text:
Childhood fever: a qualitative study on parents' expectations and experiences during general practice out-of-hours care consultations
Eefje G P M de Bont1Email author,
Nicole Loonen1,
Dagmar A S Hendrix1,
Julie M M Lepot1,
Geert-Jan Dinant1 and
Jochen W L Cals1
© de Bont et al. 2015
Fever in children is common and mostly caused by benign self-limiting infections. Yet consultation rates in primary care are high, especially during GP out-of-hours care. Therefore, we aimed to explore experiences of parents when having visited GP out-of-hours services with their febrile child.
We performed a qualitative study using 20 semi-structured interviews among parents from different backgrounds presenting to GP out-of-hours care with a febrile child <12 years. Questions were directed at parental motivations, expectations and experiences when visiting the GP out-of-hours centre with a febrile child. Interviews were audio-recorded, transcribed and analysed using constant comparison technique.
We identified four main categories emerging from the data; (1) cautiously seeking care, (2) discrepancy between rationality and emotion, (3) expecting reassurance from a professional and (4) a need for consistent, reliable information. Not one symptom, but a combination of fever with other symptoms, made parents anxious and drove care seeking. Although parents carefully considered when to seek care, they experienced increased anxiety with increases in their child's temperature. Because parents work during the day and fever typically rises during the early evening, the decision to seek care was often made during out-of-hours care. When parents consulted a GP they did not have any set expectations other than seeking reassurance, however a proper physical examination diminished their anxiety. Parents did not demand antibiotics, but trusted on the expertise of the GP to assess necessity. Parents requested consistent, reliable information on fever and self-management strategies.
Parents were inexperienced in self-management strategies and had a subsequent desire for reassurance; this played a pivotal role in out-of-hours help seeking for childhood fever. These factors provide clues to optimise information exchange between GPs and parents, by providing written, tailored, consistent information on self-management strategies for current and future fever episodes. GPs' had incorrect assumptions that parents expected antibiotic treatment.
Fever is the most common reason for a child to be taken to the general practitioner (GP) and, in the absence of the safety net of their own GP, out of hours care [1, 2]. Still, it is largely unknown what parents expect when consulting out of hours care and only limited evidence about what drives these consultations exists. Previous studies were quantitatively structured using mainly closed questions or performed in a different setting like an emergency department or the general public [3–9]. In an emergency department setting it is likely that children are more seriously ill than in a primary care setting, thereby influencing parental worries and decisions. Additionally, most consultations for childhood fever take place in primary care. Despite this, one in three GP out-of-hours consultations for children are fever related and more than 92 % of these children are managed by GPs without referral to secondary care [10]. The low referral rate highlights the general self-limiting nature of childhood fever in general practice. Despite of this, one in three children with a fever receives an antibiotic when visiting the GP out-of-hours centre [11, 12].
Insight into expectations and experiences of parents who have consulted with out-of-hours GPs with their feverish child could provide insights for future interventions targeted at increasing parental self-management, decreasing the number of (re-)consultations and potential overuse of antibiotics for febrile children during GP out-of- hours care where most febrile children are evaluated. Therefore, it is important to understand why parents consult a GP out-of-hours, what they generally experience and expect, and how they use and would desire information to be given before, during and after a consultation for childhood fever.
This qualitative descriptive study aimed to provide an in-depth overview of these factors, by exploring parental motivations, expectations and experiences with GP out-of-hours consultations for childhood fever.
We performed a qualitative study based on naturalistic inquiry using semi-structured interviews to study parents' expectations and experiences towards consultations with their febrile children at a GP out-of-hours centre [13]. We applied the consolidated criteria for reporting qualitative research (COREQ, see Additional file 1) and adhered to RATS guidelines for reporting qualitative research [14].
GP out-of-hours services in the Netherlands are organized in large-scale cooperatives [15]. These cooperatives cover the primary care by rotating shifts of GPs during evening, nights and all weekends. All out-of-hours services in the Netherlands have a triage centre in which trained nurses conduct telephone triage under supervision of a GP and divide all contacts into either telephone advice, GP consultation or home visits by GPs. More than 95 % of GPs provide out-of-hours care through this system.
The study was carried out at a large GP cooperative in Heerlen, the province of Limburg, the Netherlands. The Nightcare GP out-of-hours service in Heerlen, located in a multi-ethnic, moderate to low socio-economic area, is a Dutch GP out-of hours service providing care to approximately 270.000 inhabitants [16].
All parents presenting to the GP out-of-hours centre with a febrile child under the age of 12 years in November 2013, were eligible for inclusion and were asked prior to consultations to participate in a semi-structured interview. Parents were approached at the desk of the GP out-of-hours centre by a member of staff and asked to voluntarily sign up. We used purposive sampling based on gender, age, parity, education level and cultural background. There were no exclusion criteria. Low educational level was defined as vocational school or lower, intermediate as higher national diploma or Bachelor's degree and high as a Master's degree or higher.
Data were collected between November 2013 and January 2014. An interview guide was prepared using sensitizing concepts [17]. Questions were derived from existing literature and a priori expert discussion. The questions were directed at parental motivations, expectations and experiences when visiting the GP out-of-hours centre with a febrile child. A pilot study consisting of two, 1 h lasting focus groups, facilitated by an experienced and independent moderator, were performed to check for face validity. Based on this pilot study minor changes were made to the interview guide. The purpose of these focus groups was to test the interview guide, therefore they were not used during the analysis.
Based on the adapted interview guide, three trained researchers (DH, NL and JL) conducted face-to-face semi-structured interviews. The interviews, which lasted around 30–45 minutes, were conducted in the participants' homes or at the GP out-of-hours centre depending on the preference of the parent, within 2 weeks after the consultation. Since their children were sick at the moment they were approached, we believed it would be unethical and undesirable to perform the interview immediately after the consultation. Data saturation was achieved after 14 interviews but to ensure maximum variation 20 semi-structured interviews were performed. The interviews were audio recorded and transcribed verbatim by DH, NL and JL.
Data were analysed using constant comparison technique, coding and analysing took place simultaneously [18]. Inductive analysis was used, by using open and finally axial coding schemes using NVivo software version 9.0 [19, 20]. Inconsistencies about coding were discussed and resolved by consensus.
Data triangulation was enhanced by using parents of different ages, education levels, gender and parity and socio-economic areas and combining interview transcripts with research diaries. Hereby we were able to recruit fathers as well. Previous studies suggested fathers frequently play an important role in decision making about consultation of a doctor [21]. In addition, all researchers used a research diary to take notes on their observations and ideas about the interviews and coding scheme. This was used during interpretation and coding of the interviews and peer debriefings with the whole research team. Furthermore, a member check of the written transcript was performed among all participating parents. We provided detailed information about the methodology and background information of the parents, to help others decide whether the results are transferable to their context.
All parents received written information and provided written informed consent to participate in this study. Data were used anonymously. The study was approved by the Medical Ethics committee of the Maastricht University Medical Centre in Maastricht (ref. number NL 13-4-060.4).
Of 63 parents who visited the GP out-of-hours service with a febrile child were approached in person, 51 parents consented to receive more information about participating. From these 51, 6 parents participated in the pilot study and 20 parents participated in a semi-structured interview. Of the parents who participated in the semi-structured interviews, there were 7 fathers and average age was 32.2 years (range 22–44 years). None of the parents wanted to alter the transcript after the member check. In Table 1 the main characteristics of the participating parents are described.
Characteristics of the participating parents (n = 20)
Characteristics of parents
Number of parents
Male sex, n (%)
Civil state
Living together/Unmarried
Native country
We identified four main categories emerging from the data; (1) cautiously seeking care, (2) discrepancy between rationality and emotion, (3) expecting reassurance from a professional and (4) a need for consistent, reliable information. These main categories will be discussed in further detail. We did not observe any distinct differences between parents of different gender, age or education level. Figure 1 shows a graphical overview of the categories that were found.
Categories and their relationship. Main categories are put in Bold
Cautiously seeking care
Parents expressed a range of experiences and emotions caring for their sick child before even considering contacting the GP out-of-hours service. Contacting the GP out-of-hours service is not prompted by the fever itself, but mostly by a combination of symptoms. The additional symptoms were felt to be the main drivers of their worries and subsequently would then lead to help-seeking behaviour. Specific symptoms named by parents were listlessness, weepiness, sleepiness, lower intake of fluids and their child behaving differently than normal.
"If he's still playing I'm not worried. But last time I called the GP because he refused to eat, he wouldn't drink, he wouldn't play, he just laid there listlessly on the couch, and that is not my son." (I5)
Parents reported ongoing fever, fever not responding to antipyretics and the duration of the fever as important factors influencing their decision to contact the GP out-of-hours service.
"If it's only a short fever peak, I'm not worried. But when it [the fever] perseveres for hours, or days, I think that is disturbing." (I1)
Parents said they usually carefully wait and see before actually seeking care, especially during out-of-hours care. When they decided to seek care many described that nothing could persuade them from wanting to see a doctor at that point and that was their main reason for contacting the GP out-of-hours centre and not their own GP.
"Nobody could have stopped me. And nobody could have said to me: no, you do not need to come over right now, just visit your own GP tomorrow." (I5)
Factors influencing this decision were on one side logistical like the fact that their own GP didn't have time that same day, they picked up their child from day-care when their own GP practice was already closed or they wanted to avoid putting the child in the car in the middle of the night.
"Then we picked him up [their child at day care] and my girlfriend called the GP and they didn't have time for an appointment anymore and told us to come over the next day. But I didn't want to wait that long." (I19)
On the other side there were also other factors which were related to the fact that they experienced that fever most often rises in the early evening [22]. Parents expressed they were afraid to go to sleep when their child has a fever because they can't monitor their behaviour then.
"I noticed the fever was 39.4 °C at the beginning of the evening, which means it will only increase and I'm afraid to go to sleep then." (I6)
Discrepancy between rationality and emotion
Although parents carefully considered when to seek care, they experienced that their anxiety increases with the temperature of their child.
"…if the temperature is 39 °C I think okay, but if it rises towards 40 °C … I panic." (I13)
This may be explained by the fact that most parents believed the height of the temperature directly correlates with the illness severity of their child. They explained that in their eyes, a higher temperature correlated with a more serious illness and therefore a higher risk of complications.
"If it is higher than 40 °C, then you are talking about another, yes another severity." (I4)
However, there were also parents who acknowledged that their emotions would often take over from rational reasoning at these instances.
"Rationally I think it does not matter 38, 39 or 39.5 °C, but emotionally I feel the higher the fever, the sooner something [complications] might happen." (I7)
This discrepancy between rationality and emotion was also something that was reported in relationship to a longer duration of illness.
"Initially I usually don't panic… but if the symptoms last longer I'm not as sensible and I tend to get on the emotional side of the story." (I1)
Underlying, this was possibly related to the fact that parents were willing to await spontaneous improvement to a certain extent. However, if symptoms lasted longer they sought reassurance that they were correctly caring for their child.
"The GP reassured me at that moment [during a consultation when symptoms lasted for more than three days]. He reassured us that we were on the right track and we just had the keep going caring for our child the way we were doing. That my child would recover by himself." (I4)
The only influencing background characteristic of the participating parents we found was the fact that experienced parents (i.e. with older children) were less anxious, perhaps because they had experienced uncomplicated infections and fever with their other children and hence perceived these symptoms as a normal part of childhood.
"I also hear this from other parents. That it developed like that. They also say, I was a mess backthen. And now, with my second child, it's okay. I'm not that afraid anymore." (I10)
Expecting reassurance from a professional
The next category that came forward when elaborating on reasons to contact the GP out-of-hours service was the desire to be reassured. The first reassurance as mentioned in the previous category was the reassurance that they were caring for their child in a correct way and there was nothing else that they could do. Some parents just wanted general reassurance from a professional. Parents would formulate this in in different ways.
"…when the GP says, it's okay, then it's okay." (I10)
Others specifically wanted to know the cause of the fever and reassurance that their child did not suffer from a serious illness, and was therefore not at risk of complications.
"…It is looking for confirmation, having the idea that it's nothing serious… And having that confirmed by a doctor." (I8)
When asked what the most reassuring aspect of a GP's consultation was, the most often mentioned contributing factor was a physical examination by a GP.
"The GP successfully reassured us. He performed a good physical examination and took us seriously. I believe that's important." (I7)
The position of a GP as an expert in advice on how to care for their child's health was also described by parents when they were asked about their expectations of medication prescriptions. Parents did not expect medication, but relied on the expertise of the GP to determine what was needed. None of the parents expected antibiotics.
"…We prefer no medication. But when it is necessary, so when the GP advises medication, we would have given this." (I7)
During GP out-of-hours care in the Netherlands, patients are most likely to be seen by another GP than their own GP during daytime care. Yet, seeing a different GP does not bother them, as long as their child is seen by a doctor who takes them seriously and who can treat their child correctly.
"A doctor is a doctor, he [my child] just needs help." (I13)
Parents noticed that they are used to frequently seeing another doctor during daytime care because they attend a GP group practice. Moreover, some parents experienced a consultation with a different doctor as positive considering it as a second opinion.
A need for consistent, reliable information
Parents consulted other parents or relatives, as well as the internet as an information source before contacting the GP out-of-hours service. Conversely, this did not necessarily lead to reassurance. Some parents even pointed out searching for information on the internet led to increased anxiety.
"Sometimes I search for information on the internet, but as I have just said, I try to avoid it most of the time… Because I just read too much and then I get anxious." (I1)
Most parents did not receive written information from the GP during the consultation. Some parents suggested that information about alarm symptoms and self-management strategies would be helpful when they return home since they did not think about all the questions they had at that exact moment during a consultation.
"…Written information would be helpful. Because, most often during a consultation you do not think about all the questions you want to ask. And once you are at home you think to yourself hmmm (sighs) I should have asked that…" (I1)
Additionally, parents described they could use this information for future illnesses before contacting the GP out-of-hours service.
"For example he diagnosed an ear infection and I believe this is common in small children. If there was a booklet describing this, what an ear infection is and with a picture of the localisation…I would keep that. And I would take a look at it if he gets another ear infection. To recall what's going on in case I don't completely remember." (I13)
However, parents experienced that it would be important that this information came from one, comprehensible and reliable information source without inconsistencies.
"There is a need for one good information source which is clear and consistent, not in doctor language because normal human beings don't understand that." (I6)
Main findings
Parents generally cautiously wait and see before contacting GP out-of-hours care when their child has a fever. Not one specific symptom, but a combination of fever with other symptoms, makes them anxious and drives care seeking. Because parents work during the day and fever typically rises during the early evening, the decision to seek care was often made during out-of-hours care. When contacting a GP out-of-hours service, parents did not expect antibiotics but sought reassurance from a professional, which parents felt could be achieved by a thorough physical examination. Finally, they believed that there is a lack of reliable consistent information on (self-management strategies for) childhood fever before, during and after a consultation.
Comparison with existing literature
The degree of fever alone has previously shown to have a low predictive value for the severity of an illness in children [1]. Interestingly parents mentioned a higher temperature would indicate a more severe illness, sometimes even mentioning a specific limit. This belief is in accordance with previous research, indicating that parents still believe high fever is harmful [2, 23, 24]. There are studies that show that by increasing parental knowledge this misconception can be reduced [25]. However, some parents were able to describe that their fears were not based on their rational knowledge but mostly on their emotions. This means there were also parents who acknowledged they rationally knew that a higher temperature did not indicate a more severe illness, but emotionally their anxiety increased when the body temperature increased. Some secondary care studies describe that despite increasing knowledge, anxiety remains [26]. However, to our understanding this is the first study in which parents actually described this discrepancy between rational and emotions themselves. Education and information about fever might therefore only reduce anxiety to a certain extent. This is something to take into account when developing interventions to reduce anxiety among parents of febrile children.
The need for reassurance from an expert was expressed by all parents and is in accordance with other literature [3, 27, 28]. This reassurance can, at least partly, be obtained by a physical examination. Previous research already showed a physical examination is valued as an important component of a GP consultation and parents feel reassured when they know what's going on with their child [3, 9, 27, 28]. Parents rely on a GP for their expertise, as reported in a Scandinavian study which was aimed at studying when parents with an ill child consult a physician [9, 27].
In accordance with existing literature, we found that parents' expectations of a GP's consultation were not specific and parents generally do not expect antibiotics [3]. However, in agreement with a recent study our data suggests that parents consult because of a perceived threat to their child's health, which then in turn prompts clinicians to prescribe antibiotics [29, 30]. In contrast, only a small percentage of children presenting with a fever actually requires treatment based on the incidence of serious bacterial infections [31]. However, recent Dutch studies show that one in three to four children with fever who visit the GP out-of-hours service receive antibiotics [10, 11], suggesting that antibiotic prescribing is still higher than warranted. As in adults with acute cough, one explanation could be that GPs assume patients or in this case parents expect antibiotics [32]. This study underlines the fact that parents indeed do not expect antibiotics.
Parents actively search for information before contacting a GP [27]. As suggested previously, we found that this information did not always reassure parents, but even raised anxiety in some cases [2]. A relatively new finding of this study in comparison to previous research is the usage of the internet as a main source of information for parents. One of the challenges in the usage of internet as an information source is the fact that parents expressed that there is a lack of reliable consistent information on the internet [33].
Another important aspect of information provided to parents of febrile children that is suggested in previous studies is the fact that reliable, consistent information can potentially provide parents with better knowledge [34] and with a safety net [7]. By providing parents information on what to do and when to consult when their child has fever in accordance with the NICE 2013 traffic light system [1], their self-management can be increased without leading to complications for their children [7]. As suggested earlier, this may very well be even more effective if the same information that is provided at the point-of-care during a consultation, is also provided to parents in the general public before their children get sick [2].
This is the first qualitative describing study enrolled in a GP out-of-hours setting that gives in-depth insight into the motivations, expectations and experiences of parents when they visit a GP out-of-hours with their febrile child. This setting is important because most consultations are handled by GPs without referral to secondary care and many consultations take place during out-of-hours care [10].
Despite efforts to make parents feel comfortable and safe by letting them choose the location of the interview, parents may have given socially acceptable answers, thereby holding back valuable information. Because interviews were not executed immediately after the consultation there was some risk of recall bias. We did however perform the interviews within 2 weeks and feel this was the most ethical and pragmatic approach since it is undesirable to execute an interview with parents' their sick child being present. Although we attempted to describe the motivation, expectations and experiences of parents, there may be potential underlying and influencing factors, which were not discovered during this study.
The different perspectives, member check, peer debriefings and investigator and data triangulation helped to increase trustworthiness. However, all researchers had a medical background with an interest in general practice and infections which might have influenced their views and interpretation of the data. As only parents who visited the out-of-hours service were included, we are missing data from parents who stayed at home with their febrile child. It is possible these parents have different expectations and experiences considering fever. Additionally, since health care systems and illness experience are culturally different, we do not know to what extent these results are generalizable to other countries. Nevertheless, we believe that these results are at least to some extent generalizable to Western countries with similar health care systems. In addition, we provided information about the methodology and background information of parents to help others decide whether the results of this study are transferable to their context.
Implications for practice
Lacking self-management strategies seem to influence parental consultations which do then in turn potentially thrive antibiotic prescriptions [29, 30]. It is previously shown that an information exchange tool is effective in reducing the number of antibiotic prescriptions and intention to re-consult in children with upper respiratory tract infections and that such a tool can increase parental and clinician confidence in managing these illnesses [21, 35]. We believe that this strategy could also be used in children presenting with a fever. Therefore, future research should focus on improving information on childhood fever provided in the consulting room in a consistent, tailored, written way. However, this might be challenging during out-of-hours care where there is no pre-existing relationship between GPs and parents and where time is limited [30]. Therefore, we believe that future studies should also focus on providing consistent parental education to parents in the general public, thereby improving parental confidence and self-management when their child has a fever.
Parents of febrile children are still anxious and search for reassurance from a GP as a professional when fever is accompanied by other symptoms. They sought reassurance that they were correctly caring for their child and were additionally reassured when a thorough physical examination was conducted. This study demonstrates, in accordance with previous research, that parents of a febrile child do not expect antibiotics and are in search of consistent, reliable information about fever and specific symptoms. Enhancing parental knowledge may provide parents with a safety net [7], thereby influencing self-management and the parental need for consultations. In addition, by making this information available in the consulting room it may facilitate communication about caring for a febrile child and address misconceptions GP's still hold about parents and patients expecting antibiotics.
GP:
COREQ:
Consolidated criteria for reporting qualitative research
The authors would like to thank The Nightcare GP out-of-hours service and the parents for participating.
The Netherlands Organization for Health Research and Development (ZonMW grant 836–021022) funded this study. Jochen Cals is supported by a Veni-grant (91614078) of the Netherlands Organisation for Health Research and Development (ZonMw). The funders had no role in study design, data collection, data analysis, data interpretation, or writing the report.
Additional file 1: Consolidated criteria for reporting qualitative studies (COREQ): 32-item checklist. (DOCX 22 kb)
JC and EB conceived the idea for the study; JL, NL, DH and EB performed the interviews and data analysis and wrote the first draft of the manuscript. All authors interpreted the data and findings and all authors commented on the first draft and all further revisions (EB, LJ, NL, DH, GD, JC). The corresponding author (EB) had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the final version of the manuscript.
Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
National Institute of Clinical Excellence. NICE guideline: feverish illness in children. London: National Institute of Clinical Excellence; 2013.Google Scholar
Walsh A, Edwards H, Fraser J. Influences on parents' fever management: beliefs, experiences and information sources. J Clin Nurs. 2007;16:2331–40.View ArticlePubMedGoogle Scholar
Kallestrup P, Bro F. Parents' beliefs and expectations when presenting with a febrile child at an out-of-hours general practice clinic. Br J Gen Pract. 2003;53:43–4.PubMed CentralPubMedGoogle Scholar
Enarson MC, Ali S, Vandermeer B, Wright RB, Klassen TP, Spiers JA. Beliefs and expectations of Canadian parents who bring febrile children for medical care. Pediatrics. 2012;130(4):e905–912.View ArticlePubMedGoogle Scholar
Betz MG, Grunfeld AF. 'Fever phobia 'in the emergency department : a survey of children' s caregivers. Eur J Emerg Med 2006 Jun;13(3):129-33.Google Scholar
Karwowska A, Nijssen-Jordan C, Johnson D, Davies HD. Parental and health care provider understanding of childhood fever: a Canadian perspective. CJEM. 2002;4(6):394–400.PubMedGoogle Scholar
Jones CH, Neill S, Lakhanpaul M, Roland D, Singlehurst-Mooney H, Thompson M. Information needs of parents for acute childhood illness: determining 'what, how, where and when' of safety netting using a qualitative exploration with parents and clinicians. BMJ open. 2014;4(1):e003874.PubMed CentralView ArticlePubMedGoogle Scholar
Taveras EM, Durousseau S, Flores G. Parents' beliefs and practices regarding childhood fever. Pediatr Emerg Care. 2004;20:579–87.View ArticlePubMedGoogle Scholar
de Bont EG, Francis NA, Dinant GJ, Cals JW. Parents' knowledge, attitudes, and practice in childhood fever: an internet-based survey. Br J Gen Pract. 2014;64(618):e10–16.PubMed CentralView ArticlePubMedGoogle Scholar
de Bont EG, Lepot JM, Hendrix DA, Loonen N, Guldemond-Hecker Y, Dinant GJ, et al. Workload and management of childhood fever at general practice out-of-hours care: an observational cohort study. BMJ open. 2015;5(5):e007365.PubMed CentralView ArticlePubMedGoogle Scholar
Elshout G, Kool M, Van der Wouden JC, Moll HA, Koes BW, Berger MY. Antibiotic prescription in febrile children: a cohort study during out-of-hours primary care. J Am Board Fam Med. 2012;25(6):810–8.View ArticlePubMedGoogle Scholar
Elshout G, van Ierland Y, Bohnen AM, de Wilde M, Oostenbrink R, Moll HA, et al. Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study. Br J Gen Pract. 2013;63(612):e437–444.PubMed CentralView ArticlePubMedGoogle Scholar
Lincoln Y, Guba G. Naturalistic Inquiry. Newbury Park, CA: SAGE Publications; 1985.Google Scholar
Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.View ArticlePubMedGoogle Scholar
Huibers L, Giesen P, Wensing M, Grol R. Out-of-hours care in western countries: assessment of different organizational models. BMC Health Serv Res. 2009;9:105.PubMed CentralView ArticlePubMedGoogle Scholar
Huisartsen Oostelijk Zuid-Limburg. Organisation [http://www.huisartsen-ozl.nl/public/ozl/media/file/MJV_2011_2012.pdf]
Bowen GA. Grounded theory and sensitizing concepts. Int J Qual Methods 2006. 5(3)12–3.Google Scholar
Pope C, Ziebland S, Mays N. Qualitative research in health care. Analysing qualitative data. The BMJ. 2000;320(7227):114–6.View ArticlePubMedGoogle Scholar
Corbin J Straus A. Basics of Qualitative Research. Los Angeles, California: SAGE Publications. 2008.Google Scholar
Charmaz K. Constructing grounded theory. Los Angeles, California: SAGE Publications. 2006.Google Scholar
Francis N, Wood F, Simpson S, Hood K, Butler CC. Developing an 'interactive' booklet on respiratory tract infections in children for use in primary care consultations. Patient Educ Couns. 2008;73:286–93.View ArticlePubMedGoogle Scholar
Manfredini R, Vergine G, Boari B, Faggioli R, Borgna-Pignatti C. Circadian and seasonal variation of first febrile seizures. J Pediatr. 2004;145(6):838–9.View ArticlePubMedGoogle Scholar
Sarrell M, Cohen HA, Kahan E. Physicians', nurses', and parents' attitudes to and knowledge about fever in early childhood. Patient Educ Couns. 2002;46(1):61–5.View ArticlePubMedGoogle Scholar
Lagerlov P, Helseth S, Holager T. Childhood illnesses and the use of paracetamol (acetaminophen): a qualitative study of parents' management of common childhood illnesses. Fam Pract. 2003;20(6):717–23.View ArticlePubMedGoogle Scholar
O'Neill-Murphy K, Liebman M, Barnsteiner JH. Fever education: does it reduce parent fever anxiety? Pediatr Emerg Care. 2001;17(1):47–51.View ArticlePubMedGoogle Scholar
Crocetti M, Moghbeli N, Serwint J. Fever phobia revisited: have parental misconceptions about fever changed in 20 years? Pediatrics. 2001;107(6):1241–6.View ArticlePubMedGoogle Scholar
Ertmann RK, Soderstrom M, Reventlow S. Parents' motivation for seeing a physician. Scand J Prim Health Care. 2005;23(3):154–8.View ArticlePubMedGoogle Scholar
Ingram J, Cabral C, Hay AD, Lucas PJ, Horwood J, Team T. Parents' information needs, self-efficacy and influences on consulting for childhood respiratory tract infections: a qualitative study. BMC Fam Pract. 2013;14:106.PubMed CentralView ArticlePubMedGoogle Scholar
Cabral C, Lucas PJ, Ingram J, Hay AD, Horwood J. "It's safer to …" parent consulting and clinician antibiotic prescribing decisions for children with respiratory tract infections: An analysis across four qualitative studies. Soc Sci Med. 2015;136–137:156–64.View ArticlePubMedGoogle Scholar
de Bont EG, Peetoom KK, Moser A, Francis NA, Dinant GJ, Cals JW. Childhood fever: a qualitative study on GPs' experiences during out-of-hours care. Fam Pract. 2015;32(4):449–55.PubMedGoogle Scholar
Van den Bruel A, Bartholomeeusen S, Aertgeerts B, Truyers C, Buntinx F. Serious infections in children: an incidence study in family practice. BMC Fam Pract. 2006;7:23.PubMed CentralView ArticlePubMedGoogle Scholar
Coenen S, Michiels B, Renard D, Denekens J, Van Royen P. Antibiotic prescribing for acute cough: the effect of perceived patient demand. Br J Gen Pract. 2006;56(524):183–90.PubMed CentralPubMedGoogle Scholar
Walsh AM, Hyde MK, Hamilton K, White KM. Predictive modelling: parents' decision making to use online child health information to increase their understanding and/or diagnose or treat their child's health. BMC Med Inform Decis Mak. 2012;12:144.PubMed CentralView ArticlePubMedGoogle Scholar
Sarrell M, Kahan E. Impact of a single-session education program on parental knowledge of and approach to childhood fever. Patient Educ Couns. 2003;51:59–63.View ArticlePubMedGoogle Scholar
Francis NA, Phillips R, Wood F, Hood K, Simpson S, Butler CC. Parents' and clinicians' views of an interactive booklet about respiratory tract infections in children: a qualitative process evaluation of the EQUIP randomised controlled trial. BMC Fam Pract. 2013;14:182.PubMed CentralView ArticlePubMedGoogle Scholar
Knowledge, attitudes, behaviors, education, and communication


French Soaps: Christmas Soap on hand for the perfect last minute gift.
Christmas Soap on hand for the perfect last minute gift.
Everyone uses soap. Everyone loves to give and receive soaps for Christmas . It's one less worry around the holidays to know you have the perfect gifts.
This Butter and Goat's Milk are great for combination skin and has a luxurious lather.


The thriving level of athletic competition at Great Lakes Christian College is bringing students, faculty, staff and families together for the purpose of glorifying God through athletic competition. The heartbeat of Crusaders athletics continues to showcase Christ-centered students who care not only about the final score, but how they can share their heart through their athletic abilities. Amidst our students' success in the athletic arena, in the classroom, and as champions for Christ, our abilities have surpassed our facilities.
YOU can purchase a VIP seat today for $41.67 per month ($500) over the next year. Put a Crusader in the Chair!
$500 - Purchase a VIP seat which will include a one-year All-Access Crusader Athletic Pass and official Crusader shirt & hat, lapel pin & your name on our website!
Contact Director of Athletics Richard Westerlund at rwesterlund@glcc.edu or call 517-321-0242 ext 233 to buy your chair today.


The Harris Pye Engineering Group, global specialists in the provision of repairs, upgrades and conversions to the marine, offshore oil and gas, and associated onshore industrial sectors, has been acquired by the Joulon Group.
Joulon was created in partnership with KKR, the global investment firm to acquire well established companies globally. The investment in Joulon comes from multiple funds managed or advised by KKR. Harris Pye has been acquired toprimarily add capability in the Project Management Platform for the Joulon Group and will also have an impact in the majority of the Joulon platforms.
"We are really excited to have Harris Pye as part of Joulon Group. Harris Pye's extensive global presence and expertise in executing large distributed complex projects across any asset class is an invaluable enhancement to our capabilities," says Abhishek Kumar, Vice Chairman and Group CEO of Joulon.
"KKR/Joulon's ambition is to grow the HP Group to many times its current size, through investment, strategic acquisition and increasing market share across the Marine; Offshore Oil & Gas; Industrial and Power Services; and Renewable Energy sectors. This ambitious growth plan is very much in line with the Directors' desires, and the fact that we are now a part of one of the world's largest private equity group will strengthen our financial backing and allow us to bid for complete projects as a Tier One EPC contractor, not further down the supply chain as at present," Prendergast adds.


HomeGigsTHE FRATELLIS Share Video For New Single 'Stand Up Tragedy' – Watch Now!
THE FRATELLIS Share Video For New Single 'Stand Up Tragedy' – Watch Now!
With a flourish and a cheeky grin, The Fratellis share the video for Stand Up Tragedy, the first single taken from their fifth studio album In Your Own Sweet Time released by Cooking Vinyl 9th March. Dancing between vibrant lyrical dexterity and foot-tapping, spine-tingling rhythms, Stand Up Tragedy teases a glittering, adrenaline-charged new direction for a band still firing on all cylinders.
Kicking off In Your Own Sweet Time in style, Stand Up Tragedy bears all the trademarks of the incorrigible Glaswegian three-piece – pitch-black humour, a twitchy muscularity, and a melody that demands you dance along. However, that's not to say The Fratellis don't still have a few tricks left up their sleeves, and from the moment Jon Fratelli kicks out the first line of Stand Up Tragedy in a puckish falsetto, we're down the rabbit hole with a track shot through with gleefully absurdist abandon. Razor-sharp riffs and whooping back-up vocals filter Rolling Stones vibes through a psychedelic haze as impish, intricate rhymes crash together in a vibrant sonic pile-up.
Out 9th March, In Your Own Sweet Time once again teams up the Fratellis with six-time Grammy and Mercury nominated American producer Tony Hoffer (Beck, The Kooks, M83, Belle & Sebastian). Boasting all the sweaty, joyful energy of 1970s American pop, combined with the testosterone-fuelled virtuosity of the best British rock, In Your Own Sweet Time is a shot of pure, uninhibited, pleasure. In dark and uncertain times, sometimes all you need is to lose yourself in the moment, and first single Stand Up Tragedy demands we stop trying to make sense, take off our shoes, and dance. Let Jon Fratelli (vox, guitar), Barry Fratelli (Bass), and Mince Fratelli (drums) guide you through the chaos, and share the last laugh.
THE NATIONAL release video for 'Dark Side Of The Gym' – Watch Now!


text:
_Bietti, L.M. (in press). Collaborative remembering sequences. In B. Wagoner, I. Bresco & S. Zadeh (Eds.), Memory in the Wild (pp. xxx-xxx). Charlotte, NC: Information Age Publishing.
_Bietti, L.M. & Stone, C.B. (Eds.) (2019). Remembering with Others: Conversational Dynamics and Mnemonic Outcomes. TopiCS in Cognitive Science, 11 (4). Pages 587-927. [Special issue]
_ Bietti, L.M., Bangerter, A., Knutsen D., & Mayor E. (2019). Cultural transmission in a food preparation task: The role of interactivity, innovation and storytelling. PLOS ONE. 14(9): e0221278. https://doi.org/10.1371/journal.pone.0221278
_Bietti, L.M. & Stone, C.B. (2019). Editors' Introduction: Remembering with others: Conversational dynamics and mnemonic outcomes. TopiCS in Cognitive Science, 11 (4), 592-608. https://doi.org/10.1111/tops.12443
_ Bietti, L.M. & Baker, M.J. (2019). Collaborative remembering, temporal cement of collaborative learning: An exploration. In Lund, K., Niccolai, G., Lavoué, E., Hmelo-Silver, C., Gweon, G., and Baker, M. (Eds.), Proceedings of the 13th International Conference on Computer Supported Collaborative Learning (CSCL) 2019, Volume 2 (pp. 601-604). Lyon, France: International Society of the Learning Sciences. [Acceptance rate: 22%]
_ Bietti, L.M. & Baker, M.J. (2018). Collaborative remembering at work. Interaction Studies, 19 (3), 459-486.
_ Bietti, L.M., Tilston, O.E.R., & Bangerter A. (2018). Storytelling as adaptive collective sensemaking. TopiCS in Cognitive Science, 11 (4), 710-732.
_ Gonzalez, S., Skogmyr Marian, K., Volpin, L., Gfeller, F., Bietti, L.M., & Bangerter, A. (Eds.) (2018). Proceedings of the Young Researchers Conference of the Center for Research on Social Interactions (CRSI-YR). Travaux neuchatelois de linguistique, 68 (2), pp. 138.
_ Bietti, L.M. (2018). Memorias adaptables para la construccion de identidades colectivas. Social and Education History, 7 (2), 125-150.
_ Bianchi, R. Laurent, E., Schofeld, I., Bietti, L.M., & Mayor E. (2018). Memory bias toward emotional information in burnout and depression. Journal of Health Psychology. https://doi.org/10.1177/1359105318765621
_ Bietti, L.M. & Baker, M.J. (2018). Multimodal processes of joint remembering in complex collaborative activities. In M. Meade, A. Barnier, P. van Bergen, C. B. Harris & J. Sutton (Eds.), Collaborative Remembering: Theories, Methods and Applications (pp. 176-196). New York: Oxford University Press.
_ Bietti, L.M., Bangerter, A., & Mayor, E. (2017). The interactive shaping of social learning in transmission chains. In G. Gunzelmann, A. Howes, T. Tenbrink & E.Davelaar (Eds.), Proceedings of the 39th Annual Conference of the Cognitive Science Society(pp. 1641-1646) Austin, TX: Cognitive Science Society.
_Mayor, E. & Bietti, L.M. (2017). Ethnomethodological studies of nurse-patient and nurse relative interactions. A scoping review. International Journal of Nursing Studies.
http://dx.doi.org/10.1016/j.ijnurstu.2017.01.015
_ Bietti, L.M. & Baker, M.J. (2016). Collaborating to remember collaborative design: An exploratory study. Memory Studies, 1-19. DOI: 10.1177/1750698016683438.
_ Bietti, L.M. (2016). Review of the book Beyond the Archive: Memory, Narrative, and the Autobiographical process by J. Brockmeier. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, 17 (3), Art.3.
_Bietti, L.M., Baker, M. J., & Detienne, F. (2016). Joint remembering in collaborative design: A multimodal approach in the case of a video design studio. CoDesign: International Journal on CoCreation in Design and the Arts, 12 (4), 221-242.
_Amici, F. & Bietti, L. (eds.) (2015). Coordination, Collaboration and Cooperation: Interdisciplinary Perspectives. Interaction Studies 16 (3). [Special issue]
_Amici, F & Bietti, L. M. (2015). Coordination, collaboration and cooperation: Interdisciplinary perspectives.Interaction Studies 16 (3), vii-xii. [Introduction to the special issue]
_ Bietti L.M & Sutton, J. (2015). Interacting to remember at multiple timescales: Coordination, collaboration, cooperation and culture in joint remembering. Interaction Studies, 16 (3),419-450.
_ Bietti, L.M. & Sutton, J. (2015). Multiple timescales of joint remembering in the crafting of a memory-scaffolding tool during collaborative design. In G. Airenti, B. Bara & G. Sandini (eds.), Proceedings of the EuroAsianPacific Joint Conference on Cognitive Science, pp. 60-65.
_ Bietti, L. M., Baker, M.J. & Detienne, F. (2015). Joint remembering in co-design: An ethnographic study of functions and multmodal processes. Proceedings of the 33rd Annual European Conference on Cognitive Ergonomics. Warsaw - July, 1-3, 2015.
_Stone, C. & Bietti, L. M. (eds.) (2015). Contextualising Human Memory: An interdisciplinary approach to how Individuals and groups remember their pasts. London: Routledge.
_ Bietti, L. M. (2015). Contextualizing embodied remembering: autobiographical narratives and multimodal communication. In C. Stone & L. M. Bietti (eds.), Contextualizing Human Memory: An Interdisciplinary Approach to How Individuals and Groups Remember their Pasts (pp.127-163). London: Routledge.
_ Stone, C. B & Bietti, L.M. (2015). An introduction to contextualizing human memory. In C. B. Stone & L.M. Bietti (eds.), Contextualizing Human Memory: An Interdisciplinary Approach to How Individuals and Groups Remember their Pasts. London: Routledge.
_ Bietti, L.M., Stone, C. & Hirst, W. (eds.) (2014). Remembering in Context. Memory Studies 7 (3) [Special issue]
_ Bietti, L.M., Stone, C. B. & Hirst, W. (2014). Contextualizing human memory. Memory Studies, 7 (3), 267-271.
_ Bietti, L.M. (2014). Discursive Remembering: Individual and Collective Remembering as a Discursive, Cognitive and Historical Process. Berlin/New York: De Gruyter.
_ Cienki, A., Bietti, L & Kok, K. (2014). Multimodal alignment during collaborative remembering. Memory Studies, 7 (3), 354-369.
_ Bietti, L. (2014). Embodied and distributed contexts ofcollaborative remembering. In C. Müller, E. Fricke, S. Ladewig, A. Cienki, D. McNeill, & S. Teßendorf (eds.), Handbook Body – Language – Communication. Volume 2. Berlin: Mouton de Gruyter, pp. 2008-2016.
_ Bietti, L.M. (2013). Reminders as interactive and embodied tools for socially distributed and situated remembering. SAGE Open 3: doi:10.1177/2158244013501331
_ Bietti, L.M. & Galiana Castello, F. (2013). Embodiedreminders in family interactions: Multimodal collaboration in rememberingactivities. Discourse Studies, 15 (6), 665-686.
_ Bietti, L, Kok, K. & Cienki, A. (2013) Temporal aspects of behavioral alignment in collaborative remembering. Proceedings of the Tilburg Gesture Research Meeting 2013.
_ Medina Audelo, R. & Bietti, L.M. (2013). Autobiographical remembering and storytelling in context and history. Storytelling, Self, Society 9 (1). http://digitalcommons.wayne.edu/storytelling/vol9/iss1/1
_ Bietti, L.M. (2013). Memory and culture in the mind. Review article of Memory in Mind and Culture by P. Boyer & J. Wertsch (eds.). Mind, Culture and Activity 20 (2), 184-188.
_ Bietti, L. M. (2013). Review of the book The Memory Process: Neuroscientific and Humanistic Perspectives by S. Nalbantian, P.M. Matthews & J.L. McClelland. Social and Education History 2 (3), 341-344.
_Bietti L.M. & Medina Audelo, R. (2012). How history shapes memories in autobiographical narratives. Social and Education History 1 (3), 222-247.
_Bietti, L.M. (2012). Review of the book Cognitive Pragmatics. The Mental Processes of Communication by B.Bara. Philosophical Psychology 25 (4), 623-627.
_ Bietti, L.M. (2012). Towards a cognitive pragmatics of collective remembering. Pragmatics & Cognition 20 (1), 32-61.
_ Bietti, L.M. (2012). Joint remembering: cognition,communication and interaction in processes of memory-making. Memory Studies 5 (2), 182-205.
_Bietti, L.M. (2012). Review of the book Semiotics at the Circus by Paul Boussiac. eLanguage. June 30th.
_ Bietti, L.M. (2012). Review of the book New Adventures in Language and Interaction by Jurgen Streeck (ed.). eLanguage. March 28th.
_ Bietti, L.M. (2012). Review of the book Cultural Conceptualisations and Language: Theoretical Framework and Applications by F. Sharifian. eLanguage. March 27th.
_ Bietti, L.M. (2011). Memorias compartidas, conversacion de familia e interaccion [translation by Amanda Vallejo Morales]. Discurso & Sociedad 5 (4), 749-794.
_ Bietti, L.M. (2011). Review of the book Cognitive Systems and the Extended Mind by Robert D. Rupert. eLanguage, September 30th.
_ Bietti, L. M. (2011). The commemoration of March 24th, 1976: understanding the exceptionality of the present political discourse about the 'Dirty War' in Argentina. Journal of Language and Politics 10 (3), 347-371 [DOI: 10.1075/jlp.10.3.03bie]
_ Bietti, L.M. (2011). Review of the book Meaning in Mind and Society: A Functional Contribution to the Social Turn in Cognitive Linguistics by P. Harder. eLanguage, September 9th.
_ Bietti, L.M. (2011). La mente extendida. Ciencia Cognitiva 5 (2), 31-33.
_ Bietti, L.M. (2011). Extended review of the book The Cognitive Life of Things: Recasting the Boundaries of the Mind by L. Malafouris & C. Renfrew. Pragmatics and Cognition 19 (1), 141-149. DOI: 10.1075/pc.19.1.08bie
_ Bietti, L.M. (2011). Review of the book Memento (Philosophers on Films by A. Kania (ed.). Memory Studies 4 (2), 253-258.
_ Bietti, L.M. (2011). 'Piercing memories': Empty spaces in the histories of Argentinean families. Memory Studies 4 (1), 83-87.
_ Bietti, L.M. (2010). The construction of the moral self in autobiographical memory: being an 'ordinary man' within the experience of dictatorship in Argentina. In S. Salvatore, J. Valsiner, J. Travers Simon & A; Gennaro (eds.)Yearbook of Idiographic Science 3, pp. 253-276. Rome: Firera & Liuzzo Group.
_ Bietti, L.M. (2010). Sharing memories, family conversation and interaction. Discourse & Society 21 (5), 499-523.
_ Bietti, L.M. (2010). Autobiographical memory, narrative and history: the construction of the self within the experience of dictatorship in Argentina.Proceedings of the XVI Oral History Conference. Between Past and Future: Oral History, Memory and Meaning. Prague, Czech Republic: International Oral History Association. [CD-ROM]
_ Bietti, L.M. (2010). Review of the book What we remember. The construction of memory in military discourse by M. Achugar. Memory Studies (3), 3: 284- 287.
_ Bietti, L.M. (2010). Philosophie des Geistes. In Ch. Gudehus, A. Eichenberg & H. Welzer (eds.). Gedachtnis und Erinnerung. Ein interdisciplinares Handbuch, pp. 273-275. Stuttgart: J.B. Metzler.
_ Bietti, L.M. (2010). Can the mind be extended? And how? Review article of the book Supersizing the Mind: Embodiment, Action and Cognitive Extension by Andy Clark. Constructivist Foundations, (5) 2, 97-99.
_ Bietti, L.M. (2009). Disonancia cognitiva: procesos cognitivos para justificar acciones inmorales. Ciencia Cognitiva (3) 1, 15-17.
_ Bietti, L.M. (2009). Entre la cognición política y la cognición social: el discurso de la memoria colectiva en Argentina. Discurso & Sociedad (3) 1, 44-89.
_ Bietti, L.M. (2008). Memoria, violencia y causalidad en la teoría de los dos demonios. El Norte - Finnish Journal of Latin American Studies (3), 1-34.
_ Bietti, L.M. (2007). La importancia del análisis del discurso en los estudios de memoria. Revista Latinoamericana de Estudios del Discurso (7) 2, 129-131

redpajama_set_name: RedPajamaCommonCrawl


I spoke with my cousin the other day and as per usual he got me thinking. He asked me "what is your take on broken men and how are you, as a woman, going to play your part to fix them?" If you've bared witness to our convos this is the kind of thought processing it requires.
I had to think for a minute. I can speak about broken men all day, in fact I can talk about broken people all day, but I had never been questioned about how I planned to help with the cause. For a split second I even thought, why have I got to fix them? Is that my job?
Well yes. It is my job so to speak. It's everyone's job. Wait, let me break this down, it's not my job to fix any man but I'm starting to believe that the damage is not always caused by previous experiences. A lot of the damage we carry with us is inherited. Beliefs that our parents have instilled. Raised and conditioned to think a certain way. It allows the growth of ignorance which in turn means no one wants to acknowledge that they are in need of fine tuning.
After thinking it through I responded, "My part in fixing them? Fix myself, I can't change what has already been done, but if I have an understanding, I can raise men that in turn are not damaged goods, I can raise empresses fit for a King".
This led us to talk about the importance of women (the womb-man) and our hand in raising society. I noted that the idea of the perfect woman is too simple and in fact dumbs down what a woman's purpose and role is. Nowadays the emphasis is heavily placed on a woman being able to cook and clean. We are laughed at if we cannot participate in these activities. The attributes seem to be the considered major in regards to the quality of a woman. What about ambition? What about motivation? What about intelligence? Guys this is to be the future mother of your children, surely she needs to bring more to the table if she is going to nurture.
Life's cycle starts with the woman who gives birth. That deems the female race vital. A man first learns how to respect a woman by reflecting on his relationship with his mother. His idea of what his wife should be like should centre around his mother. The only thing we should struggle with is teaching a boy to become a man as we have never had to take part in the process ourselves. We cannot advise from first hand experiences.
I refuse to raise a man alongside my children. I am not ruling out growth, no one is a perfect package, but we have to have the same drive for self fulfilment as we do to one another. My man should not be my child.
This is a fantastic topic.
I don't think that you can fix people and it's not anyone's responsibility to do so. I do however think that seeing a partners potential and speaking positivity and life into them can possibly encourage them to begin the healing process them self.
It's kind of like happiness. Alot of people seek happiness from their partner, but I don't really think that a man or woman can make someone happy. I wonder if it's just easier to be happy around some people and we mistake that as them making us happy.
Sorry I tailed off haha- you got me thinking.


text:
Q: Is it possible to call Azure Queue from AWS Lambda My requirement is to send data received in Lambda from DynamoDB to Azure Queue in node.js.
Steps taken - AWS Side
   1. Created DDB Table
   2. Added Stream and Trigger
   3. Wrote Lambda

Steps taken - Azure Side
1. Created an Azure Queue (Service Bus)

So far so good. I can see DDB Events making its way to Lambda.
My question is now I want to send these events to Azure Queue, I could not find any online google result for this. Is it possible to put elements in Azure Queue from AWS Lambda?

A: You can use Azure Service Bus REST API in order to send your messages:
POST    http{s}://{serviceNamespace}.servicebus.windows.net/{queuePath|topicPath}/messages

https://learn.microsoft.com/en-us/rest/api/servicebus/send-message-to-queue

redpajama_set_name: RedPajamaStackExchange


I think this 4 slide rear living Grand Junction fifth wheel still has quite a bit of life & joy left for someone!! Take a look at the pictures & give us a call or stop by if you have an interest or questions!!!


text:
This Week's Jokes: Week of 6/15/15
A 27-year-old Maryland man is accused of shooting and killing an ice cream truck driver. That's one way to make the music stop.
A 27-year-old Maryland man is accused of shooting and killing an ice cream truck driver. Police say the murder was "in cold blood," because, y'know. Ice cream.
Farrah Abraham is selling necklaces with vials of her DNA in it. Ugh let's hope nobody sticks their dick in those vials, the world doesn't need any more of her.
Mashable reports that George H.W. and Barbara Bush have always believed Jeb was "the best bet" of their two sons to be President. Proving foresight and hindsight are 20-20.
Kim Kardashian and Kanye West took their daughter North to Disneyland for her birthday. Is that really a special birthday treat? Every day of their lives is based in a fantasy land.
Kristen Stewart's mother may have accidentally confirmed rumors that her daughter is dating Alicia Cargile, the actress' personal assistant. Guess whose calls won't be getting put through to Kristen Stewart anymore.
An 18-year-old woman was arrested in Florida after police allegedly found 17 photos on her phone of the teen receiving oral sex from her pit bull. "What? All men are dogs anyway," she said.
An 18-year-old woman was arrested in Florida after police allegedly found 17 photos on her phone of the teen receiving oral sex from her pit bull. Weird that those dogs get a bad rap when there are grown men who get all weird and shitty about doing that for a woman.
Mathematicians are reportedly hoarding pieces of chalk from Japanese company Hagoromo Fulltouch Chalk, which recently went out of business. When asked what's so special about it they said, "We can't really sum it up."
Radar reports that Scott Disick wants Kourtney Kardashian to agree to an open relationship. Didn't the entire family already do that when they signed on with E!?
Americans will spend $12.7 billion on their dads this Father's Day, but NBC News reports the holiday wasn't always so loved. Just like how many fathers feel about their children.
South Carolina won't take down the Confederate flag on their capital building, insisting it isn't a racist symbol. They're so in denial it's surprising they don't also insist they won the Civil War.
The Supreme Court ruled that state license plates are "government speech" which is different from "private speech," meaning you can't put anything you want on a license plate and be protected under the First Amendment. So I guess that "B0NR KING" plate I saw last week was an official government statement.
Goldman Sachs just announced a new rule that requires investment banking interns to be out of the office between 12AM and 7AM, for their own health but also because night time is when all the truly evil shady shit goes down.
Goldman Sachs just announced a new rule that requires investment banking interns to be out of the office between 12AM and 7AM. Now they'll get to over-work from home!
California's Labor Commission ruled that an Uber driver is an employee, not a contractor, meaning the company needs to pay for things like drivers' benefits and driving costs. Yep, drivers can now pass gas onto Uber.
The official Giorgio Armani Twitter account responded to a distraught tweet from Kim Kardashian wondering why "Georgio Armani" discontinued her favorite foundation, offering to send her some but also correcting her misspelling of his name. Give her a break, she comes from a whole family of people who make mistakes with spelling names–Caitlyn Jenner, for example.
The official Giorgio Armani Twitter account responded to a distraught tweet from Kim Kardashian wondering why "Georgio Armani" discontinued her favorite foundation, offering to send her some but also correcting her misspelling of his name. So they sent her her shade, but also some of their own shade.
Jeb Bush says he doesn't know that the Charleston shooting was racially motivated. I guess you have to answer that way, when a lot of your would-be voters are.
Marijuana is being allowed at this year's US Open. But you have to carry it yourself. No caddies are allowed on the green.
A report in New York Magazine reveals that American honeybees are dying out largely due to stress. Just have a drink, bees. Get a little buzz on, you'll be fine.
June 20, 2015 July 19, 2015 alisonzeidman
← GoodFellas—for Women


Nelson Mandela has to be one of the most inspiring people on the planet. To say his life has been challenging at times would be a gross understatement. As an anti-apartheid revolutionary, the first black South African to hold office and the President of South Africa, he fought passionately for his beliefs of equality no matter what your skin colour.
Mandela was sentenced to life imprisonment and served 27 years in prison. Imagine that for a moment – 27 years of your life! Needless to say, this courageous man has learned a thing or two during his 95 years of living.
Politics aside, take a moment today to soak up some timeless wisdom from Mandela, a man who was willing to die for what he believed in. Perhaps even stop what you're doing and consider what you believe in and what you would be prepared to do for it?
At the time of writing this Nelson Mandela was in a critical but stable condition – we wish him a quick and safe recovery back to wellness.
If these quotes inspired you today, pass on the inspiration!
this was a man that really what life's meaning truly is…Long the Madiba Legacy, as one man said it is not that which you do for yourself that which count but that which you do for others and that is LEGACY..


text:
The Plug Uglies were an American Nativist criminal street gang, sometimes referred to loosely as a political club, that operated in the west side of Baltimore, Maryland, from 1854 to 1865. The Plug Uglies gang name came from the enormous oversized plug hats they stuffed with wool and leather, pulling them down over their ears for head protection as primitive helmets when going into gang battles. Also, the term plug ugly was used to identify an extremely tough ferocious fighter who could give a sound beating to an opponent. The name Plug Uglies was used to refer to a number of criminal gangs in New York City as well as Philadelphia.

The Plug Uglies took part in the 1856 Baltimore Know-Nothing Riot. They allied themselves with the New York City Irish Dead Rabbits gang in looting New York City during the American Civil War in the Draft Riots of 1863. However, this latter alleged association is disputed, as the Plug Uglies, a Nativist gang, were anti-Irish.

History
The Plug Uglies coalesced in the 1850s shortly after the creation of the Mount Vernon Hook-and-Ladder Company, a Baltimore Fire Department volunteer fire company located in the Mount Vernon area. They were originally runners and rowdies affiliated with Mount Vernon. Plug Ugly captains included John English and James Morgan. Other prominent members were Louis A. Carl, George Coulson, George "Howard" Davis, Henry Clay Gambrill, Alexander Levy, Erasmus "Ras" Levy, James Wardell, and Wesley Woodward. The gang associated with the emerging American Party, also known as the Nativist Know Nothings, in Baltimore.

Like similar associations in Baltimore and other U.S. cities during this period, the Plug Uglies' street influence made them useful to party politicians anxious to control the polls on election days. The Plug Uglies were the central figures in the first election Know-Nothing Riot in Baltimore in October 1855. Together with the Rip Raps, they were also actively involved in deadly rioting at the October 1856 municipal election in Baltimore and in similar violence at the Know-Nothing Riot in Washington, D.C., in June 1857. At the Washington riot, the National Guard was called out to quell the fighting. Accounts of the Washington riot appeared in newspapers nationally and gained widespread notoriety for the Plug Uglies.

Besides election-day fighting, the gang was involved in several assassinations and shootings in Baltimore. Most notably, Plug Ugly Henry Gambrill was implicated in the murder of a Baltimore police officer in September 1858. Gambrill's trial (presided over by judge Henry Stump) and the subsequent deadly violence relating to it, made the crime one of the most sensational of the era.

The violence of the Plug Uglies and other political clubs had an important impact on Baltimore. It was largely responsible for the creation of modern policing and a paid, professional fire department, as well as court and electoral reforms. These reforms, together with the election of a Reform municipal administration in October 1860 and then the Civil War, led to the breaking up of the Plug Uglies.

The Plug Uglies were featured in Herbert Asbury's book Gangs of New York, and Lucy Sante's chronicle of old New York, Low Life.  They are also mentioned in Chapter XIII of MacKinlay Kantor's Pulitzer Prize-winning novel "Andersonville" (1955).

On July 16, 1863, during the New York City draft riots, The New York Times reported that Plug-Uglies and Bloody Tubs gang members from Baltimore, as well as the Philadelphia Schuykill Rangers under Jimmy Haggerty and other rowdies of Philadelphia," had come to New York to participate in the riots alongside the Dead Rabbits and other New York gangs. The Times said that "the scoundrels cannot afford to miss this golden opportunity of indulging their brutal natures, and at the same time serving their colleagues the Copperheads and secesh [secessionist] sympathizers."

See also
List of historical gang members of New York City

Notes

References
Haskins, James., Street Gangs, New York: Hastings House, 1974.
Sifakis, Carl. The Encyclopedia of American Crime (3rd ed.). New York: Facts on File Inc., 2005.
Tracy Matthew Melton, Hanging Henry Gambrill: The Violent Career of Baltimore's Plug Uglies, 1854–1860 (2005).

Further reading
Kobler, John., Capone: The Life and World of Al Capone. New York: J.P. Putnam's Sons, 1971.
Peterson, Virgil., The Mob: 200 Years of Organized Crime in New York. Ottawa, Illinois: Green Hill, 1983.
Sante, Luc, Low Life: Lures and Snares of Old New York (1991)
Tyler Anbinder, Five Points: The 19th Century New York City Neighborhood That Invented Tap Dance, Stole Elections, and Became the World's Most Notorious Slum (2001).

External links
The Legend of Old Smoke Morrissey by John William Tuohy

Former gangs in Baltimore
Culture of Baltimore

Former gangs in New York City

redpajama_set_name: RedPajamaWikipedia


uhleyog: We welcome John Thomas into our family!
We welcome John Thomas into our family!
Our little John Thomas was born Monday, June 20, at 2:16pm. He weighed in at 8 lbs. 4 oz. We are all so glad to have him with us -- he is truly a miracle!
Ah...what a nice rest! That birth stuff isn't easy!
Mommy and John share a few special moments together. He was a rather stubborn boy during the labor, but fortunately by the time he finially arrived, he was pretty darn cute and Mommy quickly forgave him! :) What a precious little boy -- how Good God has been to us!!
Daddy introducting John to his big sisters and big brother.
Meeting their little brother for the first time!
What a great moment!! Theresa, Joseph, and Catherine welcomed little John with such joy and excitement. There is not doubt he will be well loved!
Theresa cannot hold John enough. And her repeated phrase is "I just can't believe he is ours." She will be a great help in the days ahead.
... after eight long months of waiting!


How a missing kidney, countless lattes, and Beyoncé turned German Madrigal into Portland fashion's next hot name.
A strange but potent mix of influences catapulted 27-year-old German Madrigal from serving grande lattes to winning the coveted Emerging Designer prize during this year's local design showcase, FashioNXT. At the October show, the Salem native impressed both the judges and the crowd with a futuristic, gender-neutral collection full of sleek tailoring and vibrant pops of cobalt blue against stark black and white fabrics.
The win capped two busy years for the Art Institute of Portland student. Madrigal won a local design contest for repurposing an old bedazzled wedding gown into a chic, modern look; he showed at Portland Fashion Week; and last February the Art Institute plucked him from among 40 students nationwide to debut a collection at the school's New York Fashion Week showcase. (He'll be back again this February.) Those endeavors come after the full-time job as a barista, part-time retail work, and, of course, his studies—but he's used to working double-time.
Madrigal was born with just one kidney. He spent his early years in and out of hospitals, until his mother donated one of her own kidneys to him when he was 7. Every day, he still swallows a handful of anti-rejection pills—and a stark reminder of mortality. After finishing high school, he was on a predawn shift in a Starbucks drive-thru when fashion came calling.
A month later he was in orientation. Once accepted as a finalist for FashioNXT, he hunkered down to produce his "Equilibrium" collection, watching the Beyoncé documentary Life Is But a Dream on repeat for inspiration—and a reminder to be fierce—while he sewed the bold, minimalist line.


- Handy little alloy spacers from Try-All.
- Used more commonly as pedal cage spacers for use with VP-458A style caged pedals.
- Can also be used as a spacer for 2-bolt boosters, offering a lower profile setup.
- Dimensions: 10mm length, 9mm outer diameter, 5.3mm internal diameter.
Will these allow a 4 bolt booster to fit over my HS33 magura clamps? if not where can i get them?
Hi Tom - these will work perfectly for that. Thanks, Flipp.
Hey, is it possible to use these as spacers for 4-bolt boosters, or are they too short to get over the top half of my clamp? I have Echo TR clamps. The only ones you have in stock at the moment are these.
Hi Alex - Unfortunately they're a little too short, and are also a little too wide to fit properly in your TR clamps. Sorry!


Adidjahiem Records/TJ Records in association with Zojak World Wide are excited to announce the release of "King of the Dancehall", the brand new album from Dancehall Icon, Vybz Kartel. The 14-track set contains all-exclusive, never before released tracks from the "World Boss" Vybz Kartel. Recorded by the prolific artist before his incarceration, the tracks have been carefully completed by renowned Dancehall producer Linton 'TJ' White of TJ Records and Adidjahiem the label known for "bussing" artists like Popcaan, Jah Vinci, Lisa Hyper, Tommy Lee Sparta and more, as well as the Billboard chart topping hit "Romping Shop." Fans who have been longing to hear Kartel at his best will not be disappointed.
Distributed by Zojak World Wide, the album will hit stores on June 10th and fans can pre-order the album exclusively on iTunes starting May 6th. Listeners are in for a musical experience from the "World Boss" who is truly a voice of the people.


The walk will take an hour on level paths suitable for mobility scooters. If you would like to borrow one of Mere Sands Wood's mobility scooters, please let us know in advance.
If you would prefer not to join the guided walk you will be very welcome to take a short stroll around this beautiful nature reserve on your own - or just to join us for the AGM, tea and cake at 3.30pm.
We hope to see you at Mere Sands Wood at 2pm on Wednesday 12th September!