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Health care burden and mortality of acute on chronic liver failure in Thailand: a nationwide population-based cohort study
Sakkarin Chirapongsathorn ORCID: orcid.org/0000-0001-6924-85041,
Kittiyod Poovorawan2,
Ngamphol Soonthornworasiri3,
Wirichada Pan-ngum3,
Amnart Chaiprasert4,
Kamthorn Phaosawasdi5 &
Sombat Treeprasertsuk6
Accurate population-based data are required concerning the rate, economic impact, and long-term outcome from acute on chronic liver failures (ACLF) in hospitalized patients with cirrhosis.
We aimed to discover time trends for the epidemiology, economic burden, and mortality of ACLF in Thailand.
We conducted a nationwide, population-based, cohort study which involved all hospitalized patients with cirrhosis in Thailand during the period between 2009 and 2013, with data from the National Health Security Office. ACLF was defined by two or more extrahepatic organ failures in patients with cirrhosis. Primary outcomes were trends in hospitalizations, hospital costs, together with inpatient mortality.
The number of ACLF hospitalizations in Thailand doubled between 3185 in 2009 and 7666 in 2013. The average cost of each ACLF hospitalization was 3.5-fold higher than for cirrhosis ($ 1893 versus $ 519). The hospital is paid using a diagnosis-related group (DRG) payment system that is only 15% of the average treatment costs ($ 286 from $ 1893). The in-hospital fatality rate was 51% for ACLF while the additional fatality rate was 85% up to 1 year. The ACLF organ failure trends indicated sepsis with septic shock and renal failure as the majority proportion. Age, the number and types of organ failure and male sex were predictors of ACLF death.
Conclusions and relevance
Cirrhosis and ACLF both represent substantial and increasing health and economic burdens for Thailand. These data can assist national health care policy stakeholders to target high-risk patients with cirrhosis for care.
Acute and chronic liver diseases not only affect costs but are a burden to the worldwide health care system [1]. All chronic liver diseases show progression to cirrhosis over time, and this is a late stage of liver fibrosis which causes various complications that significantly increase mortality rates. Global cirrhosis deaths are estimated to be greater than 1.3 million per year [2]. Cirrhosis also impacts health care costs due to the need of highly specialized care with significant resource utilization for management of complications including intensive care [3]. Hospitalized patients cause an increasing economic burden with more admissions, and readmissions resulting in longer hospital stays especially for decompensated cirrhosis [3, 4].
Although there have been evidence-based quality improvements in cirrhotic care, in decompensated cirrhosis hospital patients mortality rate has remained high [5]. Among hospitalized patients with cirrhosis, those who progress to acute on chronic liver failure (ACLF) experience rapid multi-organ deteriorations resulting in high risk of mortality while consuming high intensive care resources. ACLF is a frequent complication in hospitalized patients with cirrhosis, leading to high short-term mortality risk [6, 7]. Recent studies have reported high short-term (28-day to 30-day) mortality in patients with ACLF. Although, short-term mortality rate can vary from 22 to 73%, this depends on the number of failed organs, geographic location, and definition used by Western experts (US and Europe) and Asian countries for diagnosing ACLF [7,8,9]. Epidemiological ACLF data are heterogeneous which are difficult to compare. Efforts have tried to understand ACLF's natural history and homogenies in order to compare the current evidence, which includes prevalence, pathogenesis of disease, precipitating factors, and outcomes. Furthermore, ACLF's health care burden and economic impact have not been thoroughly assessed. Knowledge of disease burden using correct population-based data are required for public health policy planning assessment and resource assignment.
Our primary objective for this study, was estimation of the number of hospitalizations, together with associated costs and economic impacts, and patients with ACLF' mortality between 2009 and 2013 in Thailand, using the database of the National Health Security Office. The secondary objectives were to investigate patient and liver disease characteristics which dominate markings of ACLF health care use and identification of the number and types of organ failure causing inpatient mortality.
All patient required data were resourced from the National Health Security Office. Data were extracted from national inpatient databases between 2009 and 2013 which included all stakeholders under the Thai Ministry of Public Health that incorporated representative administrative data sets with total population of 49.1 million. The databases included those resourced from nationwide hospitalizations. The National Health Security Office database comprised 28,294,685 individual patient discharge records between 2009 and 2013. Each record included a primary as well as other secondary discharge diagnoses, demographic data, procedure codes, mortality status, hospitalized inpatient mortalities, and various other data concerning the hospitals such as location. Each data set observation was an individual hospitalization episode which included admission of a patient and ended with discharge or mortality.
Cohort selection
Hospitalized patients with cirrhosis were identified using one or more of these: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes: spontaneous bacterial peritonitis K65.2, alcoholic cirrhosis K70.30, esophageal varices without bleeding I85.00, esophageal varices with bleeding I85.01, varices in diseases classified elsewhere with/without bleeding I85.10, I85.11, hepatorenal syndrome K76.7, cirrhosis of liver without mention of alcohol K74.0, and hepatic encephalopathy K72.90, K72.91. We tested validity of the ICD-10, World Health Organization (WHO) Version for 2016 codes with an administrative database from Phramongkutklao Hospital by using a medical-linked system on the hospital database (using 100 randomly selected medical records) to identify patients. This set of ICD-10 codes, from the WHO Version for 2016 identified patients with cirrhosis with high accuracy (sensitivity 92% and specificity 94%). Ascites (R18.8) did not change the accuracy of cirrhosis diagnosis [4, 10]. Other exposure variables included age, hospital size, sex, and geographic location within the country. Mortality rate was retrieved from the death certificate database. ACLF was defined by at least two extrahepatic organ failures (cardiovascular, renal, respiratory, or cerebral) in patients with cirrhosis. Since our database had no laboratory data, this definition was selected to mirror ACLF grade 1 following the CANONIC (CLIF Acute on Chronic Liver Failure in Cirrhosis) study criteria and to connote the significantly higher mortality rate as shown by the North American Consortium for Study of End-stage Liver Disease [7]. ACLF hospitalizations were identified by using any one of these ICD-10-CM diagnoses which were from two different organ system groups: pulmonary artery/wedge pressure, arterial line, cardiovascular failure defined by using codes for central venous pressure, septic shock, severe sepsis; renal failure defined by using codes for hemodialysis, acute kidney failure; respiratory failure defined by using codes for mechanical ventilation; and cerebral failure defined by using codes for hepatic coma [11]. The diagnostic codes related to these diagnoses are summarized in Supporting Table S1 [4, 10, 11].
Ethical consideration
This study was done with approval from The Gastroenterological Association of Thailand in collaboration with The National Health Security Office, Thailand. The research protocol was approved by the Institutional Review Board, Faculty of Tropical Medicine, Mahidol University (MUTM 2014-056-01).
Data were analyzed using SPSS Statistics (IBM, Armonk, NY). Once all the cirrhosis and ACLF hospitalizations were identified, the suitable statistical procedures were used to compute nationwide estimates of inpatient health care costs, the number of hospitalizations, inpatient fatalities and survival status. Data were summarized as median (interquartile range) or mean (range) for continuous outcomes or as counts and percentages for categorical outcomes. Normal distributions were checked by visual inspection. Wilcoxon rank sum tests were used for continuous data and chi-square or Fisher exact tests were used for categorical data to ascertain differences between groups. Two-tailed P values were reported, with P less than 0.05 considered as statistically significant. The C statistic was computed for the discriminatory model performance using significant univariate and important clinical variables, which were then incorporated into the multivariate model. Cost was estimated with inflation-adjusted to 2020 Thai Baht currency based on cost-to-charge ratios from the Diagnosis-related Group (DRG), an essential payment method in universal healthcare coverage, of the Universal Coverage Scheme's reimbursement system. DRG is the inpatient prospective payment system which categorizes hospitalization costs to determine how much to pay. Secondary outcomes included number and types of organ failure as in-hospital death predictors for an ACLF hospitalization.
Characteristics of cirrhosis and ACLF hospitalization
The number of cirrhosis hospitalizations had increased every year from 2009 (n = 45,015) to 2013 (n = 58,113). Nearly a half of those hospitalizations were for alcohol-associated cirrhosis (48.6%) and the proportion for spontaneous bacterial peritonitis involvement was 29.2% of total hospitalizations. Among every discharge, the proportion who met the ACLF criteria increased almost double between 7.1% (n = 3185) in 2009 and 13.2% (n = 7666) in 2013. During the timeline of ACLF, there were no significant changes concerning patient characteristics comprising age, sex, hospital level as well as geographic distribution on hospitalized cirrhosis and patients with ACLF.
Table 1 shows the patient demographic and disease characteristics of discharges which met the study inclusion criteria between 2009 and 2013.
Table 1 Demographic and disease characteristics of hospitalized patients with cirrhosis and ACLF between 2009 and 2013
We identified 22,950 patients with ACLF who satisfied study inclusion criteria. Overall, most patients with ACLF were admitted in Northeastern and Central regions of Thailand, 10.8% were community hospital admissions (less than 120 beds), 37.8% were intermediate-level hospital admissions (121-500 beds) and 51.4% were referral hospital admissions (more than 500 beds). The mean age was 54 years, 67% were male, and 100% were Asian (Thai descent). The most common cirrhosis complication leading to hospitalization documented was spontaneous bacterial peritonitis, and this was followed by hepatic encephalopathy. The period of hospital stay remained fairly constant from 2009 to 2013, which was higher for ACLF (9 days) in comparison with cirrhosis without ACLF (4 days). Table 2 illustrates the characteristics of ACLF patients hospitalized compared with those with cirrhosis.
Table 2 Characteristics of patients hospitalized with ACLF versus cirrhosis without ACLF
There were no differences found in age and sex between ACLF and cirrhosis.
Sepsis and septic shock were substantial trends within factors related to ACLF, which remarkably increased the proportion of septic shock from 2012 to 2013 (28.2% in 2009, 27% in 2010, 26.2% in 2011 to 39.2% in 2012 and 58.3% in 2013).
The proportion and type of organ failure in ACLF remained notably constant throughout the study period, while respiratory failure averaged 70% and renal failure averaged 58.4%. Among renal failure patients, approximately 7.2% received hemodialysis and 3% received peritoneal dialysis. Overall, 77.4% had two organ failures, 19.3% had three organ failures, and 3.1% had four organ failures.
Outcomes of cirrhosis and ACLF hospitalization
The in-hospital mortality rate was 51.7%. The 30-day mortality rate was nearly equal between 67.9% in 2009 and 68.3% in 2013 for ACLF and between 32.1% in 2009 and 31.7% in 2013 for cirrhosis. The 90-day mortality rate also was almost equal between 74.1% in 2009 and 75.1% in 2013 for ACLF and between 25.9% in 2009 and 24.9% in 2013. Throughout the study period, we found the mortality rate was 85.6% for ACLF. Sepsis and bacterial infection were the most common causes of mortality, followed by liver-related death and hepatocellular carcinoma in ACLF. Readmission rate among ACLF was only 3.4% and 30-day readmission rate was just 1%.
Table 3 represents predictors of 30-day mortality in ACLF, including age (hazard ratio [HR], 1.014; 95% confidence interval [CI]: 1.013-1.015), and male sex (HR, 1.075; 95% CI 1.056-1.095).
Table 3 Determinants of 30-day mortality in ACLF by multivariate analysis
Compared with patients, who were admitted to a community hospital, risk of death in patients admitted to an intermediate-level hospital (HR, 1.325; 95% CI 1.297-1.354) and a referral hospital (HR, 1.255; 95% CI 1.227-1.283) were significantly higher. As anticipated, the risk of death in patients with three organ failures (HR, 5.416; 95% CI 5.215-5.624) and four organ failures (HR, 6.277; 95% CI 5.331-7.391) were significantly higher compared with patients with no, one, or two organ failures. Among patients with two organ failures, respiratory together with renal failure showed the highest risk of death (HR, 5.436; 95% CI 5.271-5.605).
Costs of cirrhosis and ACLF hospitalization
From 2009 to 2013, the yearly hospitalization costs for ACLF and cirrhosis increased from $ 29 million to $ 37 million. The mean cost per hospitalization for cirrhosis minimally increased from $ 659 to $ 661, while the mean hospitalization cost for ACLF decreased from $ 1947 to $ 1892. The mean cost per hospitalization for ACLF was 3.5-fold more than that for cirrhosis ($ $1893 versus $ 519). The hospital gets payment from the Universal Coverage Scheme by using a diagnosis-related group (DRG) payment system which is only 15% of the average treatment costs ($ 286 from $ 1893). Details of costs of ACLF and cirrhosis are summarized in Supporting Table S2.
This nationwide study showed the ACLF burden in the health care delivery system. Patients with cirrhosis who developed ACLF were at risk of death which represented a relatively high health care cost. Our nationwide population-based study revealed five key findings. First, the number of hospitalizations for cirrhosis rose and the proportion of ACLF rose by nearly double. Second, alcohol-related cirrhosis was the major identified risk in patients with cirrhosis and ACLF. Third, the mean ACLF proportion in cirrhosis was about 12.3% which was mainly associated with cardiovascular, respiratory, and renal failure. Fourth, higher number and type of organ failures are stronger risk of death in patients with ACLF. Risk of death in patients with two or more organ failures was significantly more than those with no or one organ failure and cardiovascular, respiratory, and kidney failures were strong risks to predict mortality in ACLF. Five, the economic burden of ACLF is credibly more when it develops because hospitals were reimbursed from government less than expectation.
The major obstacle for studying epidemiology of ACLF has several definitions. Currently there are three ACLF definitions; the first is from the CANONIC study in Europe [7]. It reported that ACLF contributed 30% of hospitalizations with 1343 cirrhotic patients and 28-day mortality varied from 22 to 73%. The North American Consortium for Study of End-Stage Liver Disease (NACSELD), a consortium comprising tertiary-care hepatology centers in North America, study defined ACLF as two organs' failure in patients with cirrhosis [8]. In that study 24% of patients developed ACLF and 23% of patients died during their hospitalization and 30-days of follow up. However, another United States data from the National Inpatient Sample (NIS) showed lower rate of ACLF (1.5-5% of cirrhosis hospitalizations) [11]. The Asia-Pacific region definition was reported in a consensus paper of the Asian Pacific Association for the Study of Liver (APASL) 2014 meeting [12]. That study used retrospective and prospective enrollment of 1363 patients. The 1-month mortality rate was high at 51% compared with the worldwide rate. The divergence was associated with differences in studies' populations (tertiary centers versus nationwide, community versus academic hospital), patient characteristics (acute decompensation of cirrhosis in CANONIC, infection-related hospitalization of patients with cirrhosis in NACSELD, versus all patients with cirrhosis in NIS and APASL), and ACLF definition which included use of laboratory date in the CANONIC study. Concerning this discrepancy, we determined to conduct another nationwide population based data using the same ALCF definition reference from the NIS study [11]. To the best of our knowledge, this is the first report about nationwide ACLF data outside of North America. The ACLF prevalence in the Thailand health care database was more and trended to increase to nearly double (7.1 to 13.2% of cirrhosis hospitalizations) and nearly three quarters of those died within 90 days after hospitalization. These estimates of death include both hospital deaths and post discharge deaths. In our cohort, mortality for ACLF increased despite improvements of medical care. The significant increase in cirrhosis hospitalization over the study period is relate with various factors such as patient demographics, liver disease epidemiology, and clinical practice patterns. These factors can plausibly account for the drastic increase in cirrhosis hospitalization. Demographic changes, such as the aging population, with a high rate hepatitis C cirrhosis, have amplified the inferior survival in ACLF. The number of older patients with hepatitis C who live long enough to experience progression of their liver to hepatic decompensation have been increasing. Moreover, they were an evident trend related to obesity pandemic, leading to increasing prevalence of nonalcoholic fatty liver disease. Finally, the characteristics of infections in patients with cirrhosis have changed over the last decades, with a trend toward an increase in nosocomial infections, which are strong independent predictors of poor outcomes. This is important because two thirds of our ACLF cases had sepsis. This finding agrees with previous data showing that infections are a leading cause of hospitalization, decompensation, and death in patients with cirrhosis. Those data highlighted urgent needs for national policy and research for the care of patients with cirrhosis to prevent them from developing ACLF. The inpatient ACLF mortality was also associated with type and number of organ failures. Similarly, with the European and NIS studies [7, 11], we discovered that if patients developed more organ failures, then the mortality risk significantly increased. Cardiovascular, respiratory, and renal failures had the highest probability of mortality. Strategies to prevent ACLF-related mortality need to target high-risk patients. Furthermore, organ support and clinical care map of emergency liver transplantation needs development to standardize care of the sequence of ACLF patient care activities performed. Investigators of the Chronic Liver Failure Consortium have recommended early introduction of intensive care for ACLF patients within 7 days and ACLF grades assessment with different time points in order to define prognosis and assist decision-making for proper management continuation between liver transplantation and best supportive care [13].
Since care of hospitalized patients with cirrhosis, especially those with ACLF requires intensive care, so the cost of treatment of those are also expensive. However, there are only few worldwide studies of the economic burden of ACLF. Data from United States insurance payer databases showed that costs per patients-per-month of chronic liver disease associated with hepatitis C infection rose in relation to the severity of liver disease status with most involved with inpatient care. Among those with chronic liver disease associated with hepatitis C, end-stage liver disease patients have highest treatment costs [14]. Care of patients with ACLF trended to prolonged hospitalization because of intensive care unit requirements using multidisciplinary care teams with multiple-organ support. The cost of patients with cirrhosis and ACLF from NIS database from 2001 to 2011 showed that the mean cost per ACLF hospitalization in 2011 ($51,841) was around 4 times more compared with cirrhotic patients without ACLF ($14,894). The ACLF economic burden is possibly much larger if extra costs of rehabilitation facilities, nursing homes, and hospice are also taken into account. The use of Diagnosis-Related Group-Based (DRG) reimbursement for ACLF hospitals may not get adequately reimbursed. The disadvantage of DRG reimbursement is creating financial incentives toward earlier hospital discharges.
Our study had some limitations which are inherent to research involving administrative database analysis. First, this study relied on ICD 10-WHO codes to establish cirrhosis and ACLF diagnosis with short specific period (2009 to 2013). Miscoding or error in the code-assignment process could occur which may lead to misclassification bias. Second, our data from the National Health Security Office did not include full clinical details such as medications and laboratory data. Therefore, those included potential time-based patterns for diagnosing coding from ICD 10-WHO codes that would have affected our case definition. Nevertheless, this study has demonstrated the first nationwide prevalence and cost of ACLF hospitalizations outside of the United States. Our findings have demonstrated several important healthcare burdens of ACLF.
In conclusion, this study used a nationwide database to discover the burden of ACLF including both the natural course of the disease and also from a health economic perspective. Despite the inherent limitations of using administrative databases, this study's results could have several clinical implications, especially for the potential to assist health care policy stakeholders to target high-risk patients. Future studies should focus on suitable strategies to target those patients with high benefit for liver transplantation or best supportive care and aim to reduce mortality in cirrhotic patients who develop ACLF.
The data that support the findings of this study are available on request from the corresponding author, [SC]. The data are not publicly available due to their containing information that could compromise the privacy of research participants.
ACLF:
Acute on chronic liver failure
APASL:
Asia Pacific Association for the Study of Liver
CANONIC:
(CLIF Acute on Chronic Liver Failure in Cirrhosis)
DRG:
Diagnosis-related Group
HR:
ICD-10-CM:
International Classification of Diseases, 10th Revision, Clinical Modification
NACSELD:
North American Consortium for Study of End-Stage Liver Disease
NIS:
National Inpatient Sample
Asrani SK, Devarbhavi H, Eaton J, et al. Burden of liver diseases in the world. J Hepatol. 2019;70:151–71.
GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245–66. https://doi.org/10.1016/S2468-1253(19)30349-8.
Desai AP, Mohan P, Nokes B, et al. Increasing economic burden in hospitalized patients with cirrhosis: analysis of a national database. Clin Transl Gastroenterol. 2019;10:e00062.
Chirapongsathorn S, Poovorawan K, Soonthornworasiri N, et al. Thirty-day readmission and cost analysis in patients with cirrhosis: a nationwide population-based data. Hepatol Commun. 2020;4:453–60.
Kanwal F, Tansel A, Kramer JR, et al. Trends in 30-day and 1-year mortality among patients hospitalized with cirrhosis from 2004 to 2013. Am J Gastroenterol. 2017;112:1287–97.
Arroyo V, Moreau R, Jalan R, et al. Acute-on-chronic liver failure: a new syndrome that will re-classify cirrhosis. J Hepatol. 2015;62:S131–43.
Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(1426-37):1437.e1–9.
Bajaj JS, O'Leary JG, Reddy KR, et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology. 2014;60:250–6.
Choudhury A, Jindal A, Maiwall R, et al. Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models. Hepatol Int. 2017;11:461–71.
Chirapongsathorn S, Krittanawong C, Enders FT, et al. Incidence and cost analysis of hospital admission and 30-day readmission among patients with cirrhosis. Hepatol Commun. 2018;2:188–98.
Allen AM, Kim WR, Moriarty JP, et al. Time trends in the health care burden and mortality of acute on chronic liver failure in the United States. Hepatology. 2016;64:2165–72.
Sarin SK, Kedarisetty CK, Abbas Z, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014. Hepatol Int. 2014;8:453–71.
Gustot T, Fernandez J, Garcia E, et al. Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology. 2015;62:243–52.
Gordon SC, Pockros PJ, Terrault NA, et al. Impact of disease severity on healthcare costs in patients with chronic hepatitis C (CHC) virus infection. Hepatology. 2012;56:1651–60.
Oral. J Gastroenterol Hepatol. 2021;36: 27–43. https://doi.org/10.1111/jgh.15604.
The authors thank Mr. Stephen Pinder from International Program Manager Department of Clinical Epidemiology and Biostatistics Faculty of Medicine Ramathibodi Hospital Mahidol University for English Language Editing. Mr. Stephen Pinder is native-speaking medical English specialists who conducted an English language review of our manuscript.
The author would like to express sincere gratitude to the National Health Security Office of Thailand, Thai Association for the Study of the Liver (THASL) and The Gastroenterological Association of Thailand (GAT). No competing interests declared for either author.
We acknowledge the Asia Pacific Digestive Week (APDW) 2021 for selected this work to presented in oral presentation session [15].
The present study was supported by a grant from the National Health Security Office of Thailand, Thai Association for the Study of the Liver (THASL) and The Gastroenterological Association of Thailand (GAT). The authors also gratefully acknowledge use of the services and facilities of the National Health Security Office (NHSO).
Division of Gastroenterology and Hepatology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Sakkarin Chirapongsathorn
Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Kittiyod Poovorawan
Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Ngamphol Soonthornworasiri & Wirichada Pan-ngum
Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Amnart Chaiprasert
Division of Gastroenterology, Vichaiyut Hospital, Bangkok, Thailand
Kamthorn Phaosawasdi
Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
Sombat Treeprasertsuk
Ngamphol Soonthornworasiri
Wirichada Pan-ngum
SC and KP1 had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: SC, KP2, ST. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: SC. Critical revision of the manuscript for important intellectual content: SC, KP1, AC, ST Statistical analysis: SC, NS, WP, AC. Study supervision: KP2. All authors: Final approval of the version to be published.
Correspondence to Sakkarin Chirapongsathorn.
This study was carried out according to the principles expressed in the Declaration of Helsinki and was approved by the Gastroenterological Association of Thailand in collaboration with the National Health Security Office, Thailand. All data were de-identified and released for research purposes therefore the consent form was not performed. The research protocol was approved by the Institutional Review Board of the Faculty of Tropical Medicine, Mahidol University (MUTM 2014-056-01).
Not applicable. No details, images, or videos relating to individual participants are included in the manuscript.
Definition of cirrhosis and acute on chronic liver failure (ACLF) used ad inclusion criteria in the study and costs of cirrhosis and ACLF.
Chirapongsathorn, S., Poovorawan, K., Soonthornworasiri, N. et al. Health care burden and mortality of acute on chronic liver failure in Thailand: a nationwide population-based cohort study. BMC Health Serv Res 22, 156 (2022). https://doi.org/10.1186/s12913-022-07574-6
Acute on chronic liver failure (ACLF)
Costs analysis
Nationwide study


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International Table Top day, March 30th Saturday
Nadia Member UncommonPosts: 11,798
http://www.tabletopday.com/index.php
http://www.wired.com/geekdad/2013/02/international-tabletop-day/
If you look closely enough, it's clear that tabletop gaming is experiencing a glorious renaissance. Gaming conventions like GenCon and DragonCon now draw more attendees than a traditionally huge game-related show like E3, while other gaming shows like PAX and GX devote vast areas of the show to tabletop pursuits.
Nontraditional outlets like Target and Barnes & Noble are now carrying decidedly serious board games like Agricola and 7 Wonders. To top it all off, the Geek & Sundry YouTube channel just completed its inaugural season of its widely popular gaming show, TableTop. The buzz grew over the 20 episode season, with new viewers tuning in every other week to watch celebrities play board games. And, to date, the end result is nearly eight million views — all generated by word of mouth and a powerful testament to the power of the human connection in tabletop gaming.
Now, it's time to take tabletop gaming's popularity to the next level. Beginning on March 30th of this year, there will be an annual International TableTop Day, a day to celebrate board games and tabletop gaming and play games with colleagues, family, and friends.
"We're trying to build on the buzz and excitement of what we've done with TableTop and take it to the next level," says TableTop associate producer, Boyan Radakovich.
Festivities for the day are initially being organized by Geek & Sundry and their plans are ambitious. A new website has been developed to help coordinate games on International TableTop Day. If your company, gaming group, or friendly local game store will be hosting games, sign up and let others find you via an interactive map.
EQ2 fan sites
drtack1 Member UncommonPosts: 273
^ Cool o_O
ive always loved board games - especially RPG board games
like Talisman http://en.wikipedia.org/wiki/Talisman_%28board_game%29
highly recommend this site for more info about boardgaming - both physical and electronic
http://boardgamegeek.com/
a social network tool thats helped me find local boardgame activities
http://boardgames.meetup.com/
the same tool can be used to find local RPG players
http://dnd.meetup.com/

redpajama_set_name: RedPajamaCommonCrawl


I'm pretty sure the first Red Bull Dirt Pipe was a Freeride Entertainment/Red Bull collab but the reality was the MTB riders they took failed to impress. So what better way than to relaunch the whole thing and aim it the best BMXers in the world. Taupo rider Jed Mildon wins it! You can guarantee there will be riding of this calibre going down at the Frew Farm Jam next weekend as well!


Estonian designer, Triinu Pungits, is creating a stir with her printed and textured collections.
I have talked many times about the design talent coming out of the Ukraine, well there seems to be same influx of creativity from Estonia too.
Triinu Pungits is one such talent.
Hailing from Tartu, the designer was a finalist at the International Talent Support Fashion Competition, semi-finalist at the International Festival of Fashion and Photography in Hyeres and has been showing at the Mercedes-Benz Kiev Fashion Days since 2013. During her time at MBKD she won the Silver Needle, which is one of the most prestigious fashion awards in Estonia.
As you know, I love texture. If an outfit features lots of touchy-feely fabrics I will happily sacrifice an interesting silhouette and Triinu focuses heavily on texture. Knitwear and hand printed fabrics site alongside crumpled tweeds. Voluminous jackets feature rose-like adornments and a completely hand sewn, multicoloured sequin textile.
The coats are highlight for me.
There really isn't a single one I wouldn't love to wear. The two red printed coats are absolutely stunning - prints and volume.
Although this quilted, asymmetric red coat in her store (pictured below) is really floating my boat right now. At 800 euros is out of my prince range sadly but I will be keeping an eye out for that bad boy going on sale.
I also actually really love her bodysuits. I can totally see me wearing those to ballet class. Especially that black and white one featured in the photo above.


text:
1907: THE IMMIGRANT EXPERIENCE
Top 5 Things to Know Before You Play
Key things to know before playing Mission US.
City of Immigrants
Top 5 Things to Know Before You Play Mission US
Mission US is a role-playing game (RPG). In each mission you'll step into the shoes of a young person during an important time period in US history. While your character and many of the characters in the game are fictional, they are based on the experiences of real people. (You will also encounter some actual historical figures and witness historical events in the game!)
There are no right or wrong answers. The goal of Mission US is to understand history, not to win. In each mission, you'll meet a range of people with very different viewpoints, explore historical settings, and witness key past events — and will have to make difficult decisions. All of the decisions represent real alternatives that people might have encountered.
You decide your character's fate. Like other choose-your-own-adventure stories, the fate of your character is based on your choices in the game. Some of the choices you make will unlock different badges, which will also impact the outcome of your character's story in the game epilogue. You can replay the game and make different choices to see how your character's story might have turned out differently.
You will encounter difficult and challenging moments in US history. Mission US covers some troubling topics, including racism, injustice, and war, many of which remain challenges today. We think learning about such historical moments is essential for understanding both the past and present. We encourage you to reach out to a parent, teacher, or other adult you trust if you have any questions about the content you encounter in the game.
There is never just one story. Like any work of history, Mission US games are interpretations of what happened in the past based on careful research. Since they can't capture the whole story, we encourage you to learn more about this history by checking out the additional resources for each mission.
Release notes for the new City of Immigrants
Information on the new, non-Flash version of the game including notes on known bugs.
Learn more about the creation of and team behind City of Immigrants.
Play This Mission Offline
PC & Mac Download
Instructions for Installation and Use of the Downloadable Version
1) Download the game to your computer. Be sure to pay attention to where the file is being copied on your computer; different operating systems have different defaults.
2) Install the game. Locate the downloaded file named "m4_local_build" on your computer and double-click to extract the game files.
On a PC this will place a copy of the game on your computer in a folder of the same name. On a Mac this will place a copy of the game in the same place as the downloaded file.
This local build must be run through a web browser program (such as Chrome or Firefox) with Adobe Flash Player installed. You will also need to adjust your browser settings to allow the local file to be played. To do so, visit the Flash Player Global Security Settings Panel, click to "Allow" Flash, then select "Edit locations" to add the location of the downloaded game file.
3) Play the game. Double-click on the icon labeled "m4_local_build.html." The downloadable version of "City of Immigrants" may only be played in offline mode.
It's 1907. You are Lena Brodsky, a 14-year-old Jewish immigrant from Russia. How will you start a new life in America?
Start Mission
Mrs. Orloff
Lives in the same tenement as the Brodsky family and also came from Minsk. She pays close attention to the lives of all her neighbors and is a good source of neighborhood gossip.
Rosa Leone
Lena's friend, a fourteen-year old immigrant from Naples, Italy, who came to America with her family. Her family runs a small grocery store on the Lower East Side. She helps in the store and studies English at the Henry Street Settlement, all while being chaperoned by her brother. Her family plans to make money in America and then return to Italy, but Rosa is not sure that is she wants to do that. Eventually she gets a job at the Triangle Shirtwaist Company factory. Rosa and Lena meet at an English class at Henry Street.
Abigail Walker
A young reformer and suffragist who chose to live and work with immigrants in the Lower East Side after completing college. She is an idealist who believes that Progressive women can improve life for immigrants by helping them to assimilate.
Sonya Brodsky
Isaac's wife, who is also from Russia but met Isaac in New York. She manages the Brodsky household, caring for their baby, shopping, cleaning, and providing meals and laundry services for two boarders.
Lena Brodsky
Fourteen-year-old Lena was born in Minsk, Russia, where her family suffered from the anti-Jewish violence of the pogroms. Her older brother leaves for America and sends money back for another ticket. When Lena's younger brother was unexpectedly drafted into the Czar's army, Lena takes his place and travels on her own to meet her older brother in New York. She hopes to save enough money to pay for tickets for her parents to leave Russia as well. In New York, many different social, educational, and work opportunities and challenges await her.
Isaac Brodsky
Lena's older brother, who came to the United States three years earlier and is now married and living on the Lower East Side. He sells household goods from a cart on Hester Street but dreams of becoming a successful businessman with his own store.
A young Russian immigrant trying to make his way in New York by helping Jewish gang members collect debts. He enjoys dancing to American popular music and hopes to take Lena to the dancehall.
James Poole
A young reporter for one of New York City's "muckracking" newspapers. He is college educated and a pro-union reformer.
Miss Sherman
A former garment factory operator who has been promoted to forelady. She is strict and supports the factory owners in their efforts to keep young women workers focused on increasing their production.


text:
Normandia este o provincie istorică în nordul Franței, care între 1955 și 2015 a fost divizată administrativ în Normandia de Sus, la nord de Paris, pe cursul inferior al Senei, și, în partea vestică, în Normandia de Jos, care cuprindea și Peninsula Cotentin.

Pe teritoriul Normandiei trăiesc 3,5 milioane de locuitori. Cele mai mari orașe sunt Rouen (385.000 locuitori), Le Havre (247.000 locuitori) și Cherbourg (89.000 locuitori). Rouen, în trecut capitală a provinciei, este din 2016 capitala regiunii administrative Normandia.

Istorie

Invaziile normande
Numele ținutului este derivat din denumirea de normanzi ("oameni din nord"), dată neamurilor germanice din Peninsula Scandinavă care se răspândiseră între secolele VIII și XI  pe insulele britanice, ajungând în secolul al IX-lea să devasteze și ținuturi din nordul regatului francilor. Treptat, acești năvălitori au început să se stabilească în Frizia și la gurile Loarei. Sub presiunea exercitată de anglo-saxoni așa-numita "Mare Oștire" a normanzilor a debarcat în anul 878 pe continent și a devastat timp de 13 ani ținuturile de nord ale francilor, silindu-l pe Carol al III-lea cel Gros, regele Franciei Occidentale, să plătească tributuri. După numeroase conflicte cu francii, normanzii s-au așezat în ținutul actual al Normandiei. Căpetenia lor Rollo (Gånge Rolf), probabil un nobil wiking originar din Norvegia, a încheiat ulterior un acord cu Carol al III-lea cel Simplu, regele Franței, în 911 la St.-Clair-sur-Epte. Trecând la creștinism, el a primit ca feudă teritoriul din jurul Rouen-ului și de la gurile Senei, deci zona actualei Normanzii de Sus. Supușii lui Rollo s-au convertit, de asemenea, la creștinism și au colonizat Normandia, care era pe atunci în mare parte devastată și lipsită de structuri feudale și ecleziastice, apărând-o astfel de invaziile altor grupuri de wikingi. Populația va adopta inițial limba normandă, mai târziu însă limba franceză.

De la statul carolingian până la organizarea feudală a ducatului (911-1066)
După ce primii principi normanzi, Rollo (911 - 932) și fiul său William (ca. 932 - 942), care purta în același timp titlul de conte de Rouen, se limitaseră la zona Rouenului, Rudolf de Burgundia a alipit Normandiei între 924 și 933 ținuturile actualei Normandii de Jos, în care predominaseră până atunci triburi vrăjmașe noului principat, formate mai ales din danezi veniți din Anglia și norvegieni din Irlanda. Nordul peninsulei Contentin și ținutul Pays de Caux au fost cele mai marcate de colonizarea cu populații scandinavice. Carolingianul Ludovic al IV-lea (914-984) a încercat după asasinarea lui Guillaume în 942 să se descotorosească de casa princiară normandă, rămasă sub conducerea minorului Richard I, fără a avea însă succes.

Principatul a cunoscut o perioadă de înflorire la finele secolului al X-lea. După o dezvoltare în limitele hotarelor stabilite de carolingieni sub domnia lui Richard I (m. 996) a urmat o perioadă de continuă consolidare a puterii sub Richard al II-lea (996-1026), avantajată de cutumele preluate din trecutul viking, care stăteau la baza unui sistem pregnant ierarhic, caracterizat de pildă prin norma ullac, care permitea exilarea imediată a rebelilor și confiscarea bunurilor acestora. Apanajele titlului de conți asiguraseră pe de-asupra legitimarea puterii din mâinile familiei de principes Normannorum care, exercitată în modul autonom caracteristic Evului Mediu timpuriu, a dus la o stabilizare economică și politică a regiunii. Conform acestei autonomii ținuturile au purtat sub carolingieni denumirea de regnum, principii normanzi asumându-și ei înșiși răspunderea pentru implementarea dreptului și instituțiilor francilor. Titlul de marchio, marchiz, dobândit de Richard I. în 965/968, i-a permis acestuia să instituie la rândul său conți în domeniu, alegându-i din rândurile propriei familii. Titlul de duce a fost purtat de casa normandă după venirea la putere a Capețienilor, începând cu anul 987. Și ducatul a fost legat de casa regală a Franței doar prin obligații infime. Guvernarea centrală s-a bazat pe atunci, la cumpăna dintre secolele X și XI, pe trei palatinate. Două dintre acestea, Rouen și Fécamp, erau situate în inima ducatului, Bayeux într-o zonă limitrofă. Organizarea fiscală, bazată începând cu anul 1000 pe funcționari locali, și privilegiile ducale care permiseseră multor țărani să se elibereze din starea de iobăgie au dus la o enormă prosperitate a ducatului. O altă cauză a acestei înfloriri economice trebuie văzută în relațiile comerciale cu zona de nord-vest a Europei, care au fost intense până la apariția primelor așezări fortificate, în 1025-1030, din care s-au dezvoltat mai târziu orașele normande, de exemplu Caen.

Consolidarea formelor feudale a fost intrinsec legată de reinstaurarea instituțiilor bisericești. Punctul de cristalizare al acestei dezvoltări a fost abația de la Fécamp. Ctitorii importante din timpul domniei lui Richard I au fost mănăstirile de la Fontenelle și Mont Saint-Michel. Richard al II-lea s-a folosit în mod sistematic în exercitarea stăpânirii sale de această consolidare, susținându-l de exemplu pe abatele din Guillaume de Volpiano, a cărui mănăstire din Fécamp dobândise exempțiunea, în impunerea reformelor de la Cluny. Acestea au fost favorizate de creșterea demografică și economică în ținut între finele secolului al X-lea și începutul secolului al XI-lea. Aristocrația normandă era asimilată pe atunci celei autohtone și supuse unui proces continuu de înnoire prin imigranți franci.

Un puternic promotor al sistemului feudal a fost Robert I. Magnificul, duce al Normandiei între 1027 și 1035. Reformele sale, justificate de necesitatea de a administra un teritoriu întins, au căpătat în curând o dinamică proprie și au dus, după moartea lui Robert I., la dezintegrarea puterii centrale. Dezintegrarea a fost favorizată de minoratul urmașului lui Robert, William zis "Bastardul", ulteriorul cuceritor al Angliei, și s-a manifestat prin clădirea neautorizată de motte  și prin răzmerițe ale baronilor din Normandia de Jos. Ducele William și-a reinstaurat însă autoritatea cu ajutorul bisericii, declarând "Pacea Domnului" ("Pax Dei"/"Treuga Dei") în ducat și impunând în ierarhia ecleziastică oameni devotați lui. Nobilimea locală a putut fi integrată în sistemul feudal prin crearea unei grupări de "fideli" ai ducelui în cadrul ierarhiei militare. William, care reușește până în 1055 să recâștige controlul asupra întregului ducat, se va folosi de această grupare de baroni pentru a-și organiza cavaleria grea care va decide apoi importanta bătălie de la Hastings. Deși organizarea militară era redusă la anturajul ducal, casa de Normandia a reușit să-și consolideze în 1063 poziția, adăugând comitatul Maine domeniilor sale.

Normandia în organizațiile statale ale anglo-normanzilor și ale neamului Plantagenet (1066-1204)
Prin victoria de la Hastings din 1066 ducele normand, cunoscut de acum înainte sub numele de William Cuceritorul, a urcat pe tronul Angliei, pe care-l revendicase considerându-se urmașul vărului său Eduard Confesorul. Normandia a rămas sub stăpânirea sa și a devenit un principat cu o organizare feudală extrem de strictă, care nu acorda decât mărcilor o anumită autonomie. După moartea lui William ducatul Normandiei i-a revenit fiului său mai mare, Robert Courteheuse, regatul Angliei celui de-al doilea născut, William al II-lea Rufus. Cel din urmă a purtat în 1087 un război împotriva Normandiei, dorind să o încorporeze printre domeniile sale. Roadele acestui conflict le-a cules Henric I, mezinul lui William Cuceritorul, care a moștenit în anul 1100 tronul Angliei și l-a învins în 1106 pe Robert Courteheuse, reinstaurând astfel domeniul anglo-normand. După moartea lui Henric în 1135 o parte a baronilor normanzi a refuzat să recunoască dreptul lui Geoffrey al V-lea de Plantagenet-Anjou asupra ducatului, susținându-l pe Ștefan de Blois, nepotul lui William Cuceritorul pe linie feminină. Geoffrey al V-lea, conte de Anjou, era căsătorit cu Matilda (1102-1167), fiica regelui Henric I și, ca văduvă a împăratului Henric al V-lea, împărăteasă a Sfântului Imperiu Roman. Conflictul dintre casele Plantagenet și Blois a fost decis de-abia în 1150, odată cu urcarea pe tronul normand a lui Henric al II-lea Plantagenet, fiul împărătesei Matilda și al lui Geoffrey de Anjou. Acesta a adăugat domeniilor sale comitatul Anjou (în 1151), Aquitania (în 1152) și regatul Angliei (în 1154), formând astfel așa-numitul "Imperiu Angevin".

Urmașii lui William Cuceritorul au continuat opera acestuia de centralizare și uniformizare în guvernare și administrație. Jurisprudența a luat avânt în timpul domniei lui Henric I, mai ales datorită numirii de judecători călători. O primă legislație a Normandiei a fost redactată în jurul anului 1200: Coutumes de Normandie. Prin crearea unui Échiquier normand ca cea mai înaltă instanță juridică și administrativă, cu un sediu permanent la Caen (din 1170-1175) s-a consolidat organizarea fiscală a ducatului. În administrația locală Henric al II-lea s-a folosit de o nouă clasă de funcționari pentru a-și impune autoritatea față de nobilime, de așa-numiții bailli. Aceaștia erau mult mai devotați suveranului, funcțiunile lor nefiind ereditare.

Note

Bibliografie
 Henri Dubois: articolul Normandie în: Lexikon des Mittelalters vol. VI, Studienausgabe Stuttgart / Weimar 1999, col. 1241-1249.
 Karl Schnith: articolul Normannen în: Lexikon des Mittelalters vol. VI, Studienausgabe Stuttgart / Weimar 1999, col. 1249-1250.

Vezi și
 Normandia (regiune administrativă)
 Normanzi
 Limba normandă
 Dinastia normandă

Normanzi
State medievale
Ducate

redpajama_set_name: RedPajamaWikipedia


text:
To the choirmaster: with stringed instruments. A Psalm of Asaph. A Song. In Judah God is known; his name is great in Israel. His abode has been established in Salem, his dwelling place in Zion. There he broke the flashing arrows, the shield, the sword, and the weapons of war. Selah Glorious are you, more majestic than the mountains of prey. The stouthearted were stripped of their spoil; they sank into sleep; all the men of war were unable to use their hands. ...
"You shall have no other gods before Me. "You shall not make for yourself an idol, or any likeness of what is in heaven above or on the earth beneath or in the water under the earth. "You shall not worship them or serve them; for I, the LORD your God, am a jealous God, visiting the iniquity of the fathers on the children, on the third and the fourth generations of those who hate Me,read more.
See what kind of love the Father has given to us, that we should be called children of God; and so we are. The reason why the world does not know us is that it did not know him. Beloved, we are God's children now, and what we will be has not yet appeared; but we know that when he appears we shall be like him, because we shall see him as he is. And everyone who thus hopes in him purifies himself as he is pure.
And it will come about in that day, that every place where there used to be a thousand vines, valued at a thousand shekels of silver, will become briars and thorns. People will come there with bows and arrows because all the land will be briars and thorns. As for all the hills which used to be cultivated with the hoe, you will not go there for fear of briars and thorns; but they will become a place for pasturing oxen and for sheep to trample. Bible Verse Wall Art
The word that came to Jeremiah from the Lord: "Arise, and go down to the potter's house, and there I will let you hear my words." So I went down to the potter's house, and there he was working at his wheel. And the vessel he was making of clay was spoiled in the potter's hand, and he reworked it into another vessel, as it seemed good to the potter to do. Then the word of the Lord came to me: ... Christian Gifts
Being Cleansed From SinSittingLikenessExpiationGod Made Visible In ChristGod's Glory RevealedPerfection, DivineGospel, Historical Foundation OfAdoration, Of ChristGod Is TranscendentLight, SpiritualExaltation Of ChristChrist's NatureAccuracyRevelation, In NtHoliness, Believers' Growth InGlory, Revelation OfGlory Of GodDivinity Of ChristEarth, God SustainingSelf ImageImage Of God Christian Gifts
"Now I am sending Huram-abi, a skilled man, endowed with understanding, the son of a Danite woman and a Tyrian father, who knows how to work in gold, silver, bronze, iron, stone and wood, and in purple, violet, linen and crimson fabrics, and who knows how to make all kinds of engravings and to execute any design which may be assigned to him, to work with your skilled men and with those of my lord David your father. Christian Gifts
And when he had taken the scroll, the four living creatures and the twenty-four elders fell down before the Lamb, each holding a harp, and golden bowls full of incense, which are the prayers of the saints. And they sang a new song, saying, "Worthy are you to take the scroll and to open its seals, for you were slain, and by your blood you ransomed people for God from every tribe and language and people and nation, and you have made them a kingdom and priests to our God, and they shall reign on the earth." Then I looked, and I heard around the throne and the living creatures and the elders the voice of many angels, numbering myriads of myriads and thousands of thousands, saying with a loud voice, "Worthy is the Lamb who was slain, to receive power and wealth and wisdom and might and honor and glory and blessing!" ...
Solomon made all the furniture which was in the house of the LORD: the golden altar and the golden table on which was the bread of the Presence; and the lampstands, five on the right side and five on the left, in front of the inner sanctuary, of pure gold; and the flowers and the lamps and the tongs, of gold; and the cups and the snuffers and the bowls and the spoons and the firepans, of pure gold; and the hinges both for the doors of the inner house, the most holy place, and for the doors of the house, that is, of the nave, of gold. Share Your Faith Products
and in the cutting of stones for settings and in the carving of wood, so as to perform in every inventive work. "He also has put in his heart to teach, both he and Oholiab, the son of Ahisamach, of the tribe of Dan. "He has filled them with skill to perform every work of an engraver and of a designer and of an embroiderer, in blue and in purple and in scarlet material, and in fine linen, and of a weaver, as performers of every work and makers of designs. Bible Verse Wall Art
and in the cutting of stones for settings, and in the carving of wood, that he may work in all kinds of craftsmanship. "And behold, I Myself have appointed with him Oholiab, the son of Ahisamach, of the tribe of Dan; and in the hearts of all who are skillful I have put skill, that they may make all that I have commanded you: the tent of meeting, and the ark of testimony, and the mercy seat upon it, and all the furniture of the tent, the table also and its utensils, and the pure gold lampstand with all its utensils, and the altar of incense, the altar of burnt offering also with all its utensils, and the laver and its stand, Christian Canvas Art
The words of Jeremiah, the son of Hilkiah, one of the priests who were in Anathoth in the land of Benjamin, to whom the word of the Lord came in the days of Josiah the son of Amon, king of Judah, in the thirteenth year of his reign. It came also in the days of Jehoiakim the son of Josiah, king of Judah, and until the end of the eleventh year of Zedekiah, the son of Josiah, king of Judah, until the captivity of Jerusalem in the fifth month. Now the word of the Lord came to me, saying, "Before I formed you in the womb I knew you, and before you were born I consecrated you; I appointed you a prophet to the nations." ... Christian Canvas Art
"You shall make an altar on which to burn incense; you shall make it of acacia wood. A cubit shall be its length, and a cubit its breadth. It shall be square, and two cubits shall be its height. Its horns shall be of one piece with it. You shall overlay it with pure gold, its top and around its sides and its horns. And you shall make a molding of gold around it. And you shall make two golden rings for it. Under its molding on two opposite sides of it you shall make them, and they shall be holders for poles with which to carry it. You shall make the poles of acacia wood and overlay them with gold. ... Bible Verse Wall Art
19 designers and 31 writers invested their energy and creativity to this collection, each riffing on the timeless, inspired words of Scripture. Each designer worked hard to capture the essence of each verse in its historical and cultural context, and to design in a way that makes clear the way in which the original readers would have understood it. Then, after each design was complete, a writer reflected on each piece of art and the verse that inspired it. The result is 100 pairs of art and devotional that illuminate the words of Scripture. Share Your Faith Products
For the last 5 years, the in-house design team at the Faithlife Corporation has illustrated one Bible verse every day. This art has found its way onto t-shirts, magnets, and postcards—and now, a beautiful picture book. In print for the first time, art from Faithlife's Verse of the Day series paired with uplifting devotionals will encourage and inspire you. Bible Verse Wall Art
Jacob lived in the land of his father's sojournings, in the land of Canaan. These are the generations of Jacob. Joseph, being seventeen years old, was pasturing the flock with his brothers. He was a boy with the sons of Bilhah and Zilpah, his father's wives. And Joseph brought a bad report of them to their father. Now Israel loved Joseph more than any other of his sons, because he was the son of his old age. And he made him a robe of many colors. But when his brothers saw that their father loved him more than all his brothers, they hated him and could not speak peacefully to him. Now Joseph had a dream, and when he told it to his brothers they hated him even more. ... Share Your Faith Products
"Now her sister Oholibah saw this, yet she was more corrupt in her lust than she, and her harlotries were more than the harlotries of her sister. "She lusted after the Assyrians, governors and officials, the ones near, magnificently dressed, horsemen riding on horses, all of them desirable young men. "I saw that she had defiled herself; they both took the same way.read more.
"Now I am sending Huram-abi, a skilled man, endowed with understanding, the son of a Danite woman and a Tyrian father, who knows how to work in gold, silver, bronze, iron, stone and wood, and in purple, violet, linen and crimson fabrics, and who knows how to make all kinds of engravings and to execute any design which may be assigned to him, to work with your skilled men and with those of my lord David your father. Christian Canvas Art
Then to Adam He said, "Because you have listened to the voice of your wife, and have eaten from the tree about which I commanded you, saying, 'You shall not eat from it'; Cursed is the ground because of you; In toil you will eat of it All the days of your life. "Both thorns and thistles it shall grow for you; And you will eat the plants of the field; By the sweat of your face You will eat bread, Till you return to the ground, Because from it you were taken; For you are dust, And to dust you shall return."
Love is patient and kind; love does not envy or boast; it is not arrogant or rude. It does not insist on its own way; it is not irritable or resentful; it does not rejoice at wrongdoing, but rejoices with the truth. Love bears all things, believes all things, hopes all things, endures all things. Love never ends. As for prophecies, they will pass away; as for tongues, they will cease; as for knowledge, it will pass away. Share Your Faith Products
A Psalm for giving thanks. Make a joyful noise to the Lord, all the earth! Serve the Lord with gladness! Come into his presence with singing! Know that the Lord, he is God! It is he who made us, and we are his; we are his people, and the sheep of his pasture. Enter his gates with thanksgiving, and his courts with praise! Give thanks to him; bless his name! For the Lord is good; his steadfast love endures forever, and his faithfulness to all generations. ... Christian Canvas Art
Masters, treat your slaves justly and fairly, knowing that you also have a Master in heaven. Continue steadfastly in prayer, being watchful in it with thanksgiving. At the same time, pray also for us, that God may open to us a door for the word, to declare the mystery of Christ, on account of which I am in prison— that I may make it clear, which is how I ought to speak. Walk in wisdom toward outsiders, making the best use of the time. ... Christian Canvas Art
This is the book of the generations of Adam. When God created man, he made him in the likeness of God. Male and female he created them, and he blessed them and named them Man when they were created. When Adam had lived 130 years, he fathered a son in his own likeness, after his image, and named him Seth. The days of Adam after he fathered Seth were 800 years; and he had other sons and daughters. Thus all the days that Adam lived were 930 years, and he died. ... Christian Gifts
The porch which was in front of the house was as long as the width of the house, twenty cubits, and the height 120; and inside he overlaid it with pure gold. He overlaid the main room with cypress wood and overlaid it with fine gold, and ornamented it with palm trees and chains. Further, he adorned the house with precious stones; and the gold was gold from Parvaim.read more. Christian Gifts
See what kind of love the Father has given to us, that we should be called children of God; and so we are. The reason why the world does not know us is that it did not know him. Beloved, we are God's children now, and what we will be has not yet appeared; but we know that when he appears we shall be like him, because we shall see him as he is. And everyone who thus hopes in him purifies himself as he is pure. Share Your Faith Products
Masters, treat your slaves justly and fairly, knowing that you also have a Master in heaven. Continue steadfastly in prayer, being watchful in it with thanksgiving. At the same time, pray also for us, that God may open to us a door for the word, to declare the mystery of Christ, on account of which I am in prison— that I may make it clear, which is how I ought to speak. Walk in wisdom toward outsiders, making the best use of the time. ... Share Your Faith Products
In the West, the Renaissance saw an increase in monumental secular works, but until the Protestant Reformation Christian art continued to be commissioned in great quantities by churches, clergy and by the aristocracy. The Reformation had a huge effect on Christian art, rapidly bringing the production of public Christian art to a virtual halt in Protestant countries, and causing the destruction of most of the art that already existed.
Jacob lived in the land of his father's sojournings, in the land of Canaan. These are the generations of Jacob. Joseph, being seventeen years old, was pasturing the flock with his brothers. He was a boy with the sons of Bilhah and Zilpah, his father's wives. And Joseph brought a bad report of them to their father. Now Israel loved Joseph more than any other of his sons, because he was the son of his old age. And he made him a robe of many colors. But when his brothers saw that their father loved him more than all his brothers, they hated him and could not speak peacefully to him. Now Joseph had a dream, and when he told it to his brothers they hated him even more. ... Christian Canvas Art
To the choirmaster: with stringed instruments. A Psalm of Asaph. A Song. In Judah God is known; his name is great in Israel. His abode has been established in Salem, his dwelling place in Zion. There he broke the flashing arrows, the shield, the sword, and the weapons of war. Selah Glorious are you, more majestic than the mountains of prey. The stouthearted were stripped of their spoil; they sank into sleep; all the men of war were unable to use their hands. ... Christian Canvas Art
Now there were four supports at the four corners of each stand; its supports were part of the stand itself. On the top of the stand there was a circular form half a cubit high, and on the top of the stand its stays and its borders were part of it. He engraved on the plates of its stays and on its borders, cherubim, lions and palm trees, according to the clear space on each, with wreaths all around.read more. Bible Verse Wall Art
So he made two doors of olive wood, and he carved on them carvings of cherubim, palm trees, and open flowers, and overlaid them with gold; and he spread the gold on the cherubim and on the palm trees. So also he made for the entrance of the nave four-sided doorposts of olive wood and two doors of cypress wood; the two leaves of the one door turned on pivots, and the two leaves of the other door turned on pivots. He carved on it cherubim, palm trees, and open flowers; and he overlaid them with gold evenly applied on the engraved work. Christian Canvas Art
"If you happen to come upon a bird's nest along the way, in any tree or on the ground, with young ones or eggs, and the mother sitting on the young or on the eggs, you shall not take the mother with the young; you shall certainly let the mother go, but the young you may take for yourself, in order that it may be well with you and that you may prolong your days. Christian Canvas Art
Huram also made the pails, the shovels and the bowls. So Huram finished doing the work which he performed for King Solomon in the house of God: the two pillars, the bowls and the two capitals on top of the pillars, and the two networks to cover the two bowls of the capitals which were on top of the pillars, and the four hundred pomegranates for the two networks, two rows of pomegranates for each network to cover the two bowls of the capitals which were on the pillars.read more. Share Your Faith Products
The porch which was in front of the house was as long as the width of the house, twenty cubits, and the height 120; and inside he overlaid it with pure gold. He overlaid the main room with cypress wood and overlaid it with fine gold, and ornamented it with palm trees and chains. Further, he adorned the house with precious stones; and the gold was gold from Parvaim.read more. Christian Canvas Art
"Make for yourself an ark of gopher wood; you shall make the ark with rooms, and shall cover it inside and out with pitch. "This is how you shall make it: the length of the ark three hundred cubits, its breadth fifty cubits, and its height thirty cubits. "You shall make a window for the ark, and finish it to a cubit from the top; and set the door of the ark in the side of it; you shall make it with lower, second, and third decks. Christian Gifts
Now King Solomon sent and brought Hiram from Tyre. He was a widow's son from the tribe of Naphtali, and his father was a man of Tyre, a worker in bronze; and he was filled with wisdom and understanding and skill for doing any work in bronze So he came to King Solomon and performed all his work. He fashioned the two pillars of bronze; eighteen cubits was the height of one pillar, and a line of twelve cubits measured the circumference of both. read more. Christian Canvas Art
"You shall take two onyx stones and engrave on them the names of the sons of Israel, six of their names on the one stone and the names of the remaining six on the other stone, according to their birth. "As a jeweler engraves a signet, you shall engrave the two stones according to the names of the sons of Israel; you shall set them in filigree settings of gold.read more.
If then you have been raised with Christ, seek the things that are above, where Christ is, seated at the right hand of God. Set your minds on things that are above, not on things that are on earth. For you have died, and your life is hidden with Christ in God. When Christ who is your life appears, then you also will appear with him in glory. Put to death therefore what is earthly in you: sexual immorality, impurity, passion, evil desire, and covetousness, which is idolatry. ...
In the West, the Renaissance saw an increase in monumental secular works, but until the Protestant Reformation Christian art continued to be commissioned in great quantities by churches, clergy and by the aristocracy. The Reformation had a huge effect on Christian art, rapidly bringing the production of public Christian art to a virtual halt in Protestant countries, and causing the destruction of most of the art that already existed. Christian Gifts
For the last 5 years, the in-house design team at the Faithlife Corporation has illustrated one Bible verse every day. This art has found its way onto t-shirts, magnets, and postcards—and now, a beautiful picture book. In print for the first time, art from Faithlife's Verse of the Day series paired with uplifting devotionals will encourage and inspire you. Share Your Faith Products
Please note: Although the exquisite framed and unframed Christian art prints, posters, and canvases displayed in our online Christian art gallery portray strong traditional family values, biblical themes, and God's wonderful creations; not all of the artwork is Christian. Since we have partnered with art.com and allposters.com who carry a vast inventory of secular artwork, please use discretion when searching for art.
"Now I am sending Huram-abi, a skilled man, endowed with understanding, the son of a Danite woman and a Tyrian father, who knows how to work in gold, silver, bronze, iron, stone and wood, and in purple, violet, linen and crimson fabrics, and who knows how to make all kinds of engravings and to execute any design which may be assigned to him, to work with your skilled men and with those of my lord David your father. Share Your Faith Products
Beaten silver is brought from Tarshish, and gold from Uphaz. They are the work of the craftsman and of the hands of the goldsmith; their clothing is violet and purple; they are all the work of skilled men. But the Lord is the true God; he is the living God and the everlasting King. At his wrath the earth quakes, and the nations cannot endure his indignation. Thus shall you say to them: "The gods who did not make the heavens and the earth shall perish from the earth and from under the heavens." Christian Gifts
Character Of WickedRevelation, Necessity Ofevangelism, nature ofSatan, Power OfSpiritual Warfare, Enemies InImagination, Evil SchemingPresent Evil AgeNames And Titles For SatanRevelation, Responses ToShiningUnbelief, Nature And Effects OfLikenessFalse ReligionUnbelief, Sourced InSatan, As DeceiverSpiritual Blindness, Consequences OfSatanticPrincehood Of SatanImage Of God Christian Canvas Art
Now King Solomon sent and brought Hiram from Tyre. He was a widow's son from the tribe of Naphtali, and his father was a man of Tyre, a worker in bronze; and he was filled with wisdom and understanding and skill for doing any work in bronze So he came to King Solomon and performed all his work. He fashioned the two pillars of bronze; eighteen cubits was the height of one pillar, and a line of twelve cubits measured the circumference of both.read more. Bible Verse Wall Art


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Local 1180 News
Some '1180' Members Grumbling
City Corrects a Botched Admin. Manager Payout
(Download & Share)
By BOB HENNELLY Dec 24, 2019
WORKING OUT THE KINKS: Communications Workers of America Local 1180 President Gloria Middleton, seen here at a union rally prior to reaching a settlement with the de Blasio administration involving the union's pay-discrimination suit on behalf of 1,800 past and present Administrative Managers, has had to deal with city glitches in making the proper payments to employees and complaints by some of her members about how much of their awards were diverted to pay lawyers' fees in the case.
The Office of Payroll Administration mishandled payouts that were due to 1,400 members of Communications Workers of America Local 1180 who were part of a class-action pay-discrimination lawsuit, city officials have acknowledged. In April, a Federal Judge approved a $15-million settlement of a lawsuit brought by the union in 2013 during Mayor Michael Bloomberg's final year in office. The pact between the de Blasio administration and Local 1180 covered 1,800 active and retired Administrative Managers who were on the job from December 2013 through 2017.
Sharing $5.5M Payout As part of that settlement, Local 1180 members were to receive checks for the $5.5-million portion of the settlement that covers retroactive and damage payments in compensation for past pay disparities. The clerical error, which resulted in initially inaccurate electronic payments being deposited in the city employees' bank accounts, which were then withdrawn by the city, was rectified with the mailing of paper checks for the proper amounts. The city's gyrations with the payments added to the disappointment of Patty McCabe, a CWA 1180 member who works as an administrator at the Fire Academy. She said in a phone interview that she was also taken aback by the size of the legal fees deducted from her settlement. "I cleared just $2,000 for waiting for nine years, and I took more responsibility all along the way, and the union misled us," she said. "The lawyers are the only ones who made out on this." Two other union members called this newspaper to complain about the size of their payout but did not want their name published.


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Belarus Germany Lithuania Poland All countries
All countries Poland West Pomeranian Voivodeship Szczecin
Weather in Szczecin
Weather archive at the weather station ( 28 km, -1.5 °C+29 °F )
-1 °C30°F
31 minute ago at the airport (28 km) it was -2 °C+28 °F, overcast, normal air pressure, high humidity (80%), moderate breeze (6 m/s) (22 km/h) (13 miles/hour) (12 knots) (4 Bft) blowing from the west-northwest.
Yesterday (15 January, 13:00) the sea temperature (40 km) was +1.1 °C+34 °F.
Today we expect -1..0 °C°F, +30..+32 °C°F, mainly without precipitation, freezing (supercooled) fog
, moderate breeze. Tomorrow: -8..-12 °C°F, +18..+10 °C°F, without precipitation, light breeze.
Sea temperature (40 km, ) +1.1 °C+34 °F
direction NW N SE E SE SE S S S W SW S SW SW SW SW SW S S S S SW
Local time 16 17 18 19 20 21 22 23 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 00 01 04 07 10 13 16 19 22 01 04 07 10 13 16 19 22 01 04 07 10 13 16 19 22 01 04 07 10 13 16 19 22 01 Local time
direction NW NW NW NW NW NW NW NW NW N NE E E E E SE SE SE SE SE SE E SE SE SE SE SE SE SE SE SE SE SE SE S S S S S S SW W SW SW S S SW SW SW SW SW SW SW SW SW SW SW S S S S S SW S SW SW direction
84 84 86 91 90 89 90 91 92 95 92 90 93 93 93 94 95 94 92 91 90 86 81 82 85 89 90 92 91 89 91 93 93 93 95 92 91 92 89 95 94 93 93 93 96 99 96 92 91 90 89 87 89 91 87 83 81 79 74 69 71 72 73 73 73 73 Humidity,
11:23 00:53 11:39 Moon:
is available on the website rp5.ua
4 hours ago, the minimum air temperature ( -3 oC +27 oF ) was observed in Szczecinek.
2 hours ago, the maximum air temperature ( +1 oC +34 oF ) was observed in Kolobrzeg.
Goleniow
Szczecin (airport)


text:
Tides turn on e-cigarettes: Juul hiring down 37% and workforce growth stalls
Only 5 months ago, we were reporting that Juul ($JUUL) hiring had grown by 200% and its workforce size expanded by a cartoonish 400%. But things are different these days for the e-cigarette market leader as it navigates social and political backlash.
Politicians and local governments are cracking down on e-cigarette sales and there are now 18 recorded vaping-related deaths in 15 US states. Meanwhile, Juul has reducing its hiring efforts by as much as 37% in just the past two months. To add to Juul potential woes, analysts are now expecting Altria ($NYSE:MO), which has a 35% stake in the company, to write down the value of its $12.8 billion investment.
Here's what we're seeing.
Workforce growth slowdown
The number of LinkedIn users listing Juul as their employer continues to rise, but not anywhere near the pace we were seeing just a few months ago. What was once a 51% QoQ growth rate at this point last year is now just 2.1%.
Assuming this trend continues, we will likely see workforce attrition at Juul in the coming year.
Hiring plummeting
Perhaps the variable that most points to future growth — or contraction — for Juul can be found in its hiring activity over time. Just two months ago (and right around when states were banning e-cigarettes), the company had 685 job openings listed on its careers website.
As of October 1, that number sank to 434, and show little to no signs of recovery, given that the CDC released a report titled "Outbreak of Lung Injury Associated with E-Cigarette Use, or Vaping" that points to e-cigarette-related lung injury cases in 48 states and 18 deaths.
New product development?
As Juul collects itself and watches the headlines, categorical shifts in its job openings point to a potential phase of new product development, perhaps indicating a scramble to create alternative e-cigarettes that are less harmful.
Like cigarettes before it, Juul is still everywhere
While these signs of contraction are stark, Juul's roaring growth up to this point will be tough — if not impossible — to completely reverse. Juul locations are virtually ubiquitous throughout the United States and Europe.
Just like cigarettes, their availability continued — and continues to this day — to be available at almost any corner shop or gas station, bans, taxes, and CDC warnings or not.
Juul data is smoking hot - but the e-cig maker may be facing new challenges
How big will JUUL labs get? Hiring up 200%, workforce up 400% in less than a year
At least one-third of all American schools have a JUUL e-cigarette retailer nearby, data shows
Store Locations Data


Potty-training is an important milestone in your baby's life. But when is the time right? How do you go about it? And when do you stop using diapers?
Usually between their second and third birthday kids are ready to use the potty or the toilet. Here we tell you the conditions for the success of this new step. Tips on how you can encourage your kid.


Nigerian legend Jay-Jay Okocha has tipped the Super Eagles to defeat South Africa in the teams' showdown this coming weekend.
"South Africa and Nigeria is always that kind of match where bragging rights are everything. So that will be a big motivating factor for both teams, especially for us because we lost the first match," said Okocha, who was in South Africa for a Bundesliga promotion event last week.


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Advertorial feature by YCI
15 December 2014updated 28 Jan 2015 1:12pm
Young people can stop the spread of Ebola and help rebuild communities
The Ebola outbreak continues to devastate communities. Anna, a 22-year-old hairdresser from Liberia, tells us how the virus is not only taking lives but affecting local business – which for many young people is the only way out of the enduring poverty they live in.
By Y Care International
The Ebola outbreak continues to devastate communities. Anna, a 22-year-old hairdresser from Liberia, tells us how the virus is not only taking lives but affecting local business – which for many young people is the only way out of the enduring poverty in which they live.
"We used to have people coming to the salon from many different countries for us to do their hair. But since Ebola came up they're not coming any more."
Both of Anna's parents died when she was a young girl, so she is determined to survive and find a way to look after her own two children. She visited Liberia YMCA after her sister told her about the business training classes, where she signed up to train as a hairdresser.
"On my first day at the salon, I paid really close attention to how everything was being done. I followed around the staff – I was like a watch dog, just following every step. I work at the salon from 8am and normally leave by 8:30pm, or 9pm if the customers are still here. I walk here – it takes me more than an hour."
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Before this the only way for Anna to make money was to wash other people's clothes, and to help her sister sell cold water. On most days they didnt' make enough to buy food to eat. After training as a hairdresser at the YMCA, Anna has been working in a salon so she can take care of her family.
"I'm worried about the economic impact of Ebola. A lot of businesses are closing down. If they close the salon I won't be able to make any small tips that I need to survive. I don't have any savings. If I don't get this money there is nowhere else."
This is why Anna and so many young people trying to earn an income are not only fearing for their lives, but fear local businesses will soon close.
"I feel really bad that people around the whole world are talking about Liberia, saying it's a bad place, and saying they can't come here anymore. We used to have people coming to the salon from many different countries for us to do their hair. But since Ebola they're not coming any more. It makes me feel so unhappy."
We need to give Anna hope so she can create a better future.
Investing in young people after a crisis will enable long-term recovery and give courage to young people living in extreme poverty.
Y Care International supports community initiatives such as the Salon Project and other practical trades, which offer Anna and thousands more young people the chance to build a sustainable future free from disease, poverty and fear.
YOUR GIFT TODAY WILL HELP REBUILD LIVELIHOODS AND COMMUNITIES
A donation of
•£10 will buy 50 Ebola preventions posters with essential information on how to stop the spread
•£25 will buy food rations lasting two weeks for a family of six
•£50 will provide a life starter kit for a young trainee mechanic
•£88 will provide young people with support to set up or improve their business
PLEASE DONATE AT www.YCAREINTERNATIONAL.ORG/CHRISTMASAPPEAL
or Text CMAS25 then your amount (e.g. CMAS25 £5) to 70070
THANK YOU FOR SUPPORTING Y CARE INTERNATIONAL IN THIS TIME OF GREAT NEED
Y Care International
The Mayor of London is leading the way on council homebuilding – ministers must follow


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(that have had more than one bag opened). (that have had bags opened). The item "Vintage Brown Leather Soft Pad Office Desk Chair Swivel Aluminium Frame Low Back" is in sale since Wednesday, December 19, 2018.
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Several of the Maseratis bought for last year's summit of Asia-Pacific leaders have gone missing, Papua New Guinea admitted Tuesday, as it launched a probe to track them down.
The government of the impoverished nation faced harsh criticism for high spending -- including buying a fleet of sportscars which sell for around US$150,000 each -- for the November APEC summit, but promised to recoup some of the cost by selling them on.
Now, police have admitted, they don't know where the cars are.
"A police unit has been established in the National Capital District to commence the recovery of all states assets including vehicles purchased for the APEC meetings," police said in a statement.
Police did not respond to repeated requests for details about how many cars were missing or who was suspected of taking them.
Critics had argued the money could have been better spent dealing with chronic social problems in a developing nation where diseases such as polio and TB have recently re-emerged.
Prime Minister Peter O'Neill's officials said the luxury cars were needed to keep up the prestige of the event.
During the summit they could be seen parked for days on end at a warehouse by the docks.
Police said they had a arrested a man who used APEC credentials to enter wharf and siphon fuel from the vehicles.


South Korea's entertainment industry is a cultural juggernaut that has allowed the East Asian nation to punch well above its weight in terms of global soft power.
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text:
Meet Liberal Studies Faculty
Patricia Dillon, PhD
Chair of the School of Liberal Studies; Professor of History
pdillon@spalding.edu
Dr. Pattie Dillon serves as the chair of Liberal Studies and associate professor of History, having completed her BS in sociology at the University of Florida, her MA in history at the University of Central Florida, and her PhD in history at Mississippi State University (Starkville). Her doctoral research focused on the connections between race, gender, and religion during the Civil War and Reconstruction era. Dr. Dillon teaches courses on civil war and reconstruction, Jim Crow, gender history, and U.S. history since 1945. Within these courses, students use primary sources to explore the dramatic events, exciting personalities, and complex underlying forces that create historical narratives. Students are also encouraged to become their own historians by collecting and presenting oral interviews.
Deonte Hollowell, PhD
dhollowell@spalding.edu
Dr. Deonte Hollowell is a native of Hopkinsville, Ky., and a graduate of University of Louisville (Pan African Studies) and Temple University (African American Studies). Hollowell's special area of study is the relationship between African Americans and police. Hollowell is also on the Board of Directors for 2Not1, an organization that supports fathers and families, as well as The West Louisville Math and Science Project. He also works with the Pivot to Peace group, extending resources to victims of violence. Hollowell also currently serves as the Lead facilitator for the Rites of Passage Brotherhood which introduces young boys to conflict resolution tactics and traditional African method of being.
Youn-Kyung Kim, PhD
ykim@spalding.edu
Dr. Kim currently teaches courses in linguistics, humanities, and composition. She taught TESL courses (e.g., second language acquisition theory, TESL methodology, teaching grammar, and introduction to linguistics) in the TESOL Endorsement Program for public school teachers (K-12). Her main research interests are in discourse analysis in educational settings and world English. She has presented papers at TESOL national convention, AAAL (American Association for Applied Linguistics), AILA, CCCC, and International Writing Center Association (IWCA) Conference. Her dissertation was published as a book, titled Frame Analysis of Writing Center Interactions. She also has written a chapter, entitled "Frame Analysis," in Encyclopedia of Applied Linguistics published by Blackwell Publishing.
Christopher Kolb, PhD
ckolb@spalding.edu
Urban anthropologist Christopher Kolb passionately works to create opportunities for students to engage in projects that promote peace and social justice by combining community service, first-hand research, and rigorous intellectual inquiry. Kolb conducts fieldwork with long-time users of crack-cocaine, the homeless, and the formerly incarcerated. In addition to W. E. B. Du Bois, the most important influences for Prof. Kolb include German Idealist philosophy, Judeo-Christian theology, psychoanalytic theory, and many literary figures, including Flannery O'Connor, Thomas Merton, Russell Banks, Mark Twain, and, of late, Roberto Bolaño.
Charles Maynard, MFA
Director of the BFA in Creative Writing program, Professor
cmaynard@spalding.edu
The courses Mr. Maynard teaches focus on introducing students to the writing process while creating a foundation for academic writing and understanding that feedback and revision are necessary components of building a writing life. The students he teaches leave his classes with a feeling of empowerment, confidence, and understanding that they can become great writers. Mr. Maynard also serves as the Director of Spalding University's Writing Center which allows him to pursue his scholarly interests in writing center theory and best practices. Maynard is a fiction writer and game designer. His upcoming novel, The Way Things End, is to be published by Tartarus Press in England in 2019.
Kathleen Nesbitt, PhD
knesbitt@spalding.edu
Dr. Kathleen Nesbitt teaches courses in modern world literature and composition. Her travels to Central America, Europe, the Middle East and East Asia have led to the development of courses in magic realism, Irish drama, Palestinian and Israeli fiction, and Chinese film. She finds students are eager to learn about cultures through literary studies, an interdisciplinary discipline, and encourages participation in study abroad opportunities. Her current research interest is in Chinese language and literature. Also teaching expository writing courses, Nesbitt believes our small, process-centered classes, individualized instruction and tutorial support make it possible for each student to make significant progress over the course of a term.
Dorina Miller Parmenter, PhD
Professor of Religious Studies
dparmenter@spalding.edu
Dr. Parmenter is right at home in the interdisciplinary humanities with a background in religion and art. She enjoys teaching and research surrounding the creative responses that humans have had and continue to have when they contemplate the human condition. Her religious studies courses include Religion in America and Religion, Art, and Visual Culture, and she also teaches an interdisciplinary course on Humans and the Environment. Dr. Parmenter is the vice-president of the Society for Comparative Research on Iconic and Performative Texts (SCRIPT) and her research interest is material uses of the Christian Bible, on which she has published widely.
John Wilcox, PhD
Director of University Studies, Faculty Athletics Representative
jwilcox@spalding.edu
Dr. John Wilcox has been teaching at Spalding since 1987 following completion of his PhD from Notre Dame. Since 1993, he has taught philosophy during the summer for the Kentucky Governor's Scholars Program. His primary teaching interests are in ethics, logic, and the philosophy of the person. In ethics he encourages students to search for the foundation of right and wrong. In logic he helps students to develop their abilities to think clearly and consistently. He also enjoys teaching advanced philosophy courses that develop the students' abilities to read, understand, discuss, critique, and write about difficult philosophical texts.