 27 a of the German VAT act DE 111509232
Person responsible for content in accordance with 55 Abs. 2 RStV Matthias Garten, Pfützenstrasse 75a, 64347 Griesheim
Accountability for content The contents of our pages have been created with the utmost care. However, we cannot guarantee the contents' accuracy, completeness or topicality. According to statutory provisions, we are furthermore responsible for our own content on these web pages. In this context, please note that we are accordingly not obliged to monitor merely the transmitted or saved information of third parties, or investigate circumstances pointing to illegal activity. Our obligations to remove or block the use of information under generally applicable laws remain unaffected by this as per §§ 8 to 10 of the Telemedia Act (TMG).
Accountability for links Responsibility for the content of external links (to web pages of third parties) lies solely with the operators of the linked pages. No violations were evident to us at the time of linking. Should any legal infringement become known to us, we will remove the respective link immediately.
Copyright Our web pages and their contents are subject to German copyright law. Unless expressly permitted by law (§ 44a et seq. of the copyright law), every form of utilizing, reproducing or processing works subject to copyright protection on our web pages requires the prior consent of the respective owner of the rights. Individual reproductions of a work are allowed only for private use, so must not serve either directly or indirectly for earnings. Unauthorized utilization of copyrighted works is punishable (§ 106 of the copyright law).
Quelle: twigg.de


text:
Everybody that has a enthusiasm for photography can produce excellent images. No subject your degree of expertise, you may possibly want to increase your talents. If you are ready, then you have occur to the correct location. This report has ideas which can significantly enhance your pictures.
Get specialist products if you are significant about images. Search for a digital digicam with a dSLR characteristic. This allows you to get a much better notion of the frame of your photo. What you preview actually seems like the image you are using. With a great sensor, you ought to be ready to consider considerably greater pictures.
A excellent photography idea is to not get also carried absent with possessing the ideal and latest equipment. Technology's often going to be enhancing and except if you are a millionaire, it is just not reasonable to fear about obtaining the ideal camera. Try out to make excellent use of what you have.
A excellent photography tip is will not get carried away with obtaining the newest and best tools. Technologies is always strengthening and until you are a millionaire, it is just not reasonable to fear about obtaining the most recent equipment. Make excellent use of what you have.
When you are deciding on which images you want to screen, look at each image you have taken and only decide on your favorites. Will not present way too a lot of images and range the subject matter matter. You photos will not be intriguing and maintain your viewers attention if you do not mix things up and photograph different subject matter. Search for techniques to highlight distinct facets of your images as you inject each graphic with a fresh get.
Do not use the flash on a digicam unless you are in a darker place. Making use of a flash outdoor in a location that presently has a lot of mild will just make your picture come out way too vibrant. Some cameras have an automatic flash setting so that your digital camera understands when the flash is necessary.
Only select the very best photographs that you have if you are organizing on exhibiting your photographs to a person. fotograf ślubny will support them form the greatest possible view of you and your perform, which is appealing if you are striving to land a task. Usually current your greatest operate to other people.
If you want to get excellent photos, you have to consider a good deal of them buying a large memory card will permit you to keep the many photos you require to get. If you have a memory card with a massive storage area, your card can hold a lot of photos. A greater memory card also allows you shoot in Uncooked structure, which gives far more editing choices later on on.
Be all set to take a photograph at all occasions. This does not suggest you should have your digital camera in hand, this implies you need to be in the suitable condition of brain all the time. Search at the world as if you were observing it by way of your digicam. When you see something interesting, get a photo.
Use the guidelines in this write-up to experiment with topics, lighting and angles to get a unique photograph. If you implement these tips, you can get pleasure from the results you find. If this is not the situation, maintaining making an attempt new methods right up until you are completely pleased with your pictures.
- 660 Visitors


text:
If you have recently noticed that you can see termites in your walls, perhaps through a hole that they have recently exposed, it is definitely time to call an exterminator as quickly as you can in order to eliminate the problem. Termites literally feed on the cellulose that is in the structure of your home, and this can lead to a full collapse. The sooner that you are able to resolve this issue, the better off you will be. Here is how you can find termite exterminators Santa Clara County companies that will help you out this week.
How Will The Exterminate The Termites?
To eliminate the termites, it may be necessary for them to ask you to leave your home for several days. You have probably seen these large bubbles that are placed around homes. They will actually fumigate your entire home within that bubble, and it takes several days to kill them all. They will subsequently do work at the ground level, making sure that termites or not able to get back in. Even if the procedure that they use is not this extensive, your termite infestation needs to be taken care of immediately.
Where Do You Find These Companies?
Finding these companies is something that you can do in the span of a few minutes by using your smart phone or laptop computer. You should be able to locate these businesses by searching on the web, and then evaluating them based upon what previous customers have stated publicly. These comments and testimonials can help you make your decision, leading you to businesses that are doing a great job. This inside information will make it easy to make your selection and get a termite extermination company out to your home.
If you are in Santa Clara County, and you are certain that you have termites, you need to have one of these inspectors come out right away. If it is determined that you do have them, they will exterminate them for you, and can do so in just a few days. Termite exterminators Santa Clara County companies are always on the lookout for other people that they can help. You will soon be on your way to a home free from termites courtesy of one of these imputable businesses that will offer fair prices and excellent services that can help you protect your home.


text:
Peranakan museum
After our trip to the Art Museum, we walked down the street to the Peranakan Museum. Free admission too! How cool is that! We should visit the museums every National Day:)
Though my maternal grandparents were Peranakan, I am pretty clueless about my ancestral roots, so I was surprised to find out that Peranakans are not just of Malay-Chinese descent,
but also of Indian descent (the Chitty Melaka) and Jawi descent (Jawi descent).
Peranakans are well-known for their intricate beadwork art. This bedspread alone is made up of approximately ONE MILLION hand-sewn glass beads! I dread to think how long it must have taken to sew this!
The actual size of each bead is smaller than the white space in the middle of this 'o'. (on an iPad-sized screen).
Exquisite, don't you think? (I once tried cross-stitching a 10cmx10cm racoon and gave up halfway. Apparently, I don't have their sewing genes in me.)
This is so… immaculately perfect!
They made beadwork Everything, from table spreads, to purses and slippers. You must touch and feel the actual items to be impressed. My photos don't do the exquisite work justice.
Everything about the Peranakans seems to spell patience to painstaking detail and a love for the simple but beautiful things in nature. A simple flower and a peacock turns into an elaborate solid gold belt.
Butterflies turn into ornate bridal headwear.
Even their simple daily wear is not so simple…
Weddings were long, elaborate affairs that lasted up to 15 days. With no details spared. (I used 'were' because this is rarely practised nowadays in modern-day Singapore.
This wonderful couple tried to re-enact a traditional Peranakan wedding and they made it! For 3 days. About the longest modern day wedding I've come across. But I admire their effort. They have the true blue Peranakan spirit indeed!)
In case you're wondering, this is just a wedding gift box, known as 'bakul siah'. With giftboxes like that, I wonder what sort of gifts must go in to outshine the box??
Their home furniture is no doubt as ornate.
All engraved and handcrafted with expert precision
Many are inlaid with hand crafted mother-of-pearl.
How clever to use cold marble in a hot, tropical climate!
A wash basin
Wardrobe top
Bridal bed
Dining ware
And a thousand other intricate pieces
Even the tabletop ornament is not spared extravagant detail.
And religion-wise, they are very tolerant. This is a Taoist altar.
Look at this 'converted' altar.
Some puritans might probably frown at the blasphemous pairing of 'Satanic' dragon altars with the Holy Family. But well, this is Singapore afterall. "We, the citizens of Singapore, pledge ourselves as one united people, regardless of race, language or religion…" Nevertheless, this was still an eye-opener for me!
Another wonderful day out!:)
Technorati Tags: art, home, life, lifestyle, living, history, Peranakan museum, museum, excursion, experiences, heritage.


text:
Confirmed vintage up-to-date to mirror the DSM-5
The available structure, evaluation chapters on broader issues--such as interviewing--that impact all diagnoses, and case learn method give you the excellent aid for college students to ascertain and know how diagnoses are reached and applied.
Updated to mirror the newest neurobiological developments in psychopathology, this variation follows an analogous confirmed bankruptcy constitution for the disease chapters of earlier variants to facilitate readers' realizing and studying. Updates comprise subject matters akin to: the hot Schizophrenic Spectrum designation and different psychotic issues. The revised method of consuming problems. new chapters replicate the unsettled nature of the DSM-5 for teachers and clinicians alike: bankruptcy 21: stipulations for extra learn and bankruptcy 22: replacement DSM-5 version for character Disorders.
Encompassing the most up-tp-date study within the box, Adult Psychopathology and analysis, 7th Edition offers an intensive advent to our present conceptualization of psychopathology and its program in scientific perform, together with dimensional and specific classifications.
Read Online or Download Adult Psychopathology and Diagnosis (7th Edition) PDF
Similar mental illness books
Suspicious Minds: How Culture Shapes Madness
EPUB eISBN: 9781439181577
What in the event you awakened with the alarming suspicion that you simply have been being watched?
One day in 2003, a sufferer in contrast to the other that Dr. Joel Gold had visible prior to was once admitted to his unit at Bellevue health center. This guy claimed he was once being filmed regularly and that his lifestyles used to be being broadcast around the globe just like the Truman Show—the 1998 movie depicting a guy who's unknowingly residing out his lifestyles because the big name of a well-liked cleaning soap opera. Over the following couple of years, Dr. Gold observed a couple of sufferers struggling with what he and his brother, Dr. Ian Gold, begun calling the "Truman convey delusion," launching them on a quest to appreciate the character of this actual phenomenon, of delusions extra more often than not, and of insanity itself.
The present view of delusions is they are the results of biology long past awry, of neurons within the mind misfiring. against this, the Golds argue that delusions are the results of the interplay among the mind and the social international. through exploring the foremost different types of fantasy via attention-grabbing case reviews and marshaling the most recent examine in schizophrenia, the brothers exhibit the position of tradition and the social international within the improvement of psychosis—delusions particularly. Suspicious Minds offers a groundbreaking new imaginative and prescient of simply how dramatically our environment can impression our brains.
About the Author
Joel Gold, MD, is a medical affiliate professor of psychiatry at long island collage college of drugs and was once an attending psychiatrist within the division of psychiatry at Bellevue sanatorium middle for 9 years. Joel is at the college on the Institute for Psychoanalytic schooling and has a personal perform in long island. He lives in Brooklyn together with his family.
Ian Gold, PhD, is the Canada learn Chair in Philosophy and Psychiatry at McGill college. He earned a BA and MA in philosophy from McGill college and a PhD in philosophy from Princeton collage. He lives in Montreal along with his relatives.
Hypnotic Leadership: Leaders, Followers, and the Loss of Self
Charismatic management in its severe manifestations resembles a hypnotic scenario during which the fans lose their autonomic judgment. Popper compares management to fireplace. The chief is the spark, the fans the gasoline, and the conditions the oxygen that feeds the flames. fireplace can break every thing in its course, and this kind of robust fireplace is a metaphor for what's defined as Hypnotic management.
In Search of Madness: Schizophrenia and Neuroscience
Over the past twenty years, clinical articles on schizophrenia have doubled in quantity, and prophecies of step forward have seemed and receded. the result's a scattered and complicated mass of proof that's tricky to guage. How a lot growth has rather been made? Are the neurological reasons of insanity actually in sight?
Abuse: An Encyclopedia of Causes, Consequences, and Treatments
This well timed quantity exhibits how abuse affects each section of society―and how society is looking for potent how one can reply. • deals an introductory essay that locations the topic in context and gives a framework during which to check and comprehend abuse• good points entries from top students who offer a modern method of the problems • Covers quite a lot of varieties of abuse, participants and firms stricken by abuse, and other people operating to minimize and put off abuse• comprises summaries of legislation that observe to numerous kinds of abuse• offers a "topic finder" to aid readers in finding details relative to specific sorts of abuse
- Deviance : Theories on Behaviors That Defy Social Norms
- Offence Paralleling Behaviour: A Case Formulation Approach to Offender Assessment and Intervention (Wiley Series in Forensic Clinical Psychology)
- Journal of abnormal psychology
- Infectious Behavior: Brain-Immune Connections in Autism, Schizophrenia, and Depression
- 40 Years of Academic Public Psychiatry
Extra resources for Adult Psychopathology and Diagnosis (7th Edition)
Sample text
Israel, A. C. (1994). A critical examination of the use of the term "comorbidity" in psychopathology research. Clinical Psychology: Science and Practice, 1, 71–83. Livesley, W. J. (2001a). Commentary on reconceptualizing personality disorder categories using trait dimensions. Journal of Personality, 69, 277–286. Livesley, W. J. (2001b). Conceptual and taxonomic issues. In W. J. ), Handbook of personality disorders. Theory, research, and treatment (pp. 3–38). New York, NY: Guilford Press. Livesley, W.
Archives of General Psychiatry, 41, 983–989. , Lesieur, H. , & Wise, M. (1996). Impulse control disorders. In T. A. Widiger, A. J. Frances, H. A. Pincus, R. Ross, M. B. First, & W. W. ), DSM-IV sourcebook (Vol. 2, pp. 1007–1031). Washington, DC: American Psychiatric Association. Brown, T. , Campbell, L. , Lehman, C. , Grisham, J. , & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.
2001). Naming, defining, and classifying in mental retardation. Mental Retardation, 39, 47–52. Lynam, D. , & Widiger, T. A. (2001). Using the five factor model to represent the DSM-IV personality disorders: An expert consensus approach. Journal of Abnormal Psychology, 110, 401–412. Martin, P. R. (2005). Affirmative viewpoint. American Journal on Addictions, 14, 1–3. Maser, J. , & Cloninger, C. R. (1990). Comorbidity of anxiety and mood disorders: Introduction and overview. In J. D. Maser & C. R. ), Comorbidity of mood and anxiety disorders (pp.


text:
Video screenshot of the fight
Horrible footage shows how an elderly man is beaten up in Belgium by several men. He is kicked in the back and hit with chairs even after he fell on the ground.
The incident happened at the "Rooseveltplaats" in Antwerp. According to Belgian newspaper HLN, the elderly man was drinking alcohol together with his son on the terrace of a Kebab shop.
Because the owner of the place doesn't sell alcohol, he approached the father and the son to tell them he disagreed with their behaviour.
The situation escalated and a large fight started. The guests were brutally beaten and one of them even broke his leg. Both were taken to hospital.


text: Southern Railway Home Guard Newspaper. April 1941 edition of \' Southern On Guard \' the newspaper of the Southern Railway Home Guard. Four page, tabloid size paper with large numbers of illustrations concentrating on the activities of the Home Guard across the Southern Railway region. Good overall condition with folding and very minor tears and rubbing.


text:
Get Thunderstruck at the House of Blues.
As a born and raised Mavericks fan, I was programmed hate the San Antonio Spurs. And yet at the same time, as a human being, I just can't force myself to root for the Miami Heat.
So, like much of the rest of Mavs Nations, there I was last night, cheering on the Spurs in Game Six of the NBA Finals. And for what? In what was admittedly a thrilling game, our fellow Texans lost in overtime, giving the Heat one more chance to win the whole shebang in Thursday's Game Seven.
As we impatiently wait that game's start so we can root on our fellow Texans — difficult a pill as that may be to swallow — here are some distractions for your night.Â
Oh, and happy Juneteenth!
Black Problems, Bug Chaser, Mountain of Smoke, Spacebeach and Eyes Wings & Many Other Things at the Crown & Harp
Hip-hop act Black Problems, St. Louis rockers Bug Chaser and local psychedelic outfit Eyes Wings & Many Other Things should be the highlights of what promises to be a moody and experimental show at The Crown & Harp. Also, it's free. So there's that. — Stephen Young
Vintage Pop-Up Shop at Beauty Bars
Martinis? Yes. Manicures? Absolutely. Happy hour? Duh. This is Beauty Bar. It's kinda the whole concept. But then add to the equation this: Vintage accessories and swimwear will also be for sale at the Henderson Avenue spot during today's 5 p.m. to 9 p.m. pop-up affair. And nothing will cost more than $75. In other words? This sucker's not only adorable, it's affordable. Honestly, what else could a girl want in the middle of a busy work week? —Jessica Petrocchi
Thunder From Down Under at House of Blues
Australia's primary Chippendales competitor take its show on the road. Stop snickering, fellas. No one's paying to see what you look like with your shirt off. —SY
The Fibs, Sphynx and The Royalty at Lola's
This glam-filled, all-Texas bill features locals The Fibs, Austin dance-funk act Sphynx and El Paso's The Royalty, who say they sound "like Amy Winehouse went on holiday with Vampire Weekend." Put on your dancing shoes and head west for a bit of midweek fun. —SY
Fever Dreams, Vaults of Zin, Orgullo Primitivo and Kallohonka at Rubber Gloves
Utah crust punks Fever Dreams — not to be confused with local indie act Fever Dreamer — tops this evening's punk-filled bill in Denton. Texas acts Vaults of Zin, Orgullo Primitivo and Kallohonka open. —SY


text:
By Associate Kai Marks
As one might well imagine, creating a wondrous and grace-filled retreat begins long before the first gathering on Friday evening at Villa Angelica in Carmel.
A few months ago, members of the Associate Board read Dan Ebener's book, Blessings for Leaders. This book provoked discussions both about the many manifestations of leadership and the many ways in which a person can lead—as well as the need for leaders to cultivate emotional intelligence.
These discussions led us to select the theme: "God's Gift to You: Leadership."
We were fortunate to have facilitator Eileen Healy with us, who is an expert in the field of emotional intelligence. Ms. Healy is a marriage and family therapist, life coach, speaker, author, mother, grandmother, and she is also the co-founder and CEO of the Emotional Intelligence Training Institute.
Ms. Healy defines emotional intelligence as, "The ability to recognize one's own emotions and the emotions of others and to respond to those emotions in a healthy way."
Many of those who attended the retreat appreciated the way Ms. Healy customized the presentation to the particular interests of SND Associates, acknowledging that our leadership as Associates can take a variety of forms—from providing hospitality at a meeting to organizing a soup kitchen. Having a high degree of emotional intelligence is an essential part of our ministry and helps us ensure that our hearts are indeed as wide as the world. Like the size of our hearts, emotional intelligence can be increased over the course of a lifetime. As we continue to live out the truth that God is good, cultivating our emotional intelligence will only enhance our work.
In addition to a fine retreat program, we were blessed to be able to enjoy each other's company and the incredible food that was lovingly and expertly prepared by Associate Aulani Cler and Loretta Gilder.
As we reflect on our 2015 Memorial Day Weekend Retreat, we know we have much to be grateful for. The blessings of friendship and the tools for deepening our ministry will serve us for a lifetime.