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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.
Concern over bio-terrorism has led to recognition that traditional public health surveillance for specific conditions is unlikely to provide timely indication of some disease outbreaks, either naturally occurring or induced by a bioweapon. In non-traditional surveillance, the use of health care resources are monitored in "near real" time for the first signs of an outbreak, such as increases in emergency department (ED) visits for respiratory, gastrointestinal or neurological chief complaints (CC).
We collected ED CCs from 2/1/94 – 5/31/02 as a training set. A first-order model was developed for each of seven CC categories by accounting for long-term, day-of-week, and seasonal effects. We assessed predictive performance on subsequent data from 6/1/02 – 5/31/03, compared CC counts to predictions and confidence limits, and identified anomalies (simulated and real).
Each CC category exhibited significant day-of-week differences. For most categories, counts peaked on Monday. There were seasonal cycles in both respiratory and undifferentiated infection complaints and the season-to-season variability in peak date was summarized using a hierarchical model. For example, the average peak date for respiratory complaints was January 22, with a season-to-season standard deviation of 12 days. This season-to-season variation makes it challenging to predict respiratory CCs so we focused our effort and discussion on prediction performance for this difficult category. Total ED visits increased over the study period by 4%, but respiratory complaints decreased by roughly 20%, illustrating that long-term averages in the data set need not reflect future behavior in data subsets.
We found that ED CCs provided timely indicators for outbreaks. Our approach led to successful identification of a respiratory outbreak one-to-two weeks in advance of reports from the state-wide sentinel flu surveillance and of a reported increase in positive laboratory test results.
Traditional public health surveillance for specific conditions is unlikely to quickly identify a disease outbreak. Emergency department (ED) data appears to have the potential for more timely disease surveillance [1-6]. In non-traditional surveillance, signs of an outbreak might include an increase in ED visits for respiratory, gastrointestinal or neurologic chief complaints (CC).
Crucial to any surveillance is an understanding of normal patterns in the data. Utilization patterns in the ED are thought to be difficult to predict, due to large variability that arises in part because EDs are required to medically evaluate and stabilize everyone who requests care. Therefore, ED visit rates cannot be controlled by insurers, institutions or policies.
Many "drop in" surveillance systems have been hampered by a lack of knowledge of baseline activity [7]. Other systems have used short-term moving averages of the recent past to predict current usage [8], but this does not provide optimal performance when day-of-the-week or seasonal effects are smoothed away by the averaging.
Some "active" ED surveillance systems provide on-going data collection. The EMERGEncy ID NET [9] and RSVP [10] function as sentinel surveillance systems where data from a small sample used may not represent the overall occurrence of disease. If data collection is inconsistent, it does not provide reliable information about syndrome incidence.
This paper reviews our experience with an operational near-real-time surveillance system, the Bio-Surveillance Analysis, Feedback, Evaluation and Response (B-SAFER) system. B-SAFER is the result of collaboration between the Los Alamos National Laboratory, the University of New Mexico Health Sciences Center, and the New Mexico Department of Health. Medical surveillance systems such as B-SAFER require considerable expertise in computer science and systems integration for their design and architecture, to comply with security and privacy issues, and to ensure timely flow of information [11,12]. These systems also require medical and epidemiological expertise to identify appropriate items to monitor for anomalous events and to understand their significance.
This observational study uses data from the Emergency Center of the University Hospital, Albuquerque NM (UH), a tertiary-care county-university health sciences center. The Emergency Center includes pediatric and adult emergency departments, an urgent care center, a trauma center and an observation unit. There are roughly 200 patient visits per day, or 73,000 per year, representing 36 % of Emergency Department visits in Albuquerque. This study was approved by the Institutional Review Boards of the University of New Mexico Health Sciences Center and Los Alamos National Laboratory.
The data is from the computerized ED patient tracking system in place since 1994. Data in the system includes: date and time of arrival and discharge, age, sex, chief complaints, discharge diagnoses and disposition. CCs are recorded by the nurse at the time of triage and entered into the system by a clerk. The clerk may select from a drop-down menu of complaints or may enter the complaints as free text. The menu option is rarely used because clerks find free-text entry more flexible and convenient.
We group daily CC counts into seven categories: respiratory, gastrointestinal (GI), undifferentiated infection (UDI), lymphatic, skin, neurological, and "other" (Table (Table1).1). The "other" category includes all visits except those in the first six categories. These grouping categories are also used by other surveillance programs, such as ESSENCE (Walter Reed Army Institute of Research) and the Real-time Outbreak Detection System ((RODS, University of Pittsburgh) [11,13,14]. Our grouping scheme is provided in Table Table11.
To obtain this scheme, we reviewed a frequency table of all CCs which occurred at least 5 times over nine years and assigned relevant CCs to groups, as was done for example in [15] and [16]. Key words were selected to capture multiple chief complaints containing that word. For instance "breath" captures "shortness of breath", "trouble breathing", "I can't breathe", "can't catch breath", "breathing problems", etc. Common abbreviations were also included as key words. The groupings were then reviewed by the project medical advisory board which included epidemiologists, infectious disease, emergency and occupational health physicians.
Each CC is assigned to a group when the first match was made between a word in the CC and a word in our CC dictionary. There were no examples of negative chief complaints such as "no cough", in our nine-year database, so we did not develop a system for handling these. Any negative complaint would have been classified into the category of the key word.
The training set for model development was retrospective cohort data from 2/1/94 through 5/31/02. We used least squares regression in started log scale to fit trends, seasonal effects, and day-of-week effects. The "started log" is the logarithm of one plus the number of daily CCs. We add one before taking the logarithm to avoid problems with taking the logarithm of zero counts. The started log scale results in more symmetrically distributed forecast errors with variance that is much less dependent on the mean count. Results are back-transformed to natural scale for display. Error bars behave as desired (widening when the CC count increases) and skewing is commensurate with the magnitudes of the baseline values.
A model that incorporates the above effects is
S(d) = [Σi ci × Ii(d)] + [c8 + c9 × d] + [c10 × cos(2πd / 365.25) + c11 × sin(2πd / 365.25)]
a) S(d) denotes the started log of the number of chief complaints) for day d, where "Day 1" is taken as February 1, 1994,
b) [Σi ci × Ii(d)] captures the day-of-the-week effect, where the sum is over the indices i = 1 to 7 and Ii(d) denotes the indicator function for day d, i.e., Ii(d) equals 1 when day d is the i-th day of the week and equals zero otherwise, and the seven model coefficients {ci} are constrained to sum to zero,
c) [c8 + c9 × d] captures a long term linear effect,
d) [c10 × cos(2πd / 365.25) + c11 × sin(2πd / 365.25)] captures the seasonal component, where the average number of days per year is 365.25, with the model coefficients c10 and c11 dictating the time and amplitude of the seasonal effect.
This model arises from transforming the counts to started log scale and adding day-of-the-week effects to the regressor variables in a cyclical regression model [16,17]. Application of the model allows for coefficients to be set to zero when the corresponding constituent effects are not statistically apparent. For example, the coefficient c9 is zero for complaint categories that do not exhibit linear long term trends, and the coefficients c10 and c11 are zero for categories which do not exhibit seasonality. A plot of the predicted respiratory complaints and corresponding upper confidence limits from this model is given in Figure Figure1,1, illustrating how the constituent effects interact to yield baseline predictions. The predictions were obtained using ordinary least squares for parameter estimation and then back transforming from started logs to natural scale.
As with all statistical models, it is important to assess goodness of fit. A careful residual analysis reveals trends in the forecast errors, the most important of which follow from the one-size-fits-all character of the model. That is, the first order model postulates that complaint activity peaks with the same magnitude and at exactly the same time of year from season to season. Such postulated behavior is only approximately true, and the season-to-season differences lead to the trends in residuals from the model.
For example, if a peak of respiratory complaints occurs later than average in the year, then the baseline will initially over-predict (in anticipation of an average peak time) and then under-predict (when the season's peak actually occurs). Similarly, if the amplitude of a season's peak is higher or lower than the historical average amplitude, predictions will be consistently too low or too high near the peak. We return to this subject in the section on hierarchical modeling.
By comparing CC counts to predictions and confidence limits, anomalies can be identified [18,19]. Extra counts could arrive all on one day, or appear as a gradual increase starting at some particular time, or arrive sporadically, persist at a constant level for a fixed duration, etc. The best statistical test for detecting extra counts depends on the pattern of extra counts, so there cannot be a single best test for detecting all possible anomalous patterns.
A particular test, based on Page's statistic, is optimal for detecting a constant excess above baseline when the start time and duration of the excess is unknown [20]. This test also has competitive power compared to other sequential tests to detect other anomalous patterns. For these reasons, Page's statistic is widely used in statistical process control and has been proposed in the context of disease surveillance [21]. We recommend Page's statistic unless specific anomalous patterns are suspected, in which case a specialized test could be developed.
Page's statistic is a type of cumulative sum, which we denote as P(d). On each day d, the forecast error εd between the started log of the observed number of complaints and the started log of the baseline prediction is computed for each complaint category. The standard deviation sd of εd is computed as well. Then Page's statistic is calculated for day d as
P(d) = maximum of 0 and [P(d-1) + εd/sd - 1/2].
If P(d) becomes too large, then the observed complaint levels are significantly greater than the baseline predictions and complaint levels are deemed anomalously high. Here, the phrase "too large" is formally defined in terms of the desired false positive rate for monitoring, and the threshold value for P(d) is calibrated using empirical data to account for model prediction errors.
A comprehensive comparison to other data streams is beyond our scope. Briefly, we compared our respiratory CC counts to existing influenza data for the 2002–2003 influenza season. We evaluated New Mexico (NM) Department of Health sentinel influenza surveillance data reported weekly by approximately 20 clinics. When the week-long monitoring period is combined with the time needed for compilation and dissemination, notification of an outbreak early in one week is often not formally received until two weeks after it occurred. We obtained virology laboratory data from routine clinical and surveillance testing of respiratory specimens reported by three laboratories that conduct at least 75% of the clinical virology testing for NM. Such data streams have their own timeliness issues, due in part to culturing of samples.
ED data from 2/1/94 – 5/31/02 is used as training data for least squares fitting to establish control limits; data from 6/1/02 – 53/31/03 is then used in near real time surveillance. Approximately, 17% of the complaints fall into the respiratory category, 10% gastrointestinal, 6% undifferentiated infection, 3% skin, 3% neurological, 1% lymphatic and 60% "other."
For all systemic complaint categories there are day-of-week differences. See Figure Figure2.2. For five of the seven categories, there are more visits on Monday than on any other day; UDI and skin peak on Sunday. Weekly minimums occur later in the week: on Thursday for skin, Friday for GI and UDI, and Saturday for respiratory, neurologic and lymphatic. In some cases, there is a high-to-low trend as the week progresses.
For respiratory and UDI complaints, there is an average difference of 7 cases per week between Monday and Friday, and the weekly differences conform to a bell-shaped statistical distribution. While day-of-week effects are statistically significant in all categories owing to the size of the data set, in some categories there are so few complaints that the difference is of no practical consequence. For example, in the lymphatic and neurologic categories, the average difference between the weekly peak (Monday) and weekly minimum (Saturday) is less than one case per day. Certain other daily effects may exist, e.g. holiday effects [22], but sample sizes for UH data are not large enough to detect them.
As is well known, there are annual cycles of respiratory complaints with peaks in January or February. Figure Figure33 demonstrates these cycles in our data for respiratory complaints; the cycles are similar but less pronounced for UDI complaints.
Total ED visits increased over the study period by 4%, in part reflecting the population increase of about 1.5 % per year for the metropolitan area. Rates for most of the complaint categories have changed over the eight years that data has been collected. Respiratory complaints show a decrease of roughly 20% over the monitoring period (Figure (Figure4),4), illustrating that long term averages need not reflect current or future behavior. Skin-related complaints also show a slight decrease, while increases are observed in nearly all other categories. Only lymphatic complaints do not appear to change over the monitoring period. Had there been a complaint category where a nonlinear trend were clearly present, either the c9 component would have been modified periodically, or a nonlinear model would have been used.
We focus on respiratory CCs because they have the strongest season-to-season variation, which makes them the most challenging to predict, and because respiratory is thought to be one of the most important bioterrorist categories. Overlaying the data streams on the baseline plot in real time allows for visual inspection of the results, similar to that for a standard control chart. Figure Figure5a5a shows the daily counts, the baseline prediction, and the upper control limit (for a 2.5% false alarm rate) for the respiratory category. Figure Figure5b5b shows the scaled forecast errors (in the started log scale) for the prospective data. Both figures reveal a later-than-average flu season, as does Figure Figure5c,5c, showing large values of Page's statistic P(d). These plots illustrate how a misfit to the one-size-fits-all model can produce systematic trends in surveillance data. This subject is revisited in the section on hierarchical modeling.
The peak in respiratory CCs and the elevated P(d) preceded a rise in reports from the state-wide influenza sentinel surveillance system. A similar pattern, delayed by several weeks, was found in the rise of requests for laboratory tests for influenza. ED CCs also preceded New Mexico reporting of deaths from pneumonia and influenza. We conclude that surveillance using the first order model is sufficiently sensitive to mild departures from baseline activity and that it can provide timely notification relative to traditional surveillance.
In a simulation study we injected K extra respiratory CC counts beginning at random days during the test year, with the simulated outbreak lasting from 1 to 10 days, from 2 to 10 days, and exactly 1 day. Generally, departures of approximately 3 or more standard deviations from the baseline model should be detected with high probability. The simulated per-day shift above the baseline prediction ranged from 1 to 5 standard deviations in our simulations, so testing one day at a time could fail to detect those outbreak having small per-day shifts. Also, because of the pattern in the residuals near each seasonal peak, we considered EWMA (exponentially weighted moving average, see the Discussion) as one way to modify the current forecast on the basis of errors in the recent past.
In Table Table22 we give the fraction of simulations (out of 1000) in which the Page statistic exceeded its threshold of 3.3 for the null model, baseline model, and for the same models modified by the EWMA procedure. For comparison to one-day-at-a-time testing, we also give the fraction of simulations in which the maximum forecast error that occurred during the outbreak exceeded its 2.5% false alarm rate threshold of 1.96. We see that Page's test outperforms the one-at-a-time test and that the EWMA modification does not improve anomaly detection because of its tendency to underestimate the size of multiple-day outbreaks. However, if we restrict attention to those outbreaks that last only one day, then one-at-a-time testing is better (for each of the models), as we would expect. Compare the baseline model results to the null model (which uses the average CC count in the training data to predict the test data) results to gauge the benefit of fitting the baseline model. Of course the null model is not acceptable regardless of its performance in this context because it ignores the trend (which causes the null model to be biased high for the respiratory CCs), day-of-week effects, and seasonality.
Long-term trends can occur in surveillance data for multiple reasons. Changes may occur in: local resources (more or specialty EDs), access and reimbursement practices (facilities change which insurance plans with which they are associated, major shifts in insurers drives patients to other facilities), changes in the underlying population (shifts in population size or age), and changes in the local economy. Moving averages were not used because although they generate visually pleasing curves they smooth over day-of-week and seasonal effects that are important for developing baselines.
Concerning model quality, one useful test is whether the forecast error variance in the testing data is approximately the same as that in the training data. Upon dividing the forecast errors in the test data by their standard deviations in the training data, the scaled forecast error variances range from 0.87 to 1.07 for the seven CC categories (ideally, these ratios should be near 1). Further, the fraction of scaled forecast errors that exceed 1.96 ranged from 0.0 to 0.033 (when the model holds and residuals are Gaussian, the portion of one-sided residuals exceeding 1.96σ is 2.5%). Thus, departures from stationarity in the time series are mild enough that the forecast errors show that future complaints can be reasonably well predicted using a single baseline model for each category.
When monitoring complaint levels over multi-year time frames, it is necessary to periodically update baseline model coefficients in order to minimize the extrapolation in forecasting. One approach to choosing an update frequency is to do a planned update every year, but also monitor residuals for patterns, including shifting variance, that have not been observed previously to check whether additional updates are needed.
The first-order model is useful for routine monitoring. It has the obvious shortcoming, however, of describing each season in a one-size-fits-all fashion. As noted above in evaluation of the model's goodness-of-fit, forecast errors reflect modelling imperfections as well as random variability, limiting somewhat the sensitivity of surveillance to detect smaller anomalies. Improving on this situation requires more refined baselining.
Hierarchical methods [23] can overcome the one-size-fits-all shortcoming, or, at a minimum, provide information that is valuable in assessing the quality of one-size-fits-all modelling assumptions. In the hierarchical approach, each season is allowed to have its own time of peak activity, its own seasonal duration, and its own peak magnitude. For practical purposes, the hierarchical model shares the global characteristics of the first order cyclical regression model. The seasonal component is modelled with a scalable Gaussian function, in contrast with the fixed-width sine and cosine harmonics previously. And the underlying baseline changes linearly within a season, as opposed to behaving linearly over a longer time period.
Applying the hierarchical model to respiratory CC data illustrates the season-specific nature of chief complaints. On the average, our respiratory complaints peak on January 22, with a season-to-season standard deviation in the day of the peak of 12 days. The durations of individual seasons, defined in terms of the standard deviations for the Gaussian-shaped peaks, vary by factor of two over the monitoring period. And there is no apparent relation between the time that the peak occurs and the magnitude of the flu season.
Use of hierarchical models for real time syndromic monitoring could be considered, but at a significant computational cost. In order to capture the peak time and magnitude of an ongoing season, the model must be updated on a frequent (e.g., weekly) basis, involving lengthy runs of Markov chain Monte Carlo software. Because the first order cyclical regression model fits the data sufficiently well to detect anomalies of interest, we have used the first order model for routine monitoring. A similar first order cyclical regression model is used by the Centers for Disease Control to monitor pneumonia and influenza related mortality data [24], also with success.
Influenza surveillance basing alerts on comparison to historical data were described by Irvine [25]. Daily counts were compared to historical averages and standard deviations. Their data demonstrated a peak in CCs during influenza season.
Lazarus et. al. [26] use a generalized linear mixed model based on four years of data from ambulatory health encounters. They find that indicators for day-of-week, month, holiday effects as well as a secular trend term contribute significantly to their model fit. There may be ED data from other hospitals where month-to-month effects exist but are not part of a longer seasonal trend, but we don't see them in our data. Logistic regression [26] is useful for scaling over census tracts of different population sizes and, when complaint counts behave proportional to underlying census populations, is also useful in modeling overall complaint levels.
Reis and Mandl [27] used CCs for their time series models (autoregressive integrated moving average, ARIMA, models) for total and respiratory visits. After fitting a day-of-week effect and a seasonal effect, there remained positive autocorrelation in the forecast errors, which they modelled using a particular time series model. In our CC data, there is negligible autocorrelation in the errors after fitting our model, except that due to the variation in when the seasonal peak occurs. For example, if a peak occurs early, then we observe a sequence of positive errors, which leads to positive autocorrelation of the type reported. For our CC data, the best-fitting ARIMA-type model applied to the residuals after fitting the trend, seasonality, and day-of-week effect was the EWMA (equivalent to a moving average fit to the first differences, also denoted ARIMA(0,1,1) for the particular autoregressive integrated moving average model that it corresponds to). Reis and Mandl [27] note that the ARIMA model adjusts to multi-day outbreaks and so it reduces the error on days 2, 3, ... of a multi-day outbreak. Therefore they suggest using both the original errors (containing serial correlation) and the ARIMA-model-adjusted errors in two monitoring schemes.
The EWMA also adjusts to multi-day outbreaks and therefore suffers from signal loss if the outbreak persists for multiple days (the results in Table Table22 illustrate this effect). Therefore, the Reis and Mandl [27] suggestion to monitor two residual series is relevant if we use EWMA or any approach (including the hierarchical model) that uses the very recent past (in addition to the trend, seasonality, and day-of-week effects) to modify the current forecast (leading to two or more forecast methods). Also, sequential tests were not used in [27] for their 7-day simulated outbreaks. Each simulated outbreak added simulated additional counts to the daily CC data. Forecasts were made (on the basis of a model that used the overall mean, the day-of-week means, and the trimmed day-of-year means) and were modified using the ARIMA-modeling of the residuals. If any single-day forecast error exceeded a threshold, then the simulated outbreak was said to be detected. Sequential tests are ideal for multi-day outbreaks so the performance (the false negative rate for a fixed false positive rate) of Page's statistic or a moving window such as in [28] or the scan statistic such as in [29] would be better than the performance of one-at-a-time tests in the case where all simulated outbreaks lasted 7 days. Reis et al. [28] applied several sliding detection windows, each of at most 7 days to ED visit daily counts in which simulated outbreaks (in the form of additional ED visits) lasting 3, 7, and 14 days were added to the real data in a simulation study. On the other hand, if each outbreak lasted only one day, then monitoring single-day errors would be optimal. In summary, we concur with [30] regarding the robustness and simplicity of Page's test. Alternatively, there are occasions when using a modest number of specific tests is effective as was done in [29].
Many surveillance systems report the use of CCs or discharge diagnoses based on ICD-9 codes. Most of these use discharge diagnosis ICD-9 codes in specialized settings such as the Military [13] or in HMOs [23]. ED ICD-9 codes were also used when processing data retrospectively [4]. In most EDs, however, ICD-9 discharge diagnosis coding is not performed on a "near-real" time basis and would not be available for "near-real time" surveillance.
By contrast, free text chief complaints are obtained at the time of patient entry into all Emergency Departments and free text discharge diagnoses are determined at or close to the time of ED discharge. Therefore, use of our grouping scheme is relevant to the majority of EDs in which chief complaints and discharge diagnoses are recorded as free text and are available for "near-real time" surveillance.
Because of their timeliness, CCs are used in our "near-real time" surveillance system B-SAFER [31,32]. We considered using CoCo, a naive Bayesian free-text classifier developed by the University of Pittsburgh [33], but this was not made available to us. Another automated classification based on weighted key words system is used by ESSENCE [34]. The New York City Department of Health uses a key word and key phrase SAS-based coding system [35]. A comparison of the performance of expert based classification systems such as ours, and automated classification systems has not been done.
There are other potential limitations in using ICD-9 codes for surveillance. It is to be expected that early cases of unusual diseases will be misdiagnosed. Assigned ICD-9 diagnostic codes may be more reflective of the diagnostic bias or practice patterns of the provider, than of the true incidence of disease. Furthermore, ICD-9 diagnosis code assignment is potentially subject to billing bias: codes which garner the highest reimbursement may be used, rather then those that most accurately represent the disease process. Use of ICD-9 codes for chief complaints is also problematic. Because ICD-9 codes were developed for classification of diagnoses, the dictionary for chief complaints is not robust. Therefore, the use of free text chief complaints may result in increased sensitivity, although the B-SAFER team believes that some types of coding standards would be beneficial [36].
Day-of-week patterns in EDs have been previously reported in the literature [4,26,27,37,38]. Although the magnitudes of the day-of-week effects vary depending on the setting, the first day of the work week typically exhibits the greatest number of events. And, as we have shown, there is day-of-week variability within infectious disease syndromes which can be obscured by the failure to consider each body system's pattern individually. It is also important to understand utilization patterns on weekends, which ED data provides, as the effects of bio-terrorist or natural outbreaks are unlikely to be limited to weekdays.
Seasonal effects in infectious diseases are best known for respiratory infections (e.g. influenza and respiratory syncytial virus). This seasonality is in large part due to the yearly winter influenza epidemics. Our data is quite consistent with these findings. However, we provide an analysis of the pattern of respiratory related chief complaints based on the longest (8.6 years) historical data base. Furthermore, the seasonality of infectious disease complaints for other body systems, or for non-ID related complaints has not previously been reported. Seasonality in specific GI infections has been noted in other settings. Some gastrointestinal infections are more common in the winter (e.g. rotavirus) while others (e.g. Campylobacter, Cryptosporidium, enterovirus) are more common in the warm months from outdoor cooking and recreational water exposures.
Seasonality is also important because the signal-to-noise ratio in complaint counts maychange depending on time of year. As illustrated in Figure Figure1,1, the error bars are larger during the height of flu season than at other times of the year, leading to reduced sensitivity for detecting an increase in respiratory complaints at that time.
It is unclear why, in our data, the number of respiratory complaints fell with time while the number of fever complaints rose. This may reflect the relative mildness of recent influenza seasons. Alternatively, rather than actual differences in patient presentations, this may represent changes in the practices of choosing or recording chief complaints. This would require further investigation. Implementation of a standard drop-down menu for chief complaints might prevent some bias over time in the selection of chief complaints. Use of a new system, however, would likely change the distribution of chief complaints and thus not allow for the creation of baselines based on historic data.
Using the models described above we successfully identified a respiratory outbreak in advance of the traditional flu-reporting data streams described in the Methods section. Incoming B-SAFER reports were monitored at least once daily, seven days a week, by the project epidemiologist. This allowed for prompt handling of events indicating a condition reportable by statute to the NM Department of Health. Because there is approximately a 2-week delay for traditional flu-related data sources, provided our respiratory CC captures some of the NM flu cases, we expected to, and did, identify a flu-related respiratory peak in advance of these other sources.
This analysis is based on data from one ED and patterns identified may be somewhat specific to metropolitan Albuuerque. Indigent or Hispanic populations may be over-represented in the ED studied as compared to other EDs. Visit patterns may differ by the local health care infrastructure, population insurance status, access to care, or local climate. We wewere fortunate that electronic ED data was available for the previous eight years. Other institutions may lack the source data for a similar analysis.
CCs are determined by a nurse and recorded in free text by a clerk. This process may conceivably distort patients' literal CCs. Free text CCs are quite variable and require extensive processing. These CCs may also have varied had they been recorded by a physician. Although the rationale for using CCs rather than discharge diagnoses was provided above, there is a tradeoff between the better timeliness of CC data and the better sensitivity of discharge diagnoses [39]. Note that our modelling is as easily applied to diagnoses codes as to chief complaints.
Any approach to disease surveillance using either CCs or discharge diagnoses requires large numbers of symptomatic patients. Analyses based on such large-scale counts are unlikely to discover a small and geographically dispersed event such as the anthrax Anthrax outbreak of October 2001.
As we work more with our data, we will understand it better. Opportunities exist for performing sensitivity analyses, comparing the baseline patterns for CCs to those for discharge diagnoses, and more thoroughly evaluating the performance of our signals as compared to existing standards.
We have demonstrated a robust statistical approach to characterize baseline data for ED visits. We demonstrated day-of-week, seasonal and long-term effects by infectious disease in grouped chief complaint categories. ED data provides information on daily visit patterns, rather than just 5-day-a-week patterns. Using respiratory complaints as an example, we have shown that these models when applied to "near real-time" surveillance data provide an early indicator of an anomaly. This increase in respiratory visits was identified early by a rise in Page's statistic. This anomaly corresponded to events detected later by more traditional methods. Understanding baseline patterns in ED data provides the ability to distinguish expected versus unexpected events during infectious disease surveillance.
The author(s) declare that they have no competing interests.
JB and EU provided medical advice from the ED and public health perspectives. They were responsible for choice and groupings of chief complaints. JB obtained IRB approvals and recruited sites. TB and RP are responsible for choice and implementation of statistical tests. DF provided computer systems, interface and architecture. EJ provided technical input, review and project direction. JB, EU, TB and RP collaboratively wrote the manuscript. All authors read and approved the final manuscript.
The pre-publication history for this paper can be accessed here:
Supported by: Los Alamos National Laboratory directed research funding
New Mexico Department of Heath #457631
University of New Mexico Emerging Infectious Disease Center – CDC – E11/CCE620225-01
PubMed Central Canada is a service of the Canadian Institutes of Health Research (CIHR) working in partnership with the National Research Council's national science library in cooperation with the National Center for Biotechnology Information at the U.S. National Library of Medicine(NCBI/NLM). It includes content provided to the PubMed Central International archive by participating publishers.


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Sick Puppies Official Snapchat
Posted: 13 Apr 2016 19:29
As you probably all know Snapchat has fast become one of the most used social networking apps. Well Sick Puppies finally took the plunge and now have their own Snapchat. So far they have snapped several short videos of something big they were doing today. You should go follow them to see what they are up to.

subset: commoncrawl


text: Im tired of people ripping on the new guy, and complaining about people starting in the lawn care business. Thats all everyone seems to want to do anymore is complain. I am new to the business, however I am only 23 years old and have to start sometime, just like you all did at one time or another. Its not my fault that there are alot of LCO's out there, but am I not suppossed to do what I want to do for a living, because you guys have been doing it longer. Thats ridiculus. I also don't like that the market is saturated right now, but I know that I'm going to deal with it and provide the best service at a reasonable price in order to compete. Im sure not going to wine and complain about it on lawnsite, like alot of people are doing. This type of thing happens in every business, the strong will survive and the week will get weeded out.


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The Outrage of Silicone Continues, Breast Implants, Now Testicles
Breast implant scandal Has reached New Heights
The breast implant health scare has taken a further twist with a claim the French company at the heart of the scandal also made implants for male patients.
Two former employees of Poly Implant Prothese said the firm manufactured testicle, buttock and chest implants, mainly destined for export, Le Parisien reported on Thursday.
"Three people were specially trained to work on the machine that made silicone testicles," a former PIP worker told the newspaper.
A second said: "It was an injection machine that had clearly cost a lot of money. It was bought in with the purpose of entering into different areas of the [implant] market.
"It was used during the last few years in the company. Most of what was produced was sent abroad."
The testicle implants were destined to be used for reconstruction in patients who had lost a testicle through cancer or amputation or had been born with only one.
The newspaper said it was not clear if silicone used in the testicle implants was sub-standard. But one of the former employees said the gel used in the buttock and chest implants, aimed at male patients, was the same as the industrial quality material used in the breast implants that, it is claimed, have a high risk of rupturing.
"For aesthetic reasons some of our clients, especially those in South America, ordered them and in that case the gel used to make them was the suspect gel that did not conform [to health standards] that was already used in the breast implants. It might cause health problems in certain patients," said the ex-PIP worker. He said false pectorals were aimed at men who felt they were "not very well-built".
In a separate report, leading French cancer treatment centres including the respected Marie Curie Institute were said to have been seduced by the low price of PIP breast implants for use in reconstructive surgery after mastectomies.
Le Figaro claimed 16 of the country's 18 leading cancer institutes used the PIP implants up to 2010. A plastic surgeon told the newspaper that hospital authorities in Paris preferred to keep the number of suppliers of medical devices to a minimum.
"For many years PIP was kept on as supplier to the three public cancer treatment centres in Paris and the banlieue," he said, adding that PIP prosthetics were also used "in surgery lessons or in demonstrations at conferences".
The French health agency AFSSAPS said: "In France the company did not declare anything other than the production of breast implants. But we are only aware of what was produced on national soil."
Yves Haddad, lawyer for Jean-Claude Mas, the founder and former head of PIP, said his client would not be making any comment over the latest allegations.
Mas's son, Nicolas Lucciardi, admitted the company had acted fraudulently but said the French government should not have ordered the 30,000 women in France fitted with PIP implants to have them removed.
"Everyone is jumping on us. We admit there was a fraud when PIP didn't declare the type of gel used in the fabrication of its implants," he said, adding that the company had "ceased all activity" in the field.
He described the French government's action as aberrant. "The minister gave in to the call of the public opinion sirens," he said. "Nobody has proved they cause cancer."
An investigation has been launched in France into charges of "manslaughter and unintentional injury" against PIP, which supplied 65 countries and was once the world's third largest manufacturer of breast implants.
On Wednesday local judge Annaïck Le Goff visited the former PIP headquarters at La Seyne-sur-Mer in the Var in Provence, south-east France, and left with an armful of files.
A parallel investigation has been opened into "aggravated deception".
So far 2,400 French women given PIP implants have lodged legal complaints
In the U.S Breast Implant Helpline Is assisting women with Breast Implant claims. Lets hope the others never make it here.
Tags: AFSSAPS, Al, Alabama, Alaska, Arizona, Arkansas, arthritis from breast implants, Az Scottsdale, breast cancer, breast implant class action lawyer, breast implant deficiency notice, breast implant lawyer, breast implants, breast implants and cancer, breast implants ban, breast implants rupture, breast implants warning, Brooklyn, Ca, California, class action lawyer for breast implants, Co, Colorado, Conn, Connecticut, connective tissue diseases, D.C., De, Delaware, Dow Corning Class, Dow corning trust claim, FDA, FDA and breast implants, Fl, Florida, Food and Drug, Ga, Georgia, Hawaii, Idaho, Ill, Illinois, Indiana, Iowa, Kansas, Kentucky, La, Long Island Westchester, Louisiana, Lupus, Maine, Maryland, masectomy, Mass, Massachusetts, MDL-926 claim, MDL-926 Class Action, Mi, Michigan, Minn, Minnesota, Mississippi, Missouri, Mo, Montana, Ms, my Breast implant claim, N.J., N.Y, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico. N.M, New York, North Carolina, North Dakota N.C, Nv, Oh, Ohio, Ok, Oklahoma, Oregon, Pa, Pennsylvania, plastic sx, Queens, Rhode Island, RI, S.C, S.D, scleroderma, sclerosis, sclerosis scleroderma, silicone, silicone breast implanrt disease, silicone breast implant claim, South Carolina, South Dakota, Staten Island, Tenn, Tennessee, Texas, TX, Ut, Utah, Vermont, Virginia, Wa, Washington, West Virginia, Wisconsin, Wyoming.


text: Section: Wanted Title: 1995.5 S6 Avant Price: 11,000.00 Location: Iowa Date: December 08, 2004 Contact: Email: ktemac_2 at yahoo.com Phone: Description: NO PICTURES. Just about any color and condition will do, but preference is for any color other than green. Miles not a concern, but records and receipts a plus. Prefer a midwest locale, but shipping works, too. Possible trade for my older S4. Email me for details. URL: http://www.audifans.com/marketplace/show.php?table=pm_audifans_Wanted&id=853 -- [ This is an automated message ] [ You are receiving this message ] [ because you signed up for the ] [ Marketplace email notification. ]


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Click HERE for the Summer 2016 Schedule
A Systematic Approach to Spiritual Formation
Our desire is for our membeers to move beyond merely accumulating more & more knowledge about the Bible
Our infrastructure is designed to help activate the core characteristics of the New Life Profile in our members' lives by providing INSPIRATION, INSTRUCTION, INVOLVEMENT and INTROSPECTION. The Sunday School programming focuses on instruction.
INSTRUCTION – Instruction is foundational to healthy Christian development. It involves helping people increase in biblical knowledge, biblical wisdom & practical application of the Word of God. At New Life Bible Fellowship, instruction primarily takes place in our Adult Sunday School programming.
If a person is not instructed, they will be ignorant in their faith.
Our classes usually last for a quarter or trimester. They vary in content and style.


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Last Updated 2015-02-21


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*Bravo has renewed its "Project Runway" knockoff "Fashion Show" for a second season, but it has given the big "auf wiedersehen" to co-host Kelly Rowland.
The network announced it will replace Rowland with legendary supermodel Iman, who will join co-host Isaac Mizrahi when the show returns with new episodes later this year.
"We are happy to welcome Iman to the Bravo family," said Bravo executive Frances Berwick. "Breaking barriers in the fashion industry, Iman is a true pioneer and her unparalleled credibility will inspire the contestants and be a perfect match to the always exciting, Isaac Mizrahi."
In addition, Iman will also replace Rowland as a regular member of "The Fashion Show's" judging panel.
"I am so excited to be joining the Bravo team and to be working again with Isaac Mizrahi, my close friend of many, many years," said Iman.
"I am also looking forward to all of the behind-the-scenes excitement and drama that is generated through the creative process of these undiscovered fashion designers. This will certainly be a show any follower of fashion will want to see."
Bravo is currently holding open casting calls for "The Fashion Show's" second season, which will follow a group of professional designers as they compete in a "Project Runway"-like competition to have their designs sold for the mass retail market.
"The Fashion Show" was developed to fill the vacancy left when Bravo's "Project Runway" moved to Lifetime. Watch a portion from season one below.


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|Polish Music Center
(b. 1914, Łódź, Poland - d. 1979, Palm Springs, CA, USA)
Brief Biography Brief List of Works
Essay: Ryterband's Music
Born in Łódź, Poland on 2 August 1914, Roman Ryterband came from a well-to-do family of lawyers and musicians. He studied law at the University of Warsaw and piano performance at the Music Academy in Łódź. Composing music already at the age of 12, Ryterband was strongly encouraged by Alexander Glazunov to pursue a musical career, which he did by performing as pianist and composer in Łódź and Warsaw during the mid-1930s.
Touring Western Europe on the eve of World War II, Ryterband was able to take refuge in Switzerland, where he worked as a manual laborer alongside other wartime foreigners interned on Swiss territory. He also completed his PhD studies of musicology at the University of Berne, indulging his passion for studying different languages and cultures, and conducting an extensive research of Slavic, Swiss, Italian, Brazilian, Indian, and Negro folk music traditions. They inspired Ryterband to write a number of works utilizing various native idioms as well as author and deliver numerous lectures and articles on indigenous music traditions throughout his life.
Having married Italian-born Clarissa de Lazzari in 1950, Ryterband continued to reside in Berne where he appeared as pianist, composer, conductor and lecturer, earning accolades from such artists as Ernest Ansermet and Artur Rubinstein. His two daughters, Astrid and Diana, were born in Switzerland but, by the mid-1950s, Ryterband set his sights on North America. He moved his family to Montreal, where he assumed the post of music director for the classical radio station, CKVL. Just as in Switzerland, Ryterband's years in Canada were marked by his intensive participation in the local musical life, producing concerts, appearing as pianist and conductor, composing a variety of works from classical to popular vein, lecturing at McGill University, and founding his own chamber orchestra.
Ryterband's next move was to Chicago, where he joined the faculty of the Chicago Conservatory College in 1960. Active as composer and conductor, Ryterband led the Chicago Symphony Orchestra, participated in concerts and conferences of the Chicago chapter of International Society of Contemporary Music, and organized numerous events for the local Polish-American community. Ryterband's cultural contributions were recognized with a 1965 Chicago City Council Outstanding New Citizen of the Year Award.
Eager to explore new horizons and meet new challenges, Ryterband moved his family from Chicago to Palm Springs in 1967, where he spent the remaining twelve years of his life. In addition to composing and performing at various local venues, Ryterband also lectured at California State University in Los Angeles, and served as chairman of the Piano Teachers of the Desert association as well as music director for the Presbyterian Community Church of Palm Desert and Temple Sinai of the Desert in Cathedral City. He also founded and directed the annual Palm Springs Festival of Music and Art, bringing many operatic, ballet and orchestral performances for the local audiences. Diagnosed with cancer, Roman Ryterband died in Palm Springs on 17 November 1979.
Almost forty years after his death, Roman Ryterband's music remains largely unknown, especially in his native Poland, perhaps because he spent most of his creative life abroad. Ryterband's musical language represents a cross-pollination of early twentieth century modernists like Debussy and Britten with a robust admixture of folk elements present in the works of Bartok, Copland, or Kodaly. Although his career as a composer began with a few short piano works and some popular songs in Poland in the late 1930s, Ryterband came into his own during the World War II years spent in Switzerland. There he completed several large-scale solo piano cycles (24 Variations on a Folk Song, Suite Polonaise, and Three Preludes) and a number of solo and chamber works for harp (Two Images, Sonata for Harp and Two Flutes, Sonata breve and Trois Ballades hébraïques), as well as many vocal works, choral cantatas and compositions for saxophone and piano.
Although most of his catalogue is represented by chamber music (often in interesting combinations of instruments), Ryterband also penned a few large-scale orchestral works, including Jubilate Deo for soloists, orchestra, organ and men's and boys' choirs (1949), symphonic poems Vida Heroica (1953) and Russian Rhapsody (1962), as well as orchestral ballet music Tableaux of Laguna (1976) and Heracles and the Argonauts (1978). Folk and religious music add further diversity to Roman Ryterband's opus with such entries as Three Hebrew Songs for voice and piano (1938), Song of the Slavonic Plains for violin and piano (1944), Rhapsodia helvetica for trombone and piano (1948), and several songs based on Negro spirituals (The Gospel's Mah Religion, Yo' Serbant, So Sing—So Play, Trusty Jim), as well as a number of psalm settings (Pray for the Peace of Jerusalem, Raise Your Heads, O Gates) and settings of traditional texts and poetry in Hebrew, Polish, French and German.
The winner of several awards, including the First Prize at ISCM Chicago in 1961 for Piece sans titre for two flutes, Ryterband also received the Kosciuszko Foundation 1977 Award and a grant from the National Endowment of the Humanities for a work celebrating American Bicentennial celebrations in 1976.
Roman Ryterband has composed in nearly all media of musical expression. His friendship with the noted Italian-Swiss harpist, Corina Blaser, meant learning the intricacies of the celestial harp. This instrument is so dificult to play, and certianly to write for, especialy in a more advanced idiom. It is one he deeply adores.
The Sonata Breve, penned in 1961, is particulay concise in thematic material and development, intending to convey its message in the most direct manner. The first movement is virile and vehement, yet yielding to the true nature of both instruments. The second movement flows in to the third the latter a lively dialogue, and by bringing back the subject of Adagio the composer con-joins both movements actually into one.
Comments the composer: "The principle of contrast, innate law of nature, of life, and of arts, finds its expression bothin the structure of the work and the juxtaposition of serial elements and tonal gravitations. Aestheticaly, the emphasis is put on the rarely employed 'tough grip' of the traditionally serene, ephemeral or even morbid harp: it is written for violinists and harpists of our own day, aware of true unity can be achieved, as the violin and the harp cannot be entirely deprived of their sublety."
"I love the flute," says the composer, concluding his own description of his I.S.C.M. competition First Prize Award winning PIÉCE SANS TITRE, a flute duet of disarming charm, written in 1952. "A faun resting on a cliff and flirting with a dancing goat against a pastoral landscape of the antique Hellas... The short composition can be seen as an amalgamation of Debussy`s L'après-midi d'un faune and Honegger`s Danse de la chèvr. But leavingthe platform of programatic description, it is rather a scherzo stereofonico, a stereophonic joke of chasing fugato motifs deriving from two different foci, and with a calming final accordance in a unison." For concert performances the composer composer suggests to place the flutist off stage, invisible to the audience. Due to the vavid attention the piece awoke in dancers, he provided a set of choreographic guidelines.
At the time the composer lived in Montreal, he became attracted by the strong but highly refined writings of the prominent French Canadian poet, Robrt Choquette. The "Suite Mariane,"an apotheosis of the sea in fom of a modern "Divina Commedia"—which brought the author the First Prize in Literature in France—offered Roman Ryterband enough rich material to choose from. The two exquisite sonnets, Eroica and La Perle, are excerpts from large volume. Musically, the set, conceived in 1955, sublimes the change in style which already at the end of Ryterband's stay in Switzreland in the early fifties caused subconscious departure from a milder idiom. Fond of both the harp and the flute he created a tone combination which he cherished in some of his future works, here "coppered" by the timbre of mezzo-soprano or a contralto voice.
"The music absolutely serves the poetry and pays homage to the Prometheaaspirations of man in the first chant, and lives trough the sufferances of the dolorous transformation of the oyster into a perl in the secound, implaying along with the poet the unique parallel with man, whose despaired, sobbing soul one day frees itself under the impact of spirit of creativity"—these are the composer's own words.
Roman Ryterband's interest in musical folklore, in that unspoiled and fascinating well of authentic freshness and beauty, found it's expression in many pieces. The tragic chain of events during World War II moved the sensitive composer to relase his sentiments and the sorrowful crisis of humanity in music. The Trois Ballades HÊbraiques, emotionally charged with a mystic aure of trance in Le RÊvenur, with a subdued—though tragiclly deceiving—humor in Le MaÎtre Joyeux, and the subtly eloquent but at times impassioned, anguished reverie in the Berceuse, make apparent an unmistakable sensibility and nobility of the composer's soul. No wonder he chose the violin to shed the romantic glow upon the spiritual texture of his triptych.
With the Suite Polonaise, Roman Ryterband turned to the rich idiom of the Slavic nation and the Polish folk song which he knew so well from his young years spent in that country. He is a specialist on Chopin, giving lecture-recitals dedicated to this great composer. He is acquainted with Artur Rubinstein, foremost interpreter of the Polish master. Ryterband was a colleague of the noted Polish-Belgian pianist and editor of the complete works of Chopin, Stefan Askenase. At the time of composing the Suite Polonaise Roman Ryterband was living in Brme, Switzerland. He had visited the Polish Museum of Rapperswill on the shores of Lake Zürich, where a collection of rare recordings made by indigenous bands from the various provinces of the country served him as a basis for the ten dances comprising the Suite. The cyclical work encompasses a wide gamut of melodies, moods, modal reminiscences, and rhythms, which make up the imcomparable folklore of the Slavic nation. Some of the stylized movements employ authentic motifs, some use them in a mirror from and other contrapuntal attire, and some are orginal themes of the composer.
The radiance of the three selected excerpts imparts new freshness and exitement in the folkloristic section of the album. Drobny, cultivated by the mountaineers of the northern slopes of the Tatras, manifests tracs of medieval modes with intriguing harmonic sequences, coupled with stunning 3-measure and 5-measure-units in the first half of the dance, all set upon the typical "empty" intervals of the basetla, the native bass viol.
The melody which Ryterband selected for the Krakowiak,a dance from the region of Cracow, is the best known Krakowiak in that part of Poland—and, for that matter, in the whole land—however, it has been thematicly inverted right from the begining of the piece; it develops in a burlesque fashion, but gently fades away at the end. Oberek, a strongly rhythmical dance in triple meter, is a fast, rapid Mazurka, also coming from the central plains region of the country called Mazowsze. There are no limits to the exuberance and propelling drive of an Oberek, which usualy starts—as the Mazurka does—with those pace-setting, acerbic perfect fifths in the bass, and abounds with invigorating accents and syncopations.
The pianistic qualities of the Suite Polonaise present a challange to the virtuoisy of performer, and it's very contents examine his taste and understuding of the Polish musical heritage.
Nocturne in E Flat Minor
Sonata No.1 in D
Souite Polonaise (10 regional dances)
Suite Internationale
24 Variations on a Theme of a Folk Song
Trois Preludes, Hommage à Serghei Rachmaninoff
Suvenir d'un Bal (for the left hand)
Dream of Granada
Interlude at Sea
Eucalyptus Giants on Catalina Street
Ballet Vida Heroica (Piano Reduction)
Toccata for Harpsichord and Chamber Orchestra (Piano Reduction)
Under your Star "Zodiac Suite"
Music for Two Pianos
Ballet Heracles and the Argonauts (Piano Reduction/Percussion)
Alexander's Ragtime Band for 2 pianos
Music for Piano and Orchestra
Concerto for Piano, Strings and Harp
Musical Quiz (Guess The Composer) on Swiss Folk Melodies
Song of the Plains of Poland
Trois Ballades Hebraiques
Phantasie on Polish Folk Melodies for Three Violins
Violin & Harp
Sonata Breve
Trois Ballades Hébraiques
Dialogue (Piéce sans Titre) for two Flutes
Double Flute Quintet /Viola, Violoncello/Cembalo
Ballade "Castle Munchenwilr" for Soprano, two Flutes, two Violin, Piano
Flute & Harp
Sonata for two Flutes and Harp
Two Desert Scenes with Pai-yil ad lib.
Deux Sonnets (Suite marine, Robert choquette)
Cello & Piano
Triptyque Contemporain
Trombone & Piano
Rapsodia Helvetica
Saxophone & Piano
Capriccio Gavottuoso (Alto Eb)
Chagrin d'amour (Alto Eb & Tenor Bb)
Song of the Plains of Poland (Soprano Bb, Alto Eb & Tenor Bb)
Valse de Berne (Tenor Bb)
Deux Images
Contralto (or mezzo-soprano), Flute & Harp
Fünf Deutsche Lieder (German, English & French versions), high
Three Negro Spirituals (Frank Dixon), low
De Gospel`s Mah Religion, Spiritual (Roman Ryterband), low
Spring of Love [Printemps d'amour], Concerto Waltz (Roman Ryterband), coloratura
Three Hebrew Songs (Hebrew, English & German versions), high
Mother of Our Lord [Bogurodzica], based on a medieval prayer, high
Songs and Ballads of motion picture themes character
Two American Songs (Lewis Palen), high
Voice & Organ
Pray for the Peace of Jerusalem, Cantata (Psalm 122), Mezzo-Soprano
Hu Yigal - Ve' Yimale (arr. R.Ryterband) for Contralto and Organ
Voice, Choir & Organ
Yo' Serbant, Spiritual-Prayer (Frank Dixon) for Bass, Women's voices and Organ, or Bass, Mixed Choir and Organ
The Lord Reigneth,Cantata (Psalm 97, German, English, French & Hebrew versions) for Baritone, Boys' choir and Organor Women
The Men of Delta U 3 Songs for various combinations of male voices
Bouquet of Musical Flowers from Brodway to Hollywood, Phantasy for Vocal Men Quartet and Piano
Soloists, Choir & Organ
The Old Mansion [W modrzewiowym dworku], Mazur for Soprano, Tenor, Mixed Choir and Piano
May I Forget This Sorrow, Duet for Tenor and Soprano
Róze i Sen, Song with Piano
Soloists, Double Choir, Orchestra & Organ
Jubilate Deo (Hallelujah), Cantata for soprano, Tenor & Baritone, Boys' Choir, Men`s Choir, Orchestra and Organ
Trio "Jubilate Deo", Soprano, Tenor, Baritone, Organ amd Percussion
"Jubilate Deo" (Organ Reduction)
Choir A Cappella
Pater Noster for 3-part Boys` Choir
Unsere Seen for Women`s voices, or Men`s voices, or Mixed Choir
Zuruf for Men`s voices
Der Tod for Men`s voices
Lob des Liedes for Men`s voices
Der Baum for Men`s voices
Drei Gesänge for Men`s voices
Two Sonnets (Shakespeare) for Mixed Choir
Choir & Piano or Organ
Raise Your Heads, O Gates (Psalm 27), Anthem for Mixed Choir with Piano or Organ accompaniment
Thanksgiving Athems for Mixed Choir with Piano or Organ
Choir & Instruments
Christmas Processional for Mixed Choir, Brass Quartet and Organ
Une poupée pour Noël [A Dolly for Christmas] for Women`s voices, Flute, Triangle and Piano
I Wish you a Merry Christmas, A Carol Fantasy, for Piano Solo
Kleines Weinachtspraludium, for Piano
Kommet Ihr Hirten, Weinachtslieden for 4 hands, for Students
Morgen Kommt Der Weihnachtsmann, Volksweise, for 4 hands, for Students
Back to PMC Home Page Polish Composers


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Metamora Martial Arts performed at the Cherry Tree Festival in Washington, Ill., to promote our Extreme Kumi-Taku Martial Arts studio in Sunnyland.
We participated in Central Grade School's Arts Day, as we had for several years.
May 22 – We hosted students from the Harrison and Dorris College of Martial Arts for a special seminar to prepare for our first tournament that would take place the following year.
Mr. Chianakas' Black Belt Magazine column on MMA training hits newsstands.
May 10 – Mr. John Morrow hosted his 31st Annual Karate & Kung-Fu Championships in Moline, Ill. To view full results, click here.
May 25 – I led my first Arts Day at Central Grade School in Washington and was assisted by Amanda Dixon, Braden & Brandon Love and Emily Berger.
Both Justin Knobeloch and I tested for second-degree black belt. We are the fourth and fifth nidans in Metamora Martial Arts.
Andy Seidel tested for and achieved his black belt. He was the 10th first-degree black belt to be promoted in our program.
May 11 – Adair Rodriguez completed a five-hour physical exam for his first-degree black belt. On the 11th day of May 2011, he was named our 11th black belt.


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Nach dem Smombie-Jugendwort-Fake vom Langenscheidt-Verlag passt das hier wie die Faust aufs Auge: Teenage Slang: An Essential Guide For Anxious Parents. Und überhaupt, weil man's nicht oft genug betonen kann: McSweeneys 💜
Two girls one cup: A beautiful ritual in which a pair of young women are tasked with constructing the most elaborate drinking receptacle possible in under 35 minutes.
Feels: Small balls of nose mucus, widely shared on the street as a form of currency.
IRL: "I'm Richard Linklater." Teens say this regularly on online chat forums when they are pretending to be Richard Linklater.
#nofilter: Really cool. "I love Nickelback. You know the best thing about them? They're so #nofilter."
Can't even: To be comfortable carrying out arithmetic with odd numbers but unable to do so while carrying heavy machinery.
OMG: Ohhhh, Marvin Gaye. An expression conveying the realization that the subject of the conversation, hitherto unclear, was Marvin Gaye.
Selfie: An enormous orgy fueled principally by the consumption of gigantic quantities of Class A drugs.


text: I Live In Indonesia Me Too If you live in Indonesia please join this group and share your experience for us. 15 People Report Group Sort popular recent Join Yuk. Anybody live in indonesia? come and join here.. lets share what is good in indonesia so people can know us better. ddhalim 26-30, M 0 Nov 4, 2010 More Stories


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I Don't Have to Explain Myself.
Ignorance is Bliss, Especially When You Have a D*ck
"I Wouldn't Take That if I Was You"
SS Announcement: Brand Ambassador for The Wardrobe Boutique
Developing Your Bigger Picture
Full SS Keynote Speech Transcript: Tomorrow is Here!
Summer in Philly is Heating Up: Pier Entertainment Presents The Soundcheck Series
FOR IMMEDIATE RELEASE: Sincerely Syreeta raises over $1400.00 in 15 minutes for Philadelphia College Bound Student
You're Invited!| Sincerely Chosen: The Live Interview Series x 4.15.2015
Empower Yourself: 6 Steps to Navigate Changes in Life
A Long Ass Blog Post Dedicated to My Fear of Writing A Blog Post
Just A Thought| "But You're Human..."
"2014: Spread Your Wings" | #iFlew, did you?
Why I Let My 5 and 9-year-old Daughters Protest
Just A Thought| My Birth Right
"I am the melting pot--the dream--that America will never be."
With Season 2 of the Sincerely Chosen show just around the corner, it's only right to share the stories of some of the awesome sponsors who helped to make our first season a great one. I truly hope you take something valuable from their journey's and, if you're inspired to, consider supporting them.
Up next is Rashaad Lambert, a serial entrepreneur and wise guy (you'll see why).
Stay tuned for the next featured season one sponsor…
Sincerely Syreeta: Who are you? Tell the SS readers a little about yourself.
Rashaad Lambert: My name is Rashaad Lambert. I'm most widely known for my roles as Kevin in "Home Alone: Lost In New York" and Cory Matthews in "Boy Meets World." I own Sporty Marketing, TL Marketing Solutions, Cerebellum H2O as well as a few other companies where I hold minority or minimal stake. Basically, I'm in the business of owning things. I also have a large Lego collection… own that too.
SS: Haha, your sense of humor always keeps me on my toes. How'd you become a serial entrepreneur?
RL: I started my first business when I was in high school. I was a rapper and instead of selling drugs, because that's too easy, I used to sell candy, chips & t-shirts. For those who aren't familiar, the most popular things in high school in the early 2000s were: Now & Laters, oversized white t-shirts, & Rap Snacks Chips. James Lindsay (Owner of Rap Snacks) gave me a line, that's slang for discount; I used to buy t-shirts by the case; and I would get the candy wholesale from the security guard in the back of a BJ's in Springfield, PA. Long story short, my manager at the time was stealing money from my group and we had to break up. I quit rapping, went to college, and started throwing parties, concerts, and tattoo competitions. I transitioned from promotions into marketing and haven't looked back since. The rest isn't history because I'm still writing it so let's just say the rest is in "sweeps week" & the mailers haven't come in yet. *crosses fingers I don't get canceled*
SS: What has the entrepreneurial journey been like for you?
RL: It's been like riding a horse with no saddle. You know that the closer you get to your goal the easier it is to bear the bumps in the road but when you first get on, you have no idea what to expect. I take it all in stride because I know that the reward is worth the turmoil. My journey has been a constant learning experience. I am a lifelong student, without the loans, and I intend to stay that way for the duration. My mental mentors taught me that knowing what you're doing is never an absolute because there is new information every second. Warren Buffet says that he reads about his business industry for 6 hours a day. I had to discipline myself to get up to 2 hours a day–which is still a struggle–with my family, my love life and balancing my personal sanity. I've had a family as long as I've had a business so the upside of that is I learned balance from the beginning. The more one side of the scale tips, the more balance you need.
SS: What is one challenge that you have faced and how have worked to overcome it?
RL: Balance [laughs]. That has been my biggest challenge. I've worked in management since my first job so being in charge, [especially] of people 2 and 3 times my age, was never an issue. The balance came natural, but maintaining the balance is the challenge. I snap back to reality when I stop and ask myself "Which of these at this moment in time is most important?" The answer to that question is rarely ever "work".
SS: What does success mean to you and what are some signs that your business is on the road to success?
RL: The one thing I learned about being an entrepreneur is this: "nobody cares, work harder". I have a fairly sizable set of accomplishments so far and what I notice is that my past accomplishments have never had a bearing on any of my future accomplishments. This isn't really even a complicated concept, it's simply that people don't care about your accolades or even your complaints for that matter. People and progress are driven by action and results. If you win a Grammy, that doesn't mean your next album is going to go platinum. Your failure and your success are both in your hands and the daily choice that you have, that we all have, is whether you are going to use your 24 hours to get you to the next level or whether you're going just coast your way back to another dream.
SS: How has your vision and plan for the business changed or evolved since its inception?
RL: Vision must be followed by venture. My vision changes daily because my goals change daily. I now know that the thing I ultimately want to do is not as easy as I thought it would be so that has redirected future plans that I made previously. My business plan grows organically as I do. Expansion is one plan that hasn't changed. One perception I have of success is to not have to work hard so in keeping with that, another goal that hasn't changed is the continuous duplication of my efforts.
SS: Preach. And what about you? How has your business journey shaped you as a person?
RL: I'm more patient with people now. I used to have a "switch" and not a "dimmer" if you know what I mean, but now I have no choice but to listen more than I speak and listen intently with no response prepared. That's an acquired skill because our natural human reaction is to jump to a conclusion or stop listening halfway through and offer a response. I'm also more aware of my socio-political impact as a person in this country. The things that I do through my business and decisions that I make directly affect those who work for me as well as other business I work in tandem with. I must be more cognizant and careful now than when my decisions only affected me.
SS: "To whom much is given…" So why did you decide to come on board as a sponsor for #SincerelyChosen? I mean of course I appreciate it, but why?
RL: You have such a genuine spirit and are so sincere in your purpose driven life that I never hesitate to support anything that you do. You called me with a need and without a 2nd thought I rose to the occasion to help out.
SS: Gotta love the network! Haha! I appreciate your belief in my work and authenticity. What's your key to "Sincerely Lovin'" life? (A motto or mantra that you live by.)
RL: Have you ever heard of the kiwi bird? It's that same bird that's on the shoe wax container. It comes from New Zealand and is a very small bird that has a long beak. This poor bird has wings, but cannot fly. Picture this tiny bird running toward a California fire. Remember, it can't fly, and it can't see above the blades of grass. The kiwi will find out about the fire when it gets in it, burns up and dies. That's a sad story, so let's change it a bit…
The kiwi is running toward the California fire. It can't see above the blades of grass but there is an eagle 200 feet above. The eagle sees the kiwi and shouts, "Kiwi! Kiwi! Stop! Stop! There's a fire ahead!" The kiwi stops and the eagle saves the kiwi's life. Why? A different point of view; a different perspective. It is important that you begin to see the eagle view in everything you do. When you rise to the perspective of an eagle, you will begin to see new truths about your future.
SS: You better teach 'em sensei. Tell us how can we support your work.
RL: The best way to support me/us is to attend [our] events, share the information with others… and plant a tree. Yes, go plant a tree. Trust me, in 50 years when you're still able to breath without a helmet, you'll thank me.
For more information on events and services email email@example.com.
If you would like to support Sincerely Chosen and its mission for the 2016 season via sponsorship, email: firstname.lastname@example.com.
– Sincerely Syreeta


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If you are apart and on the verge of divorce you may feel that there is no hope. The truth is that there is more than hope. There are people who take control of their circumstance and get the marriage they desire after they begin to apply a few of these methods. , if you desire to know how to conserve a failing marital relationship and are all set for the intense effort involved you will find the concepts in this short article effective revitalizing refreshingReliable.
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Amy Winehouse, like numerous addicts, had other issues besides her dependency to alcohol and drugs. She likewise experienced an eating condition which is a kind of mental disorder. Lots of compound abusers have an underlying mental disorder and although this makes their addiction more tough to treat, it stresses why moms and dads have to understand symptoms of mental disorder dual diagnosis rehab in their teens and kids.
Is Addiction A Disease Or Mental Illness?
How? That's how you learned your first language (L1) whether it's English, Spanish, French or some other language. You "simulated" your Mom, Daddy, family, pals, instructors and whoever else was around making "talking" sounds at you as you formed communicative language skills.
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An undiagnosed mental disorder will often lead the sufferer to look towards drugs or alcohol in order to get relief from their signs. If a moms and dad gets their kid or teen into treatment prior to they start explore drugs or alcohol, they may have the ability to avoid developing an issue with drug abuse. Having a dual diagnosis treatment is tougher to overcome but it can be done. Capturing mental disorder early can assist to prevent dual diagnosis treatment.
We had actually started marital relationship therapy, in combination with his dual diagnosis program therapy. He was being treated for depression at this point. I did feel at sometimes in these therapy sessions that I got more out of from them, since I put so much more into them. He disliked the intrusion into our lives as he in some cases called therapy. He forgot this was his anxiety and sometimes refused to go. I would simply reschedule his appointments. He was misdiagnosed as having bipolar illness however when things continued to deteriorate, even more we got the early beginning of Alzheimer's.
Lastly make certain to ask about program approach and goals. Everybody will tell you about sobriety, however how are they getting you there? Are they confrontational? Are they non- confrontational? Do they utilize cognitive treatment? Do they have specialists utilizing other techniques that might be valuable to you?
Since it was the only one she had at the time after trying so numerous other treatment programs that did not work, Mary took that opportunity. There were times that Mary seemed like quiting, however God gave her the strength to stand firm and the decision to see her success in recovery. Today, she is a good example to her children and to her household members. She volunteers at one of these faith based rehabs two times each week and she likes to see the effect that her service has on the addicts that go and come.


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- Company Description
- Key Figures
- Contact Details `
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You enhance your self worth and understanding by identifying with Earth as your Self, your "other body".
"The same stream of life that runs through my veins night and day runs through the world and dances in rhythmic measures. It is the same life that shoots in joy through the dust of earth in numberless blades of grass and breaks into tumultuous waves of leaves and flowers. It is the same life that is rocked in the ocean-cradle of birth and death, in ebb and in flow. I feel my limbs are made glorious by the touch of this world of life. And my pride is from the life throb of ages dancing in my blood this moment." Ranindranath Tagore
I went outside to take a walk. It was mid-afternoon. It is mid-winter and the sun is low in the sky. Very overcast day. Grey-white clouds covering the sky. No blue skies and no sun shinning through. The day is quiet. No one else around. The Lands are quiet. You can feel the ebb building. Birds were settled and not much creature movement. The wind was blowing. It was one of those soft warmish winds that come up this time of year. Warmish but in a different way then warm spring winds. These warm winter winds have tinge of chill as it leaves the passing of your skin. You can feel the cold coming behind the warmth. I love these kind of days. Like the day is fully consuming being it self. And not interfered with by too much activity. Just being the day. I have been working very hard and feel behind in most everything. I was glad to just be in the day. I felt returned to fullness.
A few little candytruft flowers are blooming. Some sprinkling of ground phlox. And along the retaining wall that I am walking by is a tiny periwinkle flower blooming. It catches my eye – almost like it says – Whoa – wait up. My whole being reaches out to touch it. I want to pick up – but pause. Then I think -Yes, we want each other and besides the flower will be gone by tomorrow as periwinkle flowers are very short lived. I pick it. It seems like we are happy with each other.
After my walk I bring the periwinkle flower inside thinking I will just lay down on the counter – but then feel that the flower needs water. It has this very tiny little stem – I wasn't picking it for keeping. But I get the vase that sits over the sink and put the tiny little stem in the vase filling it with water. The stem actually reaches the water – which I am happy about. I place the vase with the periwinkle flower in the kitchen window thinking that it will be gone by tomorrow morning.
A few days later I notice it in the kitchen window – expecting to put it in the compost. But there it is perky and happy. Doing just fine. Over the next week or so I watch it every day and see that it is slowly – ever so slowly – turning itself around to face the light coming in the window. Every day I am amazed that it hasn't died. I have to put more water in the vase. No wilting. No drooping. No struggling. No angst. Just fullness. Just gradual turning to the light. I love this little flower.
Reflections- What is Nature Revealing to You?
Well, I guess you can't predict what is going to happen. It is like this little flower part of me wanted me to know something. We came together to help each other. Even though the days have been warm the nights are cold and perhaps the flower would have perished outside. Maybe it should have perished. Maybe now it is just a captured flower with no way out. I guess we could say that – but why. Maybe we are suppose to intertwine with each other and through that lies our destiny. The periwinkle flower showing me – I can't predict what is going to happen based on what I know happens. Maybe the periwinkle had such strong senses in it to live through more then one day that it reached out and captured me. Using me for its purpose to keep experiencing. Maybe the periwinkle wanted to show me that even though I am getting older that I can keep turning to the warmth and light and don't have to work hard to do it. Beauty survives naturally.
I really like this little flower. This little bit of happiness. I marvel at its spunkiness.
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"And above all, watch with glittering eyes the whole world around you because the greatest secrets are always hidden in the most unlikely places. Those who don't believe in magic will never find it." Roald Dahl


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Published by Amulet Books on May 2nd 2017
Genres: young adult, contemporary
Pages: 400
Format: eARC
Source: Netgalley
Buy on Amazon
It's the start of Jordan Sun's junior year at the Kensington-Blaine Boarding School for the Performing Arts. Unfortunately, she's an Alto 2, which—in the musical theatre world—is sort of like being a vulture in the wild: She has a spot in the ecosystem, but nobody's falling over themselves to express their appreciation. So it's no surprise when she gets shut out of the fall musical for the third year straight.
Then the school gets a mass email: A spot has opened up in the Sharpshooters, Kensington's elite a cappella octet. Worshiped ... revered ... all male. Desperate to prove herself, Jordan auditions in her most convincing drag, and it turns out that Jordan Sun, Tenor 1, is exactly what the Sharps are looking for.
Noteworthy is the cutest book of 2017. No, really, I think it is. Or at least it has been so far. I know a lot of young adult readers love the cross-dressing trope, and it's usually when a girl poses as a guy. It's really popular in movies and KDramas too, and I gotta be honest, it's not really my thing. It's just always really hard for me to believe that a girl could pass as a guy for that long–it's not just the appearance that has to pass, but mannerisms, voice, behavior, everything. And I mean, if a guy tried to pass as a girl for that long I would totally catch on. So it's a suspension of disbelief issue for me, and I really just have to close that part of my brain off so I can enjoy the book, and it's not always possible. That said, I know it's my issue, and Noteworthy did it really well. So for those that love that trope, I definitely recommend this book. The romance is the cutest, too.
Things that are great about Noteworthy:
- The diversity: Jordan is Asian American, and the rest of the characters are diverse as well. Jordan's best friend is Sikh, Jordan herself is bisexual, there are gay characters, Jordan's father is paraplegic, and the best part about it is it's all just integrated into the story really well. The world is a diverse place, and we should find the same thing in books.
- A capella is a really big thing right now and it looks to not be going anywhere soon. If you've ever wondered what it's like to be in an a capella group, or just a singing group in general, this book absolutely nails it. I've never done a capella but I was in high school choir and college choir, and yeah, it's pretty accurate. I think because a capella groups are a bit smaller the members get a bit closer and may depend on each other more, but it's like a family, which I suppose is like any group of people that spend a lot of time together.
- The book is written really well. There are a lot of characters in Noteworthy, and they are all developed really well, even the antagonists. I'm always super impressed when an author takes the time to develop little subtle nuances that make each character stand out and feel genuine. Each member of The Sharpshooters is recognizable, has their own motivations and things that make them tick.
Things that are not great about Noteworthy:
- It bothered me how much the rival a capella group got away with. It's one thing to play pranks, but they were vandalizing, sabotaging, and it got far too serious and no faculty stepped in. Now granted, I think maybe they would have if The Sharpshooters had spoken up and reported the harassment, but at one point Jordan actually does report it, and the teacher says she has to "man up." I just don't think teachers would actually do NOTHING, since a car is actually keyed, It also makes teachers look really bad, and as the wife of a husband who is a teacher, it pisses me off a bit.
- The book took a while to get moving. I wouldn't say it was boring, but the book was a bit wordier than I would have liked. I just feel it could have been condensed more, that it was maybe too long. There were scenes, more towards the beginning, that I feel were not integral to the plot and probably could have been left out.
I definitely recommend Noteworthy. It was cute, handled some serious topics really well, had an adorable romance, and since there are not a lot of books about singing in YA, this is definitely a great addition.


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Katekyo Hitman Reborn Fanfic
Mukuro x Fran
One sided Byakuran x Mukuro
Slight Byakuran x Fran depending on how you take it. 7 w 7
Warning: Bondage/Torture/rape/violence/boy love.
Rated M
It was just a typical day, typical weather, typical mood. The sun was just starting to set behind the trees, giving off a deep glow of red and orange. Shadows spread over the ground, telling all the little creatures it was time to rest.
Two bodies were nestled together on the bed they shared, one had his hand on his lover's chest, face buried deep into the neck, and the other; a taller male, had his arms wrapped around the other protectively.
The smaller one, known as Fran, began to close his eyes. Sleep getting the better of him and gave into the dark's comforting embrace.
The second male broke the silence with his signature laugh and nudged Fran. "Kufufu. . Oya, Little One, don't fall asleep. You know what will happen if you don't go back tonight."
"Urasai, Shishou." He replied in an emotionless tone. Mukuro chuckled again and held him up. "Mister "scary" boss will not be happy."
Fran sat up and elbowed the pineapple head in the chest gently. "I know. . but I don't want to go yet." Despite his whining though, he swung his feet over the edge of the bed any way, slipping his feet into his shoes and tieing the boots. He picked up the frog hat he was forced to wear and placed it back on his head.
"Don't worry. You'll be back tomorrow." Mukuro stood up behind him and snaked his arms around his shoulders, laying his head ontop of the large gray frog hood.
"Of course I will." he said as he quickly turned around, placing a soft kiss on his master's lips and turning back around. "Love you, bye."
"Kufufu. That's the first time in the whole 4 months we have been together you've told me you loved me without me having to say it first~." the older teased, prodding his finger into Fran's cheek. The latter groaned in annoyance and smacked the hand away.
"I just felt like saying it." He grabbed his coat, slipping it on his shoulders, and started to head towards the door.
Mukuro, having looked out the window and seen how dark it was, started to get a little worried for his love's safety. "Maybe I should come with you." he some how managed to sound completely unworried even though in the inside he held concern.
"Che, I'll be fine. I have walked home alone before." Fran assured.
"Well then, alright." he didn't really feel like pursuing it any further, he just wanted to go to bed.
Fran nodded slightly and opened the door, turning around once more to look at Mukuro, giving a soft smile only reserved for the pineapple head.
Upon seeing that smile, Mukuro's heart grew warmer and he smiled back. They didn't need to say anything else at that moment, because they knew exactly what the other was thinking.
After a few seconds of eye connection, Fran turned and closed the door, heading out into the tree surrounded area. It would take him about half an hour to walk through the woods and back to the Varia Hideout. Maybe half the time if he ran.
At first when he walked about ten minutes, he felt calm and normal. But then he started to hear rustling of leaves and began to feel uneasy.
'It's nothing. . .Just birds, or something.' He told himself, but it didn't help when he heard a slight chuckle echo through the tree tops. '. . .Just the wind.' he said, but despite his comforting words, he was still panicking. His foot steps got quicker.
Not even being half way home, he got worried; he felt like a little child in the dark. 'Get it together, what's the worse that can happen? If it's some psycho killer I can easily get away. Nothing to worry about.'
The chuckle turned into a dark laugh, and it was obviously not the wind. Fran quickly stopped and looked around, his emotionless eyes holding small fear, but still managed to seem unaffected by the random noises.
Suddenly, there was a gush of wind from behind him as he felt a pair of strong arms wrap around his neck and a hand place itself over his mouth.
His heart quickened and eyes widened. He didn't have enough time to summon an illusion before he was knocked over the head and started to black out. His vision wavered as the man behind him let him go. His footing became weaker and he stumbled forward, falling unconscious quickly.
"Kuahaha. . .So, you're the one Mukuro "loves"? I can see why, you certainly are a cute one." The eerily bitter-sweet voice spoke out softly, light powder-purple eyes scanned the smaller's body, examining his features before kneeling down and picking him up.
"It's a shame you have to die, though. Because Mukuro is mine." He grinned an evil smile, laughing quietly. A small trickle of blood from the greenette's head caught his eye, and he dipped his finger tip into the crimson liquid.
"You have such beautiful blood. I want to see more." and with that, he started walking away, chuckling under his breath as he made his way back to base.


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This was one of my father's favorite dishes, so it seems fitting to post it today. He loved all things Irish and was quite proud of his Irish heritage.
I'm pretty sure my youngest inherited her fieriness from that line 😉
In the month of March I always make a big Irish dinner and it remains one of my favorite meals to cook.
This is a great recipe to use up leftover corned beef (or roast beef if you don't enjoy corned). I've made this even with some cubed leftover Canadian Bacon, or crumbled bacon too. It's delicious any way! If I'm thinking ahead I cook the potatoes even a day or two ahead of time to make these super easy and quick to cook. Happy St Patrick's Day!
3 lbs gold potatoes, peeled and cut into 1/2″ cubes (Should be 5-6 cups)
2 T oil
1 large white onion, diced (about 2 cups)
1 1/2 lbs leftover cooked roast beef or corned beef, diced (about 3 cups)
1/2 tsp smoked paprika
1 tsp garlic powder
1 tsp kosher salt
1/2 tsp black pepper
Heat oil in a large skillet over medium heat. Add potatoes and cover. Cook 10 minutes, stirring once or twice.
Uncover and add onions. Cook about 5-10 minutes longer.
Add beef and spices, cook until heated through and potatoes and onions are golden and tender.
If desired, serve with a poached or fried egg and fresh parsley.
SHORTCUT VERSION: Boil or bake your potatoes, peel on, ahead of time. Cook until barely tender.
Chill, then peel and cut into cubes. Cook in an uncovered skillet along with the oil and onions until golden, then continue as above, adding meat and spices.
- 3 lbs gold potatoes, peeled and cut into 1/2? cubes (Should be 5-6 cups)
- 2 T oil
- 1 large white onion, diced (about 2 cups)
- 1 1/2 lbs leftover cooked roast beef or corned beef, diced (about 3 cups)
- 1/2 tsp smoked paprika
- 1 tsp garlic powder
- 1 tsp kosher salt
- 1/2 tsp black pepper


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Latest Indian Railway jobs notification has been issued for the post of Staff Nurse on contract basis in Southern Railway. Education Qualification, Experience requirements, Method of application, Selection Procedures and all other details of this Southern Railway Recruitment 2017 have been explained below. Candidates are advised to read this Railway Vacancy notification carefully before applying. Candidates interested in applying for these Indian Railway Staff Nurse jobs have to apply in the prescribed application format.
Southern railway Recruitment 2017
Indian Railway vacancy notification has been issued for 14 posts of Staff Nurse on the Contract basis, out of which 03 posts are reserved for OBC Candidates, 02 posts for SC Candidates, 01 post for ST Candidates and remaining 08 posts for Unreserved / General category candidates. Candidates those who are willing to apply for this Indian Railway Staff Nurse Recruitment 2017 have to send the application in the prescribed format before 05th May 2017.
Details of Southern Railway Recruitment 2017
Name of the post – Staff Nurse
No of vacancy – 14
Salary – Rs.21190/-
Job Location – Chennai
Method of application – Offline
Eligibility Conditions for Southern Railway Staff Nurse recruitment 2017
Age Limit:
Between 20 to 38 Years of Age
Age Relaxation:
SC/ST – 5 Years
OBC – 3 Years
Education Qualification:
Candidates must have passed three years course in General nursing and Midwifery from a school of Nursing or any institution recognised by the Indian Nursing Council or B.Sc (Nursing) and must have registered as a Nurse and Midwife.
How will be the Indian Railway Staff Nurse Selection Procedure?
Selection for this job will be made on the basis of Interview. Candidates will be shortlisted on the basis of Educational and experience qualification and only those shortlisted candidates will be called for interview. The Final selection will be made on the basis of performance in the Interview. The place and Date of Interview will be informed to the candidates in due course.
How to apply?
Candidates willing to apply for this Staff Nurse job in Railway have to download the application form attached to the Official notification and send it to the address mentioned below along with 2 passport size photograph and attested copies of Date of Birth Proof, Educational and Technical Certificates, caste certificate (if required)
Address to send application form
Asst. Personnel Officer/Engg,
Office of the General Manager,
Southern Railway, Park Town,
Chennai 600 003
The envelope should be superscribed as "Application for the post of Staff Nurse".
Application form along with all attachments should be sent through post or can also be dropped at the box kept at the above-mentioned address.
Important Dates:
Last date for Receipt of application form – 05-05-2017 (5:00 pm)
Important Links:
Official Notification of Southern Railway Staff Nurse Recruitment 2017
You will be interested in Latest Railway Jobs 2017
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