text:
- Research article
- Open Access
- Open Peer Review
Barriers to pandemic influenza vaccination and uptake of seasonal influenza vaccine in the post-pandemic season in Germany
© Böhmer et al.; licensee BioMed Central Ltd. 2012
- Received: 9 June 2012
- Accepted: 22 October 2012
- Published: 31 October 2012
In Germany, annual vaccination against seasonal influenza is recommended for certain target groups (e.g. persons aged ≥60 years, chronically ill persons, healthcare workers (HCW)). In season 2009/10, vaccination against pandemic influenza A(H1N1)pdm09, which was controversially discussed in the public, was recommended for the whole population. The objectives of this study were to assess vaccination coverage for seasonal (seasons 2008/09-2010/11) and pandemic influenza (season 2009/10), to identify predictors of and barriers to pandemic vaccine uptake and whether the controversial discussions on pandemic vaccination has had a negative impact on seasonal influenza vaccine uptake in Germany.
We analysed data from the 'German Health Update' (GEDA10) telephone survey (n=22,050) and a smaller GEDA10-follow-up survey (n=2,493), which were both representative of the general population aged ≥18 years living in Germany.
Overall only 8.8% of the adult population in Germany received a vaccination against pandemic influenza. High socioeconomic status, having received a seasonal influenza shot in the previous season, and belonging to a target group for seasonal influenza vaccination were independently associated with the uptake of pandemic vaccines. The main reasons for not receiving a pandemic vaccination were 'fear of side effects' and the opinion that 'vaccination was not necessary'. Seasonal influenza vaccine uptake in the pre-pandemic season 2008/09 was 52.8% among persons aged ≥60 years; 30.5% among HCW, and 43.3% among chronically ill persons. A decrease in vaccination coverage was observed across all target groups in the first post-pandemic season 2010/11 (50.6%, 25.8%, and 41.0% vaccination coverage, respectively).
Seasonal influenza vaccination coverage in Germany remains in all target groups below 75%, which is a declared goal of the European Union. Our results suggest that controversial public discussions about safety and the benefits of pandemic influenza vaccination may have contributed to both a very low uptake of pandemic vaccines and a decreased uptake of seasonal influenza vaccines in the first post-pandemic season. In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in all target groups to identify if this trend continues and to guide public health authorities in developing more effective vaccination and communication strategies for seasonal influenza vaccination.
- Vaccination
- Influenza
- Coverage
- Pandemic
- Germany
In Germany, annual influenza epidemics usually occur during the winter months December to March. In the last decade, an estimated zero to 19,000 excess deaths per year were attributable to influenza virus infections [1]. Moreover, approximately one to six million influenza-related excess physician consultations per season were estimated for Germany [2]. Severe influenza virus infections or influenza-related complications typically occur in the very young and elderly population as well as in persons with underlying chronic medical conditions.
Annual vaccination has proven to be an effective method to reduce the burden of influenza disease [3]. In Germany, vaccination against seasonal influenza is recommended by the Standing Committee on Vaccination (STIKO) for individuals who have either an increased risk to develop severe influenza disease (i.e. persons aged ≥60 years, pregnant women, and persons with certain chronic medical conditions) or who are likely to transmit the virus to vulnerable groups (e.g. health care workers (HCW)) [4]. Vaccination is free of charge for the target groups in Germany. During the influenza pandemic 2009/10, STIKO additionally recommended vaccination with a monovalent vaccine against the pandemic influenza virus strain A(H1N1)pdm09 for the whole population. Due to expected limitations in vaccine supplies at the beginning of the vaccination campaign, STIKO defined and ranked priority groups for the pandemic vaccination: 1) HCW, 2) persons with underlying chronic conditions, 3) pregnant women, 4) household contacts of vulnerable persons, 5) all other persons aged 6 months to 24 years, 6) all other persons aged 25–59 years, 7) all other person aged 60 years and above [5]. The pandemic vaccination campaign started in Germany on 26 October 2009 [6]. The AS03-adjuvanted monovalent vaccine Pandemrix® was almost exclusively used and available in sufficient quantities [7].
During the pandemic, vaccination against A(H1N1)pdm09 was subject to controversial discussions, not only in Germany but also in many other countries worldwide [7–9]. Main topics of the debate in the media and among experts and 'self-proclaimed experts' were vaccine safety, effectiveness, and concern that there were too little data on the new vaccines or vaccine ingredients (especially new adjuvants) available. Moreover, the general necessity of vaccination in view of the relative mildness of the pandemic influenza disease was called into question [7, 9–11]. As a result, compliance with the national recommendations for pandemic vaccination was very poor in Germany. Since Germany has no central immunization registry, information on vaccination coverage (and factors influencing coverage) is only available from telephone and household surveys [12–15]. According to the results of thirteen consecutive cross-sectional telephone surveys (total n=13,010) conducted during the pandemic, only 8.1% of the general population aged ≥14 years living in Germany received a vaccine against pandemic influenza [6].
To develop target group specific communication strategies and to enhance compliance with the official recommendations it is important to monitor vaccine uptake in each of the target groups and to understand factors that influence uptake. This applies not only for annual influenza vaccination campaigns but also for the planning of future vaccination campaigns during a pandemic. The influence of the 2009/2010 pandemic situation on seasonal influenza vaccine uptake in Germany in the post-pandemic seasons has so far not been investigated. For this purpose, we utilized data from the large (~22,000 respondents) 'German Health Update 2010' (GEDA10) telephone survey and a smaller GEDA10 follow-up survey (~2,500 respondents). The objectives of our study were (1) to assess seasonal influenza vaccination coverage for seasons 2008/09 to 2010/11, (2) to assess pandemic influenza vaccination coverage for season 2009/10, (3) to identify predictors of and barriers to pandemic vaccine uptake, and (4) to detect a potential influence of the pandemic situation on seasonal influenza vaccine uptake in the first post-pandemic season (2010/11).
Study population and survey design
The GEDA survey design has been described previously [12, 13, 16]. In brief, GEDA is a large annual telephone survey which is conducted by the Robert Koch Institute (RKI) as a part of Germany's national health monitoring. The study population consists of persons ≥18 years of age who are living in a private household in Germany, have sufficient knowledge of the German language, and can be contacted via landline telephone. The GEDA study protocol was approved by Germany's federal and regional data-protection commissioners. All data were collected and analysed in an anonymous manner.
In this study we present data from GEDA10 which was conducted between 22 September 2009 and 10 July 2010. Since the annual GEDA survey was not conducted in 2010/2011, we conducted a follow-up interview among a subsample of 2.493 GEDA10 respondents (from now on referred to as the GEDA follow-up survey) from 1 April to 2 July 2011 to assess seasonal influenza vaccine uptake for the post pandemic season 2010/11. Based on a sample size calculation, 385 subjects were needed to estimate a prevalence of 50% ("worst case scenario") vaccine uptake with a confidence interval of +/− 5%. Our sample size of ~2,400 subjects for the follow-up survey was based on the premise to estimate a prevalence (i.e. vaccination coverage) of 50% for up to six subgroups (=cells; 6*385≈2400).
Since both surveys were conducted by RKI, the ownership of the data lies with RKI and we did not have to obtain permission to use the data for this study. Similar to the previous GEDA survey (GEDA09), a public use file of the GEDA10 dataset will be provided soon. Data from the GEDA follow-up survey will not be openly available.
To control for possible selection biases, weighting factors for the GEDA10 sample were constructed by taking age, sex, educational status, geographical region, and household size into consideration. Potential participants of the follow-up survey were sampled disproportionally to their weighting factors in GEDA10. We applied this method to avoid that groups which were already underrepresented in GEDA10 become underrepresented again at the sampling stage in the follow-up sample and thus to prevent further bias. Weighting factors for the follow-up survey were constructed in a first step on the basis of the values calculated for GEDA10 (for age, sex, education, adipositas, smoking status, subjective health, physical activity, employment status), and, in a second step, on population data gathered in the Microcensus 2008 [17], taking geographical region, age, sex, and educational status into account.
Information on seasonal influenza vaccination status for season 2008/2009 was collected from all participants of GEDA10. Between 1 January 2010 and 10 July 2010 respondents were additionally asked to provide information on seasonal and pandemic influenza vaccination status for season 2009/10. Unvaccinated survey participants of GEDA10 were additionally asked to state their reasons for not receiving a pandemic influenza vaccination. Information on seasonal vaccination status for season 2010/11 was collected from all respondents of the GEDA follow-up survey. In the follow-up survey, respondents were additionally asked by whom they were vaccinated (general practitioner/other physician in private practice/occupational physician/other) and in which month they received the vaccination against seasonal influenza in season 2010/11. One should note that GEDA10 does not cover the paediatric population (aged 0–17 years) for which pandemic vaccination was also recommended in Germany. Information on vaccination coverage in this particular age-group was therefore not available from this data source.
We calculated the response for GEDA10 by using Response Rate 3 as defined by the American Association for Public Opinion Research (AAPOR) [18]. Response Rate 3 is the proportion of the number of complete interviews divided by the number of interviews plus the number of non-interviews (refusal and break-off plus non-contacts plus others) plus cases of unknown eligibility. For cases of unknown eligibility Response Rate 3 estimates what proportion of cases of unknown eligibility is actually eligible. This estimation is based on the proportion of eligible households among all numbers for which a definitive determination of status was obtained (hence a very conservative estimate). We additionally calculated the cooperation rate at respondent level, which is defined as the proportion of all respondents interviewed of all respondents ever contacted [18]. Since the GEDA follow-up survey was not a random digit dialling study (as GEDA10), we reported the minimal response rate (Response Rate 1 as defined by AAPOR, [18]) for the follow-up survey.
Definition of variables
Socio-economic status levels were created as described by Lampert and Kroll on the basis of self-reported educational, income, and professional status of survey respondents [19]. In accordance with the STIKO-recommendations [4], persons were classified into the target groups for seasonal influenza vaccination in our study if they reported (1) to be ≥60 years of age, (2) to have at least one underlying chronic disease (defined here as having a chronic underlying respiratory, cardiovascular, liver, or renal disease, cancer, or diabetes), or (3) to work as HCW. Since female respondents of child-bearing age were not asked whether they had been pregnant during the last influenza season, it was not possible to include pregnant women as target group in our analysis. The geographic region category 'Western Federal States' (WFS) comprised the federal states Schleswig-Holstein, Bremen, Hamburg, Lower Saxony, Hesse, Rhineland-Palatinate, Saarland, North Rhine-Westphalia, Baden-Württemberg and Bavaria; 'Eastern Federal States' (EFS) comprised Mecklenburg-Vorpommern, Brandenburg, Berlin, Saxony-Anhalt, Thuringia and Saxony.
Statistical analysis
Data analysis was performed using PASW 18.0 for Windows (SPSS Inc., Chicago, USA). Proportions were calculated by using procedures for the analysis of complex samples. Univariate analyses were conducted to determine associations between pandemic influenza vaccine uptake and socio-demographic, health-related and professional factors. A p-value ≤0.05 was considered to indicate a statistically significant difference. Odds ratios (OR) and 95% confidence intervals (CI) were calculated as appropriate. Multivariable analysis was performed by entering variables potentially associated with vaccine uptake (p-value <0.2 in univariate analysis) into a multivariable logistic regression model in a first step, followed by step-wise backward removal of variables with a p-value >0.05 to produce a final model. Interaction terms were included to account for effect modification between independent variables.
Sample characteristics
Characteristics of participants in the 'German Health Update Survey' (GEDA10) and the GEDA10 follow-up survey
GEDA10 September 2009 – July 2010
Follow-up survey April – July 2011
Age group
18-39 years
40-59 years
≥60 years
Place of residence
Western Federal States
Eastern Federal States
Underlying chronic disease
Health care worker
Seasonal influenza vaccination coverage
Seasonal influenza vaccine uptake by sex, age group, place of residence and target group, seasons 2008/09 − 2010/11, Germany
Season 2008/09
Season 2009/10
Season 2010/11
n=22,009% (95% CI)*
n=13,040% (95% CI)*
n=2,492% (95% CI)*
29.8 (29.0-30.6)
26.6 (25.6-27.6)
28.3 (26.0-30.6)
30.8 (29.7-31.9)
27.2 (25.8-28.6)
28.2 (25.3-31.3)
28.8 (27.6-30.0)
26.0 (24.5-27.5)
28.3 (25.0-32.0)
Age group
18-39 years
14.8 (13.8-15.9)
12.8 (11.6-14.1)
13.3 (10.7-16.6)
40-59 years
23.9 (22.8-25.0)
21.2 (19.8-22.6)
21.5 (18.6-24.7)
≥60 years
52.8 (51.0-54.5)
47.5 (45.2-49.8)
50.6 (45.7-55.5)
Place of residence
Western Federal States
26.7 (25.8-27.6)
24.0 (22.9-25.1)
25.8 (23.3-28.4)
Eastern Federal States
41.5 (39.6-43.5)
36.7 (34.3-39.2)
37.7 (32.6-43.0)
Target group
health care workers
30.5 (27.6-33.6)
27.3 (23.6-31.3)
25.8 (20.4-32.1)
chronically ill persons
43.3 (41.7-44.9)
39.8 (37.8-41.9)
41.0 (36.9-45.3)
non-target group
16.6 (15.8-17.5)
14.2 (13.2-15.3)
14.8 (12.5-17.5)
Pandemic influenza vaccination coverage
Determinants of pandemic influenza vaccine uptake, Germany, season 2009/10
A(H1N1)pdm09 vaccination coverage; % (95%CI)#
Odds Ratio (95%CI)#
8.8 (8.2-9.5)
7.8 (7.1-8.7)
9.9 (8.9-10.9)
1.29 (1.14-1.45)**
1.36 (1.15-1.61)**
Vaccinated against seasonal influenza in season 2008/09
for agegroup 18–59 years
4.4 (3.8-4.9)
22.9 (20.7-25.3)
6.54 (5.43-7.87)**
5.98 (4.96-7.20)**
for agegroup ≥60 years
1.9 (1.3-2.8)
18.5 (16.1-21.1)
11.60 (7.51-17.01)**
4.76 (1.60-14.18)**
Place of residence
8.9 (8.2-9.6)
8.7 (7.3-10.3)
0.98 (0.84-1.14)
Socioeconomic Status
7.6 (6.1-9.5)
8.0 (7.3-8.9)
1.06 (0.89-1.25)
1.01 (0.77-1.33)
12.2 (11.1-13.4)
1.69 (1.40-2.03)**
1.61 (1.23-2.11)**
Health care workers
8.4 (7.8-9.1)
16.5 (13.9-19.6)
2.16 (1.75-2.67)**
2.30 (1.78-2.96)**
Underlying chronic disease
7.2 (6.6-7.9)
12.2 (10.9-13.6)
1.79 (1.58-2.02)**
1.42 (1.19-1.69)**
The most frequently reported reasons for not receiving the vaccination were (1) 'fear of side effects of pandemic vaccines' (stated by 37.2%; 95% CI: 36.1-38.3), (2) 'pandemic vaccination is not necessary' (33.8%; 95% CI: 32.7-34.9), (3) 'pandemic vaccination not officially recommended for me' (16.6%; 95% CI: 15.8-17.5), and (4) 'reject vaccinations in general' (8.5%; 95% CI: 7.8-9.2).
Factors associated with pandemic influenza vaccine uptake
Results of univariate and multivariable analysis of factors potentially associated with pandemic influenza vaccine uptake are shown in Table 3. Having received a seasonal influenza vaccination in the previous season (season 2008/09) was the strongest independent predictor of pandemic influenza vaccination. However, this effect differed by age group and we therefore included an interaction term in the final model. Additionally, working as HCW, having a chronic disease, high socioeconomic status, and being male were significantly associated with higher uptake in multivariable analysis.
The aim of this study was to assess the uptake of seasonal influenza vaccines in specific target groups for seasons 2008/09 and 2009/10, as well as for pandemic influenza vaccines during the pandemic season 2009/10 in Germany in the total adult population by using data from a large population-representative telephone survey. By using data from a smaller follow-up survey, our study moreover provides the only so far available data on seasonal influenza vaccination coverage in Germany for the post-pandemic season 2010/11. Overall, only 8.8% of the adult population in Germany followed the official recommendation and received a vaccination against pandemic influenza in season 2009/10. The follow-up survey revealed a decrease in seasonal influenza vaccine uptake in the first post-pandemic season across all target groups when compared to the pre-pandemic season 2008/09, most prominent among HCW. With an average coverage of 50% in the elderly, 41% in the chronically ill, and 28% in HCW in seasons 2008/09 to 2010/11, the EU goal of reaching a seasonal influenza vaccination coverage of at least 75% in the target groups [20] has not yet been achieved in Germany.
Having received a seasonal influenza shot in the pre-pandemic season was the strongest predictor for receiving pandemic influenza vaccination in our study. The high correlation between seasonal and pandemic influenza vaccine uptake highlights the significance of habitual behaviour with regard to influenza vaccination decisions. In addition and independent from this factor, persons belonging to at least one of the recommended target groups for seasonal influenza vaccination were significantly more likely to receive a pandemic influenza vaccination than persons not belonging to a target group. Our results are broadly in line with the findings of a prospective monitoring survey on pandemic influenza vaccination in Germany [6] and two reviews investigating determinants of pandemic vaccine uptake [21, 22]. Prior seasonal vaccination was not only found to be positively associated with the intention to receive the pandemic vaccination among adults in several industrialized countries (e.g. in the UK [23], France [24], Australia [25], and the US [26]) but also with the actual receipt of the vaccination (e.g. [6, 27, 28]). When developing vaccination strategies for future pandemic situations one should therefore consider targeted strategies for enhancing coverage among those who do not fall within the target groups for seasonal influenza vaccination and thus do not regularly receive a seasonal influenza shot. A further opportunity to enhance compliance with national recommendations and therefore vaccination coverage in a future pandemic situation could be to increase seasonal vaccine uptake in the target groups. However, major reasons for not being vaccinated were the perception that vaccination was not necessary or not safe. It can be assumed that both reasons will not be barriers to high pandemic vaccine uptake in a future pandemic setting if the mortality is much higher than during the 2009/10 pandemic.
A higher uptake of seasonal influenza vaccines in season 2009/10 was observed in the follow-up survey population when compared to the total GEDA10 study population in 2009/10. It is therefore very likely that the point estimates for seasonal influenza vaccination coverage for the 2010/11 season, which were based on data from the same follow-up survey, were also overestimated. Taking into consideration that acceptance of seasonal influenza vaccination was higher in the follow-up survey population, our study results suggest that seasonal influenza vaccine uptake in the recommended target groups in Germany has decreased in the post-pandemic season 2010/11, not only in comparison to season 2008/09 but also to the pandemic season 2009/10 (compare Figure 2, empty symbols). Hence, our findings are discordant with observations made in several other industrialised countries. For instance, seasonal influenza vaccination coverage in the UK remained stable between seasons 2009/10 and 2010/11 among at risk persons under 65 years of age (51.6% vs. 50.4% vaccination coverage) as well as among persons aged ≥65 years (72.4% vs. 72.8%) [29]. Among high-risk persons aged 18–64 years living in the US, seasonal influenza vaccine uptake was 46.2% in the pandemic and 46.7% in the post-pandemic season [30]. However, in both countries acceptance and uptake of pandemic influenza vaccination was higher as compared to Germany (UK: 37.6% vaccination coverage in clinical risk groups [29]; US: 41.2% among all persons aged ≥6 month [31]). In France, despite the poor uptake of pandemic influenza vaccines (11.1%), an increase in seasonal influenza vaccine uptake was observed in the post-pandemic season among persons aged ≥65 years with underlying chronic conditions (62.6% in season 2009/10 [27] vs. 71.0% in season 2010/11 [32]). In the upcoming years, the uptake of seasonal influenza vaccines should be carefully monitored in Germany in all target groups to identify if this trend continues. Especially the strong decrease in vaccination coverage among HCW is of concern, and communication activities should be strengthened especially for this target group not only to achieve individual protection of this target group but also to protect vulnerable patients managed by HCW.
In our study 'fear of side effects' was found to be the most frequently stated reason for rejecting pandemic vaccination, thereby confirming findings of 13 smaller consecutive surveys carried out during the pandemic in Germany [33]. Conversely, believing that the pandemic vaccine is safe was significantly associated with the receipt of the pandemic vaccine in many countries worldwide [21]. Appropriate addressing of vaccine safety concerns by public health authorities may be an important factor to maintain public trust in national vaccination recommendations and beyond that to enhance vaccine uptake in future pandemic situations [22, 33].
In our study, 8.5% of those who did not receive a pandemic influenza vaccination stated that they reject vaccinations in general. This translates into a proportion of 7.7% for the total study population. Little is known about the exact proportion of vaccination opponents among the general adult population in Germany. In a recent survey performed by the German Federal Centre for Health Education (BZgA) among 3,002 parents of children aged 0–13 years, 35% stated that they reject particular vaccinations for their children, but only 1% of parents reject vaccinations in general [34]. Since our study did not focus on the general rejection of vaccinations in the population, we did not ask further detailed questions related to this topic to verify this attitude and the underlying reasons. Therefore, this figure must be interpreted with caution.
Our study has some limitations that need to be acknowledged. Calculation of influenza vaccination coverage was based on self-reported vaccination status and may therefore be prone to recall problems. However, it was shown in several studies that self-report of influenza vaccination status has an adequate degree of validity [35, 36]. Furthermore, the response rate in GEDA10 was comparatively low at 29%. However, it should be noted that the chosen method of calculating the response rate (namely Response Rate 3 as defined by AAPOR [18]) is a very conservative approach and that our response rate is comparable to studies using the same approach (e.g. CDC-Behavioral Risk Factor Surveillance Rates Report [37]). Finally, it cannot be ruled out that other reasons than the controversial discussions on the pandemic vaccination have also contributed to the observed drop in seasonal influenza vaccination coverage in 2010/11.
In conclusion, poor compliance with official vaccination recommendation resulting in low uptake of pandemic influenza vaccines during the pandemic season 2009/10 suggests that public communication strategies and vaccination campaigns during the influenza A(H1N1)pdm09 pandemic in Germany were not successful. In addition, our results raise concerns that controversial discussions about the safety and necessity of pandemic influenza vaccines may have contributed to decreased seasonal influenza vaccine uptake in the first post-pandemic season. It is therefore crucial to develop concerted communication strategies based on the lessons learned from the 2009/10 influenza pandemic and to include them in the national pandemic preparedness plan. This should be done, not only with respect to a competent handling of pandemic situations but also to avoid a decrease in the acceptance of vaccinations in general. In this respect, communication strategies and different modes of communication to specific target groups should be evaluated and implemented already in non-crisis situations, to be enhanced during a pandemic influenza situation or other public health crisis. This is of particular importance, since seasonal influenza vaccine uptake in the recommended target groups in Germany stagnated at a low level since 2005 [38] and does by far not meet the EU goal of 75% [20]. Further studies should be conducted to monitor the trends of seasonal influenza vaccine uptake in Germany in the specific target groups including pregnant women (which is a target group for seasonal influenza vaccination since 2010) and to precisely identify barriers to influenza vaccination in the upcoming years which might differ from the pandemic and the first post-pandemic season. This information would be crucial to guide public health authorities in developing more effective communication strategies for seasonal influenza vaccination tailored to specific target groups.
We would like to thank all colleagues at the Robert Koch Institute who were involved in the planning and implementation of the GEDA2010 and the GEDA follow-up survey.
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- Vaux S, Van Cauteren D, Guthmann JP, Le Strat Y, Vaillant V, de Valk H, Levy-Bruhl D: Influenza vaccination coverage against seasonal and pandemic influenza and their determinants in France: a cross-sectional survey. BMC Publ Health. 2011, 11: 30-10.1186/1471-2458-11-30.View ArticleGoogle Scholar
- Rodriguez-Rieiro C, Esteban-Vasallo MD, Dominguez-Berjon MF, Astray-Mochales J, Iniesta-Fornies D, Barranco-Ordonez D, Cameno-Heras M, Jimenez-Garcia R: Coverage and predictors of vaccination against 2009 pandemic H1N1 influenza in Madrid, Spain. Vaccine. 2011, 29 (6): 1332-1338. 10.1016/j.vaccine.2010.10.061.View ArticlePubMedGoogle Scholar
- Health Protection Agency: Influenza vaccination uptake monitoring on behalf of the Department of Health. 2011, Available at: http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1195733756886#r5 (day of access: 28/03/2012)Google Scholar
- Centres for Disease Control and Prevention: Recent Influenza Vaccination Trends across Influenza seasons. 2011, Available at: http://www.cdc.gov/flu/professionals/vaccinations/trends-summary.htm (day of access: 28/03/2012)Google Scholar
- Centres for Disease Control and Prevention: Final estimates for 2009–10 Seasonal Influenza and Influenza A(H1N1) 2009 Monovalent Vaccination Coverage - United States, August 2009 through May, 2010. 2011, Available at: http://www.cdc.gov/flu/professionals/vaccination/coverage_0910estimates.htm (day of access: 28/03/2012)Google Scholar
- Guthmann JP, Fonteneau L, Bonmarin I, Levy-Bruhl D: Influenza vaccination coverage one year after the A(H1N1) influenza pandemic, France, 2010–2011. Vaccine. 2012, 30 (6): 995-997. 10.1016/j.vaccine.2011.12.011.View ArticlePubMedGoogle Scholar
- Walter D, Böhmer M, Reiter S, Krause G, Wichmann O: Risk perception and information-seeking behaviour during the 2009/10 influenza A(H1N1)pdm09 pandemic in Germany. Euro Surveill. 2012, 17 (13): pii:20131-Google Scholar
- German Federal Centre for Health Education (BZgA): Parental Survey on "Childhood Vaccinations". 2011, Available at: http://www.health-record.net/resources/Elternstudie_Impfen_im_Kindesalter_2011.pdf (day of access: 01/10/2012)Google Scholar
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- Mac Donald R, Baken L, Nelson A, Nichol KL: Validation of self-report of influenza and pneumococcal vaccination status in elderly outpatients. Am J Prev Med. 1999, 16 (3): 173-177. 10.1016/S0749-3797(98)00159-7.View ArticlePubMedGoogle Scholar
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- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2458/12/938/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.


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There has been recently a craze amongst netizens to post up 'MR removed' videos on the internet which also led to many comparing the vocal powers of various singers.
'MR removed' videos minimizes any MR (music recorded) in the song and maximizes the vocal of the singer – the singer's vocal will be the only thing audible possible.
For a singer who cannot sing well, with all the sound magnification and voice companion at the chorus, the song may sound alright. But with the 'MR removed' version, only the vocal of the singer will be clearly audible.
Especially recently, a lot of 'MR removed' versions of live performances have been posted on the internet, and netizens have been comparing between singers on their vocal prowess.
Currently, the hot favourites for 'MR removed' clips are done mostly on popular groups and also other singers – but dance songs have been given especially sharp evaluations by the netizens.
While netizens felts that singers like Big Bang, Dong Bang Shin Ki, So Nyeo Shi Dae, Cheon Sang Ji Hee and BoA have good live vocal capabilities, some netizens felt that live performances by WonderGirls, KARA and TaeGoon to be disappointing.
So Nyeo Shi Dae – 'Gee' (MR Removed)
Big Bang – 'Sunset Glow'
SHINee – 'Replay'
WonderGirls 'Tell Me'
Hyori 'U-Go-Girl'
Some other 'MR Removed' clips….
- Must watch! Dong Bang Shin Ki – Bolero MV
- Dong Bang Shin Ki – O Jung Ban Hap live performance
- JaeJoong – Maze live performance
- Big Bang 'Haru Haru' live performance
- Big Bang 'Foolish Love' live performance
- SS501 – U R Man live performance
- SS501 – Because I am Stupid live performance
- So Nyeo Shi Dae – Kissing You live performance
- So Nyeo Shi Dae 'Gee' and WonderGirls 'Nobody' live performance
- WonderGirls – Nobody MV
- WonderGirls – So Hot live performance
- KARA – Pretty Girl live performance
- TaeGoon – Call Me live performance
- SHINee – Love Like Oxygen live performance
LOL.. this MR Removed videos are really interesting.. I actually found one for Dong Bang Shin Ki's 'Bolero' MV, and OMG Dong Bang oppas' vocals sounds superb..
Filed under: Kpop news | Tagged: Big Bang, BoA, Cheon Sang Ji Hee, Dong Bang Shin Ki, KARA, SHINee, So Nyeo Shi Dae, SS501, TaeGoon, WonderGirls |

subset: commoncrawl


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User: rejoicefulone
Info Reviews Forum Msgs. Contact
Member since August 30, 2007
- Hey! I am a US Cellular Customer Service Agent. I look forward to working for a great company who values their customers and their employees. I am a former employee of at&t and I am enjoying the new change!


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Dear Folks,
This is truly an experiment since I have never used this kind of software before.
The "Give-A-Way" -- My PDF of some of my favorite dozen recipes using Basil.
The contest will run for about 1 week, I will let you know when it is near ending. All of the timing and collection of data is done by the software system. When the contest ends, the software randomly selects the winner and I contact you to let you know you won. The PDF has no pictures and no pictorial cover. It is in black and white text, but the recipes are delicious! :-)
When I receive your acknowledgement that my "you won" email is received by you, I send you the PDF file.
I welcome any and all comments and observations, as I truly want this to work and be successful, because I have plans to offer more give-a-ways in the future.
The contest begins tomorrow morning (December 13th) at 12:30 a.m.
I set it up so everyone can enter once a day until the contest ends, so you have multiple chances to win.
Good Luck!.
a Rafflecopter giveaway
-- Catherine, The Herb Lady
If you enjoyed this post, subscribe below by entering your email, to get all my posts!
Disclaimer: Clicking on links on this blog may earn me a small commission if you purchase something. Your price does not change.
Monday, December 12, 2016
The Give A Way for My Collection of Basil Recipes Starts Tuesday, December 13th!
Posted by Catherine, The Herb Lady at 3:36 PM
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|Department of Public Information • News and Media Division • New York
Biographical Note
Secretary-General Appoints Abdallah Wafy of Niger Deputy Special
Representative for Democratic Republic of Congo
United Nations Secretary-General Ban Ki-moon announced today the appointment of Abdallah Wafy of Niger as his Deputy Special Representative for the Democratic Republic of the Congo, where he will head the Rule of Law component of the United Nations Mission there.
Mr. Wafy replaces Leila Zerrougui of Algeria, who assumed her appointment as Special Representative of the Secretary-General for Children and Armed Conflict in August 2012. He has been serving as Deputy Special Representative for the Rule of Law in the United Nations Organization Stabilization Mission in Democratic Republic of the Congo (MONUSCO) ad interim since September 2012, in addition to his responsibilities as Police Commissioner and Head of the Mission's police component.
Prior to joining MONUSCO as Police Commissioner in 2010, Mr. Wafy held various senior positions in the Government of Niger, including, notably, Senior Security Adviser to the Minister for Interior, Public Safety and Decentralization; Inspector General of Police; Special Security Adviser to the President; and Ambassador Extraordinary and Plenipotentiary to Libya and Permanent Representative of the Community of Sahel-Saharan States in Tripoli. He has also served with the civilian police in the United Nations Operation in Côte d'Ivoire (ONUCI) from 2006 to 2007, and as Deputy Head of the Police component of the United Nations Organization Mission in the Democratic Republic of Congo (MONUC) in 2009.
Mr. Wafy holds a master's degree in law from the Université du Bénin ( Lomé, Togo) and graduated from the Ecole nationale supérieure de police (Saint-Cyr au Mont d'Or, France).
He is married and has five children.
* *** *


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Reviews (1)
This is a replacement Snap-In Cradle/Backing Plate for the Raymarine Micro Compass. This item comes included when purchasing the Micro Compass or Micro Compass Kit (TKT060, TKT061)
1 Item(s)
Jeff 10/302/2015 04:19 PM
- more than 4 year(s)
Don't make screws too tight!
The cradle holds the compass snugly, but be careful not to make the mounting screws too tight, the plastic cradle will break and you will have to buy this replacement.
1 Item(s)


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This is an archived article that was published on sltrib.com in 2014, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
A 33-year-old Utah prison inmate accused of killing his cell mate last April has pleaded not guilty to homicide charges.
Steven Crutcher was charged last September with first-degree felony aggravated murder in the April 20, 2013 death his cell mate, 62-year-old Rolando Cardona-Gueton.
When Cardona-Gueton was found dead in his Gunnison cell last April, it initiallly appeared the man may have committed suicide. But after an investigation, police and prosecutors believe Crutcher killed the man with a bedsheet.
Sanpete County Attorney Brody Keisel said in September that Cardona-Gueton was found "as if he had [hanged] himself."
Keisel had declined to discuss what evidence led investigators to become suspicious about the death, but said a bedsheet that was torn into strips and braided together was used to kill Cardona-Gueton, who had been at the prison since 2011, serving time for theft and drug distribution.
A preliminary hearing in the case was held Wednesday in Manti's 6th District Court. After Judge Wallace Lee heard evidence about the case, he ruled there was probable cause to believe Crutcher committed the crime and ordered him to stand trial on the charge.
Crutcher will be in court again on July 9 for a scheduling conference.
Crutcher is already serving a sentence of up to life in prison for an aggravated kidnapping charge in June 2009, according to court records.
According to the Associated Press, Crutcher attempted to escape the Iron County jail when he cornered a deputy at the jail and threatened to detonate a bomb if he wasn't released. It was later discovered that the "bomb" was fashioned from toilet paper rolls, headphone wires and a pencil eraser.
Crutcher was at the Iron County jail in 2009 on suspicion of stealing a car. He pleaded guilty that year to second-degree felony theft by receiving stolen property in Cedar City and was sentenced to another one to 15 years at the prison.
Keisel said that Crutcher and Cardona-Gueton had been in a cell together for just a few days before the alleged murder.
Twitter: @jm_miller


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|List of Indian players taking part in Olympics 2012
|Indian Representative
|Women's (Individual)
|Laishram Bombayla Devi
|Deepika Kumari
|Chekrovolu Swuro
|Women's Recurve (Team)
|Laishram Bombayla Devi
|Deepika Kumari
|Chekrovolu Swuro
|Men's (Individual)
|Jayanta Talukdar
|20 Km Race (Men)
|Gurmeet Singh
|Baljinder Singh
|Irfan Kolothum Thodi
|Discuss Throw (Men)
|Vikas Gowda
|Discuss Throw (Women)
|Krishna Poonia and Seema Antil
|Shot Put (Men)
|Om Prakash Karhana
|Triple Jump (Men)
|Renjith Maheshwary
|Triple Jump (Women)
|Mayookha Johny
|800 meter Race (Women)
|Tintu Luka
|Marathon (Men)
|Ram Singh Yadav
|Ram Singh Yadav
|Basanta Bahadur Rana or Sandeep Kumar
|Individual (Men)
|Parupalli Kashyap
|Individual (Women)
|Saina Nehwal
|Mixed Doubles
|Jwala Gutta and Valiyaveetil Diju
|Doubles (Women)
|Jwala Gutta and Ashwini Ponnappa
|Light Flyweight (Men)
|Devendro Singh
|Bantamweight (Men)
|Shiva Thapa
|Lightweight (Men)
|Jai Bhagwan
|Light Welterweight (Men)
|Manoj Kumar
|Welterweight (Men)
|Vikas Krishan Yadav
|Middleweight (Men)
|Vijender Singh
|Light Heavyweight (Men)
|Sumit Sangwan
|Flyweight (Women's)
|Mary Kom
|India in Pool B with Germany, Netherland, Korea, New Zealand and Belgium
|63 Kg Category (Women)
|Garima Chaudhary
|Men's Single Scull
|Lightweight Men's Double Sculls
|50 m Rifle 3 Positions (Men)
|Sanjeev Rajput
|50 m Rifle Prone (Men)
|Joydeep Karmakar
|10 m Air Rifle (Men)
|Abhinav Bindra and Gagan Narang
|25 m Rapid Fire Pistol (Men)
|Vijay Kumar
|Double Trap (Men)
|Ronjan Sodhi
|Trap (Men)
|Manavjit Singh Sandhu
|25 m Pistol (Women)
|Rahi Sarnobat and Heena Sidhu
|10m Air Pistol (Women)
|Annuraj Singh
|Trap (Women)
|Shagun Chowdhary
|100 meter freestyle (Men)
|Virdhawal Khade
|100 meter breaststroke (Men)
|Sandeep Sejwal
|200 meter Freestyle (Men)
|Aaron D'Souza or Virdhawal Khade
|200 meter breaststroke (Men)
|Sandeep Sejwal
|1500 meter Freestyle (Men)
|Saurabh Sangvekar
|Table Tennis
|Single's (Men)
|Soumyajit Ghosh
|Single's (Women)
|Ankita Das
|69 Kg category (Men)
|Katulu Ravi Kumar
|48 Kg Category (Women)
|Ngangbam Soniya Chanu
|55 kg Freestyle
|Amit Kumar
|60 Kg Freestyle
|Yogeshwar Dutt
|66 Kg Freestyle
|Sushil Kumar
|74 Kg Freestyle (Men)
|Narsingh Pancham Yadav
|55 Kg Freestyle (Women)
|Geeta Phogat
|Total 12 Events
|Total 51 Categories
|Total 73 representatives
|(54 Men and 19 Women)
List of Indian players taking part in Olympics 2012
Posted by Amardeep Singh Chauhan
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Malcolm's Kothi at Nalcha
Medium: Photographic print
Date: 1902
Photograph of a ruined Islamic building at Nalcha, Madhya Pradesh, taken by an unknown photographer in c.1902. The building is known as Malcolm's Kothi (mansion) because it was once the residence of Sir John Malcolm (1769-1833), a British army officer who served in India in various high-ranking capacities including those of Political Officer, Resident to Scindia's Court and to Mysore, and Governor of Bombay between 1827-30. He lived at Nalcha, which lies to the south of Dhar, between 1818-22 while in charge of the province of Malwa. Afterwards the house was used as a travellers' bungalow and was at one time a tehsil (district) headquarters before falling into disrepair. This historic province in central India had been the stronghold of the Hindu Paramara dynasty from the 9th to the 13th centuries with their capital first at Ujjain and then at Dhar. Malwa fell to Muslim rule first under the Delhi Sultanate in the early 14th century, then later under the Sultans of Malwa when the governor of Malwa declared his independence from Delhi. It was embellished with a distinctive provincial style of Islamic architecture. The province was taken over by the Mughals in 1561, and when their empire disintegrated was annexed by the Marathas in the mid-18th century. It was taken over by the British when the Marathas agreed to a subordinate role under their control.


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At One Fine Baby we've had the privilege of meeting and working with some pretty amazing Aussie brands. One perfect example is Redsbaby, an innovative bunch of people who when wanting something that wasn't available, went out and created it themselves. This Australian owned and operated company creates clever strollers built for Australian families.
Just two short years ago Redsbaby burst onto the Australian scene. Since then the local focus as been set on its flagship product, the Redsbaby Bounce. Thousands of parents all over the country have fallen in love with the contemporary and stylish products that are also kind to the budget. Aussies love to support Aussies!
While form and function are at the forefront of Redsbaby's cutting-edge strollers, safety is the cornerstone. This means Redsbaby has quickly established itself as a trusted brand with parents.
We are excited that the 3 new Redsbaby products will be launching at One Fine Baby in Sydney on November 14 – 15!
The Redsbaby Jive is sophisticated with its clean lines, precision detailing and supreme function, all combining to create the ultimate pram. The sophistication of this little-people mover can't be overestimated. The beauty of the Jive is in its restraint.
The Jive is lightweight and user-friendly, and also offers its young passengers an ergonomic design for the ultimate in comfortable travel. The seat is reversible, and it reclines and has an adjustable footrest, while the bassinet is freestanding, so it can be placed on the ground. The Jive also incorporates Redsbaby's new Maxiair™ canopy and Stayput™ harness padding. It can be used for children up to 20 kilograms, and is suitable for newborns.
The second new Redsbaby product is the Move. As the name suggests, the Move is a compact design created for agility, combined with the signature Redsbaby sense of style. It's an active stroller for parents on-the-go fitted with three all-terrain, air-filled wheels ensuring bub has a smooth ride, even off the footpath.
The innovation of the Move comes from the fact that a smooth ride doesn't equal a bulky stroller! In fact, it's compact and slimline, as well as lightweight, with a freestanding, single handed fold. The Maxiair canopy has been designed especially for Australia's hot weather with large mesh panels, meaning there's plenty of cool air flowing around baby.
Redsbaby's third new product being debuted at the Sydney fair is the 2016 model of their popular Bounce. Packed with a number of new and improved features, such as the inclusion of the Maxiair Canopy which improves airflow around your little one – perfect for the hot Australian conditions. Other new features include a larger, easy-access storage basket, rear all-terrain air-filled tyres as standard, improved frame folding and unfolding motions, stay-put harness padding and much more!
This original design has been updated and improved for the modern, style-conscious family and is available in a range of new colours and prints.
Come along to One Fine Baby Sydney on November 14 & 15 to see the full range of Redsbaby products and try them out for yourself! Register for your tickets to the fair online now.


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Watch your baby using a Dropcam! We used to have our camera sitting on a shelf, but I had to tech-nest my way to a better solution. Now, the Dropcam is mounted to our co-sleeper using a Manfrotto magic arm and this 3D-printed Dropcam mount. Per the description in Shapeways, you will also need a ¼-20 threaded insert. I happened to already have the magic arm, so the incremental cost wasn't high.
I was in Taiwan for 2 days this week, and it was great to be able to check up on him from half way around the world.


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Too busy to workout? Moms (and moms-to-be): You only need a few seconds to get in shape with a good Vine or two. Break a speedy sweat with these short videos.
If there's one thing that makes a workout appealing to pregnant women and new moms alike, it's efficiency. So the idea of sourcing exercise routines on apps like Vine, with its six-second video rule, definitely appeals.
One mom-of-two from Ontario, Canada, spotted a trend and created OneSet, a Vine-like app for fitness enthusiasts that lets users submit short workout videos that anyone can do in the comfort of their own home with little to no equipment. The app has lots to offer pregnant women and new moms, as many of its users are expecting themselves or have little ones running around them as they navigate new parenthood and working out.
Feeling inspired, we've gathered 8 of our favorite mom-friendly break-a-sweat "Vines" (OK, they're technically Instagram videos, but you get the idea), many from the OneSet app, which you can download in the Google Play store (coming soon to the App store). These seconds-long videos are as quick as it gets.
All You Need is a Chair
Mom Alexa Jean Brown, 24, makes child's play of chair exercises. Follow her lead and you'll get your legs and butt burning as your tot watches in wonder. (via @alexajeanfitness)
Playground as a Gym
View this post on Instagram
#moveoftheday Will you try this move the next time your at the park??? Flash back to Summer ☀🙏☀and my amazing motivating daughters doing this with me! . Cause we really have #NoExcuses at all! Parks are free we where given an amazing body to use appreciate and #Love ❤ . TAG a friend you know would like this! 👯👭
A stay-at-home mom with major motivation, Ronda Race makes the most of time at the playground with her daughter by using the swings to work her abs, butt, and legs. (via @race4fitness)
Tone for a Better Birth
View this post on Instagram
33 weeks #twinpregnancy There are many versions of side planks that you can do both pre and post pregnancy. This is one of my multi functional side plank variations that I like to do during late pregnancy to help strengthen both the core and glutes. ● You can finish each set with a side stretch similar to what Rachel does in the video. ●Exercise Info: Perfect form and technique is crucial to ensure you are working the correct muscles groups. ●Try to take the leg a little further back ●Keep your foot relaxed ●Lift your rib cage up ●Maintain Neutral spine ●Exhale throughout lift contracting TA and PFM ★For a full program with safe and effective exercises to follow during your pregnancy check out our fit2birthmum program. http://www.pregnancyexercise.co.nz/products/fit2birthmum/ #fitandpregnant #pregnancy #pregnancyexercise #fitmums #fitpregnancy #prenatalfitness #pregexvideos
A multifunctional side plank is great in late pregnancy to prep the core and glues for birth. Just remember to breathe! (via @pregnancyexercise)
An Every-Trimester Move
Squat rotations are easy and stable movements to do with a bulging baby bump. Use hand weights to make it a little more challenging. (via @knockedupfitness)
Sweat With a Friend
View this post on Instagram
15s of video - 15min of shooting... We still have to work on our technique, but this gives you some ideas!! I could easily make blooper reel from just this group of exercises, but it was fun and effective! Merci @gracealoha for being so patient and motivated 😃👍 Squat and rotate / Sit up and squat / plank high five HAVE FUN!!
Grab a friend and a willing baby for some squat rotations, sit-up and squats and plank high-fives like this Los Angeles mom of one and her powerhouse pal. (via @ourfitfamilylife)
Keep it Simple
View this post on Instagram
#SweatADay Day 27: V-Jumps @underarmour @underarmourwomen #IWILLWHATIWANT #SweatMadness Another mashup. A core/Pilates exercise with a plyo. V-sit, stand up and jump. The challenge is in making the transition smooth and actually pausing in the v-sit. Core contracted. Back lifting. Breathe. Beats by @ludacris: Stand Up. Apps: #picplaypost #gravie #vsitjumps #core #plyo #benchwarmer #marchmadness #underarmourwomen #underarmour
The next time you're at the park with your clan, take a time out to do a few V-sit, stand and jump moves for a good core workout. (via @shauna_harrison)
Workout While You Wait
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🎥 Full-Body Wall Workout 🔥 Who needs a gym when you have a wall......This was an absolute killer! The perfect way to utilise your own body weight; toning your muscles, building functional strength and burning tons of calories! 😜 Also anyone wanting to build up some handstand strength.... I recommend giving this one a try 😉 Details 👇 ⭐Bridge Walk Ups x 20 ⭐ Decline Kickback x 16 ⭐ Superman x16 ⭐ Decline Climbers x16 Complete 3-4 sets! Note the reps and sets are just a guide. Find a number that challenges you and then try to beat it next time. It's all about working at your level. @activestyle.com.au #activestyle
A wall is all you really need to do bridge walk-ups, decline kickbacks, superman, and decline climbers like this Australian mum. Do it while waiting for your kids to get out of school, and try to ignore those funny looks! (via @achieving_balance)
Finding Balance
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Workout Instructions Candlestick dips are great for your obliques and balance. Make sure your back is straight when doing this exercise. They are great if you are an expecting mother. Do 2 sets of 20 each side. 1. Candlestick dips Let me know how you liked the workout and if there is anything you would like for me to demonstrate. If you are interested in any Beachbody Challenge, be sure to let me know and check out my website in my bio and here as well. http://www.beachbodycoach.com/MIRLEYGRAF #picplaypost
Maintaining good balance is especially important when your center of gravity is shifting during pregnancy. These easy candlestick dips will also give your obliques some attention. (via @simplefabfitness)


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About the CA
The CA Academy is resource to help CAs meet the needs of their chiropractors and the patients they serve. It provides an online meeting place, a chance to connect with other CAs, and resources to make practices more effective. It will also be a way for the NCCA to communicate important information regarding laws, rules, insurance, and practice management. It will provide training and education to help create a well-rounded practice, improve office function and quality of patient care.
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2019 CCA Recertification
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CA 50-Hour Basic X-ray Program, Module 84


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That fashionable corporate holiday is finally over and what better way to celebrate it by beating a dead horse? It has all been said and done by nearly every horror writer on the planet but there are a few romantic horror stories that seem to fall from the cracks so I am here to bring you my personal favorite mind-fucking, dysfunctional couples. When we're discussing disastrous fictional couples, a few classics come to mind; King Kong, Bride of Frankenstein, every God damn couple in Tim Burton's movies, Gale and Dewey, Seth Brundle and Veronica Quaife, Micky and Mallory Knox, and the best couple on the list – Dracula and Mina. Not today! Here are ten couples that you rarely see on anyone's list.
*Note: There are spoilers and I'm sure at least two of these are on your list but they're worth mentioning again!
Naturally, I have to start off with The Joker and Harley Quinn seeing how Suicide Squad is right around the corner. There's a lot of psychology that goes into this relationship. No, really. Harley Quinn was The Joker's psychiatrist but this backfires. If you read the comics or watched the critically acclaimed animated TV series then it's obvious the two have sexual tension but if anything, Harley Quinn is just another one of The Joker's victims after he brainwashed her and drove her absolutely bat shit crazy. It's pathetic. This woman has gone out of her way to be by his side through all the chaos. She does everything she can to show how much she loves him but he only sees her as another one of his toys. However, behind the scenes photos show the two kissing so maybe he's not completely dead inside and there's something there after all. The two are dynamite together but could very well be horrible for each other.
Homoerotic horror films is another beaten horse but no one ever mentions Death Becomes Her! The boiling relationship between Mad and Hell (Love the nicknames) is one of the most frightening friendships in history. The two become fixated with hurting each other. Stealing the men in their lives was only foreplay. Blasting holes through each others stomachs and taking shovels to their heads followed. Bruce Willis becomes the man standing between the two who has taken it upon himself to care for the girls as they chip and peel until he comes to grips with his sanity and manages to escape. As for the ladies, they're stuck with each other forever. This is only a theory but the die-hard obsession between the two just SCREAMS homo.
The sadism and masochism between Frank and Dorothy is a bitter pill to swallow. Frank is obsessed with the nightclub singer who grows fond of the sadistic sexual torment. He rapes and beats her when he's not busy torturing her husband and kidnapping her son. Frank inhales some unknown source through a mask and calls Dorothy 'Mommy' while he's raping her then insists she call him 'Daddy.' We are never given a background story on Frank so his motives are hard to decipher. Dorothy begins a relationship with the film's protagonist Jeffrey Beaumont. Even in this dysfunctional relationship, she begs for Beaumont to give her a good smacking. With Beaumont's help, Dorothy has a happy ending with her son. It's too bad about her husband.
Louis becomes a father figure for Claudia after turning her into a vampire. He happens upon her crying over her dead mother who succumbed to the plague but it was Lestat who manipulated him into turning her. The relationship between the two is easily up for interpretation but if you read the books and dig deep into the character's actions, it's clear that Louis feels for her as she matures into a woman, mentally. She will always have the body of a child but she's highly sophisticated. As innocent as she appears, Claudia is hostile which results in her heartbreaking death. Seriously, am I the only one that cries every time? There are several complex relationships throughout the Anne Rice series. Lestat feels for Louis and Armand falls in love with him. Can you imagine? Brad Pitt and Antonio Banderas having hot sex!
This movie is hard for me to watch because suckling eye balls and fucking a steel pipe attached to a rotting corpse (gross) is not appealing to me and I'm into some pretty obscene shit. The sequel goes even further. No ma'am! However, I have to give props to this unique couple. After Robert's demise, Betty still has the feels to dig up his body and take it home for a shag. If you're into necrophilia, give this romp a go.
This is undoubtedly one of the most underrated horror films. Seeing this movie for the first time when I was ten, Frances Bay scared the ever-living-shit out of me. Mr. and Mrs. Pickman have a very special relationship. The lovely couple owns The Pickman Hotel where Lady Pickman handcuffs her husband every evening and proceeds to chop the poor old bastard into pieces as she transforms into some Lovecraftian creature which should make it obvious why I adore this movie so. This story line was influenced by Lovecraft's Pickman family in "Pickman's Model." This Lovecraft short was published in 1927 in an issue of Weird Tales. It was also adapted for television in an episode of The Night Gallery, which I have not seen. However, Mr. and Mrs. Pickman were not original characters out of Lovecraft's stories. The only relation is the hotel and moving paintings where the evil continues to grow.
Director Andrzej Zulawski based this disturbing jumble on his real life divorce and it's set against the horrors of The Cold War which provided a bleaker look at this paragon. Technically, it's not a horror film. There is in fact a monster. There are doppelgangers and child death but it's nothing more than an arthouse drama. Possession centers around an unhealthy marriage. Anna tells Mark that she wants a divorce. It gets ugly and not in a War of Roses kind of way. Suspicions of adultery arise then the two come head to head with electrical carving knives. They beat the crap out of each other and in between all of this madness, Anna goes into some sort of nervous breakdown complete with spasms and bizarre noises that look like something out of a possession film. Ignore the film's title. It's a metaphor. That infamous 'possession' scene provides what they refer to as a miscarriage but she clearly gives birth to this 'thing' then proceeds to fuck it. Happy Valentines Day!
This twisted circus side-show remains a favorite in my collection. Alejandro Jodorowsky's work of art is based on a Mexican serial killer, loosely based. It's filled with rich symbolism though the character study is poor. Fenix grew up in the circus life with a murderous master of ceremonies for a father and a crazed cult leader for a mother who gets her arms chopped off by his father. His only friend is a dwarf and Alma, a mute mime. The two are separated and he's placed in a mental hospital until he breaks loose and goes on a killing spree while Alma is in search for her long-lost friend after escaping her abusive whore of a mother. It's a match made in heaven. There's also the whole Norman Bates Freudian psychotherapy with Fenix and his mom but I prefer to stray from that topic.
Bring on the tissues! Fucking George R.R. Martin. The Wildlings were free folk that would often steal their wives from the wall. After Snow kills Orell and captures Ygritte, she believes that she is now his and he belongs to her. Ygritte echos, "Like the night you stole me. The thief was bright that night." However, Snow had no intentions on stealing her or ever falling in love with her. His intent was to kill until he discovered she was a woman. The brother's of the Night's Watch have sworn celibacy so Snow continues to resist her but being the Wildling hottie that she is, he fails this oath and eventually falls in love with her. George R.R. Martin being the serial killer that he is kills her character off but even after her death, Snow refuses sexual advances from other women, claiming Ygritte as his one true love. We're left with what looks like the end of Jon Snow but I'm betting that crazy woman who had the demon baby brings him back to life.
Let's face it, all the couples on this schizophrenic show are fucked. It's hard to pick just one. Shelly Johnson is my favorite character and the copious amounts of horse shit she has to suffer through takes the cake. I mean, I could have settled with Nadine who becomes a middle-aged cheerleader with an eye patch and a cradle robber but it's my least favorite story line. Any who, Shelly is a drop out that works at the Double R Diner when she's not catering to her husband who insists on beating her over every asinine thing. Her husband was also one of the last people to see Laura Palmer alive, the dead girl Twin Peaks is centered around. Shelly is having an affair with the insanely adorable but mind-numbingly stupid Bobby Briggs who use to date Laura. Bobby is a drug dealer but he's kind and genuinely cares for Shelley. Lucky for these two, Shelly's husband eventually ends up in a catatonic state so they get to carry on their relationship in between diaper changes.


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If you are anything like me, you don't say those seemingly simple words often enough.
Over time, I believe I've gotten better at admitting my mistakes. Yet far too often I still remain more worried about protecting my ego than owning up to reality.
We've all witnessed friends, colleagues, bosses, loved ones and public figures make a mistake but fail to accept it.
Regardless of where you stand on the political spectrum, or whether you believe that the country desperately needs to tackle the role of government, mounting deficits and an explosion in entitlement payments, much of what Mitt Romney said on the hidden video released earlier this week was wrong-headed and ill-informed. And pretty much everyone knows this.
The campaign has spent the last couple of days parsing the statements, shifting blame, trying to direct attention elsewhere and over-explaining. It's not helping.
I've engaged in the same defensive, ego protecting behavior when I knew I was wrong. Thankfully, I've been on a much smaller stage and dealing with dramatically less weighty issues.
Here's the thing. Most of the time I'm wrong, the people around me realize it. My defensiveness only serves to impede growth and keep me dis-connected.
Saying "I was wrong" unleashes me, and brings me closer to people.
And I get bonus points for adding "and I'm sorry and I will work hard to do better next time."
Your turn Mr. Romney.


text: Jenna Fryer Associated Press Published 6:45 PM EDT Oct 13, 2018 Talladega, Ala. — Timothy Peters bumped leader Noah Gragson out of his way on the final lap at Talladega Superspeedway, then blocked traffic for the final mile to win the Truck Series race Saturday. It was the 11th victory of Peters' career and third at Talladega, the most wins at the Alabama track among Truck Series drivers. "If I kept my head on straight, I knew I had a chance to win," said Peters, who at 38 years old has been relegated to a partial schedule. "I wish my phone would ring a little more frequently," said Peters, who thanked GMS Racing for the three-race deal that put him back into victory lane for the first time since 2015. FR8AUCTIONS 250 RESULTS Peters didn't lead until the final lap of the crash-packed playoff race. He had to force Gragson out of his way to get to the front. "My spotter said clear, and I just wasn't clear enough," Peters said of his move on Gragson. "We are going down to the checkered flag, Noah is going for it, too. Was it a block? I don't know. At that point it didn't matter." Chris Fontaine was running second when he triggered a 10-truck accident with 36 laps remaining. That set up a red flag stoppage of nearly 12 minutes and more wrecks throughout the field. Todd Gilliland was second when he tried to pass leader Grant Enfinger with 12 laps remaining,… [Read full story]


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I devised a couple of new cocktails for the recent Hollywood Christmas Party. The White Liz was named for the hostess who loved it as it is stylish, tasty and packs a punch! The quantities are per cocktail and both designed to be served in a martini glass. Quantities for larger numbers are given on my White Christmas Cocktail post http://cookupaparty.co.uk/white-christmas-cocktails/
2oz Gin
1oz Cointreau
1/4 oz Velvet Falernum
1/4 oz lime juice
1 x fresh lime leaf finely chopped
Mix in chilled cocktail shaker with finely chopped lime leaves and crushed ice. Shake and serve in a Martini glass.
Garnish – glace cherry on cocktail stick
This is a beautiful raspberry red colour and dangerously delicious!
2oz White rum
1oz raspberry puree
1/4 oz lemon juice
1/4 oz raspberry liqueur
Fresh lime for garnish
Mix in a cocktail shaker with crushed ice. Shake and pour into a Martini glass
Garnish – thin slice of lime on side of the glass


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GAELIC 2005 Symposium - The e-services environment: changing to a higher gear
Venue: CSIR International Convention Centre
Location: Pretoria, South Africa
|Event Date/Time: May 09, 2005
|End Date/Time: May 10, 2005
|Registration Date: Apr 22, 2005
The academic library consortium, GAELIC, is hosting a two day symposium called "The e-Services Environment: Changing to a Higher Gear" from 9-10 May 2005 at the CSIR International Convention Centre, Pretoria.
The focus of the symposium is to examine the challenges facing South African academic and research libraries in delivering e-Services especially within the emerging e-Research environment where our libraries find themselves at the centre of converging streams of technology, digital scholarship and changing research practices.
The symposium is an opportunity for both international and South African colleagues to share their insights and expertise so that our librarians are equipped to plan and act strategically. Find out how we can lead our institutions in addressing the new needs of digital scholarship (humanities, social sciences and physical sciences), and get to grips with what the e-Research infrastructure requires. The presentations and workshops will consider the implications of e-Research for our research libraries and research institutions, including data curation, open access, institutional repositories, digital expertise etc
The target audience is library and information professionals in research and academic environments, including academic libraries, research council libraries, national and provincial government department libraries, corporate research libraries, public & community library research sections, LIS teaching departments.
Seize the moment to network with international and South African experts and colleagues brought together by GAELIC to explore and share how the rapidly emerging e-Services will impact your library and organisation. Be part of the debate about the challenges facing South African academic and research libraries in delivering e-Services.
Diarise it now- join us at the GAELIC 2005 Symposium.
For more information & online registration, go to www.fotim.ac.za/conference.html


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Patient Resources
First visit
Prior to your initial visit, we will attempt to mail a pre-registration form to you to begin organizing your chart, or you may also download the forms to the right. This will allow a more efficient use of your time once you arrive. We request that you arrive 10 minutes before your scheduled appointment in order to confirm the information in your chart, as well as confirm your insurance authorizations. For a complete eye exam, please allow approximately 1 1/2 to 2 hours for your initial visit. Since your eyes will possibly be dilated, please remember to bring your sunglasses. You may also wish to bring a friend or relative to drive you home. If the appointment is for a minor (under 18 years of age), please remember that for legal reasons a parent or guardian must be present during the exam.
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The Medical Eye Exam
The type of eye exam you receive will depend on the nature of your eye problems. As mentioned above, some exams include dilation while others do not. As part of a complete eye exam, you can expect to have your vision checked and your need for a prescription measured manually and by a computer with special infrared technology. Also, your field of vision, pupil reactions, and eye tracking will be noted. For some patients, we also check their depth perception and their color vision. A glaucoma test (pressure check) and an evaluation of the front and back of the eyes are also done. Special care is taken to determine the status of the cornea, the lens, the optic nerve, the ocular blood vessels, and the retina. Dilation is used to look at the edges of the retina that are not readily seen otherwise, and is a useful tool to get the most accurate prescription possible. This comprehensive testing allows us to evaluate a person for conditions such as cataracts, glaucoma, diabetes, dry eyes and macular degeneration. Additional tests that can provide other valuable information will be performed as needed.
Please call our office immediately if you have a serious problem with your eyes or a possible emergency. If you need assistance after regular office hours, please call 911 or go directly to the emergency room or urgent care center. The emergency physician will evaluate your situation and consult with us as needed. Refills of medications can be handled during regular hours by having your pharmacist contact our office.
Patient Forms
To save time during your appointment, you can fill out these forms at home and then bring them with you.
Note: These files are in PDF format. If you do not have Adobe® Reader® on your computer, you can download it for free by clicking here or on the Get Adobe Reader icon.


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This gorgeous, large Kutani platter or tray is a beautifully hand painted winter scene of an eagle with its prey. It was identified by Georges Bouvier of the Kutani Ceramics Website as Yokohama Kutani, signed Yokohama Shimada Seizo e. He dates the tray 1910-20.
The tray is 14-1/4" x 11-1/2" and in very good condition. There are no chips, no crazing and no repairs. There is a very fine hair line to the glaze on the back of the tray which does NOT go through the body. The tray rings when tapped.
Note the heavily enameled "falling snow" on the tree in the upper right side.
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Packaging and Transport
When bagged under its house brand, Tropical Gourmet, ECOFRUT's products are available in 85g (3oz) bag format and come stowed within a cardboard display carton each carrying 20 bags. Tropical Gourmet products are bagged in Biaxially Oriented Polypropylene (BOPP) material which provides an adequate moisture barrier to sustain the product characteristics between 270-360 days under manufacturer's recommended storage conditions.
ECOFRUT products can also be sold under private label or in bulk format. Ocean shipment is done in 20' or 40'HC dry non-palletized containers.


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GHHIS and Pohick Church Docent
Sometimes referred to as "the Mother Church of Northern Virginia," Pohick was the first permanent church in the colony to be established north of the Occoquan River, sometime prior to 1724, near the site now occupied by Cranford Methodist Church on Old Colchester Road. It was named "Pohick Church" because of its proximity to Pohick Creek ("Pohick" comes from a Dogue Indian word meaning "hickory").
In 1732, the Virginia General Assembly established Truro Parish, defining it as all the lands in the colony above the Occoquan River, extending to the western frontier. As the only church within these boundaries, Pohick became the head parish church of the newly formed district. The large church parishes in colonial times served as local government districts before the establishment of counties.
George Mason was a life-long Anglican who attended services regularly, and was first elected as a vestryman for Truro Parish in 1748. Members of the vestry oversaw a great number of tasks, both religious and governmental. In addition to collecting tithes or church taxes; building and maintaining churches and chapels in the parish boundaries as needed; and providing for ministers, clerks, and sextons; there was the responsibility to care for the poor—allowances and care for the sick and destitute, the maintaining of neglected children and widows, and the care and apprenticing of orphans.
By 1765 the old wood-frame church was beginning to show signs of decay, and the question of rebuilding came before the vestry. It was said that George Washington, who had joined the vestry in 1763, favored building a new church on a more central site two miles north of the old church. George Mason opposed such a move, pleading that their ancestors had worshipped at the old church and many of them were buried in the adjoining churchyard. The question was left unsettled, and another vestry meeting was appointed for a final vote by all 12 members of the vestry. In the meantime, Washington surveyed the neighborhood and marked the houses and distances on a well-drawn map. Armed with his survey map, Washington was said to have presented his case for the new site as being more centrally located to the greatest number of plantations and parishioners. When the vestry voted on November 20, 1767, the resolution to build a new Pohick Church at the new site was carried by a majority of seven to five.
Even though the old site had been nearer to Gunston Hall and the new one was closer to Mount Vernon, the debate and its ultimate outcome did not cause any grievances between the two old friends or end their ability to work together for the good of the parish. When the Vestry further decided to build the new Pohick Church on a grander scale, constructing it out of more durable stone and brick, George Mason, along with his fellow vestrymen George Washington and George William Fairfax, was part of the church building committee that approved the building designs and construction work.
When Daniel French the undertaker (the colonial word for what we would call a building contractor) for the new church construction died suddenly in late 1771, it was George Mason, as executor of his estate, who stepped in as undertaker and completed the building of the current Pohick Church in 1774. An interesting connection between Gunston Hall and Pohick Church also dates to this time: in 1772 Mason approved the hiring of master carver William Bernard Sears to handle all the interior wood carving and decorative gilding in the church until its completion. Sears, by then a well-established craftsman in the Alexandria area, had first come to Virginia as Mason's indentured servant and had carved all the impressive woodwork at Gunston Hall several years before.
Mason continued to serve as a vestryman all during the difficult years of the Revolutionary War. By the time the Virginia General Assembly disestablished the Protestant Episcopal (formerly Anglican) Church in 1785, eliminating local tax support for the parish churches and disbanding their vestries, George Mason had guided and supported Pohick Church and the poor and needy of the area for a period of 35 years.
Journal Of Early Southern Decorative Arts, November, 1982, Volume VIII, Number 2. Winston-Salem, NC: The Museum of Early Southern Decorative Arts.
Lillback, Peter A., George Washington's Sacred Fire. Bryn Mawr, PA: Providence Forum Press, 2006.
Minutes of the Vestry, Truro Parish, Virginia, 1732-1785. Baltimore, MD: Gateway Press, Inc., 1995.
Slaughter, Philip, The History of Truro Parish in Virginia. Philadelphia, PA: George W. Jacobs & Company, 1907.


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Alligator Captured Not Far from Tyler
If you're a pet owner like me, you might let your imagination get the best of you, worrying about what all the unmentionables that could possibly get your pets if you let them loose outside. I mentioned to my spouse once that I worried an alligator might eat our schnauzers, and I was laughed at heartily. I supposed it was ridiculous because we lived in Austin at the time in the middle of concrete and pavement and it wasn't the least be swampy. But today I learn, it can happen in Texas.
Two pets were snared by an alligator over in Bowie County this month, an alligator that had made a home for himself in a backyard pond. Bowie County is in northeast Texas on the border of Arkansas and Oklahoma. Those dang ponds ... if it's not mosquitos to worry about, it's alligators. We really do have a lot of outdoor stress in Texas these days. Did they catch the gator?
An East Texas Wildlife biologist had been trying to catch this alligator for about two weeks, and he was finally able to wrestle it in Sunday night. It weighed 700 pounds!
Hopefully this gator was all by himself and doesn't have a pet-eating family that is still lurking in ponds. And if the gators are still out there, do they like mosquitos?


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Like buses three wonderful books of motherhood have come along at once into my life...which I really want to share with you. So, being me I've gone the whole hog and am sharing ALL my favourite books on mothering to celebrate Mother's Day here in the UK and Ireland this Sunday.
Now I need to be clear here: I am NOT talking about parenting books, (usually written by smug nannies or doctors with willies... which tell you how to do it all -if you're perfect, have no feelings, aren't exhausted, are perfectly patient and have an angel child), and let's all feel guilty cos we're not doing perfectly enough - gah! How I hate those books...
No, I am talking about books of soul, written by mamas, for mamas. Books to nurture, support, inspire, to reflect back the myriad emotions of motherhood through the lens of words and images... and what I love most is that they are published BY women, FOR women - long live indie publishing, it's putting the soul back into books and giving authentic voice to women!
Musings on Mothering - edited Teika Bellamy, with a foreword by Naomi Stadlen, Mother's Milk Books 2013.
I was invited to contribute to this book, a fundraising initiative for La Leche League. The words I contributed were some of the most powerful I have written on motherhood, and I was very honoured to hear that they were shared at the inaugural Story of Mum retreat last week.
This book is a celebration of motherhood, attachment parenting and breastfeeding. An impressive collection of writing, poetry and art on the theme of motherhood. The talent of the contributors was humbling, and much of the poetry and art truly breathtaking, each expressing in their own unique way the ineffable nature of motherhood. Sensitive, reflective and beautifully compiled - it brought me to tears many times.
An Anthology of Babes: 36 Women Give Motherhood a Voice - edited by Suzi Banks Baum, Laundry Line Divine, 2013.
This is precisely the experience of reading this book. Like a fruit cake full of juicy currants, cherries and toothsome nuts, it is SO rich and deep and true.
I cried many times, tears of recognition and empathy. And many times I felt myself holding my breath, or my heart missing a beat as I listened to these sacred stories of the inner life of mothers so rarely told. It is a pocketful of mothers: wise real women, who speak of the tender, tragic and mundane moments – we hear of miscarriage and premature births, of babies lost and children grown, of domesticity, creativity and connection. Many of its contributors words will be carried always with me in my heart.
Birth, Breath and Death: Meditations on Motherhood, Chaplaincy and Life as a Doula - Amy Wright Glenn, Create Space
We are born, we die, and in between these irrevocable facts of human existence the breath weaves all moments together.
At the age of fourteen, Amy began to question her family's strict faith and embarked on a life-long personal journey towards spiritual truth. Her quest has taken her around the world, to further studies and to both ends of life's spectrum, in her dual callings as doula and chaplain to the dying and their families.
This little book is exquisitely written and is full of profound insight, reflection and compassion on the subjects of life, love, birth, mothering and death. Reading it is a meditation in its own right. It is a book of soul which leaves you richer.
What Mothers Do (Especially When it Looks Like Nothing), Naomi Stadlen
I read this book religiously when each of my babies were infants on the breast, bathing in its loving wisdom. I hated it when Mr DA would come home and ask what I'd been up to - there I was exhausted, covered in vomit, shaking with hunger... I'd cast my mind back and "nothing" is all I could think of. I had no words for the invisible acts of mothering that I had been doing. This book helped to give me language... and value to what I did day after day in the early years. I have yet to read her second book, How Mothers Love, but have heard many good reports of it.
Moods of Motherhood - Lucy H Pearce, 2012.
Moods is a compilation of my best-loved posts on motherhood from Dreaming Aloud, my columns from JUNO magazine and many new pieces, never before published. It is a book full of my trademark searing honesty and raw emotions. It will make you laugh and cry - wherever on your mothering journey you may be.
Topics include: tenderness, pregnancy and birth, happy days, anger and fierceness, playfulness, love, patience, homemaking and much, much more... it is illustrated throughout with beautiful black and white photographs. I have put it together by topic so that you can dip in and out, wherever you are in your mothering journey. Pick it up for wisdom, reassurance, a laugh, some empathy. Take me to the park in your bag, keep me by your bed, or on your bookshelf... what a funny concept!
The Rainbow Way: Cultivating Creativity in the Midst of Motherhood. Lucy H Pearce, Soul Rocks Books, 2013
My Amazon #1 bestselling book, featuring the words of over fifty creative mothers: visual artists, writers, film-makers, potters, performers and crafters.
Visioned as the guide and mentor that most creative women yearn for, but never find in their daily lives, The Rainbow Way explores the depths of the creative urge, from many perspectives. This positive, nurturing and practical book promises to empower you to unlock your creative potential within the constraints of your demanding life as a mother. It has been credited by women across the globe for kickstarting their creativity and making them feel seen and accepted as creative mothers.
Finding Your Inner Mama: Women Reflect on the Challenges and Rewards of Motherhood - Edited by Eden Steinberg. Trumpeter, 2007.
"Motherhood is not what we imagined. It is more delightful, more heartbreaking...It is not the calm after the storm we have been led to expect. It is almost more than a person can bear. Almost." -Ariel Gore, The Mother Trip
A soul-manual of mothering, sketching the landscape of the mother-soul and speaking truly of the vocation of motherhood, the dark and the light, the unspoken and unspeakable. It is written by women of courage, insight and vision who are putting into words a realm of experience which has traditionally been left without language.
Divided in to four sections: The Reality of Being a Mother; The Inner Work of Motherhood; Why is Being a Mother so Hard?; and Finding Balance, this collection of writing by psychologists, poets, novelists, spiritual teachers, and everyday mums explores the rich, transformative journey of motherhood. Amongst the contributors are some of the most talented American women writers of our generation: Louise Erdrich, Adrienne Rich and Ariel Gore.
And finally, hot off the press - the New Mama's Welcome Pack - which includes an e copy of my book Moods of Motherhood, as well as inspiration and resources from over 60 other mamas - this is the ultimate gift for new mamas to give wisdom, reassurance and practical help. The mama receives one short email a day, with words of love, and a resource.
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Ume Kyu Roll
pickled plum and cucumber
Category: Standard Roll
Level: Beginner
Description: The Ume Kyu roll is a wonderful roll. It has a very unique flavor. Like a pop-rocks sushi roll. The pickled plum has a sparkling sweetness to it. Combine that with the tasty cucumber and it's a nice tasting simple roll for vegetarian and beginners alike.


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My grandkids are always excited about special holidays because NeeNee dresses the table with fun and colorful place settings. This is their place setting for St. Patrick's day.
After lunch, we will playing a Shamrock dice game. Well, it was going to be a dice game until four-year old Fischer misplaced the die. We will using the spinner from the game Chutes and Ladders instead. Those green bills are what they will be getting if they win. You will find the printable shamrock templete here.
How to play Lucky Shamrock:
The object is to color in all the numbers on the shamrock. Each person rolls the die and crosses off that number on the shamrock. If you roll a number that you no longer have, you pass the die to the next player. First person to color in all their numbers wins.
Happy St. Patrick's Day. May luck be on your side!