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Northern Vietnam is an endemic region for fish-borne zoonotic trematodes (FZT), including liver and intestinal flukes. Humans acquire the FZT infection by eating raw or inadequately cooked fish. The production of FZT-free fish in aquaculture is a key component in establishing a sustainable program to prevent and control the FZT transmission to humans. Interventions in aquaculture should be based on knowledge of the main risk factors associated with FZT transmission.
Methodology/Principal Findings
A longitudinal study was carried out from June 2006 to May 2007 in Nam Dinh province, Red River Delta to investigate the development and risk factors of FZT infections in freshwater cultured fish. A total of 3820 fish were sampled six times at two-month intervals from 96 fish farms. Logistic analysis with repeated measurements was used to evaluate potential risk factors based on information collected through questionnaire interviews with 61 fish farm owners. The results showed that the FZT infections significantly increased from first sampling in June to July 2006 (65%) to sixth sampling in April to May, 2007 (76%). The liver fluke, Clonorchis sinensis and different zoonotic intestinal flukes including Haplochis pumilio, H. taichui, H. yokogawai, Centrocestus formosanus and Procerovum varium were found in sampled fish. Duration of fish cultured (sampling times), mebendazole drug self-medication of household members, presence of snails in the pond, and feeding fish with green vegetation collected outside fish farms all had a significant effect on the development of FZT prevalence in the fish.
The FZT prevalence in fish increased by 11 percentage points during a one-year culture period and the risk factors for the development of infection were identified. Results also highlight that the young fish are already highly infected when stocked into the grow-out systems. This knowledge should be incorporated into control programs of FZT transmission in integrated small-scale aquaculture nursery and grow-out systems in Vietnam.
Citation: Phan VT, Ersbøll AK, Nguyen KV, Madsen H, Dalsgaard A (2010) Farm-Level Risk Factors for Fish-Borne Zoonotic Trematode Infection in Integrated Small-Scale Fish Farms in Northern Vietnam. PLoS Negl Trop Dis4(7): e742. https://doi.org/10.1371/journal.pntd.0000742
Editor: Banchob Sripa, Khon Kaen University, Thailand
Received: March 1, 2010; Accepted: May 27, 2010; Published: July 13, 2010
Copyright: © 2010 Phan et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: The Danish International Development Assistance (Danida) provided funding through the project entitled "Fish Borne Zoonotic Parasite in Vietnam" (FIBOZOPA no. 91140/file no. 104.Dan.L.8.f.; http://fibozopa2.ria1.org/_E#). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Author Summary
Fish are the second intermediate host for fish-borne zoonotic trematodes (FZT). Humans acquire the FZT by eating raw or inadequately cooked fish. Therefore any sustainable program to prevent and control human FZT infection should consider how to minimize the FZT prevalence in fish. Understanding the development in prevalence of FZT in fish and the risk factors involved are of key importance in order to plan and implement an FZT prevention program successfully. During a one-year production cycle in integrated small-scale aquaculture grow-out systems, the FZT prevalence in fish increased by 11 percentage points. Three risk factors associated with the development of the prevalence of FZT infection in fish were identified including presence of snails in the pond, feeding fish with green vegetation collected outside fish farms, and mebendazole medication by the household members. Aquaculture management solutions addressing these three risk factors as well as the high level of FZT infection in juvenile fish stocked in grow-out systems should be found in order to produce fish free of FZT, which are safe for human consumption.
Fish-borne zoonotic trematodes (FZT) belonging to the Opisthorchiidae and Heterophyidae families are important emerging and re-emerging pathogens causing liver and intestinal fluke diseases in human [1], [2]. The life cycle of FZT involves humans and animals such as dog, cat, pig and fish-eating birds as final hosts. The FZT live and develop to adult flukes in the liver or intestines of the final host and produce eggs that are excreted into the environment through faeces. The eggs are ingested by fresh water snails, where they develop to a stage called cercariae. Free swimming cercariae are shed to the water before they penetrate into fish. Inside the fish tissues, cercariae transform into encysted metacercariae [2]–[4]. Humans and animals acquire the FZT infection through consumption of raw, inadequately cooked, dried, salted or pickled fish that harbor infective metacercariae stages [4]–[6]. Keiser and Utzinger [4], [5] estimated that about 681 million people worldwide are at risk of infection and more than 46 million people are infected with liver flukes (Clonorchis sinensis and Opisthorchis sp.). There are no such estimates available of the number of people infected with intestinal flukes worldwide [4], but the prevalence of infection is believed to be high, e.g. the Red River Delta, Northern Vietnam is endemic for FZT, including both liver and intestinal trematode infections in humans and animals [7]–[9].
The fisheries sector in Vietnam plays an important role in providing food for domestic consumption and generating foreign currencies through export of seafood with aquaculture products contributing significantly to such export. From 1998 to 2008, the aquaculture sector in Vietnam expanded rapidly with the production volume increasing about 5.8 times from 425,000 tons to about 2.5 million tons in 2008. In the same period, the overall export value of seafood increased from 858 million USD to 4,510 million USD [10]. Vietnamese aquaculture systems include marine, brackish water and freshwater aquaculture. The freshwater aquaculture production environments include ponds, ditches, cages, net enclosures and pens in reservoirs, lakes, rivers and channels, and paddy fields. In the Red River Delta of Northern Vietnam, small-scale polyculture farming with several carps species and tilapia is the most important farming system [11]. At the study site in Nam Dinh province, fish are stocked continuously in small-scale grow-out ponds and partial harvest is done to generate extra income or for household consumption. The main stocking season for grow-out ponds is late Spring and early Summer where juveniles are available from the nurseries.
In Nam Dinh province in particular, is mainly practiced as small-scale family-based systems. The cultured fish are a main protein source for the households and consumed by the families at any time of the year. In Nam Dinh province, as in many other areas in Northern Vietnam, freshwater fish ponds are stocked with multiple fish species and raised in a continuous production cycle. The aquaculture activities are often integrated with livestock, and vegetable production. The grow-out ponds are earthen ponds and often located in backyard of households (Figure 1.). These systems are conducive for the life cycle of FZT as contamination with FZT eggs from animal and human hosts is high and the snail intermediate host are often present in high numbers. There have been a number of educational campaigns to stop people in Nam Dinh province from eating raw or inadequate cooked fish, however, the FZT prevalence in humans in Nam Dinh remains high [8]. It is an arduous task to convince people to stop eating raw and inadequate cooked fish because there is a long tradition for eating such dishes. Therefore, producing fish free of FZT for human consumption is important to prevent such infection in human.
Shown a typical grow-out pond in Nam Dinh province. The pond is earthen pond and located near the households.
The present study was carried out during a period of 1-year and aimed to investigate the prevalence and the development of FZT infection in fish during a 1-year culture cycle and to assess risk factors for FZT infection in fish.
Ethics statement
The study protocol was approved by the Aquatic animal scientific committee of Research Institute for Aquaculture No.1, Dinh Bang, Tu Son, Bac Ninh, Vietnam. Informed consent was obtained in writing from fish farmers as they submitted a signed request form to participate in the study.
Study area, design and unit
Nam Dinh province is well- known as an FZT endemic province with high FZT prevalences in humans (64.9%), cats (70.2%) and dogs (56.9%) [8], [9]. The study was conducted in Nghia Lac and Nghia Phu communes in Nam Dinh province, which is located in the Red River Delta in Northern Vietnam (Figure 2). The main stocking season is late Spring and beginning of summer. During other times of the year, juveniles are stocked at convenience by farmers. The stocked juveniles mainly originate from local nurseries. The main species stocked are grass carp (Ctenopharyngodon idellus), silver carp (Hypophthalmichthys molitrix), common carp (Cyprinus carpio), Rohu (Labeo rohita), and Mrigal (Cirrhinus mrigala). So-called self-recruiting species of fish (SRS fish) are occasionally accidently introduced to the ponds during intake of water from nearby canals. Depending on species, the stocked fingerlings are grown for 8 to 12 months to reach harvest size.
Shown a throw of cast net when sampling fish from a grow-out pond in Nam Dinh.
This study was carried out during a 1-year fish production cycle from May 2006 to April 2007 and designed as a longitudinal study with 6 repeated samplings from the same ponds at 2-month intervals. The study unit was the pond at each sampling time.
Farm selection and fish sampling
Fish farms were selected from a list of households obtained from the local health clinic in each of the two communes. Farms with no fish ponds and farms that participated in a previous human FZT prevalence study reported by Dung et al. [8] were excluded because infected individuals were given drug treatment. Farms were randomly selected from the adjusted lists of households. If the farm had more than one pond, then one pond was randomly selected and used for fish sampling throughout the study period. A total of 96 fish farms were investigated.
Each farm was given one cast net for fish sampling in order to avoid risk of contamination between ponds. In each pond, a cast net was thrown in each of the four corners and in the middle of the pond (Figure 3.). All fish caught from the five throws were put in a bucket and 10 fish were randomly selected (irrespective of fish species). However, if less than 15 fish were caught in a pond then the all fish were selected for analyses.
Nam Dinh province is located in the Southern Red River Delta, bordered by Ha Nam province to the North, the Gulf of Tonkin in the South-East, Thai Binh province to the East and Ninh Binh province on the West. Nghia Lac and Nghia Phu communes belong to Nghia Hung district, Nam Dinh province.
Analysis for FZT metacercariae in fish
Fish samples were preserved on ice and transported within 12 hours to the parasitological laboratory of the Centre for Environment and Disease Monitoring in Aquaculture (CEDMA), Research Institute for Aquaculture No.1 (RIA1), Dinh Bang, Tu Son, Vietnam. In the laboratory, fish samples were kept in a refrigerator at 4°C for no more than five days before being processed. The length and weight of each fish were recorded before being processed and digested in 1% pepsin for the release of metacercariae following procedures previously described [12] and modified as described by Chi et al. [13]. Small fish (less than 200 g in weight) were ground and digested whole. For larger fish (>200 g), the whole fish was ground, mixed well and a 50 g sub-sample was obtained and digested for recovery of metacercariae.
Metacercariae identification skills among staff were evaluated at the beginning of the study to ensure that FZT species were correctly identified by providing test samples for each staff to identify. Three times during the study period, the identification of the metacercariae was verified by experimental infection of mice and subsequent identification of adult flukes recovered. The experimental infections and identification of adult flukes followed previously described procedures and criteria [14]. The identity of metacercariae verified in animal experiments was subsequently confirmed to be correctly identified.
Snail sampling and cercariae analysis
Data on snails were extracted from Dung et al. [15]. Snail sampling was conducted by the same person in all ponds during the morning hours for 30 minutes per pond using a scooping method and/or hand-picking from the pond. Snails were transferred to plastic containers and transported alive to the laboratory where they were identified according to keys by Brandt [16], Thanh [17] and Frandsen and Christensen [18]. Snails were then examined for trematode infections using one or more of three methods depending on snail size, i.e. shedding, crushing and cutting, and cercariae were identified only to major group [15].
Questionnaire development and interviewing
A questionnaire including 33 questions was formulated based on information obtained during group discussions with international experts, scientists at CEDMA and fishery staff at provincial level about potential risk factors for FZP infection at farm level. Information was obtained about farm practices in relation to the pond management, animal reservoir host and human waste such as how often and how farmers clean the pond, water source, practices for keeping animals such as dogs, cats, pigs, chicken and ducks, toilet facilities and others. The draft questionnaire was pretested by interviewing aquaculture research staff at CEDMA and five farmers in each commune with the farmers subsequently being excluded from the study. Needed adjustments were then made to the questionnaire which also included a section for recording observations made during the farm visit.
Four persons were involved in interviewing the managers of the farms. Before the interviews were initiated, the four persons discussed and agreed upon the method of interviewing and filling out the questionnaires. Each farm was interviewed one time in the connection with the first sampling by two persons. One person was always the interviewer and the second person was observing the interview and took notes about observed farm management practices, presence of animal and toilet facilities etc. in order to validate the answers given by the manager of the farm.
Most of the questions in the questionnaire were closed with 2 to 4 possible answers. Open questions were used to obtain information about pond area, number of fish stocked and yield. The questionnaire can be obtained from corresponding author.
Derived questionnaire variables
All questionnaire variables were initially evaluated using frequency distributions in order to obtain variables for further analysis. For some questions, most farmers gave the same answers. Hence these variables (questions) were excluded from the analysis because they did not contribute to explaining differences in transmission due to skewed distribution. Furthermore, many of the questions were not independent. Therefore, new variables were derived based on biological similarity and normal daily practices. As an example, a variable "animal fed with live fish" was derived based on specific information about how pigs, dogs and cats were fed or seen eating live fish. Area of pond was categorized into less than 300 m2 and ponds equal to or more than 300 m2. The source of green vegetation for feeding grass carp was originally one question in the questionnaire. However, two new variables were derived as feeding grass carp with additional vegetation originating from inside the garden (yes/no) and feeding grass carp with additional green vegetation originating from outside the garden (yes/no). The term of "additional green vegetation" here includes some types of grasses (sometimes from flooded areas) or aquatic plants collected from other habitats. The remaining variables were derived by aggregating some of the answers possibilities.
Statistical analysis
Data were analysed using the Statistical Analysis System (SAS®, version 9.1). The dependent variable was number of FZT infected fish out of number of examined fish in the pond at each sampling time. Descriptive analysis was performed by means of number of farms, number of infected fish, number of sampled fish, overall FZT prevalence by sampling times and potential risk factors for FZT transmission at the farms. Initially, two-by-two tables were used to evaluate confounding between potential farm-level risk factors.
The effect of potential risk factors on the prevalence of FZT infection in fish was evaluated using a logistic analysis with repeated measurements. The potential risk factors were included in the analysis. Farm nested within commune was included as a random effect. The autocorrelation between repeated measurements was taken into account by introducing a 1st order autoregressive correlation structure in the model. Backward elimination was applied to obtain the main effect resulting model. Interactions (2-way) between variables in the main effect resulting model were evaluated. In order to evaluate confounding between excluded potential risk factors with risk factors in the resulting model, each excluded variable was then added to the resulting model one by one for testing significance. Odds ratios were calculated only for significant effects. A P-value <0.05 was considered significant.
Descriptive analysis
Initially, there were 96 farms included in the study. However, during the 1-year study period some farms terminated fish culture with only 61 farms being sampled five times while 52 farms were sampled six times. A total of 3820 fish originating from 61 farms were examined for FZT.
FZT in fish and snail species.
Among the fish species sampled for FZT examination, Rohu, Silver carp, Mrigal and Grass carp were the dominating species comprising 85% of the total number of fish analyzed. Table 1 lists the different fish species, the percentage infected with FZT, and the parasite species found. The weight of fish sampled ranged from 8 to 1400 g depending on fish species. The liver fluke, Clonorchis sinensis, was only found in 1 of 1185 Silver carps analyzed. Different intestinal flukes including Haplochis pumilio, H. taichui, H. yokogawai, Centrocestus formosanus and Procerovum varium were commonly found in most fish species. Haplochis pumilio was recovered from all 18 fish species and the main cultured fish species (Grass carp, Rohu, Mrigal, Silver carp and Pacu) were infected by five different zoonotic intestinal trematodes. Non-zoonotic Exorchis spp. were found as metacercariae in fish in this study area (unpublished data).
The snail fauna in ponds was dominated by species of the Viviparidae family (53% of all snails collected) and Thiaridae family (41%), but species of the Ampullaridae family (5.5%) and Bithynidae (0.4%) were also present. Stenothyra messageri and different pulmonate snail species were occasionally found. Among Viviparidae, only Angulyagra polyzonata was found while within the Thiaridae, Melanoides tuberculata was dominating (75%); the other species in this family were Thiara scabra (22%), Tarebia granifera (1.5%) and Sermyla requetii (1.7%). The cercariae types recorded from the ponds were echinostomes, gymnocephalous, monostome, parapleurolophocercous (no pleurolophocercous cercariae were found in ponds), and xiphidio cercariae. The trematode species found in the fishes all belonged to the Heterophyidae and these produce cercariae of the parapleurolophocercous (or pleurolophocercous) group, which was the most common type found in the ponds (37% of all infections found). In the ponds, these cercariae were found exclusively in species of the Thiaridae.
FZT development in the 1-year study period.
The FZT prevalence in fish sampled increased 11 percentage points over the period, from 65% in the initial sample to 76% in the final sample (Table 2). The increase in FZT prevalence in Nghia Lac and Nghia Phu communes were 9 and 12 percentage points, respectively.
Table 2 shows the descriptive analysis of potential risk factors for FZT infection in fish during the 1-year study period. The FZT prevalence increased by 12 percentage point increase in fish fed additional vegetation collected outside the farm garden, but only 3 percentage points when fed with green vegetation collected within the farm garden. Fish cultured in ponds with snails had an 18 percentage points increase in FZT prevalence, while fish from ponds without snails only showed a 6 percentage points increase in FZT prevalence. In farm households that kept cat(s), the FZT prevalence in fish increased by 10 percentage points, while in farms that did not keep cats the increase was 6 percentage points. If household members had taken a standard round worm treatment with mebendazole during the previous year, the FZT prevalence in fish increased by 13 percentage points, while in those that had not taken treatment showed a 6 percentage points increase in FZT prevalence.
Risk factors for FZP infection in freshwater fish cultured in small-scale integrated ponds
Table 3 presents the final model of risk factors for FZT infection in fish at farm level. Duration of culture period (sampling time) had a significant effect on the development of FZT infected fish (P = 0.012). The odds of FZT prevalence in fish at sampling time 3, 5 and 6 was more than 1.6 times higher than at sampling time 1. Farms with household members that took self-medication with antihelminthic worm tablets had 1.52 time higher risk of FZT infection than farms with household members that did not take such treatment (P = 0.015).
Odds of FZT infection in fish from ponds with snails was 1.52 times higher (P = 0.022) than if no snail was seen present. Farms feeding green vegetation supplied from outside their garden had significantly higher FZT infection (OR = 1.59) compared to fish from farms that fed green vegetation originating from their own garden.
The data we present here form the first study of risk factors for FZT development in fish based on a longitudinal study design. Prevalence of FZT in fish was high in these grow-out ponds and we identified a number of factors that promote transmission of these parasites to fish.
The FZT prevalence was found to be high at the beginning of main stocking season of fingerlings with a subsequent increase in FZT prevalence in grow-out ponds increased from 65% to 76% during the 1-year culture period. The juveniles fish obtained from the local nurseries were highly infected when stocked in the grow-out ponds studied (Van Thi Phan, personal communication). Therefore, it is important that nurseries are a focal point for interventions to prevent juvenile fish from becoming infected with FZT. The larger fish in grow-out ponds seem to be more resistant to FZT infection as there was only 11 percentage points increase in infection during the 1-year culture period. Minimizing the FZT transmission in both juveniles and ready-to-harvest fish is important in preventing FZT transmission to humans since it is normally recognized very difficult to change people's eating habits and stop them from eating raw fish, in particular when such habits are rooted in old cultural traditions.It was also found that the increase in FZT prevalence was faster (3 to 7%) during the initial culture period from June–November and subsequently remained relatively lower and stable (1.2 to1.4% through the remaining period at sampling intervals 4, 5 and 6). Sampling time 4 was at the end of lunar year where the farm household members begin harvesting fish to be consumed during the New Year celebration, but also the time where new fingerlings are stocked into the ponds. At this time of the year, the water temperatures in Northern Vietnam usually range between 14–20°C compared, to the summer period (May to October), when temperatures normally range from 28–35°C. It has previously been shown that snails stop shedding cercariae into water at low water temperatures [19]. Further studies are needed to assess the impact of changing water temperatures on presence of snails and their shedding of cercariae.
We only found C. sinensis (liver fluke) in a single fish which was surprising since Dung et al. [8] based on faecal (stool) examinations as well as identification of collected adult flukes reported high prevalence of C. sinensis in people from the same study area in Nam Dinh province. This could mean that people acquire liver flukes infections from eating raw or inadequately cooked fish from other sources, e.g. from natural habitats or other places than Nam Dinh province. Intestinal fluke species recovered from this study were similar with those reported in Nghe An province [13] and elsewhere in Southern provinces [20], [21], except that Stellantchasmus falcatus were not found in our study.
Snails are the first intermediate host for FZT and its presence is essential for further transmission and infection of fish. Snail species belonging to Thiaridae family are a common first intermediate host for intestinal FZT [19], [22] while species of the bithynidae are hosts for C. sinensis [15]. In the present study, species of snails of the Thiaridae family, important vectors of FZT, were one of the dominating snail types found in ponds. According to Schell (1985) only pleurolophocercous cercariae are produced within the families Opistorchidae and Cryptogonimidae, while both parapleurolophocercous and pleurolophocercous cercariae are found within the Heterophyidae (intestinal trematodes). In other habitats such as canals and rice fields associated with the fish ponds in Nam Dinh, species of the Bithynidae and Stenothyridae are abundant, but also in these habitats parapleurolophocercous cercariae is the most common type found in snails [15]. Dung et al. [15] found that parapleurolophocercous constituted 40.3% of all infections found in snails, while pleurolophocercous only constituted 0.3%, but these could thus potentially belong to three different families. One species belonging to the Cryptogonimidae, Exorchis spp. (not zoonotic), has been found as metacercariae in fish in this area (unpublished). Identification by PCR of cercariae similar to the most common type of parapleurolophocercous cercariae found in our study showed it to be H. pumilio [23]. Clearly, there is a need for more detailed identification of cercariae using molecular techniques to clarify host parasite relationships in the study area and elsewhere.
It is a common practise of farmers to feed additional green vegetation to grass carps that are cultured together with other fish species in the same pond. Collection of green vegetation from external sources can introduce infected snails attached to such vegetation. FZT eggs originating from nearby wild animals and humans may also be introduced as such eggs could be present in the mud attached to roots of floating plants. In any case, the practice of adding vegetation to ponds was associated with a significant increased risk of FZT infection in fish. Water intake to the ponds is also a potential risk factor for introducing snails and cercariae into the ponds, but it was not found significantly associated with FZT infection in this study. This may be because the farmers studied use primarily rain water for their ponds, although water from nearby canals may be introduced into the ponds during flooding in rainy season. Thus, further studies are needed to assess the relative importance of introducing snails and cercariae into the ponds through contaminated green fodder and surface run-off into the ponds and through different water sources used to fill the ponds. Similarly, the relative impact of interventions to control such potential risk factors in FZT transmission, e.g. feeding only pelleted feed, preventing surface run-off into ponds, lining of pond embankments to control vegetation and snail populations needs to be assessed. The management of fish feed has previously been proposed as one intervention to control the introduction of snails [24].
The common standard treatment among people in the study area against infection with soil-transmitted round worms is the anthelmintic mebendazole. However, this drug does not have an effect on FZT. Fish cultured in household ponds where the members took this drug had a significantly higher risk of FZT infection compared to fish at farms, where the household members did not take such treatment.. The higher risk of FZT infection in fish associated with mebendazole treatment of household members is difficult to explain. This risk may occur simply by chance. However, one of the most common side effects of mebendazole is diarrhea [25]. Diarrhea would lead to more frequent defecation and this combined with more loose stools and a common open defaecation practice in the study area could increase the risk of faecal (egg) contamination of ponds and other habitats. It may also be speculated that although adult intestinal flukes may be inactivated at some level by mebendazole, eggs may still be viable and excreted at higher rates [26]. Further investigations on this are needed.
Even though the presence of cats on the farm did not have a significant effect on FZT prevelence in fish in this study, it should still be considered to include control measures for cats as the farms that kept cats showed twice as high increase in FZT prevalence in fish compared to farms without cats. Cats have been shown as an important final host for sustaining the life cycle of FZT [9], but their importance in FZT transmission may be questioned as cats tend to deposit faeces away from the pond [26].
Cast net were used in the study to ensure that the fish were randomly sampled and this technique is considered as a good technique for random sampling of fish in aquaculture [27]. However, aquatic plants were often present in varying quantities in the small-scale farm ponds studied. Therefore in some cases, selection bias may have occurred as the fish could escape when the net could not reach the bottom of the ponds due to the presence of aquatic plants.
From the final model of risk factors, it is suggested that snail control either by better pond preparation practices, biological control measures (e.g. stocking of snail eating fish), and ensuring that green vegetation fodder is collected from FZT free areas are important interventions to reduce FZT transmission. Further, better general human hygenic behaviour should be promoted, in particular when individuals take mebendazole drugs, to avoid shedding FZT eggs into the pond environment. However, any practical control strategy for FZT infection in fish farms should be pre-tested and evaluated before being introduced to farmers to apply at their farms.
The results from the present study provide together with findings from other studies in Vietnam on risk factors for FZT infection in humans and animals [7]–[9] important knowledge about FZT transmission that can be used to establish sustainable measures to reduce and control FZT infection in fish raised in grow-out ponds. As juveniles fish already showed high FZT prevalence, any interventions should focus on controlling FZT transmission in nurseries as they appear to be hot spots for FZT infection.
The authors would like to thank staff of Centre for Environment and Disease Monitoring in Aquaculture (CEDMA), Research Institute for Aquaculture No.1 (RIA1), for their support in field and lab works. The farmers in Nghia Lac and Nghia Phu communes, Nghia hung district, Nam Dinh province are thanked for their participation in the study. Special thanks are given to Ms Bui Thi Dung for generation of snail data.
Author Contributions
Conceived and designed the experiments: VTP AKE AD. Performed the experiments: VTP KVN. Analyzed the data: VTP AKE. Contributed reagents/materials/analysis tools: VTP. Wrote the paper: VTP AKE KVN HM AD. Analyzed data on snail presence in ponds: HM.
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- 13. Chi TTK, Dalsgaard A, Turnbull JF, Tuan PA, Murrell KD (2008) Prevalence of zoonotic trematodes in fish from a Vietnamese fish-farming community. Journal of Parasitology 94: 423–428.TTK ChiA. DalsgaardJF TurnbullPA TuanKD Murrell2008Prevalence of zoonotic trematodes in fish from a Vietnamese fish-farming community.Journal of Parasitology94423428
- 14. Kay H, Murrell KD, Hansen AK, Madsen H, Nguyen TTT, et al. (2009) Optimization of An Experimental Model for the Recovery of Adult Haplorchis Pumilio (Heterophyidae: Digenea). Journal of Parasitology 95: 629–633.H. KayKD MurrellAK HansenH. MadsenTTT Nguyen2009Optimization of An Experimental Model for the Recovery of Adult Haplorchis Pumilio (Heterophyidae: Digenea).Journal of Parasitology95629633
- 15. Dung BT, Madsen H, The DT (2010) Distribution of freshwater snails in family-based VAC ponds and associated waterbodies with special reference to intermediate hosts of fish-borne zoonotic trematodes in Nam Dinh Province, Vietnam. Acta Tropica. BT DungH. MadsenDT The2010Distribution of freshwater snails in family-based VAC ponds and associated waterbodies with special reference to intermediate hosts of fish-borne zoonotic trematodes in Nam Dinh Province, Vietnam.Acta TropicaIn press. In press.
- 16. Brandt RAM (1974) The non-marine aquatic Mollusca of Thailand. Achiv für Molluskenkunde 105: 1–423.RAM Brandt1974The non-marine aquatic Mollusca of Thailand.Achiv für Molluskenkunde1051423
- 17.
Thanh DN (1980) Identification of freshwater invertebrates in Northern Vietnam. Science and Technology Press (in Vietnamese).. 490 p.DN Thanh1980Identification of freshwater invertebrates in Northern VietnamScience and Technology Press (in Vietnamese).490
- 18. Frandsen F, Christensen NO (1984) An Introductory Guide to the Identification of Cercariae from African Fresh-Water Snails with Special Reference to Cercariae of Trematode Species of Medical and Veterinary Importance. Acta Tropica 41: 181–202.F. FrandsenNO Christensen1984An Introductory Guide to the Identification of Cercariae from African Fresh-Water Snails with Special Reference to Cercariae of Trematode Species of Medical and Veterinary Importance.Acta Tropica41181202
- 19.
Sen-Hai Y, Long-Qi X (2005) Intestinal trematode infections in China. In: Arizono N, Chai JY, Nawa N, Takahashi Y, editors. Asian Parasitology (Vol.1), Food-borne Helminthiasis in Asia. Chiba, Japan: Federation of Asian Parasitologists, Chiba, Japan. pp. 61–78.Y. Sen-HaiX. Long-Qi2005Intestinal trematode infections in China.N. ArizonoJY ChaiN. NawaY. TakahashiAsian Parasitology (Vol.1), Food-borne Helminthiasis in AsiaChiba, JapanFederation of Asian Parasitologists, Chiba, Japan6178
- 20. Thu ND, Dalsgaard A, Loan LTT, Murrell K (2007) Survey for zoonotic liver and intestinal trematode metacercariae in cultured and wild fish in An Giang Province, Vietnam. Korean Journal of Parasitology 45: 45–54.ND ThuA. DalsgaardLTT LoanK. Murrell2007Survey for zoonotic liver and intestinal trematode metacercariae in cultured and wild fish in An Giang Province, Vietnam.Korean Journal of Parasitology454554
- 21. Thien PC, Dalsgaard A, Thanh BN, Olsen A, Murrell KD (2007) Prevalence of fishborne zoonotic parasites in important cultured fish species in the Mekong Delta, Vietnam. Parasitology Research 101: 1277–1284.PC ThienA. DalsgaardBN ThanhA. OlsenKD Murrell2007Prevalence of fishborne zoonotic parasites in important cultured fish species in the Mekong Delta, Vietnam.Parasitology Research10112771284
- 22.
Long-Qi X, Sen-Hai Y, Ying-Dan C (2005) Clonorchiasis sinensis in Japan. In: Arizono NCJNYT, editor. Asian Parasitology 1, Food-borne helminthiasis in Asia. Chiba, Japan: The Federation of Asian Parasitologists. pp. 27–33.X. Long-QiY. Sen-HaiC. Ying-Dan2005Clonorchiasis sinensis in Japan.NCJNYT ArizonoAsian Parasitology 1, Food-borne helminthiasis in AsiaChiba, JapanThe Federation of Asian Parasitologists2733
- 23. Skov J, Kania PW, Dalsgaard A, Jørgensen TR, Buchmann K (2008) Life cycle stages of heterophyid trematodes in Vietnamese freshwater fishes traced by molecular and morphometric methods. Veterinay Parasitology 160: 66–75.J. SkovPW KaniaA. DalsgaardTR JørgensenK. Buchmann2008Life cycle stages of heterophyid trematodes in Vietnamese freshwater fishes traced by molecular and morphometric methods.Veterinay Parasitology1606675
- 24. Khamboonraung C, Keawvichit R, Wongworapat K, Suwanrangsi S, Hongpromyart M, et al. (1997) Application of hazard analysis critical control point (HACCP) as a possible control measure for Opisthorchis viverrini infection in cultured carp (Puntius gonionotus). Southeast Asia Journal of Tropical Medicine and Public Health 28(1): 65–72.C. KhamboonraungR. KeawvichitK. WongworapatS. SuwanrangsiM. Hongpromyart1997Application of hazard analysis critical control point (HACCP) as a possible control measure for Opisthorchis viverrini infection in cultured carp (Puntius gonionotus).Southeast Asia Journal of Tropical Medicine and Public Health28(1)6572
- 25. Albonico M, Smith PG, Hall A, Chwaya HM, Alawi KS, et al. (1994) A randomised controlled trial comparing Mebendazole and Albendazole against Ascaris, Trichuris and the hookworms. Transactions of the Royal Society of Tropical Medicine and Hygiene 88: 585–589.M. AlbonicoPG SmithA. HallHM ChwayaKS Alawi1994A randomised controlled trial comparing Mebendazole and Albendazole against Ascaris, Trichuris and the hookworms.Transactions of the Royal Society of Tropical Medicine and Hygiene88585589
- 26. Waikagul J, Watthanakulpanich D, Muennoo C, Maipanich W, Sa-nguankiat S, et al. (2005) Efficacy of benzimidazole carbamate on an intestinal fluke co-infected with nematodes. Journal of the Medical Association of Thailand 88: 233–237.J. WaikagulD. WatthanakulpanichC. MuennooW. MaipanichS. Sa-nguankiat2005Efficacy of benzimidazole carbamate on an intestinal fluke co-infected with nematodes.Journal of the Medical Association of Thailand88233237
- 27. Liberg O (1980) Spacing Patterns in A Population of Rural Free Roaming Domestic Cats. Oikos 35: 336–349.O. Liberg1980Spacing Patterns in A Population of Rural Free Roaming Domestic Cats.Oikos35336349
- 28. Cameron A (2002) Survey toolbox for aquatic animal diseases: a practical manual and software package. ACIAR Monograph Series 94: 1–375.A. Cameron2002Survey toolbox for aquatic animal diseases: a practical manual and software package.ACIAR Monograph Series941375


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Bikini Vitamins Organic Garcinia Cambogia Appetite Suppressant and Weight Loss Supplement with Green Tea, Acai, Apple Cider Vinegar, Kelp, Grapefruit and Much more 30 Day Provide
Item Description
Item Description
Bikini Vitamins are specially formulated with the fat blocking action of Garcinia Cambogia, the thermogenic energy advantages of Green Tea and Caffeine, and the remarkable antioxidant properties of Acai, along with the many benefits of Apple Cider Vinegar, Kelp and Grapefruit. Get your body bikini prepared and move over to the lighter side of weight loss! Greatest outcomes achieved when taken in conjunction with a sensible diet regime and a typical physical exercise routine.
Price: $9.95
- All-natural FORMULA To Aid Get Your Physique Bikini Ready All Year Extended
- Effective Components including, Garcinia Cambogia, Green Tea, Caffeine, Antioxidants, Acai, Apple Cider Vinegar, Kelp and Grapefruit.
- Secure AND Dependable: Made with the highest top quality components. Manufactured in GMP certified and FDA registered facilities.
- one hundred% SATISFACTION Assured: We stand by our goods one hundred%. We by no means compromise on top quality or service, to guarantee excellence in providing you with a superior product.
- Direct from Manufacturer – Do not be fooled by the imitators

subset: commoncrawl


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When I first starting blogging I had absolutely no idea about photos, none whatsoever. I didn't know about cropping and exposure and all the other wonderful things that can make a poor photo just a little bit better. As time went on I started to edit my photos and start to use our nicer plates to photograph an item of food on.
Then I discovered the world of props.
I now have a few of these said props scattered about the house, some that I've had for a while, and a few more recent purchases (shhh don't tell the husband!).
I must admit that I am often a bit lazy when it comes to styling, usually because there is an army of hungry mouths waiting to be fed, and often just click and run.
I am still learning and have a long way to go but the queen of props and styling in my eyes has to be the lovely Lucy. I discovered her blog a few months ago and read her posts, such as Baby B's Baby Shower, in awe of her imagination and styling ability, as well as her amazing props - where does this woman keep all this stuff!
Lucy, being the kind and generous lady that she is, has decided that she will share some of her styling tips over the coming months, to help those of us with lesser ability, in her brand spanking new feature #SundayPropShop.
She will guide us through suitable locations to take our photographs, showing us her behind the scenes shots (my favourite part being the nosey parker that I am) and how to edit those not so great shots, and of course there will be props, lots of props.
When I remembered about the Sunday Prop Shop last night it was too dark to take any photographs so this morning myself and my young props assistant ferried a few of my favourite accessories out into the sunny garden for a quick shoot. Then we ferried them all back in again 5 minutes later.
I also have quite a few props dotted around my kitchen so I also gathered a few of those up on my favourite indoor place to photograph food, my kitchen sideboard.
You may have spotted one or two of these items in posts recently.


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how do you call chris when
- he's hungry: chris food.
- he's with drift: chris woof.
- he's emotional: chris mood.
- he's angry: chris rude. (nah he's an angel)
- he's under the shower: chris nude.
- he's on his motorcycle: chris vroom.
- he's taking a picture: chris zoom. (haha jk he never takes pictures)
- he's surfing in australia: chris dude.


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NEPA Known World
Natural Healing
The BECMI rules are mum on the way natural healing occurs. The older rules and the RC rules conflict. Therefore, we will house rule it:
Characters regain 1 hit points for every night's rest. This rest must be equivalent to the rest needed to regain spells. A wandering monster attack in the middle of the night will not preclude healing but characters must get a minimum of six hours of sleep to achieve the healing.
If a character is on complete bed rest (not adventuring or resting overnight), s/he will regain 1d4+1 hit points per day. Complete bed rest means no more strenuous activity then carefully going up a flight of stairs or fixing and eating a bowl of oatmeal.


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Slithe 15:52 27 Dec 2005
OK - you need to find what type of card your motherboard supports- is it AGP or PCI? AGP is a brown slot, whilst PCI is white. If you open up your case, then you can look and find out.
I am presuming that you have onboard graphics with the Dell?


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Here at Sky Ortho, we are dedicated to making beauty and health as painless as possible. Dr. Larson and the her highly qualified team have the training, experience, and heart to make each visit a great one! Every aspect of our practice is designed with you, the patient, in mind.
Place Categories: Health
Place Your Review
Report this?


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The city of Brookhaven has closed a foot bridge in Ashford Park, 2980 Redding Road, after establishing its ownership of the bridge. The city hired a structural engineer that inspected the bridge and issued an assessment that states the bridge connecting Camille Drive and Valvedere Road is unsafe for foot traffic and must be closed.
The city is planning repairs and will keep residents informed on further updates once a timeline is established.
Information: www.brookhavenga.gov.


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Since 1879, companies of the WP BAKERYGROUP have had a major influence in the development of bakery technology. Today they cover the complete process chain from dough production to the forwarding of packing lines. The additionally offer services such as engineering, complete solutions for different retail environments or integrated energy management for bakeries.
Whole process chain of bakery machines.
Dough Dividing Machine B/V 300
Universal Dough Divider
This dough divider is suitable for most common types of dough as well as sensitive dough's. The divider handles a big variety of dough types such as wheat, wheat/rye, stiff (pizza) dough's, as well as soft (French) dough's.
The Spiral Mixer
The KRONOS is a robust, reliable mixer with wheel-out bowls. KRONOS Pro can be easily adjusted to the individual needs of the customer through different available options - either as a stand-alone mixer or in a mixing system.
MATADOR® – truly multi talented
Confidence and reliability
Every MATADOR® has been built to meet one clearly defined requirement: To deliver extremely consistent and reproducible baking results – over many decades, of course! The total number of benefits leaves no doubt as to what this deck oven is really about – a truly multi talented MATADOR®.
High quality, Mediterranean bakery items, attractive snacks – these were the trends in 2016. Our year in review shows just how well our technology is suited for these trends and how successful bakers work with it. | » Further reading
Panini, ciabatta, baguette: large-format photos of Mediterranean pastries turned the WP BAKERYGROUP exhibition booth into an attractive highlight at the Südback. The atmosphere at the most important German trade fair for the bakery trade was excellent and the WP exhibition booth was very w...| » Further reading
WP Haton is a prime example of reorganization. The company was honored for this achievement by the online magazine nieuworganisereren.nu at the Nieuw Organiseren Festival in Amersfoort (Netherlands). Flexible working hours, employee participation and need-based processes: in many production ope...| » Further reading
Werner & Pfleiderer Lebensmitteltechnik GmbH
von Raumer Str. 8–18
91550 Dinkelsbuehl
Phone: +49 9851 9050
Business matching
Get in contact with German companies in 3 easy steps! With one single question you can reach all relevant German Pavilion exhibitors of your selected industrial branch.
Click here if you notice an image that violates copyright or privacy rights.


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Sailboat Sunset Napkin
per set of 4 napkins
15% Off with code BIZDEALFIFTY
Select an option:
Cloth Cocktail Napkin 12" x 12"
- $39.05
Cloth Dinner Napkin 20" x 20"
- $35.70
Cloth Napkins (set of 4) cocktail 12" x 12"
- $11.15
Cloth Napkins (set of 4) dinner 20" x 20"
About This Product
- Sold by
Style: Cloth Napkins (set of 4) dinner 20" x 20"
From parties to seasonal events, these 100% cotton napkins are the perfect finishing touch. Printed with vibrancy and accuracy, these napkins are the perfect canvas for your designs, photos and monograms. And with both cocktail and dinner sized covered, you're sure to find a set of napkins that will "wow." After all, you are the hostess-with-the-mostest!
- Dimension: 20"(width) x 20" (height).
- 100% grade A woven cotton.
- Fabric is made from natural fibers, which may result in irregularities
- Machine washable.
- Made in the USA.
- Designer Tip: To ensure the highest quality print, please note that this product's customizable design area measures 20" x 20". For best results please add 5/7" bleed.
Will be made by
Zazzle Home
Reno, NV
About This Design
Sailboat Sunset Napkin
Ocean sunset with sailboat digital painting, with a old style ships wheel as a frame.
Artwork designed by
Tennessee, United States
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Rating: G Report this product


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Why You Should Have a Mentor
Have you ever tried to learn a new skill all alone? Probably shortly after starting you realized that it can be extremely difficult to tackle all on your own. Plenty of times when you do not know what you do not know, you can be clueless even when you have the internet as a tool for help. I truly believe that everyone should have a mentor for whatever they are trying to improve in and hopefully by the end of this post you will be convinced enough to go out and get your own!
Access to the Unknown
As I mentioned, when you do not even know what you are missing in your knowledge, it can be very hard to know what direction to progress in, and sometimes leave you very confused and discouraged. Having a mentor there that has been through it all, can guide you in the right direction and say "Hey you have not learned anything about databases yet, check out PostgreSQL because that is one that I use." This now leads you in the right direction to help plug your knowledge gaps.
Saves You Time
The amount of hours, days, weeks, and sometimes even months my mentor has saved me by sending me over a text that guided me in the right direction is enormous. Sometimes its even laughable to think that without him there, I would have spent a very large amount of time learning the hard way.
Since your mentor has been through the hard way, he can save you all the time he lost and even more by giving you the foresight of knowing it all already.
Act as a Motivator
Time and time again, people get discouraged from completing something that they think is worthwhile because the people they surround themselves with are not supportive of their goals. They end up getting influenced by these naysayers, and give up on their goals.
A mentor provides you with someone that could be your source of motivation. They know your struggles having been in you shoes. They also believe in you, otherwise they would have never agreed to become your mentor in the first place. On top of that, when someone teaches you personally, they are somewhat invested in your success because your success is a reflection of their teachings.
If you are looking to meet more like minded people in your field, having a mentor could be a great way to branch out. Your mentor likely has his or her own friends, his or her own colleagues that are on par or near his or her skill level. As you progress and improve, your mentor could introduce you to these people. This would expand your network with high quality people.
Feedback and Perspective
I cannot tell you the amount of times that I believed that I was doing the best job possible with something, or I was over confident in my abilities. Having a mentor can really give you some perspective in the sense that their skill level could be your end goal for your own skill level. Having that person there to compare yourself too can let you know how unskilled or skilled you really are.
Also your mentor can comment on your abilities and let you know how you really have progressed. Sometimes it can be really tough to see ourselves from a third person's perspective and be truly objective about ourselves. A mentor has the ability to give you that constructive criticism so you may instantly improve.
As you can see, there are many benefits and advantages to having a mentor. So what are you even waiting for then go out and get one!
Reach out and follow me on twitter! Check out my GitHub for my open source projects! Take a look at my YouTube Channel.


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Beauty Cosmetic Shop UK - Beauty and Beauty
Category : Other Services Posted : 30/05/2017 Price : Free Location : Lichfield(Staffordshire)
At theskinstore, you can get a variety of beer brands that can make you look more beautiful and gorgeous. You can make your skin shiny like pearls. You can place an online order to get the beauty products.
1300 880 811
Website URL – www.theskinstore.com.au


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How Neat Are You?
Just because it's gross doesn't mean you want to hang around and make it not gross. You prefer to take a head-in-the-sand approach when it comes to filth, and pray that it'll go away or someone else will take care of it in the meantime. You save a lot of energy that way; bravo!
You'd rather handle everything yourself then deal with micromanaging other people's cleaning habits (which can never match up to your own). You know exactly how and when to clean everything, and you leave a dazzling trail of neatness in your wake. Sorry the world is so much grosser than you.
You maintain a healthy balance. You don't automatically wrinkle your nose when you walk into slightly messy room, but you also know how to clean up after yourself and be a grown-up human in the world. You make an excellent roommate/romantic partner/general cohabitant.
Long ago you decided that life is too short to spend deliberating between Swiffers and mops. You're mystified by squeegees, baffled by fabric softeners, and always so busy moving on to your next activity that you don't bother to clean up the first. You might, however, want to invest in a vacuum, just for the sake of appearances.
Images via Shutterstock.


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Find The Right Clinic For You.
Find Clinics in Romania. Select the best Clinic in Romania, save money on your treatment, compare reviews, prices and find all the information you need.
Dr. Silviu Moraru in Bucharest, Romania offers you an opportunity to solve your dental problems, to have a pleasant stay in Romania and also financial gain by important savings on treatment costs and also on accomodation and recreation.
Rosetti Dent Clinic is a dental practice which offers full prophylactic and curative treatment for acute and chronic afflictions. The procedures will be applied by a team of professionals in a warm and friendly environment at a level which corresponds with current european standards.
Omnia Dental is a clinic specialized in treating periodontal disease, dental implants, prosthetics and dental esthetics. We find rapid and long-standing solutions for treating periodontitis, no matter its evolution stage.
HEALTHSNAP DENTAL CLINIC is a center for Implantology and Aesthetic Dentistry, opened in 2007, offering its patients the dental services of European quality.We are located in an easily accessible area, near the Dristor intersection.


text:
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Diane papalia psicologia descargar
Diane e papalia psicologia Diane stein reiki-essentiel
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This is an ultra whimsical ceramic teapot made to resemble a real reef fish. The inspiration for this fish is based on the Coral Hind Grouper. Lola's best friend ironically is Sonya the pelican. A love for glitzy bling brought these two ladies together. Both are decked out with ceramic beaded necklaces, Lola has earrings and both have rhinestone studded sunglasses to top off their fabuloso ensambles.
This teapot will measure approximately 10" from lips to tip of her tail, 10" in height including her beaded wires and 5" deep.
Please note: This is a Made to Order listing and will take approximately 4-6 weeks to complete.
Your teapot will be formed using soft stoneware clay. I will use the potter's wheel to throw her ring body and a pyramid cylinder for her base. She was finished off using handbuilding techniques to bring her to life. All of the clay and glazes that I use are certified non-toxic, lead-free so if you want to give her a smooch, go right ahead.
This teapot has all of the elements of a teapot but isn't practical for use. Because of her lucsious lips, she's a drooler. No microwave for her either because of the metal wire embellishments. She does make a fantastic addition to a teapot or fish collection or for someone that loves whimsy.
If you have any questions that I haven't answered through the listing or in my Shop Policies, please send me a convo.
I accept payment through PayPal as well as Etsy Direct Checkout and Etsy Gift Cards Please be sure to follow all of the links to make sure that your payment is processed completely. If this is your first time, and have questions, please send me a convo.
I allow 7 days for you to make payment. If payment is not received within 7 days the sale will be cancelled and the item will be relisted. If there's going to be a delay in making payment, please let me know ahead of time and we can work something out.
Once I've received confirmation of your payment your purchase will go out to you with an e-mail to you to confirm shipment. I prefer to ship via USPS or FedEx. If you prefer a different carrier, please let me know and I'll make it happen for you. If the shipping costs are less than what you paid, I'll refund the excess. I take great care in packing to make sure that your purchase arrives unbroken. Damages do happen, unfortunately, and if, when you receive your shipment, there is damage, broken or chipped, please convo me asap so that I can file the claim. Your choice refund or replacement.
International shipping? Yes, most listings are available for international shipping. Larger items are excluded due to the high cost.
My goal is to make my customers happy. If you are not 100% thrilled with your purchase - do not hesitate to contact me. Not a problem returning the item. Just send me an Etsy Conversation first. Time-frame for returns is 14 days from the date that you received the item. You will be refunded the cost of the piece including shipping charges. Your refund will be in the same form of payment used to place your order. Please be sure to insure the shipment. Unfortunately I cannot refund if the item arrives broken and is not insured. If you'd prefer to exchange for another piece, not a problem, just let me know.
Gifts- if you received item(s) as a gift, I understand that the 14 day rule for returns may be difficult, for that reason I will accept gift returns within a reasonable number of days. Please send me an Etsy Conversation. If a gift is returned you have two options: 1) You may receive a Gift Certificate or 2) You can elect to have the buyer be credited for the purchase price of the item


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- int.嘿!,哈!
- 别碰那道铁丝网, 能钩伤你的!
- You could do yourself a mischief on that barbed-wire fence!
- 锤子是用来钉钉子的。
- A hammer is used for driving in nails.
- "演讲人似乎没有什么独到的见解,他的讲话充满了陈词滥调。"
- The speaker seems to have no original ideas; his speech was full of platitudes.
- "这个音讯的大意似乎是,有几名高级军官逃离了他们国家。"
- The purport of the message seemed to be that a few top army officers had fled from the country.
- "这一家人在遭到不幸的车祸前,日子过得太平安宁。"
- The family had lived in peace and tranquillity before the unfortunate traffic accident.
- "那艘船只得在利物浦停靠,装载补给品。"
- The boat had to put into Liverpool for supplies.
- "她生性轻浮,什么事情都不肯认真对待。"
- She has a frivolous nature and won't take anything seriously.
- "我和我的未婚夫打算在夏威夷结婚,因为我们的家人住在那里。"
- My fiance and I are planning to be married in Hawaii because our families live there.
- "在给予高薪的允诺的引诱下,许多年轻的日本工程师去了中东。"
- Many young Japanese engineers have been lured to the Middle East by the promise of high wages.
- "我没钱了,我可以给你一张借条借十块钱吗?"
- I haven't any money; can I give you an IOU for$10?
- "通过餐馆的窗口可以订购汉堡包,然后通过这个窗口把汉堡包递给在外面等候的顾客。"
- Hamburgers are ordered through a window in the restaurant and then are handed out through the window to the waiting customer.
- "一位在钟塔上工作的油漆工把一桶油漆挂在一根指针上,把钟弄慢了。"
- A painter who had been working on the clock tower hung a pot of paint on one of the hands and slowed it down!
- "一枚手榴弹意外地发生了爆炸,接着是一片混乱,使我不知所措。"
- A hand grenade exploded by accident and I got lost in the ensuing confusion.
- `他乐而不富'是`他富而不乐'的反题。
- `He is happy but not rich' is the converse of `He is rich but not happy'.
- `你见过大象吗?'`见过。'
- `Have you ever seen an elephant?' `Yes I have.'


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Fowler sees clock ticking on schools' hopes for funding
A politically created crisis over state K-12 funding continues despite Gov. Bruce Rauner doing what had to be done to end it, Sen. Dale Fowler (R-Harrisburg) said on his website recently.
"Sadly, the clock continues to tick on a the eve of a new school year, which has prompted several area superintendents to question how long they are able to keep their district's doors open without state funds," Fowler said in his post.
Senate Bill 1, the funding measure, was approved by the General Assembly two months ago but not sent to Rauner until July 31 – a delay many Republicans have called a crisis manufactured by majority Democrats.
Fowler supported Rauner's amendatory veto of SB1, which stripped the measure of additional funding for Chicago Public Schools that he deemed unfair. The bill has since been returned to the Legislature, which can accept it, attempt an override it or do nothing, which would effectively kill the bill.
In addition to updating constituents on the ongoing school funding battle, Fowler also noted that he met with representatives from the Illinois Truckers Association to learn about the challenges they are facing. At a recent round table, he said he discussed fuel blending taxation, fees, permits and licensing with representatives from more than a dozen trucking businesses. The group also discussed road safety, a pertinent topic in light of recent traffic incidents in southern Illinois.
Organizations in this Story
Dale Fowler for State Senate
Harrisburg, IL - 62946


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Coastal Carolina University nursing certificate
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Think about what career is best suited for you, and where you want to study. Request more information now.
Learn about Coastal Carolina University nursing certificate, and registering for elective lectures. Which college degrees give you the best chances of finding employment after graduation? You can enter nursing with either an associates degree or BSN. As a licensed vocational nurse (LVN), you may provide patient care under the supervision of a registered nurse (RN). Concentrating on Coastal Carolina University nursing certificate, for example, you may gain an advantage in job recruiting on-campus. Check with the CNA department for course registration deadlines, and nursing assistant program requirements. Please use the form above to request admissions info for Coastal Carolina University.
The Certified Nursing Assistant (CNA) designation is the first step in becoming a nurse. After Becoming a CNA, you will assist in caring for patients by monitoring vital statistics, bathing, feeding and maintaining personal hygiene. Most CNA and nurse's aide programs can be completed within a few months, allowing you to begin working. As the public ages, nursing care has become a major source of employment for technical program graduates.
The next step in a nursing career is to become a Licensed Practical Nurse (LPN) or a Licensed Vocational Nurse (LVN). This is a one year long program, in which you'll work under an RN, and be assigned advanced care work. Practice requirements for nurses aides and LPNs vary from state to state, but basic duties include passing meds, wound care, and administering feeding tubes. One year nursing certificate programs train students to pass the licensing test, in order to become an LPN or LVN, and it is common for 90% or more of the graduating class to find nursing jobs within 6 months. You don't have to become a registered nurse to make good money, as a licensed practical nurse with several years of work experience can earn well over $43,500 a year. Beyond major requirements within the CNA department, you may consider Edgecombe Community College vaccination requirements as a complementary elective to your primary course of study.
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Accommodation in Llandudno & Conwy
Stay in Conwy County, we're very accommodating!
Are you looking to book a family holiday?
Planning a short break or some shopping for unique bargains?
Or looking to visit one of our many attractions and things to do such as the Great Orme, Llandudno Pier, Llandudno Cable Cars or our famous Llandudno Beach and Colwyn Bay Beach?
If so, the range of accommodation in Llandudno and Conwy will suit all tastes and budgets.
Our places to stay cover all bases, from friendly seafront hotels to luxury country houses, boutique accommodation to great-value bed and breakfasts, well-equipped caravan parks to self-catering apartments.
If you want to sip champagne before a spot of fine dining in a top hotel, or prefer to do your own thing in quality self-catering, we've got the place that's just right for you.
If you're looking to head out into the beautiful countryside of the Conwy Valley, you'll find historic accommodation with oak beams and real fires, delightful holiday cottages looking out over miles of Snowdonia scenery and family-friendly self-catering properties.
Back on the coast, you can even stay on the doorstep of a World Heritage Site in the medieval town of Conwy.
Our ever-so-flexible accommodation in Llandudno appeals to families and couples, country lovers and fans of the seaside, guests looking for romantic breaks and outdoor adventures.
And since the habit of spending 'two weeks beside the seaside' no longer applies as it once did, there's a great choice of short break and special price packages available, not just in the quieter months but throughout the year.
Whichever type of accommodation in Llandudno & Conwy you decide to choose, many can be found in close proximity to our award-winning beaches and restaurants.
Search & Book your Llandudno and Conwy Accommodation today.
Our search function to the right of the page will let you search all of our accommodation in Llandudno options.
If you need any help with your booking, please contact our friendly staff at Llandudno Tourist Information Centre or Conwy Tourist Information Centre.
And don't forget to take a look at our events calendar too, there's lots of exciting festivals, events and celebrations taking place that you might like to join in.
Further Resources
For more information on accommodation in the various towns and villages of Conwy such as Betws-y-Coed, Colwyn Bay, Abergele, Rhos-on-Sea, Llanrwst, Towyn and Deganwy then simply click on them pages for more details.
Accommodation Highlights
Acacia Apartments
These lovely apartments are conveniently situated on the level and are minutes from...
Four Saints Brig-y-Don Hotel
Four Saints Brig-y-Don Hotel is located at characteristic locations in Llandudno.
Belle Vue House
Prime location on the seafront by the pier entrance overlooking sandy beach and...
The Imperial Hotel
The hotel offers you a warm welcome to Llandudno, the Queen of Welsh Resorts.


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Residents and visitors alike flock to the Palm Desert Civic Center Park every Thursday evening in May and October for the City's free Concerts in the Park. Held on the terraced lawn of the Civic Center Park Amphitheater, music lovers can look forward to diverse musical offerings that may range from reggae to R&B, and from country to indie.
Music lovers are encouraged to bring a blanket or a chair with them in order to sit back, relax and enjoy live music under the stars. Food trucks are on hand to offer up mobile culinary creations, or concertgoers can bring a picnic along to enjoy with the show. Alcoholic beverages and smoking are prohibited in the park.
The next concerts will be held in October 2017, starting at 6pm each week. These are the scheduled performers:
- October 5: The Long Run (Eagles Tribute band)
- October 12: The Dustbowl Revival
- October 19: Yachty by Nature
- October 26: AMFM
For additional details on the performers, please refer to the individual calendar listings found in the Events section of this website.
Civic Center Park is located at the northeast corner of Fred Waring Drive and San Pablo Avenue. For additional information about the Concerts in the Park series, please call 760-346-0611, ext. 416.


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Joey Bada$$ is coming with a new album in 2017 titled ABBA, expected to arrive later this year via Pro Era/Cinematic Music Group. Late last year, the Brooklyn-native previewed an untitled song which touched on the current climate in America and various social issues affecting minorities across the country. On Thursday night (Jan. 19), Joey liberates the full version of the track titled "Land of the Free.""Something we need in a time like this… #LandoftheFree #AABA," tweeted Joey, who is seen wearing shirt that says "Make Amerikkka Suck Again" on the song's artwork. A record needed at a time of uncertainty, hours beforeDonald Trump's inauguration as the President of the United States, hear "Land of the Free"
Download Joey Badass – Land Of The Free


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- select colour
it's an internet thing!
it's an internet thing!
"You just have to keep trying to do good work, and hope that it leads to more good work. I want to look back on my career and be proud of the work, and be proud that I tried everything. Yes, I want to look back and know that I was terrible at a variety of things."
"Choose a job you love, and you will never have to work a day in your life."Jon Stewart on Confucius
"All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence."Jon Stewart on Martin Luther King, Jr.
"Opportunity is missed by most people because it is dressed in overalls and looks like work."Jon Stewart on Thomas A. Edison
"By working faithfully eight hours a day you may eventually get to be boss and work twelve hours a day."Jon Stewart on Robert Frost
"Nothing will work unless you do."Jon Stewart on Maya Angelou
"The seven marvels that best represent man's achievements over the last 2,000 years will be determined by Internet vote... so look for Howard Stern's Private Parts to come in No. 1."
"McVeigh's lawyer got him the death penalty, which, quite frankly, I could have done."
"I'm not just a boy toy. I have feelings and dreams like anybody else."
"I've always liked Atlanta. And not just for the strip clubs, but the shopping and the food."
"If the events of September 11, 2001, have proven anything, it's that the terrorists can attack us, but they can't take away what makes us American - our freedom, our liberty, our civil rights. No, only Attorney General John Ashcroft can do that."


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Culture @ the Olympics issues, trends and perspectives
The Opening Ceremony of the Olympic Gamesi Andy Miah The Olympic Games Opening Ceremony is the most watched event in the world with an expected 1.4 billion people tuning in to a Summer Games ceremony. Most of this audience will have had no prior coverage of the local political issues that surrounded the Games, nor will they care too much about these matters, since they are tuning in to see athletes prepare to compete in sports. While the Winter Games attracts fewer viewers than the Summer, due in part to their being fewer countries participating, they are no less pivotal in terms of how they define an Olympic host population's emotional attachment to its Games. Thus, opening ceremonies tell powerful stories about the Olympic host's identity and values, which are consumed and interpreted by a local and global audience. In Torino 2006, the Ferrari spinning doughnuts in the stadium and the avant-garde costumes emphasized Torino's
Vancouver 2010 torch relay in Whistler, photo by Kris Krug
design excellence and was reminiscent of the extraordinary beauty of the opening ceremony of Albertville 1994. In Beijing 2008, the choreographic feat of 2,008 dancers, the magnificence of the 'bird's nest' Olympic stadium and the fireworks spectacle that typified China's expertise with pyrotechnics, all showcased China's emergence as a global superpower. In Vancouver tonight, the Opening Ceremony will be a turning point for how many Vancouverites feel about the last 7 years of preparation. For those who may have been negatively affected by the process, the sight of athletes entering the arena can often inspire feelings of
Culture @ the Olympics, 2010: vol. 12, issue 6, pp. 32-34
admiration, pride and a great sense of empathy over the athletes' imminent challenge, which can move even the hardest cynic. These athletes have trained all their lives for this single competition and we, as their audience, have the opportunity to witness their defining moment. What they achieve will become part of our history and, particularly for those who see the sports live, the spectacle can be an experience of a lifetime.
in Ancient Olympia, Greece. From there, it was taken across the world to Canada, where the flame relay began. In recent years, the relay became an international event, moving from one country to the next. However, after the protests that occurred on the approach to the Beijing 2008 Olympics, the IOC decided to end such extensive relays. This is unfortunate and the IOC should reconsider this decision, not least because the torch is the sole opportunity for the general public to encounter the Olympic experience. As the opening ceremony begins, the flame works its way to the stadium, ready for one of the Games' most iconic moments: the lighting of the cauldron. This moment also has important cultural significance, both in terms of who lights the cauldron and how it is lit.
Olympic flame lighting ceremony, Olympia, Š VANOC/COVAN
Technically, the Vancouver 2010 opening ceremony began a few months before February 12th, when the Olympic flame was lit
Unforgettable moments in Olympic history include the archer of Barcelona 1992 who shot a flaming arrow into the cauldron, thus igniting it (he actually overshot for safety, but the choreography read beautifully). As well, the continual pressure to surpass the spectacle of previous Games leads to quite remarkable and sometimes convoluted feats.
Miah, 2010: Opening Ceremony 33
moment overwhelms an audience through drama alone. As the cauldron is lit in Vancouver, the frustrations of many locals will be temporarily put on hold, as the ceremony will have weaved a narrative around some of these tensions, occasionally exposing them. Also, out of respect for the visiting nations, the desire to be a good host - and the need to have a very big party - this moment will be a collective, cathartic experience for many Vancouverites.
Beijing 2008 Opening Ceremony, Photo from Wikipedia.
The Beijing 2008 Olympic Games was no exception, as the former Chinese gymnast, Li Ning, sprinted a victory lap across the upper part of the stadium, suspended high above the ground, before finally arriving to the cauldron. It was a moment that beautifully articulated China's technological power and its burgeoning creative industries.
As dawn breaks the next day, it will be business as usual for those very same people, as both the competitors and the activists go about their work, all in the name of making Olympic history. But, one thing is for sure - they'll all meet again at Holland Heineken House in Vancouver the following night, and each subsequent night of the Games! This was originally published in the Huffington Post (2010, Feb 12).
The individual chosen to light the cauldron often has important symbolic value for a nation. On some occasions, a well-known global personality is chosen, such as Muhammed Ali at the 'CocaCola' Games of Atlanta 1996. However, often, the individual is not well known to a global audience, thus requiring that this
Miah, 2010: Opening Ceremony 34
Published on Feb 10, 2010
Article about the Olympic Games Opening Ceremony


text: Yep, another one available for one who wants it. Came from a 20-39PC if anyone needs to know (drivers are the same in the originals). I'll be installing my new driver this week. As with the others, $40 plus shipping is the cost. Email me or post here. I check my email more often so you might get better results from an email message. Thanks, Bob


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Passionate educationist and proud Malaysian
Finally here to see my sister's newborn baby! Supposed to come with Karthik in Sept but I can't take it already, wanna see his cute face since I won't get to see it much anymore.
Halo so I've disappeared from dayre again, and in a blink of an eye, I'm almost done with my year here in London! 😱I spent the last few weeks writing like mad. Writing at home, writing in cafes, writing in libraries, writing with friends, writing alone. And.....I've written a grand total of 17,500 words!!! That's 38 pages of words and words and words 😱I still have 3,000 more to go but already I feel like a very seasoned writer hahahaWrite until I got lotsa pimples on my face also wtf
Hello after missing for a month......Haha I dunno what was I so busy with as well until I couldn't update my dayre. I guess I've just been busy enjoying my last few weeks of London and spending time with friends and writing my dissertation that I didn't feel like there was much to update. But actually looking back at my pictures, there are so much to talk about!
Thanks for the advice guys.
We're in Edinburgh!I never expected it to be so pretty, and we were also lucky that the day we went hiking up the hills was the sunniest day of the week so the pictures came out perfect 😍
Guess who's in London this last week???Shanshan, my best friend from college! We're celebrating our 10-year friendniversary this year so she's visiting me for a week.When she got here, London was experiencing heatwave so this is a sticky and sweaty pic of us in the bus. 34 celcius can you believe it??
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text:
Skip to comments.Ieyoub Touts Record, Leadership as Louisiana Gubernatorial Campaign Hits Alexandria
Posted on 09/04/2003 11:22:31 AM PDT by Theodore R.Edited on 05/07/2004 6:49:41 PM PDT by Jim Robinson. [history]
Attorney General Richard Ieyoub touted his record and leadership ability Wednesday as his gubernatorial campaign came to Alexandria.
"We have a very strong message of bold, energetic leadership for the people of Louisiana, which is absolutely necessary, if we're going to move this state in the right direction," he said.
(Excerpt) Read more at thetowntalk.com ...
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Wednesday, August 26, 2009
Its a small world, afterall
Not only did we have the same flight attendant that we've had for the past couple flights home from Boston, but we also had the "pleasure" of being on the same plane as the man who vindictivly outed me to my parents 26 years ago.
The man, henceforth referred to only as "Walt" (not his real name, of course), was my roommate in Washington DC during a semester study program in the winter and spring of 1983. Walt and I ended up being roommates because we connected in the dorm as early move ins, and you know how miserable life can be when when you don't click with a dorm mate. I was scheduled to live with one of the other Journalism program participants, but Walt and I decided to switch roommates since we had sometime to talk, and so it was done. After all we laughed at the same things and appeared to share the excitement about being in Washington, which was a far cry from his tiny college and my small Ohio college. What could go wrong?
We got along OK at first. We did a walking tour of Washington with a couple schoolmates of his from his school who were there in the same program. However, by the end of third weekend, the friction was starting to show, and by the time I discovered that he was an idiot, it was too late. We were stuck with one and other.
The discovery that Walt was an idiot happened when my cousin Betty, called a cousin on her mother's side who lived in DC and arranged for Jenny to take Walt and I out for dinner. In the course of conversation, Jenny mentioned that her mother and father would be hosting our mutual cousin, and my mother at Jenny's fathers house the following month. "Your parents, they are divorced?" Walt asked. Jenny explained that yes, they were divorced, and sensing a moral lesson on the tip of Walt's snarling tongue tried to politely divert the conversation to another topic.
Walt, however had other plans, and proceeded to attack. "I think that divorce is a sign of weak character. Parents have an obligation to stay together for their children whatever the cost may be, " he judged.
Jenny and I were both dumbstruck.
First of all it wasn't polite. Second of all, it was none of his business. Third of all, only an idiot would say such a thing.
Its one thing to be thought an idiot, its something else to open ones mouth and remove all doubt as Walt had just done. Adding insult to the injury that he inflicted, was the snarl of implied superiority and snobbery that threw into jab, as if the action would twist the sword that he believed he just delivered.
Within a week or so of this, Walt started getting very pissy. And he started reading my journal. By the end of the semester we barely spoke. Walt availed himself to being very bigoted, very narrow minded, and very dangerous.
However judgemental, petty and snide he was, I never thought it was within his ability to call my parents and disclose to them that their son, that would be me, was gay. This came about after Walt confirmed what he suspected. He had seen me out in DC with the man I was dating. And according to mutual friends, he was digusted.
I don't know what followed next, but sometime in the next couple weeks a caller started making anonymous phone calls to my parents. Unlike the caller ID of today, or the power of *69, in 1983, such calls were untraceable. The caller told them that they had a right to know about my deviant lifestyle.
In May of 1983, we parted. I was as glad to see him out of my life as I would be to get over food poisoning. And by July 1983, the cat was out of the bag with my parents. What followed was a scene out of Tennessee Williams. Again, it was 1983, and 26 years ago being gay was still not something that most families even acknowledged in other people, let alone in their own children.
For a while I was angry and betrayed. Then the dawn of knowledge slowly gave way to just anger. However, when the dust cleared, and while his act was malevolent, Walt had done me a huge favor. While my friends around me twisted themselves in knots on how to come out to their families, I didn't have to live that lie. The deed was done. The cat was out of the bag. And in the end, we were a much healthier family for it.
Ironically, I settled in Columbus, and as it turns out, Walt went to grad school in Central Ohio. We may have crossed paths three time in 26 years, but it amount to nothing but an icy stare.
So when we sat down in row 13 of Delta Connect plan yesterday, the graying pudgy man behind us looked familiar, but his identity was still unknown. While we waited for everyone to board, the man behind us started several quick phone conversations, and it was then, after hearing that nasally, snarky voice, that Walt was confirmed.
Its a delicate difference between confronting the past and allowing it to be. The line is thin as a single thread. If Walt was the one who made those calls to my parents, then no amount reasoning could be made with him, no repayment for damages done could be collected. And what was I angry about? That he betrayed me? Hardly. If anything my anger with him is what he made innocent bystanders go through at the time.
Walt's outing me made me more sensitive to the plight of people being outed, and for that gift I am grateful. And for the many years of not having that weight on my shoulders, I am grateful as well.
I'm sure that Walt and I will cross paths again. It seems that we are destined to do so. I wish him no ill will, I wish him all the happiness that he sought to rob from me and my family. I have a home, we have our health, and the husband and I have each other. We have so many good things going for us and those we love - we have plenty to share with others, even Walt.
6 comments:
You may have been the gay one, but 'ol Walt sounds like one bitchy queen to me!ReplyDelete
BTW, I absolutely love your blog and I'm happy that you're having such a nice life. Keep up the beautiful work, my friend!
what an awful story. i mean, that you had to co-exist with this piece of drek. it's very big of you to wish him well. my mother might have wished him just a "slight" case of psoriasis of the anus.ReplyDelete
Ugly is as ugly does - no wonder he's pudgy and graying. Kudos to you for turning the other cheek; I would have bitch-slapped him into the galley.ReplyDelete
My dear brother outed me to my parents, when I was 19. He "found" a gay news magazine which "accidentally" riffling through my room, and presented it to mum and dad, saying he thought they ought to know.ReplyDelete
This led to six years of shouted arguments, most lasting several hours. In the first I tried to be reasonable and understanding, correcting their confusions and ignorance. Then I realised (a) they didn't want their confusions and ignorance corrected, and (b) I actually rather enjoyed humiliating loudmouthed people with no grasp of what they were shouting about.
So, for six years they tried to make me realise no son of theirs could be a pervert, and I made them cry - with nothing more than basic truth and basic logic. An odd sort of symbiosis.
Eventually they persuaded themselves I'd never been outed and they started breezily talking about marriage and girlfriends.
My brother has never talked about what he did. It's just possible he's embarassed about it.
This comment has been removed by the author.ReplyDelete
My husband's sister accidently outed him in a comedy of errors.ReplyDelete
He had been back east and he came out to her, but told her he was unsure how to come out the folks. Two of his older brothers were already out of the closet (the eldest brother, now deceased, was at the time, happily heterosexual and married with kids, etc.)
When the husband arrived home from that trip, he called to tell the folks he was home. Then the in-laws called the sister to her that Erik had arrived safe and sound. In idle chat sister then let slip she was so glad that Erik had told them. Surprised by this news, the inlaws called Erik and said "we've had an interesting talk with your sister and she tells us that you are gay. Is this true?" So he was out to his parents.
About five minutes after the call ended (on a good not - his parents are very forward thinking) Erik's phone rang again. It was his brother from Colorado. "Mom and Dad just called with the "good news" and they wanted me to call and make sure that really are gay." So brother asked my husband: When you kiss a girl, what's it like. "Its ok." responded husband. Brother then asked: When you kiss a guy, whats it like? Husband replied "Its REALLY OK."
So for as ugly as my coming out was, and as lonely as those years were, the rich reward is that God has us endure what we must, and if we survive, we are rewarded. My reward is that I have a great family in the in laws, and most importantly, I have the best possible match in my husband.
Love is all around us if we are open to receiving it.


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A fear of causing offence by asking patients their ethnic origin has led to a gap in data collection that could help identify those with a high risk of chronic illness, new research claims.
Researchers at the University of Warwick have found GPs and nurses often fail to ask about a patient's ethnic origin for fear of offending them.
They say that this has led to a gap in ethnicity data collection for patients, which means experts are being prevented from identifying and assisting ethnic minority patients with a high risk of chronic illness.
This is particularly important for cancer, the researchers claim, as ethnic minorities may leave it too late to go to their GP and consequently have poor survival rates.
Professor Janet Dunn, who led the study, stresses that the accurate collection of ethnicity data can help researchers assess the size of a problem, how to tackle it and how to ensure resources are targeted at high-risk populations.
For example, in the UK the Bangladeshi community has the highest percentage of male smokers, 44%, followed by Irish males at 39%. The average figure for the general population is 27%.
South Asians in the UK are 50% more likely to die prematurely from coronary heart disease than the general UK population. Males and females of Pakistani and Bangladeshi origin are also six times more likely to have diabetes.
Professor Dunn said: "Ethnic data collection is a sorely neglected area and it is vitally important that we take steps now to assess the health of all ethnic groups in society. Poor recording of this data in the UK has been identified, especially in primary care.
"There are many reasons for this, including awareness of sensitivities when asking for these data, lack of motivation to collect or provide data, unwillingness (or inability due to language barriers) for individuals to provide information, and lack of understanding as to how such data can or will be used."
When asked how they felt about providing their ethnicity, the overwhelming majority of South Asian volunteers who were interviewed in their own language as part of this study would not have a problem, provided that it was used to improve healthcare services.
Professor Dunn will present her findings from the Cancer Research UK-commissioned Cancer Ethnicity report to the Warwick South Asia Group workshops, being held at the University of Warwick this week.
The Nursing in Practice Awards 2008will reward best practice in a variety of clinical areas. If you knowsomeone who is quietly making huge strides in their area, but are notgetting the recognition they deserve, why not nominate them? Or maybeyou were you involved in an innovative, or introduced a new strategy orprotocol in your practice that improved service delivery? Tell us about it. For more information go to www.nursinginpractice.com/awards
Do you believe a fear of causing offence is the main reason for the reported lack of ethnicity data in primary care?
Your comments: (Terms and conditions apply)
"Yes, from my experience. Some Jewish clients were very rude to me when I asked for this information. The older clients seem to identify this with past abuse." - Jemma Joseph-Crosby, East London