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Combining information from surveys of several species to estimate the probability of freedom from Echinococcus multilocularis in Sweden, Finland and mainland Norway
Acta Veterinaria Scandinavica volume 53, Article number: 9 (2011)
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The fox tapeworm Echinococcus multilocularis has foxes and other canids as definitive host and rodents as intermediate hosts. However, most mammals can be accidental intermediate hosts and the larval stage may cause serious disease in humans. The parasite has never been detected in Sweden, Finland and mainland Norway. All three countries require currently an anthelminthic treatment for dogs and cats prior to entry in order to prevent introduction of the parasite. Documentation of freedom from E. multilocularis is necessary for justification of the present import requirements.
The probability that Sweden, Finland and mainland Norway were free from E. multilocularis and the sensitivity of the surveillance systems were estimated using scenario trees. Surveillance data from five animal species were included in the study: red fox (Vulpes vulpes), raccoon dog (Nyctereutes procyonoides), domestic pig, wild boar (Sus scrofa) and voles and lemmings (Arvicolinae).
The cumulative probability of freedom from EM in December 2009 was high in all three countries, 0.98 (95% CI 0.96-0.99) in Finland and 0.99 (0.97-0.995) in Sweden and 0.98 (0.95-0.99) in Norway.
Results from the model confirm that there is a high probability that in 2009 the countries were free from E. multilocularis. The sensitivity analyses showed that the choice of the design prevalences in different infected populations was influential. Therefore more knowledge on expected prevalences for E. multilocularis in infected populations of different species is desirable to reduce residual uncertainty of the results.
The fox tape worm Echinococcus multilocularis (EM) is a parasite of public health significance. The life cycle involves foxes and other canids as definitive hosts and rodents as intermediate hosts [1] although many other mammals species can be aberrant intermediate hosts (Figure 1). Humans become infected via the oral route, probably via contaminated hands after handling infected canids, contaminated plants or soil or through eating contaminated berries [1, 2]. Human infection with EM can result in alveolar echinococcosis, a serious disease. If untreated the mortality exceeds 90% within 10 years, if treated the survival rate after five years increased to 88% [3].
EM is endemic in large parts of Europe [1] and the parasite is increasingly reported from countries near Sweden, Finland and Norway [4–7]. There is evidence that the parasite may be emerging in Europe [3, 8–11]. EM is notifiable in humans and animals and has never been found in Sweden, Finland and mainland Norway. This favourable situation is probably largely attributed to the fact that this area is geographically isolated from countries where EM has been detected in combination with stringent import regulations including a requirement for anthelminthic treatment of companion animals (i.e. cats, dogs and ferrets). Furthermore EM has not been reported from adjacent areas of Russian Karelia, and according to Henttonen et al. [12], in all probability not on the Kola Peninsula. In Sweden, Finland and Norway, the climate is favourable for EM and susceptible hosts occur [13], hence it is possible that EM could be established if accidentally introduced. Once established in an area it is considered impossible to eradicate EM because of the sylvatic life cycle [14].
The present EU regulation allows Sweden, Finland, UK, Ireland and Malta to maintain national rules for the entry of companion animals over a transitional period to protect them from imported EM infections. In addition Norway (mainland) considers itself free from EM and has separate import regulations for pets from countries other than ones mentioned above. However, these special requirements may be costly and laborious for the pet owner and could be considered disproportionate. If a country wants to maintain stricter national import regulations for dogs and cats than EU generally, it should be able to plausibly demonstrate its freedom from EM. The aim of this study was to assess the EM status of Sweden, Finland and mainland Norway using past surveillance data. The study shows that there is a high probability that the three countries were free from EM in 2009.
Design of the study
The probability that Sweden, Finland and mainland Norway are free of EM and the sensitivity of the surveillance systems for EM, i.e. the probability of case detection, were estimated using the method described by Martin et al. [15]. By use of modelling, the method allows combining results from several independent components of a complex surveillance system into a single measure; i.e. the sensitivity of the combined surveillance activities. The model can be graphically presented by scenario trees (Figure 2) that contain infection and detection nodes, and illustrate all possible pathways from the starting point (the population is infected) to the outcome (negative or positive test results) [15]. The model is based on two key assumptions: All results of the surveillance system are negative, i.e. disease is not detected, and the specificity of the surveillance system is 100%, i.e. each surveillance system component (SSC) (Table 1) is defined to include any necessary follow-up testing of potentially false positive results [15]. In the present study, the method was extended to combine information from surveillance systems in up to five different populations. A design prevalence was specified for each population surveyed (see further explanation below). Given the defined design prevalences (P*) the probability of freedom by country was calculated. The study period was from 1 January 2000 to 31 December 2009 and the surveillance for each year was modelled separately.
Input values
Number of animals examined
Five different animal-taxons, hereafter designated species, were included in the surveillance of EM: red fox (Vulpes vulpes), raccoon dog (Nyctereutes procyonoides), domestic pig, wild boar (Sus scrofa) and voles and lemmings (Arvicolinae, several species). Only pigs having access to pasture were considered to be exposed to EM and hence included in the study. The number of animals examined per year in each country is detailed in Table 2. A detailed description of the surveillance activities in each country is provided in the additional file 1: EM_DDF_Annex_datasources_2011_01_25.pdf
Design prevalence
The design prevalence P* is the probability that an animal is infected given that the infection is present in the country. For each species, a separate design prevalence was specified (Table 3) based on prevalence estimates previously published. For foxes and raccoon dogs a design prevalence of 1% was used in agreement with the suggestions for harmonized monitoring of EM within the European Union [16].
For pigs the design prevalence was based on results from surveys for EM performed by inspection of pig livers at the slaughter house. In Hokkaido, between 1983 and 2007, approximately 0.1% of slaughtered pigs were reported to have livers with lesions due to EM [14, 17, 18]. In Lithuania, lesions due to EM were found in 0.5% of pigs (n = 612) from small family farms [19] and in Switzerland, livers from 10% of fattening pigs (n = 90) raised outdoors, originating from six farms with a high proportion of condemned livers, had EM lesions [20]. As these estimates originate from (high) endemic areas it was expected that the prevalence at the country level would be lower. Based on expert opinion, it was decided to use 10% of the lowest estimate, i.e. 0.01% as the design prevalence for the whole country.
Reports of EM found in wild boars [21, 22] were not considered sufficient for estimation of the design prevalence. However, wild boars are expected to be more exposed to EM than domestic pigs, hence it was decided to use twice the design prevalence of pigs, i.e. 0.02%.
The prevalence estimates of EM in voles are reported to vary between as well as within species [23, 24]. The common vole (Microtus arvalis) and water vole (Arvicola amphibious previously called A. terrestris) are considered to be the most important intermediate hosts in Central Europe [23–25]. Water vole is common in Nordic countries, but common vole does not occur in Sweden and Norway and has a very limited distribution in Finland. However, other Microtus species do occur in the area. Most of the rodents of this study (70-90%) were bank voles (Myodes glareolus), and the prevalence was set to fit that species. The reported prevalence estimates for this species varied from 2.4% to 10.3% [26–28]. In accordance with the reasoning for pigs, the design prevalence was set to 10% of the lowest estimate, i.e. 0.24%.
Test sensitivity
The sedimentation and counting technique (SCT) is considered the reference test for EM in definitive hosts. The sensitivity has been estimated to be 98% to 100% [24, 29]. However the lower bound for the sensitivity (98%) as estimated by Eckert [30] was considered to be too high for a country where EM has never been diagnosed and therefore the personnel being less experienced (personal communication, Dan Christensson). In the present study, the sensitivity of SCT was therefore described with a Pert distribution with the parameters (0.9, 0.98, 1) [31].
The coproantigen ELISA (CoA) was estimated to have a sensitivity of 83.6% when investigating 87 wild foxes of which 55 were found positive in the SCT test [32]. In foxes with a detected parasite burden of > 21 worms the sensitivity of CoA reached 93.3%, but in foxes with ≤ 20 worms it was only 40% [32]. The sensitivity was described with a Pert distribution with parameters (0.40, 0.84, 0.93). The same estimates for sensitivity for CoA were used for foxes and raccoon dogs as the excretion of coproantigen is not expected to vary significantly between these species [33].
The overall diagnostic sensitivity of the modified taeniid egg isolation from faeces [34, 35] and multiplex PCR [36, 37] used in Norway was described by Pert distribution with the parameters 0.29, 0.5 and 0.72 [38]. In Finland, a modified taeniid egg isolation (McMaster with sucrose, specific gravity 1.25) was used with a sensitivity that was assumed to be 35% of the method used in Norway [19].
Meat inspectors in Sweden, Norway and Finland are not expected to be familiar with the white nodular lesions in the pig liver caused by EM. The pathological characteristics in pigs, an aberrant intermediate hosts, differ from rodents, the natural intermediate host. Most of the detected lesions have been described as small and calcified and may look similar to non-essential lesions such as "white spots" caused by passage of ascarid larvae [17]. Therefore the probability that EM lesions would be detected during meat inspection was estimated to be approximately 0.1 and was described by a Pert distribution with parameters 0.01, 0.1 and 0.2. The probability of taking a sample for further examination varies among the countries. In Norway, laboratory examination of samples is free only when a notifiable disease is suspected and the probability that a sample would be taken was considered to be very low and was described by a Pert distribution with parameters 0.1, 0.2 0.3, based on estimates from meat inspectors. In Sweden and Finland, the probability of sampling was expected to be higher as all samples can be submitted for further examination without any costs. However, as the probability is difficult to estimate, a conservative approach was chosen and the estimate for Norway was used for all three countries (Table 3).
Identification of EM lesions in pigs and wild boars by histological examination can be very difficult as older lesions very often are calcified and only fragments of the laminated layer of the parasite can be found. It can be expected that such lesions will not be identified by pathologists unfamiliar with EM. If a PCR is done on all putative lesions, the sensitivity of laboratory examinations is estimated to be a minimum of 80%, most likely 90% and a maximum of 95% (personal communication, Peter Deplazes). However, as EM has never been diagnosed in any of the three countries, it cannot be expected that all potentially suspect lesions will be submitted for further examination by PCR. The probability of diagnosing EM, if an EM lesion was sent to the lab, was estimated to be rather low and was described by Pert distribution with parameters (0.1, 0.4, 0.5) (Table 3). In wild boars, meat inspection is usually performed by laymen and the overall sensitivity of meat inspection was considered to be lower, we assumed it to be 50% of the sensitivity in domestic pigs.
In Finland, voles were dissected as part of regular long-term surveillance of small rodent populations by the Finnish Forest Research Institute. Voles were dissected by experienced biologists paying special attention to liver lesions. Thus, parasitic cysts were reliably investigated and identified at the species or genus level by morphology, sometimes also genetically for Taenia phylogenetics [39]. Consequently, the sensitivity of dissections, i.e. the probability of detecting a liver lesion due to EM, is estimated to be high and was described by Pert distribution with parameters (0.8, 0.9, 0.99) (personal communication, Heikki Henttonen) (Table 3). As the dissections of rodents in Sweden were performed by laymen, the sensitivity was estimated to be 10% compared to the estimate in Finland (Table 3).
Probability of introduction
In Sweden and Norway, dogs that are introduced from countries where EM is endemic and that do not comply with import requirements, are considered to be the most important pathway for introduction of EM. In Finland, the risk of introduction by wildlife is also considered important as EM is now present in neighbouring Estonia [40]. The annual risk of introducing at least one infected dog to Sweden has, depending on the degree of compliance with the import requirements, been estimated to be 0.64, 0.45 and 0.13 assuming 90%, 95% or 99.9% compliance, respectively [41]. The degree of compliance is unknown. In the UK it is estimated to be approximately 95% to 96% (personal communication, Tonima Saha). A risk of introduction of minimum of 0.13, most likely 0.45 and a maximum of 0.64, based on a 99%, 95% and 90% compliance was therefore used in this study.
The probability of establishment was considered to be dependent on the probability of infected dogs excreting eggs and the probability of excreted eggs starting an endemic cycle. Of the total infection period in dogs of approximately 120 days, the prepatent period constitutes approximately 28 days and the effective patent period approximately 43 days (95% CI 21.9-93.1) [33, 42]. Therefore, it was assumed that dogs imported after 71 (28+43) days post infection would excrete very few eggs and were assumed to not initiate an endemic cycle. Consequently, approximately 60% (71/120) (95% CI 42% (49.9/120) -100% (121/120) of imported infected dogs would excrete sufficient eggs for initiating an endemic cycle. Furthermore, it was expected that the risk of initiating an endemic cycle would differ depending on the presence and number of suitable hosts. As no data were available, it was estimated that 50% (minimum 30% and maximum 70%) of infected dogs would excrete eggs in areas suitable to initiate an endemic cycle. Hence, the risk of introduction and establishment by dogs was described as a conditional probability parameterised with:
Pert(0.13, 0.45, 0.64) × Pert(0.42, 0.6, 1) × Pert(0.3, 0.5, 0.7) Where Pert(0.13, 0.45, 0.64) is the risk of introduction, Pert(0.42, 0.6, 1) is the probability that an introduced infected dog would excrete eggs and Pert(0.3, 0.5, 0.7) is the probability that an endemic cycle is initiated given introduction of an infected dog excreting eggs (Table 3). The estimated total number of dogs in Norway and Finland are approximately 50% and 75%, respectively, of the Swedish populations and the number of dogs entering the country was assumed to be proportional to the total number of dogs in each country. Therefore, the risk of introduction of EM by dogs was assumed to be 50% and 75% of the Swedish risk for Norway and Finland, respectively. EM is present in Estonia south of Finland and infected foxes or raccoon dogs may carry the infection to Finland via the Karelian Isthmus (> 300 km) or in midwinter by passing over frozen Gulf of Finland (52-120 km). This risk is dependent on number of host-related and environmental factors difficult to assess. However, the risk was considered less than that of numerous imported dogs and was estimated on average to be 50% of the risk of dog import.
Calculation of surveillance system sensitivity
The sensitivity was calculated annually for each surveillance system component (SSCSe Sp ) and then for the whole surveillance system (SSSe).
Surveillance system component sensitivity
The annual sample sensitivity, i.e. the sensitivity for each sample of animals (Sa) within an animal species tested with test (t) given that the species was infected at the design prevalence for that species (P* Sp ), was calculated as:
Where Sa s is the sample s, Se t is the sensitivity of the test t, N s, Sp, t, y is the number of animals in the sample s of species Sp tested with test t in year y (Table 3) and P* Sp is the design prevalence for the species Sp (Table 2).
The annual sensitivity for SSC for a single species and a single year, i.e. the probability of a positive test result in at least one individual animal in any of the samples of animals tested that year, was calculated according to the binomial distribution. For a SSC with two samples tested with different tests the sensitivity was calculated as:
Where 1- Sa s Se Sp,t,y is the probability of not detecting EM in the sample s of animals of species Sp tested with test t in year y.
Calculation of the probability of freedom from EM in the country
The probability that the country is free from EM was calculated using Bayes theorem [15]. The posterior probability of freedom from infection (corresponding to the negative predictive value of a diagnostic test) was calculated for each of the 10 years as:
Where PriorPInf y is the pre-surveillance probability that the country is infected and SSCSe y is the sensitivity of all SSC s in year y. Although the infection has never been recorded in Sweden, Finland and Norway, a non-informative prior probability of infection (0.5) in January 2000 was used, assuming no prior information about the disease status. The SSCSe y i.e. the sensitivity of all SSC s in year y, was calculated according to the binomial distribution:
Where 1- SSCSe Sp, y is the probability of not detecting EM in species Sp during year y.
The probability of introduction (PIntro) during one year y represents the probability that disease is introduced in the country and established at the design prevalences (P*). Either the infection may occur from a starting point of complete absence or the infection level may increase from some low level (<P*) to exceed P* during the next year, y+ 1. The prior probability that the country is infected at the beginning of y+ 1 is given by the function [15]:
Where PriorPInf y+1 is the prior probability of infection in year y+1, PostInf y is the posterior probability of infection in year y and PIntro y+1 is the probability of introduction in year y+1.
Scenario analysis
A scenario analysis was performed by running two "what-if" scenarios to evaluate the effect of changes in the input variables on the probability of freedom: i) The prior probability of infection was decreased from 0.5 to 0.2 to include prior knowledge of absence of human cases, ii) The design prevalence for foxes was decreased from 1% to 0.5% and 0.05%. These estimates reflect the lowest prevalence estimate found in the literature [43, 44] and 10% of the lowest reported prevalence in accordance with reasoning for the other species included in the study. Furthermore two "what-if" scenarios were run to evaluate the effect on the sensitivity of the surveillance system in the surveyed species: i) the sensitivity for dissection of rodents in Sweden was increased to Pert(0.8, 0.9, 0.99), i.e. the same as used for Finland, reflecting dissections performed by experts and ii) the probability of detecting EM lesions in pigs, the probability of submitting a suspected lesion to the laboratory and the probability of diagnosing a submitted sample at the laboratory was increased to Pert(0.4, 0.5, 0.6), Pert(0.8, 0.9, 0.99) and Pert(0.8, 0.9, 0.95) respectively. These values reflect what could be expected following the education of meat inspectors and assuming that all suspected lesions were tested with PCR.
Stochastic simulation
The model was developed using Excel 2007 (Microsoft Corporation, Redmond, WA, USA) and @RISK, (Palisade, Newfield, NY, USA). The model was run with 5000 iterations for each scenario.
Probability of freedom from EM
The cumulative probability of freedom from EM in December 2009 was high in all three countries, 0.98 (95% Credibility Interval 0.96-0.99) in Finland and 0.99 (0.97-0.995) in Sweden and 0.98 (0.95-0.99) in Norway. Results from the model indicate that the probability of freedom in Finland has been high since 2000, in Sweden since 2001 and in Norway since 2007 (Figure 3).
Surveillance system sensitivity
The estimated annual sensitivity of the surveillance system in Finland was high during the whole study period, in Sweden and Norway it was high from 2001 and 2007 respectively (Figure 3). In Finland surveillance in rodents was the component with the highest sensitivity followed by surveillance in foxes and raccoon dogs. In Sweden and Norway surveillance in foxes was the component with the highest sensitivity (Figure 4). The annual sensitivity of the surveillance system component for rodents during years 2005 to 2007 and raccoon dogs during years 2008 and 2009 in Sweden was approximately 0.2 (Figure 4A). The annual sensitivity for components domestic pigs and wild boars was below 0.01 in all countries except Sweden where the sensitivity in wild boars increased over the years from < 0.01 to 0.03 in 2009.
Scenario analysis
By reducing the prior probability of infection in the year 2000 to 0.2, the probability of freedom became slightly higher during the first years of the study period but it did not have any impact on the probability of freedom at the end of 2009. In Sweden the probability of freedom in 2000 increased from 0.53 (Figure 3A) to 0.82. In Norway, the probability of freedom between 2000 and 2006 varied between 0.47 - 0.66 (Figure 3C) and increased to 0.74 - 0.81 when using a lower prior probability of infection. For Finland and for the remaining years in Sweden and Norway, when the sensitivity of the surveillance systems as well as the probabilities of freedom were high (Figure 3), reducing the prior probability of infection did not have any major impact on the probability of freedom. When the design prevalence in foxes was decreased from 1% to 0.5% and 0.05%, the probability of freedom in 2009 decreased to 0.95 and 0.54 for Sweden and 0.90 and 0.35 for Norway while it remained at 0.98 in Finland. By increasing the sensitivity of the surveillance in rodents in Sweden to the same level as in Finland, the annual sensitivity of this surveillance system component increased from 0.20 to 0.88 in the period 2005 to 2007. Finally, increasing the overall sensitivity of meat inspection in pigs from 0.007 to 0.4 and in wild boars from 0.004 to 0.2 increased the annual sensitivity of the surveillance system component pigs and wild boars to approximately 0.3 and 0.85 in Sweden (Figure 5). In Finland and Norway it was low, < 0.2 and < 0.1 in pigs and wild boars.
The results of the model confirm that there is a very high probability that Sweden, Finland and mainland Norway are free from EM at the set design prevalences. Even though the surveillance differs between countries as seen in table 2, the most significant contribution to this conclusion originates from the surveillance of foxes in all three countries. However, in Finland the raccoon dog SSC and the vole SSC also had a very high sensitivity. This highlights that additional species to foxes and raccoon dogs as suggested in the EFSA report [16] can also be important in surveillance systems for EM. The sensitivity of pig SSC and wild boar SSC was low in all three countries. This is in contrast to Japan where meat inspection of pigs is considered highly informative to monitor the presence of EM [14]. However, when the sensitivity of meat inspection for pigs and wild boars was increased to 0.4 and 0.2 the annual sensitivity of these SSC s in Sweden increased up to approximately 0.3 and 0.8 respectively (Figure 5). This could be achieved by educating meat inspectors and laymen performing meat inspections in wild boars. Wild boars are especially interesting as they are more exposed to faeces from wild carnivores and reports from the literature show that lesions due to EM can be found in this species [21, 22]. In this study this was reflected by using a higher design prevalence in wild boars compared to pigs. Therefore, surveillance in wild boars might be valuable for documenting EM status in the areas were wild boars are present, i.e. in the southern half of Sweden, south of latitude 61°N and to some extent also in southeastern Finland where the small wild boar population is slowly increasing. In Norway, this mode of surveillance is not yet feasible due to very low numbers of wild boars in nature. As wild boar carcasses usually are inspected by laymen, it will be crucial to document their competence in identifying EM lesions for such a surveillance strategy to get international acceptance. The results of this study are based on many assumptions. When data from literature were lacking, estimates based on expert opinion has been used. To avoid over estimate of the probability of freedom, precaucionary estimates were often used. Therefore, it was concluded that the main results of this study would still be valid, although other experts may give different estimates.
The European Food Safety Authority's recommendations for a surveillance programme to document freedom from EM [16] are based on surveillance in foxes or raccoon dogs only. However, EM has a life cycle involving several species and the first reported detection of EM in a country has been both in the main hosts such as foxes and in intermediate hosts such as voles or humans [45]. In this study, information from several species was combined into one measure for the probability of freedom of the country. Thereby, when documenting disease freedom, the number of samples per species can be adjusted so that the most cost-efficient samples are collected.
In the present study the scenario analysis showed that lowering the prior probability of infection, reflecting absence of human cases of AE, increased the probability of freedom during the first years of the study period but it did not have any impact on the probability of freedom in 2009. However if the sensitivity of the surveillance system had been lower, the effect of using a lower prior can be expected to be higher. It was concluded that absence of cases of AE, given an efficient surveillance system and compulsory notification, is important when demonstrating freedom from EM.
The choice of design prevalence is a crucial part to demonstrate freedom from infection as a "higher" level of surveillance is needed to demonstrate freedom from infection at a lower design prevalence [15]. This relation was highlighted in the scenario analysis in the present study, showing that the probability of freedom decreased when the design prevalence in foxes was decreased. When defining the target design prevalences, international standards should preferably be used [15]. However, as the design prevalences used in standards vary greatly between diseases and as no standards for EM exist, a design prevalence of 1% for foxes or raccoon dogs as suggested by EFSA, was used in the present study [16]. It could however be questioned if the same design prevalence, as suggested in the EFSA report, should be used for foxes and raccoon dogs as the prevalence in raccoon dogs are reported to be lower compared to foxes [46–48]. However, the diet of raccoon dogs is highly variable and differs geographically [49]. In Finland, the proportion of mammals in their diets appears to be higher than in Germany and Lithuania [49] and voles as food are almost equally frequent for raccoon dogs as for foxes in Finland [50]. Consequently, the same P* was used for both canid species in this study. For the remaining species, the use of 10% of the lowest prevalence estimate found in literature can be regarded as a precautionary estimate based on expert opinion.
Although surveillance of disease occurrence in different species has been included in studies to document freedom [51], to the authors' knowledge, combining results of surveillance for one disease in a number of different species using separate design prevalences has not previously been used. However, more knowledge on the expected prevalences of EM in different species is necessary to optimize the surveillance when using surveillance data from several species to document disease freedom.
In our model, the annual probability of introduction and establishment of EM was assumed to be rather high in all three countries (Figure 3) which might seem to contradict the results of the study showing that all three countries most probably are free from EM. This might be explained by EM already being introduced and established, but at a prevalence below the design prevalence. If EM was introduced the geographical spread may be very slow as reported from Japan [14]. Another possible explanation is that the risk of introduction and establishment is overestimated. The probability of introduction and establishment is based on a risk assessment for EM introduction to Sweden [41]. The true number of dogs introduced is not known and the risk assessment uses a conservative estimate that may be too high. Furthermore, the report does not differentiate between animals imported and animals in transit, the latter probably constituting in a smaller risk of excreting eggs in the environment. No data were available on the risk of establishment given introduction of an infected canid. However, the estimate used in the study may be too high as dogs travel freely between other European countries and EM is not reported to be present in all these countries. It was therefore concluded that the estimated combined risk of introduction and establishment may be too high.
According to the EFSA report, the sample size needed to document freedom from EM infection, i.e. to detect a prevalence of 1% with 95% confidence [16], can be collected during a five-year period, without taking into account the risk of introduction. Therefore, the surveillance systems designs assessed in this study more than fulfills the recommendations provided by the EFSA.
Results indicate that there is a high probability that Sweden, Finland and mainland Norway were free from E. multilocularis by the end of 2009 based on surveillance results collected from January 2000 to December 2009. The study showed that the method described by Martin et al. could be successfully applied using surveillance data from several animal species to quantify the probability of disease freedom and to estimate the sensitivity of the surveillance systems. The scenario analyses showed that the choice of the design prevalences was important for the result and that more knowledge is needed on expected prevalences of E. multilocularis in infected populations of different species.
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Takahashi K, Mori C: [Host animals and prevalence of Echinococcus multilocularis in Hokkaido]. Public Health in Hokkaido. 2001, 27: 73-80. in Japanese
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Bruzinskaite R, Sarkunas M, Torgerson PR, Mathis A, Deplazes P: Echinococcosis in pigs and intestinal infection with Echinococcus spp. in dogs in southwestern Lithuania. Vet Parasitol. 2009, 160: 237-241. 10.1016/j.vetpar.2008.11.011.
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Sydler T, Mathis A, Deplazes P: Echinococcus multilocularis lesions in the livers of pigs kept outdoors in Switzerland. Eur J vet Pathol. 1998, 4: 43-46.
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Boucher JM, Hanosset R, Augot D, Bart JM, Morand M, Piarroux R, Pozet-Bouhier F, Losson B, Cliquet F: Detection of Echinococcus multilocularis in wild boars in France using PCR techniques against larval form. Vet Parasitol. 2005, 129: 259-266. 10.1016/j.vetpar.2004.09.021.
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Pfister T, Schad V, Schelling U, Lucius R, Frank W: Incomplete development of larval Echinococcus multilocularis (Cestoda: Taeniidae) in spontaneously infected wild boars. Parasitol Res. 1993, 79: 617-618. 10.1007/BF00932250.
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Eckert J, Schantz PM, Gasser RB, Torgerson PR, Bessonov AS, Movsessian SO, Thakur A, Grimm F, Nikogossian MA: Geographic distribution and prevalence. WHO/OIE Manual on Echinococcosis in Humans and Animals: a Public Health Problem of Global Concern. Edited by: Eckert J, Gemmell MA, F-X M, Pawłowski ZS. 2001, Paris: World Organisation for Animal Health, 101-143.
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Hofer S, Gloor S, Muller U, Mathis A, Hegglin D, Deplazes P: High prevalence of Echinococcus multilocularis in urban red foxes (Vulpes vulpes) and voles (Arvicola terrestris) in the city of Zurich, Switzerland. Parasitology. 2000, 120 (Pt 2): 135-142. 10.1017/S0031182099005351.
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Hanosset R, Saegerman C, Adant S, Massart L, Losson B: Echinococcus multilocularis in Belgium: prevalence in red foxes (Vulpes vulpes) and in different species of potential intermediate hosts. Vet Parasitol. 2008, 151: 212-217. 10.1016/j.vetpar.2007.09.024.
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Hadorn DC, Stärk KDC: Evaluation and optimization of surveillance systems for rare and emerging infectious diseases. Veterinary Research. 2008, 39: 57-10.1051/vetres:2008033.
The project was funded by the Nordic Council of Ministers, Nordic Working Group for Microbiology & Animal Health and Welfare, project number 2010-007. The authors would like to recognize the contribution of the National authorities, representatives of the industry in Sweden, Norway and Finland, Researcher Gert Olsson, and Prof. Åke Lundkvist for providing data. The authors would also like to recognize Prof. Peter Deplazes, Prof. Bruno Gottstein and Prof. Heikki Henttonen and Epidemiologist Jenny Frössling for valuable contributions to this paper.
Additional information
Competing interests
MC works at the Swedish Board of Agriculture and is involved in the negotiations at the EU level concerning pet import regulations. The other authors declare that they have no competing interest.
Authors' contributions
HW, NH, PH, MI and AW contributed to the design of the study. HW built the simulation model and performed the analysis. HW, MI, PH, GH, HU, RD and DC contributed with data to the model. All authors contributed with their expert knowledge to estimate input values to the model and also participated in writing the paper. All authors have approved the final manuscript.
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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Wahlström, H., Isomursu, M., Hallgren, G. et al. Combining information from surveys of several species to estimate the probability of freedom from Echinococcus multilocularis in Sweden, Finland and mainland Norway. Acta Vet Scand 53, 9 (2011). https://doi.org/10.1186/1751-0147-53-9
- Surveillance System
- Wild Boar
- Water Vole
- Common Vole
- Meat Inspection


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DJ John Entertainment
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GOLD DJmark Award Holders
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Other Local DJs
These members do not currently hold a DJmark Award, however they are working towards attaining one as soon as possible.
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Typical DJ Prices in Walsall
Firstly, a disclaimer. There are LOTS of mobile DJs and entertainment companies out there, mostly run by individuals - some as a part-time extension of their hobby and others as a full-time professional business. There are endless debates about pricing on DJ forums and social media groups, with some DJs happy to work for under £100 a night and others that "wouldn't load the van" for less than £500 for the same event. So there is a much wider range of pricing (and service level) than in many other industries, for example plumbers. There is no such thing as a 'standard DJ'!
However, many people have never booked a DJ before and have no idea when it comes to how much they should budget. So what we've done is look at the details for literally hundreds of events that have taken place in and around the Walsall area to come up with some guideline pricing showing typical rates for common types of event. We update these price ranges on a regular basis to reflect current trends.
The only sure way to get accurate prices is to request FREE DJ quotes for your Walsall party or event.
We costed DJs for a typical Wedding Reception in Walsall
This is for an evening-only event of 4/5 hours duration with no add-ons or extras. Just a DJ with his/her sound and lighting equipment.
|Budget DJ
|Mid-range DJ
|Premium DJ
|£150 - £188
|£188 - £296
|£296 - £440
We costed DJs for an ALL DAY Wedding in Walsall
This would typically include music for the ceremony, background music and microphones during the wedding breakfast, and an evening disco with no add-ons or extras. Just a DJ with his/her sound and lighting equipment.
|Budget DJ
|Mid-range DJ
|Premium DJ
|£225 - £300
|£300 - £470
|£470 - £670
We costed DJs for an Adult Evening Function in Walsall
Birthdays, anniversaries, engagements, social events, Christmas parties etc. come into this category. Prices are for an evening disco with no add-ons or extras. Just a DJ with his/her sound and lighting equipment.
|Budget DJ
|Mid-range DJ
|Premium DJ
|£125 - £174
|£174 - £262
|£262 - £460
We costed DJs for a Children's Party in Walsall
This would usually be a weekend afternoon or weekday evening event lasting 2/3 hours. Prices are for a disco with no add-ons or extras. Just a DJ with his/her sound and lighting equipment.
|Budget DJ
|Mid-range DJ
|Premium DJ
|£100 - £161
|£161 - £233
|£233 - £290
What type of DJ is right for my party?
You can expect a low-cost DJ in Walsall to attend your function with a basic sound rig, often just a couple of entry-level speakers to provide sound for the dancefloor, and a small selection of lighting effects working in "sound-to-light" mode - ie. flashing different colours in time to the beat. You can expect limited interaction with your Budget DJ prior to the party. Most will accept some music requests on the night but will be working with a fairly limited music collection.
Many Budget DJs are part-time operators working to supplement other income. As such they are usually a good choice for low-cost venues such as pubs and village halls, and events such as 18th birthday parties and engagements.
A mid-range DJ will likely have a choice of equipment which will be selected to best suit your function and venue, and might offer some level of control over the lighting to keep it synchronised and befitting of the music style playing. They will usually offer a consultation in advance and be skilled enough to "hold the function together" on the night, continually thinking and planning ahead to make the event go smoothly. You can expect smart dress, good levels of presentation and confident microphone skills.
Many mid-range DJs are full-time businesses who can devote time to forward planning for your party in Walsall, as well as offering a range of add-on services. Lots of mid-priced DJs will be members of organisations such as DJmark giving you confidence in their service. This means they will hold Public Liability Insurance, have regularly safety tests undertaken on their electrical equipment ("PAT"), and will issue contracts for bookings. They will also be able to provide consistently good feedback from former clients.
A premium DJ is most likely to work with you in advance to plan all aspects of the event, from equipment and lighting needs through to music preferences, announcements, key timings and the structure of the party. They will be willing to work with other entertainment providers and the venue management to avoid any unnecessary "surprises". They possess the experience and skills to ensure meticulous planning and preparation befitting of their fee, and will be smartly presented on the day to suit your function.
The perfect choice for an important event such as a wedding reception or corporate gathering, premium DJs will be able to confidently lead your celebration. Generally run as full-time businesses, Premium DJs operating in the Walsall area are most likely to offer an impeccable feedback record and have attained DJmark Platinum or Diamond level - demonstrating their commitment to customer service.
Check out our Top 10 mobile discos in Walsall based on customer feedback!
Venues for hire in and around Walsall
Are you looking for a suitable venue to hire in or around Walsall? Our DJs have played at hundreds of local pubs, clubs, community centres, village halls, hotels and more.
Here's a summary list of function rooms local to Walsall - for full details click on any venue name!
0 in Walsall / 3 nearby
Nearby (3 options)
Oak Farm Hotel, Cannock WS11
Ramada Birmingham North, Cannock WS11
Roman Way Hotel, Cannock WS11
2 in Walsall / 7 nearby
in Walsall (WS6 - 2 options) - More Details
Cheslyn Hay Village Hall, Pinfold Lane, Cheslyn Hay
Great Wyrley Community Centre, Landywood Lane, Great Wyrley
Nearby (7 options)
Blakenall Community Centre, Walsall WS3
Calf Heath Village Hall, Wolverhampton WV10
Essington Community Centre, Wolverhampton WV11
Featherstone & Hilton Community Centre, Wolverhampton WV10
Pelsall Community Centre, Walsall WS3
Shareshill Village Hall, Wolverhampton WV10
The Hub at Ashmore Park, Wolverhampton WV11
5 in Walsall / 39 nearby
in Walsall (WS6 - 5 options) - More Details
Cheslyn Hay Working Mens Club, Station Street, Cheslyn Hay
Great Wyrley Football Club, Hazel Lane
Great Wyrley Sports & Social Club, 343 Walsall Road
Harrisons Sports & Social Club, Wharwell Lane
Hawkins Social Club, Coppice Lane, Cheslyn Hay
Nearby (39 options)
Bloxwich Cricket Club, Walsall WS3
Bloxwich Golf Club, Walsall WS3
Bloxwich Memorial Club, Walsall WS3
Bridgetown Social Club, Cannock WS11
Cannock Conservative Club, Cannock WS11
Cannock Cricket & Hockey Club (Chase Park), Cannock WS11
Chadsmoor Progressive WMC, Cannock WS11
Chase Park, Cannock WS11
Colebatchs Club, Walsall WS3
Corpus Christi Social Centre, Wolverhampton WV11
ECC Sports & Social Club, Wolverhampton WV10
Edward Street Working Mens Club, Cannock WS11
Essington Broad Lane Club (WMC)(S&S), Wolverhampton WV11
Essington Rugby Club, Wolverhampton WV11
Essington Working Mens Club, Wolverhampton WV11
Fishley Park Leisure Centre, Walsall WS3
Greenfield Golf Club, Wolverhampton WV10
Grosvenor Park Football Club (Bloxwich United)(Ex Blakenall), Walsall WS3
Gunners Club, Walsall WS3
Lido Working Mens Club, Cannock WS11
London Midland Railway Club, Wolverhampton WV10
Longford Social Club, Cannock WS11
Old Hall Snooker Club, Walsall WS3
Oxley Park Golf Club, Wolverhampton WV10
Pelsall Cricket & Sports Club, Walsall WS3
Pelsall Labour Club, Walsall WS3
Polish Community Centre (Club), Wolverhampton WV10
Royal British Legion Bloxwich, Walsall WS3
Royal British Legion Cannock, Cannock WS11
Royal British Legion Wednesfield, Wolverhampton WV11
St Marys Social Club, Cannock WS11
The Pavilion Sports & Social Club (Goodyear Pavilion), Wolverhampton WV10
Victoria Club, Cannock WS11
Wednesfield Football Club, Wolverhampton WV11
Willenhall Rugby Club, Wolverhampton WV11
Windsor Unionist Club, Wolverhampton WV10
Wolverhampton United Football Club - Events, Wolverhampton WV11
Wyrley Juniors Football Club, Wolverhampton WV11
Yates Sports & Social Club, Walsall WS3
0 in Walsall / 3 nearby
Nearby (3 options)
Avon Business & Leisure Centre, Cannock WS11
Grand Station, Wolverhampton WV10
The Premier Suite, Cannock WS11
10 in Walsall / 66 nearby
in Walsall (WS6 - 10 options) - More Details
Old Wyrley Hall, Olde Hall Lane, Great Wyrley
The Colliers Arms, High Street, Cheslyn Hay
The Ivy House, Stafford Road, Great Wyrley
The Malt at Landywood, Holly Lane, Great Wyrley
The Mary Rose, Moons Lane, Cheslyn Hay
The Masons Bar & Restaurant, Stafford Rd
The New Talbot, Low Street, Cheslyn Hay
The Wheatsheaf, Walsall Road, Great Wyrley
The White Horse, Mount Pleasant
Wolfies Bar, Hazel Lane, Great Wyrley
Nearby (66 options)
Berry Brook Farm, Wolverhampton WV10
Moseley Park, Wolverhampton WV10
The Anchor Inn, Wolverhampton WV10
The Ascot Tavern, Cannock WS11
The Ashmore, Wolverhampton WV11
The Beacon Way, Walsall WS3
The Bloxwich Showman, Walsall WS3
The Bluebrick, Wolverhampton WV10
The Bridge Inn, Cannock WS11
The Chase Gate, Cannock WS11
The Dog & Partridge, Wolverhampton WV10
The Dog & Partridge, Wolverhampton WV11
The Duck at Chadsmoor, Cannock WS11
The Elms, Wolverhampton WV10
The Gatehouse, Wolverhampton WV10
The Golden Lion, Wolverhampton WV10
The Great Western, Wolverhampton WV10
The Green Rock Tavern, Walsall WS3
The Harrowby Arms, Wolverhampton WV10
The Hatherton Arms, Walsall WS3
The Jolly Collier, Cannock WS11
The Jubilee Inn, Cannock WS11
The Kings Head, Walsall WS3
The Lady Diana, Walsall WS3
The Linford Arms, Cannock WS11
The Linthouse Inn, Wolverhampton WV11
The Longford House, Cannock WS11
The Longford House, Cannock WS11
The Mill Farm, Cannock WS11
The Mill House, Wolverhampton WV10
The Minerva Inn, Wolverhampton WV11
The Moreton Arms, Wolverhampton WV10
The Moseley Park, Wolverhampton WV10
The Nest, Cannock WS11
The Nickelodeon, Wolverhampton WV11
The Old House At Home, Walsall WS3
The One Man And His Dog, Walsall WS3
The Orbital, Cannock WS11
The Otter & Vixen, Wolverhampton WV10
The Prince Of Wales, Walsall WS3
The Pyle Cock, Wolverhampton WV11
The Queens, Walsall WS3
The Queens Head, Walsall WS3
The Red White & Blue, Wolverhampton WV10
The Robin Hood, Cannock WS11
The Romping Cat, Walsall WS3
The Royal Oak, Cannock WS11
The Royal Tiger, Wolverhampton WV11
The Saddlers Arms, Walsall WS3
The Shed, Wolverhampton WV10
The Sir Robert Peel, Walsall WS3
The Sneyd, Walsall WS3
The Spotted Cow, Walsall WS3
The Spread Eagle, Wolverhampton WV11
The Spring Cottage, Walsall WS3
The Talisman, Wolverhampton WV10
The True Briton, Wolverhampton WV11
The Tumbledown Farm (Ego), Cannock WS11
The Victoria, Walsall WS3
The Village Inn, Wolverhampton WV11
The Wheatsheaf, Walsall WS3
The White Hart, Cannock WS11
The White Lion, Cannock WS11
The Why Not Inn, Wolverhampton WV11
The Yew Tree, Cannock WS11
Vinnys Bar , Cannock WS11
Walsall DJ Booking Tips
For many, their choice of DJ for parties in Walsall will make a dramatic difference to the success of their event - in a lot of cases possibly one of the most important (and expensive) days of their lives. For others, where the music is just incidental, a basic service is often all they need.
The biggest deciding factor in ensuring the quality of the DJ service that you hire in Walsall, Cheslyn Hay, Great Wyrley is usually the budget. We urge you to consider this very carefully as an overall percentage of the cost of your event. Don't shop for a DJ in Calstock - Gunnislake purely on price, because many affordable yet experienced DJs will actively avoid clients that appear not to value the service and focus only on cost. Instead, shop around on the suitability, reputation and level of service being offered - then, once you have a shortlist of suitable DJs you can then review the pricing.
Many review platforms such as Facebook and Google accept "reviews" from ANYONE whether or not they've actually used the service - including the DJ, the DJ's partner, the DJ's friends, the DJ's dog...
needadisco.com reviews can only be submitted by clients that have used the service including people like you partying in Walsall. We do not accept random reviews. We also think that reviews can go out of date quite quickly, so we do not count reviews that are more than 3 years old to be sure that you're getting an up-to-date picture. Also, our Walsall discos are clearly ranked on specific criteria such as audio quality, lighting quality, presentation, music choices, request handling, microphone use, audience interaction and more, so that you can quickly compare local DJ services.
All DJmark Award holding DJs in Walsall operate legally and with due regard for excellent customer service.
DJmark is the longest established and most rigorous awarding body for the UK mobile disco industry, working with mobile DJs to independently check paperwork, credentials and customer feedback. If you employ a DJmark Award holding DJ for your wedding or party in Walsall, you can be assured that you will be working with "one of the good guys". Learn more about DJmark and how booking an award holder can save you a lot of time and potential stress for your party in Walsall.
Be very clear about your expectations for the event and TALK to your potential DJ about them. Don't be afraid to walk away if you're not confident in his/her abilities to deliver.
Do you want a straightforward 'same-as-everyone-else' mobile disco or are you looking for something a little different? Are you looking for a Walsall DJ who can rapidly switch genres to suit the guests ... or would you prefer a club-style DJ with a predetermined set and excellent beatmatching skills? Would you be happy with a silent DJ or would you like someone with microphone skills and the right presence to confidently make announcements and keep your guests informed?
DJ Hire FAQs for events in Walsall
needadisco.com has been helping arrange DJs and mobile discos for parties being held in Walsall since 2006. In that time we've confirmed more than 60,000 events and our DJ members have accrued positive feedback in 99.96% of cases. If you are thinking of hiring a DJ click the button below to get rapid free quotes from a selection of available companies, or read our FAQs.
|Who are the best mobile DJs in Walsall?
needadisco.com used various methods to rate the quality and safety of the mobile DJs and disco companies that it recommends. We not only look at customer feedback but also their documentation such as insurance, electrical testing records, approach to health & safety and many more aspects. In our opinion, the best mobile DJs available to hire for weddings, parties and events in Walsall are:
- The Specialist Wedding DJ
- Atmosphere Roadshow
- PC Roadshows Entertainments
- Suburban Sounds
- Dynamix Disco
|How can I find a reliable DJ in Walsall?
Easy - just request quotes from needadisco.com and our experienced mobile disco members will be in touch with free quotations and more information about their service. There's no obligation to book and you can close your enquiry at any time.
needadisco.com has hundreds of safety and quality checked DJs available for all types of events being held in Walsall - weddings, birthdays, socials, children's parties, school discos, corporate events - you name it!
|How much should I expect to pay for a Walsall DJ?
For an entry level DJ you can expect to pay anything from £150 upwards for a small evening function. A more realistic amount if you are looking for an experienced DJ with a good standard of audio and lighting equipment and positive feedback from recent customers would be in the region of £188 - £296 for an evening event. If you are looking for a professional DJ with an impeccable and long-standing feedback record for an important event such as a wedding reception you can easily add another 50-100% to these amounts.
Remember - for most parties the DJ is the one aspect that will be remembered long after the cake, buffet or wedding dress - and you really want it to be for the right reasons!
|I'm having a party in Walsall and I've never booked a DJ before!
needadisco.com makes it really easy for you to find a suitable mobile DJ for your party. Simply provide a few details about your plans and let our members contact you with further information about what they can offer and a quotation. Then you can pick the one you like the sound of and book them directly. There's no middlemen agencies involved and no commission to pay.
We have DJs based in Walsall and the surrounding areas willing to travel.
|What other party services do you provide in Walsall?
Many of our DJs also offer other popular party services - such as dancefloor hire, photo booths, LOVE letters, and some even provide photography, catering, venue decoration, bouncy castle hire and much more!
You can request quotes for any or all of these products and services and choose your favourites in your own time.


text:
Most counselors, psychologists and psychiatrists agree that until a person either admits they have a problem or they hit "rock bottom" no one is able to help that person; the consensus, as well, is, if a person has even one person that they have convinced that they do not have a problem (the term is triangulated), then the person most likely will not "hit rock bottom." Our Hope is that the girl realizes that she is a sinner and will come to a Saving Knowledge of Our Lord Jesus Christ.
When the girls come in they do not feel they have any problems, it is their parents, their siblings, and everyone else who have the problems; one girl stated that she was FINE with the way her life had been at home. Her parents, on the other hand were NOT fine with the way things had been at home. The hope is that she will realize that she has a problem and she needs to change this behavior, many parents share how they have tried "everything": grounding, disciplining, counseling (secular and Christian), medications, grounding, homeschooling, involvement with the law, psychiatric hospitals/facilities, living with friends or other family members, etc., all to no avail. The parents do not know what to do, they cannot live "as prisoners in their own homes," cannot get help that works, and cannot continue to live in fear for themselves, their daughter, or their other children; they hope to help the girl make changes that will enable her to live a successful life and become a productive member of society.
When a girl arrives there is a period of adjustment, which we call the "honeymoon period," where she usually complies and gives us very few problems, this can last from a few hours to months. After the girl "settles in," whether it is because she is comfortable with us, or she realizes that her parents will not come and remove her immediately, things change drastically, all of the behaviors she exhibited at home come out, and we see the "real" girl. We then try to work with her, showing her how her behavior is destructive, that she did these same things at home, pointing her to ways that will help her, unfortunately, many times, they do not want to change the behavior or still want to blame others, this time it is us, or the other girls.
"Fake it until you make it" used to be the motto spoken amongst themselves, we have not heard them say it but have watched them perform it. Many times they profess to get saved, or they start "complying" but when they see it does not make them "happy" or get them something, they want they stop. They are "doing good" because they have a true heart change, they are "doing good" to manipulate and get their way. Many times their parents will contact us and tell us that they or daughter is reverting back to her old patterns; they will say something like: I can see "that" look, or "that" action, I can "hear" "that" tone, usually followed by: this is what is coming next. The girl gets angry at us, and tells us that WE are causing her to do this, even though this is what she always does. Recently, one parent stated "if she would just comply her life would be so much better. This behavior will get her nowhere in life."
When the girl never believes that her actions and behaviors are hers or are a problem she sees no need to change. Some of the times
The behaviors which caused the parents to make this decision include, but are not limited to:
Refusing to do their school work
Violence at home and/or school
Refusing to do anything they are told
Threatening family members
Gang affiliations
Starting drugs
Smoking, drinking, boys
Lie about their parents to school personnel and to Government officials
Lying about boys doing things to them, especially when the girl gets caught
Triangulating one parent against another, or someone else against their parents
We have hesitated sharing the backgrounds of the girls we take in, because our hope and prayer is that they will change, and that their past will not be their present and future. We realize that we must share them as discreetly as we can so that their present behavior might be understood.
Backgrounds of some of the girls:
One girl had made sexual allegations against her step-father, he was found guilty and was not allowed to be around young people; he had been the coach for her brother's sports teams, now he could not do this. The girl's father and step-mother took the young lady and the girl would never be allowed to live in the mother's home, again. At the father's home, which was nowhere near the mother's home, the girl found the same type of friends and started exhibiting the same behavior, lying, stealing, smoking, and staying out all night. Dad tried everything to help his daughter, to no avail. She came to us.
While with us, the girl showed improvement, although there were areas of concern as well. One time she shared that she no longer smoked cigarettes, we looked at her and said "of course not! You don't have ACCESS to cigarettes or drugs." One time she had been taken off of sweets for one week, she was caught putting several teaspoons of sugar in her coffee, when no one was watching; we explained to her mother that she still desires what she should not have, such as drugs. Luke 11:24-26 explains this, if a person "cleans up their life" but does not fill it with the Bible, and good things, they will be worse than they were before they "cleaned up their life."
After being with us for over a year, it appeared that the young lady had changed her behavior, and her father and step-mother thought they had safe-guards in place, to keep the girl away from her bad behaviors. They would take her to church, and drop her off, she would go in the front door, walk through the foyer, and go out the back door to meet her friends and smoke and do drugs; they found this out when they went back to pick her up after church one day and she was not there.
They brought her back to the ranch, and just a few weeks before she was to graduate she walked off of the property. She apologized later and asked to be allowed to come back and finish her school. She did not carry through on this.
She loved working with the horses and had such a fun personality. She was always making us laugh, and pulling pranks on us.
This girl was younger, when her parents called us. They said she refused to do anything she was told, was not doing her school work, and was out of control. She gave us problems from the minute she arrived; as with the others, it was never her fault. She immediately started triangulating with her parents and Circle of Hope Girls Ranch, and it was working, her step-mother always felt bad for her, and would reassure her that she knew that she hadn't done anything wrong. yet, when we spoke with her, she informed us that she knew that the girl was doing exactly what she did at home, what caused them to have to make the decision to send her to us. Unfortunately, this was hurting the young lady, and was causing her to become bitter and angry, because she felt we were lying to her. We often see a pattern of enabling behavior with parents, they hope they can appease their child into doing what is right, unfortunately this leads to the child becoming more bitter and angry. They feel they are never wrong, and when a consequence comes, they are a victim. Her parents proved to be less than honest with us, as well. It was sad to watch this young girl triangulate so well.
Such a pretty, sweet-looking and sounding, young lady. She was good at playing the victim, then she got caught breaking her parents rules and earned some consequences that she did not like. When she got to school she told her school counselor that her step-mother abused her. CPS showed up at the school and spoke with her, her step-mother was cleared and they contacted us. Whenever a situation came up, where the girl was wrong, she always made it appear that the "other girls were out to get her." She went home and appeared to do well, she had struggles, which is to be expected, but counseled with her Pastor. Within a year the girl had gotten in with the wrong crowd, started doing drugs, as soon as she was caught she started blaming everyone.
This young lady had been causing problems at home for quite awhile, but her parents thought they could weather the storm, until one day her father, who was a well known detective, was confronted at work about his abuse of his daughter. She had gone to school and showed a counselor "the bruises that she had on her body from her father's beating." A nurse had enough common sense to use alcohol on the "bruises" and found out it was make-up, which the girl had learned how to apply in drama class. The young lady eventually went home, and appeared to integrate back into the family, but shortly afterward, the bottom fell out and she went straight back to her old ways.
We have had many young ladies brought to us from other facilities. The girls were determined to get kicked out, and they did. Many times the Director of the other facility calls and asks us to consider taking the girl, because the parents have no idea what to do, but the facility has reached the end of their resources for the girl. Some run away from the facility on a regular basis, some are abusive to the staff, some have abused younger girls while there, while others are flat-out rebellious and refuse to do anything they are told, all of them cause chaos which affects the other residents and the staff.
One of these girls stands out, she was transported here, and was so angry and violent that she bit the person who was transporting her on the leg. She caused disruption here, refusing to do as she was told, finding ways to disrupt everyday activities. After awhile, she realized that this was not working, and she settled down. Several months later the transporter brought a different girl, and inquired about her, she spoke to him and apologized for biting him. She shared how thankful she was that she was safe.
She had such a beautiful smile that would light up the room, and she would laugh at the silliest things.
When she left, she had nothing but praises and thanks for us and plans for a bright future. We are not sure what happened, but she has since joined with the choir of voices accusing us and attacking us.
A desperate call of help from an Aunt who adopted her niece; the girl had multiple police and CPS interactions. These ranged from making allegations against her mom to physical assault against her peers. Her mom was afraid that she was going to lose her job, because she was constantly having to leave work to bail her daughter out of trouble. She was so concerned that her daughter would finally do something that would cause her to be arrested.
The girl loved sports, softball was her favorite and she really enjoyed being around the horses; her laugh was infectious and her eyes sparkled.
It was such a sad day when she decided to run away because she did not think she was going home; the saddest part was she would be leaving in a few weeks. She had just had a visit and her mom and step-father were in the process of finalizing all of the plans to take her home. It hurts when they run away, thinking it makes it easier on them, then they make up lies to the authorities, to scare their parents into taking them home. However, on their visit they praise Circle of Hope Girls Ranch and the staff for changing their life.


text:
Disciplined Repeatable Rules-Based Process
The Managed Risk Fund strategy is composed of 3 components, designed to work together to weather any market environment in a systematic way:
•a long position in the SPY ETF (S&P500 index)
•a long position in a SPY leap put option
•a short strangle with SPY, adjusted on a monthly basis
- During a strong bull market, the long SPY portion of the portfolio generates the bulk of the returns, while the leap put's loss of value is hedged by the short strangle.
- During a strong bear market, the exponential gain of the leap put covers the linear loss of the SPY ETF, and then some.
- During a sideways market like 2011, the SPY position and the leap put neutralize each other, but then the short strangle generates income.


text:
Hime-sama Love Life! - Episode: 4/?
Other name: Princess Love Life!; 姫様LOVEライフ!; 공주님 Love 라이프
Genres: 1080pAnalBased Visual NovelBig BoobsBikiniBlow JobsBoob JobsCosplayHand JobsHaremMaidNakadashiNTR (Netorare)PlotSchool GirlsSwimsuitVirgin
Studios: PoRO
Fansub: HAnime
Cen?: Censored
Status: Ongoing
Views: 31823 Total Fap: 3 Login to Bookmark
Yahiro is enjoying his life with his girlfriend Maika. She is usually very bitchy, but after a bit of prying, she is really just an obedient slut. Seeing her like that, Yahiro decides to take advantage.
"You know, it feels good in the ass too."
Surprised Maika responds and says
"You freaking pervert trash."
She complains, but Yahiro reaches for her legs as she gets smaller and smaller from fear. This only makes Yahiro more aroused…
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