Copyright © 2013 Marco Campo dell'Orto et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Introduction. The use of ultrasound during resuscitation is emphasized in the latest European resuscitation council guidelines of 2013 to identify treatable conditions such as pericardial tamponade. The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. As ultrasound guidance lowers the complication rates and increases the patient's safety, pericardiocentesis should be performed under ultrasound guidance. Acute care physicians actually need to train emergency pericardiocentesis. Methods. We describe in detail a pericardiocentesis ultrasound model, using materials at a cost of about 60 euros. During training courses of focused echocardiography participants tested the phantom and completed a 16-item questionnaire, assessing the model using a visual analogue scale (VAS). Results. Eleven of fourteen questions were answered with a mean VAS score higher than 60% and thus regarded as showing the strengths of the model. Unrealistically outer appearance and heart shape were rated as weakness of the model. A total mean VAS score of all questions of 63% showed that participants gained confidence for further interventions. Conclusions. Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.
Pericardial tamponade is a potentially life-threatening condition and can lead to cardiac arrest. The latest ERC guidelines of 2010 emphasize the use of ultrasound during resuscitation in order to detect reversible causes such as pericardial tamponade to provide early and targeted treatment . It has been shown that echocardiography can be integrated into peri-resuscitation care in an ALS-conform fashion . Thus, acute care physicians will encounter patient scenarios where no specialist is available, but a treatable condition needing immediate intervention is detected. There are several conflicts. Ultrasound now can detect reversible conditions such as tamponade. Thus, emergency or critical care physicians face the problem for treating these conditions, even without experience due to a lack of training in ultrasound-guided pericardiocentesis, because training phantoms are not readily available. Also, the required equipment needed to perform pericardiocentesis is not available in all ambulances or emergency rooms.
The skill for performing a focused echocardiography exam can be acquired in brief training courses . The recommended standard treatment of tamponade in various guidelines is pericardiocentesis. It has been shown that pericardiocentesis can safely be performed under echocardiographic guidance with success rates as high as 100% [4–6]. Most physicians as well as specialists have not been trained to perform pericardiocentesis during their residency and do not feel comfortable while performing it. Several ultrasound models or phantoms for teaching and training ultrasound-guided procedures, such as venous puncture, have been developed [7, 8]. For the training of pericardiocentesis, both the cadavers and pericardiocentesis training models are available . These models have been shown to facilitate practicing the skills needed to perform pericardiocentesis.
However, most of the available models are expensive (i.e., the "Blue phantom" transthoracic echocardiography and pericardiocentesis ultrasound training model starting at 15.000 USD ) and cannot be afforded by many institutions, especially in low-income countries. A low-cost pericardiocentesis phantom has been published during our project timeline, but there was no systematic evaluation of its features and its effectiveness .
We aimed to (1) construct a low-cost pericardiocentesis phantom that can be rebuilt easily and to (2) assess its effectiveness.
A square plastic container was constructed using PCV-planks ( cm, thickness 0.3 cm), filled with gel wax, which was heated until liquid (about 80–100°C), and then filled into the container (Figure 1). The gel wax served as a stable platform within the phantom. For the heart model, a celluloid table tennis ball was filled with water using a syringe until no air was left inside. This water-filled celluloid ball was to mimic a ventricle. The ball was then put into a balloon, which was filled with red ink-colored water until it was deaerated completely and knotted. This balloon was placed onto the solidified gel wax. The container was then filled with ultrasound gel to the brim, and all the air bubbles inside the ultrasound gel were smoothed out using a spoon or a syringe (Figures 1(a)–1(h)). Finally, the model was covered by silicone skin or Thera-Band, a rubber band usually used for gymnastic exercises (Figures 2(a) and 2(b)). These were to mimic the skin piercing. All materials needed for the construction of the model cost approximately 60 euros in total, and the preparation can be completed within 2 hours. The specific materials we used and their prices in common stores are listed in Table 1. Instead of the plastic container used in our model, any square container withstanding heat can be used; the most expensive part of the model was the gel wax which also can be replaced by gelatine to reduce further costs.
Table 1: List of materials used in our model. Instead of gel wax, gelatine can be used to reduce costs. Any kind of plastic container with a square form is suitable as well.
Figure 1: The construction of the pericardiocentesis phantom. (a) A celluloid table tennis ball is filled with water. (b) The ball is placed onto a balloon filled with ink-colored water. (c) The balloon is filled with water. (d) The balloon is dereated and knotted. (e) The container is filled with gel wax. (f) The balloon is placed onto the gel wax. (g) The container is filled with ultrasound gel. (h) All air bubbles are smoothed using a syringe or a spoon.
Figure 2: Two types of skin can be used: (a) silicone skin or (b) Thera-Band.
We used a mobile ultrasound device (Vscan, GE healthcare) for the purpose of the study. Study participants were asked to place the probe onto the model, simulating both the parasternal long- and short-axis views. Structures identified on the ultrasound image were skin, surrounding tissue, pericardium, pericardial effusion, and the heart model (left ventricle) (Figures 3(b)–3(d)). For cannulation, an 18 G needle with a 5 or 10 mL syringe attached was used. The needle was visualized during the entire procedure and advanced until seen inside the pericardium (Figure 3(d)). A reddish fluid could be aspirated if the needle was correctly placed inside the pericardium. After the tap, a decrease in the pericardial effusion volume could be seen (Figures 4(a) and 4(b)).
Figure 3: A participant is pericardiocentesis (a), the corresponding image is shown in (b), the left ventricle is colored in red, the effusion is colored in blue (c), and visualization of the needle is shown by yellow arrow (d).
Figure 4: (a) before the pericardiocentesis model, (b) after puncture and aspiration of fluid, and (c) after 60 punctures and four weeks of storage; at this stage, the balloon needs to be replaced and refilled.
The study participants were recruited during focused echocardiography in life support training courses (FEEL) organized by http://www.sonoabcd.org/. These courses, opened to physicians of all specialties, are part of a postgraduate training programme in the emergency ultrasound of Germany, Austria, and Switzerland and were certified by the German Society of Ultrasound in Medicine (DEGUM).
As a control group, medical students without prior exposure to ultrasound or pericardiocentesis were recruited for the study. All subjects participated voluntarily and granted verbal consent to allow collecting the data anonymously and to be processed and published. This trial is a part of a series of studies in emergency ultrasound from our working group and approved by the institutional review board, as stated in previous reports .
Participants were asked to fill out a 16-item questionnaire with a visual analogue scale (VAS) directly after using the pericardiocentesis model. Each question was accompanied by a single, horizontal 16 cm line without numbers. Participants could mark the line in between two extremes (example question: "How well can the heart be recognized in the phantom?" ranging from "very bad" to "very good"). The marks were measured to an accuracy of 1 mm, and those measurements were converted into percent values (Table 2). The questions were related to visualization of heart, pericardium and effusion, visualization of the needle, sense of puncture through the pericardium, how close they felt the model came to reality, and if they felt that the model increased their self-assurance in regard to ultrasound-guided pericardiocentesis (Table 2).
Table 2: Questions of the evaluation of the phantom. All questions except no. 16 had to be answered via a visual analogue scale (VAS).
Additionally, participants were asked if they had performed any kind of puncture, no punctures before, or if they had distinct experience in pericardiocentesis. Question 16 asked all participants about their profession and their specialty.
Three groups of participants were defined according to the level of previous experience with pericardiocentesis or punctures. Group 1 consisted of participants who had no experience with punctures of any kind ( ). Group 2 was formed of participants who had not performed any pericardiocentesis before but had experience in performing other kinds of punctures (i.e., neuromuscular blocks and central lines) ( ). Group 3 consisted of participants who marked that they had performed pericardiocentesis before ( ).
Statistical analysis was performed using GraphPad Prism 5, La Jolla. Only descriptive statistics (mean, median, and standard deviation) were calculated. The scores of the three groups were compared using the Mann-Whitney U test in order to identify the differences in ratings between the groups.
A percentage value above 60% was defined to represent the strengths of the phantom and the value below 60% to represent the weaknesses. The liberal 60% cutoff value was chosen, as the model was not created to represent reality as best as possible but to simulate the act of puncture using a readily available phantom.
The model was constructed several times by a fellow (AS) and was assembled in a mean time of about 2 hours. A single phantom was used for more than 60 punctures without being destroyed. The ultrasound appearance of the model after more than 60 punctures and 4 weeks of storage at room temperature is shown in Figure 4(c). Only the balloon with the enclosed celluloid ball had to be replaced so that the model could be used for further training. The first model was constructed in 2011 and showed no signs of moulding or decay even after more than 24 months of storage at room temperature.
A total of participants (specialties: 40 anaesthesia, 13 internal medicine, 3 surgery, 4 students, and 7 physicians without specialisation) used the pericardiocentesis model and filled out a questionnaire during two ultrasound courses in April and June 2013. As specified above, three groups were defined according to the level of experience regarding pericardiocentesis. There was no statistically significant difference in the answer score to any of the 16 questions between the 3 groups. Therefore, data were pooled and presented as box plots (Figure 5). Mean scores for questions 1 to 14 ranged from 48% to 78%. The 60% cutoff value was surpassed in 11/14 questions. The weaknesses of the phantom were questions 9, 11, and 12, showing that the model was regarded as not realistic by most participants, and that the decrease in fluid could not be followed well. The highest scores (78% ± 19, mean ± SD, and 76% ± 18, resp.) were reached for questions regarding the visibility of the effusion and its discrimination from the surrounding tissues. Training with the phantom increased the confidence to perform future pericardiocentesis ( ).
Figure 5: Results of pooled VAS score per question. Each number of the x-axis represents a question of Table 2. Data were pooled, because there was no difference in the evaluation results between the three test groups (participants ).
Pericardiocentesis as the standard treatment for pericardial effusion and tamponade has to be performed under great pressure in situations such as shock and resuscitations. In the era of interventional cardiology, the incidence of tamponade has increased and postcardiotomy effusions after hospital discharge can be observed [2, 6].
Echocardiographic guidance has increased the safety and lowered the complication rates . The current ERC guidelines of 2010 enforce the use of ultrasound in peri-resuscitation settings to identify reversible causes such as pericardial tamponade .
As most physicians do not practice pericardiocentesis in a controlled environment (i.e., cath lab or ICU) routinely, ultrasound phantoms have been designed as simulation has been shown to increase the competencies of physicians in medical procedures .
Available pericardiocentesis trainers are either expensive or nondurable when used multiple times [9, 10]. The goal of our study was to construct a pericardiocentesis phantom that is easily rebuilt, available to small institutions and low-income countries and can be reused multiple times.
The model we constructed costs about 60 euros and can be assembled using readily available materials in about 120 minutes. To reduce further costs, some of the materials can be replaced at an expense of reduced durability.
Zerth et al. published only recently another model but reported that the model can only be stored for 2 weeks at room temperature and used for about 40–50 punctures . As we did use gel wax instead of gelatine, our model will not mould and can be stored for more than two years. Our models were used in average for more than 60 attempted punctures. After those 60 attempted punctures in a training course and 4 months of storage, only the balloon surrounding the celluloid ball had to be replaced as all surrounding structures were still intact (Figure 4(c)). This can easily be done by lifting the silicone skin, replacing the balloon, smoothing out air bubbles, and covering the model with the artificial skin again. Thus, it can be reused with minimum repair effort in discontinuous teaching pathways.
Replacing the gel wax with gelatine may also reduce costs but also will make the model prone to moulding. As a less expensive substitute for the PVC-planks, we used to assemble a square container; any plastic container available in the required format can be utilized (i.e., 2.5 Liters by http://www.becherprofi.at/, product ID 00200835 for 0.81 euro a piece). All of the required materials are readily available, and the construction of the model is independent of specialized tools. As the durability of the presented model in regard to its low cost is high, our development may be used as an alternative to high end simulation equipment. Especially in resource-limited settings, low-cost models are needed for sufficient training. As the model or its components can be transported with minimum space requirements, it can be made available even to remote areas. This is of gaining importance as pericardial effusion and consecutive tamponade, occurring in up to 20%, in developing countries are mostly caused by infectious diseases such as tuberculosis which is regarded as an epidemic in some areas .
In contrast to Zerth et al. , we performed a standardized evaluation of our model using a questionnaire. Although our pericardiocentesis model was rated only as valuable by the study participants in most regards, it shows clear feasibility and can enrich specialised ultrasound training. However, the lack of a realistic appearance of the phantom itself and the heart was assessed as a weakness. Practicing pericardiocentesis with our model gave the participants more confidence for further interventions whenever in the future they have to perform one.
Our study is limited by the fact that most of the study participants did not have experience with pericardiocentesis and thus could not compare the model to "real life" circumstances. Another limitation is that surprisingly there was no difference between the group of physicians experienced in pericardiocentesis and the group without any experience with punctures of any kind, showing that this can only be of subordinate impact.
Our low-cost pericardiocentesis model, which can be easily constructed, may serve as an effective training tool of ultrasound-guided pericardiocentesis for acute and critical care physicians.
Marco Campo dell'Orto and Dorothea Hempel contributed to the paper equally and shared the first authorship.
The authors thank Marcus Mihlan for his technical help within the evaluation process. The coauthor Agnieszka Starzetz was a main contributor to the project and completed a thesis on the development of the phantom at The University of Frankfurt, Medical Faculty. The development was completely independently funded by http://www.sonoabcd.org/ (formerly AG Notfallsonographie).


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One thing I want to tell you, the examination is only a means, not the fundamental purpose, prove nothing. Failed to come again on the line! I am a college student and now do not want to be a rookie, I had to update more distant targets, are preparing for the GRE exam, I believe I CET experience will help me! I want to be a rookie, is willing to fly the Dapeng!
My English test scores were only just more than 90 points.
To a veritable rookie like me characters, CET-6 (failed the exam grade) is a luxury dream. But in reality I made in the it! examination in June last year, my capacity as social candidate (schools are not candidates, had to find another way) bite off CET-6 this nut. Aftertaste in my mouth now will immediately twitched, and then smiled knowingly. Do not CET?!
For the GM test, skills use it properly or not has a great influence on test. Following my reading and hearing the two main parts (a total of 60 points) about my preparation strategy 1. reading: as half of the CET exams, is very important. (The so-called reading, CET. Reading waste, CET game Game over) the first key step in understanding the full text to the effect that is indispensable, fast read this article, and quickly check the key words (such as Essential,Important,Indispensable,Inevitable) and corresponding questions, immediately cross off some absolute options (such as All,Absolute,None,Must,Utterly) then the answer, Correct answers basically came out. Arrangements for time, my personal recommendation is 35 minutes to do the first three readings. Fourth guess method (read the first sentence of the paragraph, last paragraph. In the question stem Verb Verb meaning of the corresponding text, remember that is not a Word, the correct general options is that it).
2. listening comprehension: Dear volume made by the examiner will generally arrive 5 minutes early, we'll use the 5 minute quick look the first 10 items, also immediately starts to hang out with all the options of different sections (ESP:verb) which won the initiative and gentle mind, took the issue to the listening level play a very useful. As regards the second part of the addition to other cattle, basically everyone will feel very difficult, so for most of the candidates was fair, then rookie candidates are dominant (Ah-Q therapy). It main test everyone listening comprehensive ability, plus all accumulated daily, (this year I encounter questions about Franklin, had almost no easily). There is an important principle in the right mind to treat hearing problems, do not suddenly or Tao.
For Rookie candidates, basically the two main components of reading and listening can pass CET exam. On the other part wanted to give some suggestions: vocabulary is the part we are most afraid of, it should be placed at the end, thinking that 10 wrong anyway only 5 minutes, not as valuable as reading scores. CET mistakes tend to be more easily meet don't give up, I think the simple than the college entrance examination. Writing rookie here are some templates back before the exam.
In short, peace of mind + competitive drive + serious + exam with a bit of luck, worry-free rookie can passed CET exam! of course cattle for examination shall be such mentality: dealing with a test the strength of the best thing to do is to make yourself far above test levels.


text:
Heavy Ion Accelerator Symposium 2013
Spectroscopy of Neutron-Deficient Nuclei Near the Z=82 Closed Shell via Symmetric Fusion Reactions
F.G. Kondev1a, M.P. Carpenter1, S. Zhu1, R.V.F. Janssens1, I. Ahmad1, B.B. Back1, P.F. Bertone1, J. Chen1, C.J. Chiara1,2, C.A. Copos1, J.P. Greene1, C.R. Hoffman1, B.P. Kay1, T.L. Khoo1, T. Lauritsen1, E.A. McCutchan1,b, C. Nair1, A.M. Rogers1,c, D. Seweryniak1 and D. J. Hartley3
1 Argonne National Laboratory, Argonne, Illinois 60439, USA
2 Department of Chemistry and Biochemistry, University of Maryland, College Park, Maryland 20742, USA
3 Department of Physics, U.S. Naval Academy, Annapolis, Maryland 21402, USA
a e-mail: kondev@anl.gov
In-beam and decay-spectroscopy studies of neutron-deficient nuclei near the Z=82 shell closure were carried out using the Fragment Mass Analyzer (FMA) and the Gammasphere array, in conjunction with symmetric fusion reactions and the Recoil Decay Tagging (RDT) technique. The primary motivation was to study properties of 179Tl and 180Tl, and their daughter, and grand-daughter isotopes. For the first time, in-beam structures associated with 179Tl and 180Tl were observed, as well as γ rays associated with the 180Tl α decay. No long-lived isomer was identified in 180Tl, in contrast with the known systematics for the heavier odd-odd Tl isotopes.
Present address: NNDC, Brookhaven National Laboratory
Present address: Nuclear Science Division, Lawrence Berkeley National Laboratory
Behavior of intruder based states in light Bi and Tl isotopes: the study of $^{187}$Bi $\alpha$ decay
Eur. Phys. J. A 5, 49-52 (1999)
Studies of multi-quasiparticle K-isomers in rare-earth and trans-fermium nuclei
ND2007, 61-64 (2007)
Failure of the Gross Theory of Beta Decay in Neutron Deficient Nuclei
-decay spectroscopy of light odd-odd Bi isotopes - II: 186Bi and the new nuclide 184Bi
Eur. Phys. J. A (2003) 18: 55-64
Deep inelastic reactions and isomers in neutron-rich nuclei across the perimeter of the A = 180-190 deformed region

redpajama_set_name: RedPajamaCommonCrawl


text:
El bromuro de plata es un compuesto químico, cuya fórmula es AgBr, ampliamente utilizado en el campo de la fotografía debido a su sensibilidad a la luz.

Empleo
El bromuro de plata se utiliza en la emulsión del papel fotográfico. Las sales se depositan en suspensión en una capa de gelatina. Cuando la luz incide sobre el compuesto, la plata y el bromuro se ionizan, lo cual genera una imagen latente en las partes del negativo que contienen el bromuro de plata ionizado por la luz. Mediante el proceso de revelado, el agente revelador, que puede estar compuesto por metol (genol) e hidroquinona, cede electrones al bromuro de plata ionizado, estabilizando los dos elementos del compuesto y por ende separándolos.

Obtención
Aunque también puede encontrarse en forma mineral, el bromuro de plata suele prepararse con la reacción de nitrato de plata (AgNO3) y bromuro de potasio (KBr).

Propiedades
El bromuro de plata no es casi soluble en agua, pero más fácilmente en disoluciones de amoníaco, tiosulfato , ((cianuro)), ((kebabh))

Reactividad química
El bromuro de plata reacciona fácilmente con amoníaco líquido para generar una variedad de aminocomplejos:

AgBr + nNH3 → Ag(NH3)21+
{AgBr(NH3)2} {AgBr2(NH3)2}1− {AgBr(NH3)} {AgBr2(NH3)}1−

El bromuro de plata reacciona con trifenilfosfina para dar un producto tris(trifenilfosfina):

Referencias

Bromuros
Compuestos de plata
Productos químicos usados en fotografía

redpajama_set_name: RedPajamaWikipedia


This is a special event for the whole family in conjunction with the Broadview Heights "Home Days on the Green". Race begins and ends at the Broadview Heights Recreation Center: 9543 Broadview Road, Broadview Heights, OH 44147. There will be fun for the entire family including inflatables, a live DJ, awards and a pancake breakfast.
1 Mile Walk: $15 on or before July 7; $20 race day.
Must be three or more people living at the same address - valid through the mail only. Must be received by Wednesday, July 5th. Mail one entry form per person, together in one envelope.
Online at www.hermescleveland.com until Friday, July 7 at 9am, online processing fee applies. Paper registrations can be found at the recreation center.
The city of broadview heights is currently seeking sponsors for the broadview heights 5k: "mayor alai's 5k & 1-mile walk/run for health & wellness". The event will be held on the morning of sunday, july 9th, 2017. Race begins and ends at broadview center, 9543 broadview road, broadview heights, 44147. We typically have over 300 participants as well as many spectators. We offer a one-mile walk, the timed 5k run, awards ceremony, inflatables and a dj. There is also a pancake breakfast that follows the race. We are seeking platinum, gold & silver level sponsors and we are also in need of raffle prizes and treats for the race goodie bags. We hope you will consider sponsoring this exciting special event for the whole family! Gift certificates make great raffle prizes and can be counted towards your sponsorship total! Contact Ryan for more information at Rmeyer@broadview-heights.org.


text:
Mazda/PRNewsFoto/File
The Mazda6 SKYACTIV-D Clean Diesel race car, set to debut at the Indianapolis motor speedway this week. It will be the first Diesel car in over 60 years to race at the Brickyard.
Mazda brings diesel back to racing
Mazda is keen on making a diesel impact this year with the upcoming release of the Mazda6. Now, the automaker is applying diesel technology to its race car.
By Jeff Glucker Guest blogger
Mazda is keen on making a diesel impact this year. Many folks are waiting to get their hands on the upcoming oil-burning Mazda6. It's the first time a Japanese automaker has sold a diesel mill here in the States since it came attached to a vehicle wearing an Isuzu badge.
Since this is Mazda we're talking about, the automaker is also applying the diesel tech to its racecar. That racing machine is heading to Indianapolis Motor Speedway this week, which makes it the first diesel-powered racer to hit the Brickyard in 61 years.
Back in 1952, the Cummins Diesel Special took to the track to compete in the Indianapolis 500. The Kurtis Kraft car was powered by a 6.6-liter in-line six-cylinder turbocharged diesel motor that was good for 380 horsepower.
Today, the Mazda SKYACTIV Diesel racecar "makes do" with a much smaller 2.2-liter turbocharged diesel mill. This unit is good for around 400 horsepower and 450 pound-feet of torque.
The Mazda machine made a bit of history of its own when it became the first-ever diesel powered racecar to run at Daytona. Now it's bringing the diesel tech to the Brickyard, and taking over where the 1952 Cummins Diesel Special left off. It's even more special when you consider how close to stock the Mazda motor actually is.
Mazda states that 51 percent of the engine parts are stock, and 63 percent of the weight is stock. Once that diesel-drinking Mazda6 hits the streets, we expect many a tuner will be learning new tricks to tune that four door.
2014 Acura RLX – Review (The Car Connection)
2014 Mercedes Benz E-Class – Review (The Car Connection)
2014 Kia Cadenza – Review (The Car Connection)
https://www.csmonitor.com/Business/In-Gear/2013/0729/Mazda-brings-diesel-back-to-racing


BANGOR - The vacant house seat for district 124 is down to two candidates after Democrats selected their nominee Tuesday night and Republicans did the same Wednesday night.
Democrat Joe Perry a business owner and former Bangor City Councilor and Republican Thomas White a Maine Maritime Graduate are competing for the vacant District 124 seat. That position used to be held by Aaron Frey, a Bangor Democrat who recently replaced Governor Janet Mills as the state's attorney general.
"So I'm going to be working very hard between now and march twelfth for the special election because I want to get back to work in Augusta," said Perry.
"Just being out there being available to answer questions how I can better represent Bangor Orono and just making sure people know who I am and why I want to serve in Augusta," said White.
White said he wants to focus on student debt, find new opportunities to attract a younger workforce here in the state as well as trying to reduce energy costs and income tax. He now works at Eastern Maine Development Corporation.
"I think just being able to have a voice down there to understand small businesses and there needs especially workforce and the struggle there is something that I could bring down there," White said.
Joe Perry, who is also a former state lawmaker, said he wants to work with everyone in the legislature and work on passing the state budget, "It really is different when you're in the majority you have to govern and you have to own everything that happens so I really think having done that for a number of years will be a real asset."
Voters will vote on March 12th for the candidate who will serve out the remainder of Democrat Arron Frey's term which is through December 2020.


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"Charl has reached the pinnacle of achievement in the game of golf andhis exceptional career i.th just 14 designers showing collections in addition toguest shows from Roberto Cavalli and Jean Paul Gaultier.ctor at Yves Saint Laurent inMarch 2012, following the exit of former creative head Stefano Pilati.com/C2eCXyABhq—Brent Cross (.brentcross) July 30,2016 The app is k buy mlb jerseys online nown to drain mobile phones .VoxPop, online T-shirt company has also entered into partnerships withseveral companies such as Mar cheap mlb jerseys aliexpress v.Key Apparel Trends from the Spring/Summer 2015 Tradeshows.public, has committed itself to increasing the wages of itsemployees in the Unites States to 10 US dollars per hour.The Georgian-born wunderkind, who grew up as a refugee in Germany afterfleeing his war-torn homeland, channelled the prudent bourgeois hausfraulookso beloved of the German leader.Lama -- who said it would be a "dream come true" to follow othertransgender models onto major catwal.umer needs and similarly the perception of womenshoppers towards branded garments is also changing.lacement, just asthere were extra buttons, beads, fabric and anything else that could beanticipated to be a problem.The brand has a wide range of apparels such as designer suits, formalsuits, waistcoat, waistcoat set.


Avery's Story NPCs | Mac Wants The What?
Below is a list of each NPC in "Avery's Story" that you can recruit; detailing their name, class and conditions for recruitment.
Recruited at Start but leaves temporarily and will automatically rejoin during the main mission.
Recruited at Start but leaves temporarily. Rejoins during the final assault.
When you have access to the upper levels of the Submersible, Delonge can be found in one of the side areas. He's found in the "Dorm Area"; Ask him about his work and then you can ask him to join you.
When you have access to the lower levels of the Submersible, Anders can be found in one of the side areas. He's found in the "Incineration Room"; Just talk to him and he will join you.
Can be found in the test chambers. Just speak to her and she will join you.
Joins you during the main mission, before the final assault.
Found in the "Checkpoint" area where Fletcher guards. You must speak to him before the final assault or he will leave.


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Green Day, YUNGBLUD among Rock Am Ring, Rock Im Park artists
The lineup is already looking stacked.
Alex Darus
[Photo by: Green Day/Pamela Littky, YUNGBLUD/Jonathan Weiner]
Green Day, YUNGBLUD, Korn and more have been announced as part of this year's stacked lineup for Rock Am Ring and Rock Im Park.
The festival takes place in Germany over the weekend of June 5-7.
Read more: KFC tests fried chicken sandwich with donuts for buns
Also announced for the festival are System Of A Down, The Offspring, Of Mice & Men, August Burns Red and more. You can see the full announcement post below.
Bandwelle! System Of A Down, Green Day, Volbeat, Billy Talent, Broilers, Korn, Disturbed, Deftones, The Offspring, Trailerpark, Bilderbuch, Weezer, Wanda, Alan Walker, Trettmann, Yungblud, Heaven Shall Burn, Powerwolf, Bosse, Of Mice & Men, Motionless In White, August Burns Red pic.twitter.com/yoSajlq4k5
— Rock am Ring (@rockamring) September 17, 2019
The musical event has taken place since 1985, with last year's lineup including The 1975, Tool, Slipknot, Bring Me The Horizon and more.
You can get information about tickets here and check out the epic video teaser for the festival below.
Read more: Ozzy Osbourne finishes "greatest album" with Post Malone producer
This is far from the only stacked lineup Green Day will be apart of next year.
We're still not over the band, along with Fall Out Boy and Weezer, announcing their Hella Mega tour and new albums. Luckily, the bands each gave us new songs to hold us over in the meantime, with Green Day dropped "Father Of All…"
The song is also the name of the band's upcoming 13th studio album. The followup to 2016's Revolution Radio is slated for release February 7, 2020 via Reprise/Warner with preorders available here.
Billie Joe Armstrong recently opened up about the inspiration behind the track.
"I knew I wanted to do something different," Armstrong tells Rolling Stone in regards to his search for a new sound. "I'd always loved British mod music from the Sixties, but I wanted to go to where the source was and see if I could put [soul] through the Green Day filter. It was a lot of trial and error, a lot of pulling my fucking hair out."
Armstrong was at home jamming with drummer Tre Cool when Cool began to play "a nasty fucking beat." It didn't take long for Armstrong to then come up with the title.
"I told my engineer, 'I might look like a fucking idiot, but bear with me,'" Armstrong explains.
The song, he says "was like a unicorn falling out of the sky: 'I don't know what this is, I don't know how I did it, but this is the direction I'm headed.' "
You can check out "Father Of All…" below.
The Hella Mega tour kicks off June 13 in Paris and will run throughout Europe, the U.K. and North America with the Interrupters as support. Green Day will be prefacing the tour with solo appearances in Europe and Asia.
The general public can purchase tickets beginning Friday, Sept. 20 at 10 a.m. local time at Ticketmaster.com. You can see the full list of dates below.
Green Day dates:
03/08 – Singapore, SG @ Singapore Indoor StadiUM
03/11 – Bangkok, TH @ Impact Arena
03/14 – Manila, PH @ Mall of Asia Arena
03/17 – Taipei, TW @ Taipei Arena
03/20 – Hong Kong, CN @ Asia World Expo
03/22 – Seoul, KR @ Jamsil Indoor Gym
03/25 – Osaka, JP @ Intex
03/27 – Tokyo, JP @ Makuhari, Messe
03/24 – Moscow, RU V Spartak Stadium
05/27 – Helsinki, FI @ Suvilhati
05/29 – Stockholm, SE @ Tele2 Arena
05/31 – Alesund, NO @ Colorline Stadium
06/03 – Berlin, D [email protected] Wuhlheide (with Weezer)
06/10 – Milan, IT @ Ippodromo San Siro (with Weezer)
06/13 – Paris, FR @ La Defense Arena
06/14 – Groningen, NL @ Tadspark
06/17 – Antwerp, BE @ Sportpaleis
06/21 – Vienna, AT @ Ernst Happel Stadium
06/24 – Glasgow, UK @ Bellahouston Park
06/26 – London, UK @ London Stadium
06/27 – Huddersfield, UK @ The John Smith's Stadium
06/29 – Dublin, IE @ RDS Arena
THE HELLA MEGA TOUR with Weezer and Fall Out Boy
07/17 – Seattle, WA @ T-Mobile Park
07/21 – San Francisco, CA @ Oracle Park
07/24 – San Diego, CA @ Petco Park
07/25 – Los Angeles, CA @ Dodger Stadium
07/28 – Commerce City, CO @ DICK's Sporting Goods Park
07/31 – Arlington, TX @ Globe Life Field
08/01 – Houston, TX @ Minute Maid Park
08/05 – Miami, FL @ Hard Rock Stadium
08/06 – Jacksonville, FL @ TIAA Bank Field
08/08 – Atlanta, GA @ SunTrust Park
08/11 – Minneapolis, MN @ Target Field
08/13 – Chicago, IL @ Wrigley Field
08/15 – Pittsburgh, PA @ PNC Park
08/16 – Hershey, PA @ Hersheypark Stadium
08/19 – Detroit, MI @ Comerica Park
08/21 – Washington, DC @ Nationals Park
08/22 – New York, NY @ Citi Field
08/24 – Toronto, ON @ Rogers Centre
08/27 – Boston, MA @ Fenway Park
08/29 – Philadelphia, PA @ Citizens Bank Park
What do you think about Green Day, YUNGBLUD and all of the other acts announced for the festival? Sound off in the comments down below!


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Online Terms … Ugh!!
Brian Rogers @theContractsGuy February 24, 2018
Do you have an uneasy feeling when you "agree" to legal terms on websites, your iPhone, apps, and the like? You feel like you should be reading the terms before you accept them, but you don't have time. Plus, you wouldn't understand them if you read them. Plus, you have no choice but to agree to the terms, so why not save some brain cells and just click "I agree" and get on with your life?
When I do presentations on electronic contracting, I ask the audience how many read online terms before they agree to them (none), whether they think the terms they click on are enforceable (yes), and whether they think they should read them (yes).
The absurdity of online terms
It's easy to make comedy out of this because it's so absurd. For example, over 7,500 online shoppers unwittingly sold their souls in 2010 to Gamestation, an online gaming store, via the company's online terms. The amazing thing about this April Fool's prank is not that most shoppers failed to notice that they were selling their souls but rather that 12% of the shoppers actually noticed the "immortal soul clause" and opted to save themselves.
And who could forget the South Park Human CentiPad episode where business casual G men come looking for Kyle to enforce the Apple iTunes terms and conditions? My favorite part is when Kyle's friends say in amazement, "You didn't READ them? … Well, how do you know if you agree to something if you don't read it?" Good question indeed.
And then there are the poor folks who gave up their firstborn children in this experiment and in this one.
Although it truly is impossible to know if you agree to something when you don't read it, people can't read all the terms that are presented to us. This 2012 Atlantic article reports on a Carnegie Mellon study that estimated that it would take 76 work days to read the privacy policies one encounters on websites each year. That's just privacy policies, which tend to be pithy compared to full-blown online terms. And that was years ago; online terms have grown since then. And of course our electronic devices have their own terms. The Amazon Kindle's terms alone would take nine hours to read.
Sure, no one reads online terms, and courts are engaging in a fiction when they enforce as an "agreement" something that they know hasn't been read. But what's the harm?
A lot of cases considering online terms involve boilerplate provisions such as venue clauses, which purport to require users to sue in a specific state. Such venue clauses make defending suits more convenient for the website owner and considerably more expensive for the user, who would have to hire local counsel and probably travel out of state for the litigation. But even if the parties were to negotiate this clause, the consumer would never win. Apple is simply not going to agree to defend itself in Missouri just because one of its users would prefer that. So in this case when users click "I agree" they are truly agreeing to something that they would agree to even if the contract were fully negotiated. Is there any real harm in that?
More disturbing are the clauses that require disputes to be settled by binding arbitration and that prohibit class arbitration. I've always been skeptical of the value of most class action lawsuits to the individual plaintiffs who often receive little from class action settlements and judgments. Thus, I stated in my 2011 post AT&T Mobility v. Concepcion: Is Class Arbitration Dead? that giving up a possible class action in exchange for an arbitration regime that provides real relief to consumers wouldn't be that bad. (The Supreme Court's breathtaking post-Concepcion decisions showed just how naive I was.)
I started to think more deeply about this problem after reading Margaret Radin's book Boilerplate, which helped me to see how online terms such as arbitration clauses with class action waivers completely nullify fundamental rights, such as having access to courts. It's not that I think there's anything wrong with arbitration agreements, or even class action waivers, but people who give up fundamental rights should at least know what they are doing. The rights should not be taken away unless users agree to it. Not fake agree, but really agree.
Another factor to consider is that courts have safety valves to keep seriously onerous provisions in online terms from being enforced. One is the doctrine of unconscionability, which permits courts to refuse to enforce terms that are seriously out of whack. Another is the doctrine of reasonable expectations, which allows courts to kick out contractual provisions that a typical consumer would not reasonably expect to be in the contract. So your souls and babies are safe, even if you click "I agree."
But even though the most onerous provisions might be thrown out by a court, it's problematic that basic rights such as access to courts are relinquished through a farce. Everyone knows nobody reads online terms. How can basic rights be nullified through such a fake process?
Kar and Radin
Last weekend I read an article by Robin Kar and Margaret Radin titled Pseudo-Contract & Shared Meaning Analysis. The too-short and over-simplified summary is this: When people enter into a transaction such as an online purchase of a song from iTunes, there is true agreement as to basic terms, such as price, the identity of the song, and that the user is getting a personal license to play the song. Although Apple makes consumers click a button stating that they agree to Apple's voluminous terms and conditions, most of these terms–although masquerading as contract terms–are actually "pseudo-contract" terms. They are fake because true contracts are agreements, and there is no agreement–or even awareness–of these pseudo-contract terms on the part of the consumer.
Kar and Radin also provide a framework for determining which terms are true contract terms and which ones are fake, which they refer to as shared-meaning analysis. I'm still mulling over the article and its implications for contract boilerplate and broader contract law, and I want to revisit Radin's book Boilerplate, but the article really stimulated my thinking. If you are interested in a thoughtful, scholarly discussion of the issues, I encourage you to read Kar and Radin's article. It's much shorter than the Kindle terms and conditions.
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Michael Feldman Feb 24, 2018 Link Reply
Another great article, thanks. You mention the doctrine of unconscionability and the doctrine of reasonable expectations, but to what extent would the doctrine of adhesion be successful in mitigating enforcement of an agreement? You need something and since you have no way of amending the agreement it's not negotiated. Additionally, the individual consumer is no match for a corporation such as Apple with its legion of attorneys and my understanding is that many courts recognize this as a factor.
Many thanks and best regards,
Mike Feldman
Brian Rogers Feb 24, 2018 Link Reply
Mike: Thanks for your thoughts. These are largely contracts of adhesion, so you're right on. There are additional aspects of contract law that protect consumers, such as courts' refusal to enforce contracts that are against public policy or that have an illegal subject matter. So, once again, your souls and babies are safe! Still, I'm increasingly bothered by the fiction that we're living under and that's so pervasive in the everyday lives of ordinary people.
Liquidated Damages in Missouri
Attorney Fees in Contracts


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Psychotherapy Practice Research Network
Psychotherapy Practice Research Network /
The Psychotherapy Practice Research Network (PPRNet) blog began in 2013 in response to psychotherapy clinicians, researchers, and educators who expressed interest in receiving regular information about current practice-oriented psychotherapy research. It offers a monthly summary of two or three published psychotherapy research articles. Each summary is authored by Dr. Tasca and highlights practice implications of selected articles. Past blogs are available in the archives. This content is only available in English.
…I blog about the impact of COVID-19 on mental health workers' well-being, the impact of working alliance and therapist cultural humility on the impact of microaggressions, and ways of addressing cultural topics in psychotherapy
Type of Research
ALL Types of Research (clear)
Empirical Articles
Meta-analyses
Randomized Controlled Trials (RCTs)
ALL Topics (clear)
Adherance
Alliance and Therapeutic Relationship
Attendance, Attrition, and Drop-Out
Client Factors
Client Preferences
Cognitive Therapy (CT) and Cognitive-Behavioural Therapy (CBT)
Depression and Depressive Symptoms
Efficacy of Treatments
Feedback and Progress Monitoring
Illness and Medical Comorbidities
Interpersonal Psychotherapy (IPT)
Medications/Pharmacotherapy
Neuroscience and Brain
Outcomes and Deterioration
Practice-Based Research and Practice Research Networks
Psychodynamic Therapy (PDT)
Resistance and Reactance
Suicide and Crisis Intervention
Therapist Factors
Transference and Countertransference
Trauma and/or PTSD
Treatment Length and Frequency
Parallel Process in Psychotherapy Supervision
Tracey, T. J., Bludworth, J., & Glidden-Tracey, C. E. (2011). Are there parallel processes in psychotherapy supervision? An empirical examination. Psychotherapy, 49(3), 330-343.
Parallel process was first proposed in the psychodynamic literature as the replication of the therapeutic relationship in supervision. Parallel process is also recognized as an important aspect of supervision in developmental and interactional models of supervision, even though those models do not endorse the unconscious aspects of parallel process. Parallel processes in supervision occur when: (1) the trainee therapist brings the interaction pattern that occurs between the trainee therapist and client into supervision and enacts the same pattern but with the trainee therapist in the client's role, or (2) the trainee therapist takes the interaction pattern in supervision back into the therapy session as the therapist, now enacting the supervisor's role. For example, a client comes into therapy seeking guidance because things are not going well in his relationships. He desires structure and direction from the trainee therapist (client's behaviour is submissive). The trainee therapist attempts to help the client by providing guidance (therapist's behaviour is relatively dominant). The client then responds with "Yes, but…" to suggestions offered by the trainee therapist (client's behaviour is non-affiliative). The trainee therapist over time starts to become subtly "critical" of the client (therapist matches the non-affiliative client behavior). The trainee therapist goes into supervision complaining about the client's "resistence" and the trainee therapist asks for help and direction from the supervisor (trainee therapist increases his submissive behavior in a parallel enactment of the client's submissive stance). As the supervisor provides some direction (supervisor increases her dominance), the trainee therapist responds with "Yes, but. . ." (trainee therapist increases his non-affiliative behavior). The supervisor engages in more "critical" comments than usual in response to the therapist (supervisor matches the non-affiliative trainee behavior). In this way, the supervision interaction becomes a relative replication of the therapy relationship, captured in the parallel amounts of dominance/submission and affiliation/non-affiliation exhibited by the participants in relation to each other. Tracey and colleagues (2012) studied this phenomenon by coding moment by moment interpersonal interactions using an interpersonal circumplex model (i.e. a model that assesses relative dominance and affiliation) among 17 triads of clients/trainee therapists/supervisors in a series of single case replications. The authors hypothesized that relative dominance and affiliation would be parallel between clients/trainee therapist pairs and corresponding trainee therapist/supervisor pairs in contiguous sessions. Significant results were found for each dyad within the 17 client/trainee therapist/supervisor triads. Therapists in the role of trainee altered their behavior away from their usual in supervision to act somewhat more like particular clients did in the previous therapy session. Supervisors tended to engage in complementary interpersonal responses in the subsequent supervision session. This provided evidence for parallel process at an interpersonal level of interactions. Further, positive client outcome was associated with increasing similarity of trainee therapist behavior to the supervisor over time on both dominance and affiliation. That is, the more therapists acted like their supervisors in the previous supervision meeting on both dominance and affiliation, the better the client outcome.
This article provides intriguing evidence for an interpersonal model of parallel process. Supervisors may choose to communicate with the trainee about how the trainee therapist and client are interacting, as well as how the trainee and supervisor are interacting. In this way, the supervisor makes the implicit aspects of the parallel process more explicit for the trainee therapist. The trainee then can make choices about how best to proceed based on the new understanding of the interactional pattern at the process and content levels of interaction. For example, a therapist and supervisor can come to understand a block in the supervisory alliance as a parallel to a similar impediment in the trainee therapist-client relationship. A supervisor working through the block in supervision to create a more collegial and affiliative environment may model for the trainee therapist ways in which to effectively and collaboratively work with their client.
Author email: Terence.Tracey@asu.edu
Are the Effects of Psychotherapy for Depression Overestimated?
Niemeyer, H., Musch, J., & Pietrowsky, R. (2013). Publication bias in meta-analyses of the efficacy of psychotherapeutic interventions for depression. Journal of Consulting and Clinical Psychology, 81, 58-74.
Meta-analyses are important ways of summarizing effects of medical and psychological interventions by aggregating effect sizes across a large number of studies. (Don't stop reading, I promise this won't get too statistical). The aggregated effect size from a meta analysis is more reliable than the findings of any individual study. That is why practice guidelines almost exclusively rely on meta analyses when making practice recommendations (see for example the Resources tab on this web site). However meta analyses are only as good as the data (i.e., studies) that go into them (hence, the old adage: "garbage in, garbage out"). For example, if the studies included in a meta analysis are a biased representation of all studies, then the meta analysis results will be unreliable leading to misleading practice guidelines. One problem that leads to unreliable meta analyses is called publication bias. Publication bias often refers to the tendency of peer reviewed journals not to publish studies with non-significant results (e.g., a study showing a treatment is no better than a control condition). Publication bias may also refer to active suppression of data by researchers or industry. Suppression of research results may occur because an intervention's effects were not supported by the data, or the intervention was harmful to some study participants. In medical research, publication bias can have dire public health consequences (see this TED Talk). There is lots of evidence that publication bias has lead to a significant over-estimation of the effects of antidepressant medications (see Turner et al (2008) New England Journal of Medicine). Does publication bias exist in psychotherapy research, and if so does this mean that psychotherapy is not as effective as we think? A recent study by Niemeyer and colleagues (2013) addressed this question with the most up to date research and statistical techniques. They collected 31 data sets each of which included 6 or more studies of psychotherapeutic interventions (including published and unpublished studies) for depression. The majority of interventions tested were cognitive behavioral therapy, but interpersonal psychotherapy, and brief psychodynamic therapy were also included. The authors applied sophisticated statistical techniques to assess if publication bias existed. (Briefly, there are ways of assessing if the distribution of effect sizes across data sets fall in a predictable pattern called a "funnel plot" – specific significant deviations from this pattern indicate positive or negative publication bias). Niemeyer and colleagues found minimal evidence of publication bias in published research of psychotherapy for depression. This minimal bias had almost no impact on the size of the effect of psychotherapy for depression.
This is a very important result indicating that despite a minor tendency toward a selective publication of positive results, the efficacy of all reviewed psychotherapy interventions for depression remained substantial, even after correcting for the publication bias. Niemeyer and colleagues' findings demonstrate that publication bias alone cannot explain the considerable efficacy of psychotherapy for depression. Psychotherapeutic interventions can still be considered efficacious and recommended for the treatment of depression.
Author email address: helen.niemeyer@hhu.de
How to Reduce Premature Termination in Your Psychotherapy Practice
Swift, J.K., Greenberg, R.P., Whipple, J.L., & Kominiak, N. (2012). Practice recommendations for reducing premature termination in therapy. Professional Psychology, 43, 379-387.
As discussed in a previous blog entry, Swift and Greenberg (2012) found that almost 20% of adult individual therapy patients drop out of therapy. Dropping out is generally defined as clients unilaterally terminating psychotherapy prior to benefitting fully and against their therapist recommendation. In this paper, Swift and colleagues review five methods with the best research evidence to reduce premature termination. (1) Providing education about duration and course of therapy. Research indicates that 25% of clients expect to recover after only two sessions of therapy, 44% after four sessions, and 62% expect to recover after 8 sessions. However the research literature indicates that it takes 13 to 18 sessions for 50% of clients to recover. Further, although some clients improve quickly and maintain that, some clients may feel worse before they get better, especially if the symptoms are related to painful feelings or events. So aligning client expectations about the length of treatment and the course of treatment may reduce dropping out. This education should be research based to increase the credibility of the information. (2) Providing role induction. Clients who are naıve to therapy may start not knowing what behaviors or roles are most appropriate on their part and could feel lost or like they are doing things wrong. Role induction refers to providing clients with some pre-treatment education or orientation about appropriate therapy behaviors. This could be done by video, verbally, or in writing. A meta analysis found that pre-therapy role induction increases attendance and reduces drop outs. (3) Incorporating client preferences. Client preferences include wants or desires concerning the type of treatment that is to be used, the type of therapist one would like to work with, and the roles and behaviors that are to take place in therapy. A recent meta analysis found that clients who had their preferences accommodated were almost half as likely to drop out of treatment prematurely compared with clients whose preferences were not taken into account. (4) Strengthening early hope. Although it is important that clients do not hold unrealistic expectations (i.e., recovery after only two sessions), it is also important that they have a general hope that therapy can help them get better. Research evidence shows that expectations for change explain as much as 15% of the variance in therapy outcomes. (5) Fostering the therapeutic alliance. The therapeutic alliance involves agreeing on goals and tasks of therapy, and a positive bond between client and therapist. A rupture in the alliance has been associated with dropping out of therapy, and a previous meta analysis found that a stronger alliance was associated with fewer drop outs.
Therapists can do 5 things that are research supported to reduce patient drop outs. (1) Provide education about duration and course of therapy. Practicing clinicians can help their clients to develop realistic expectations about duration and recovery prior to the start of therapy. Clinicians working with a more severely disturbed population or working from an orientation that espouses longer treatment durations may want to alter the education they provide to better fit their clients. (2) Provide role induction. Clinicians can provide education about the "jobs" of both the client and the therapist, such as who is expected to do most of the talking and who will be responsible for structuring or directing sessions. This type of induction should also include a discussion of the rationale for the approach that will be used. (3) Incorporate client preferences. Accommodating client preferences does not mean the therapist should automatically use the client's preferred methods. Often clients are unaware of what treatment options are available or best suited for their particular problems. Instead, therapists should consider sharing their knowledge about the particular disorder and the nature of different approaches to the treatment of those problems with clients. Clients can then share their preferences regarding those treatment options with the therapist and work collaboratively toward a decision about which approach might be best. (4) Strengthen early hope. Therapists should express confidence that the therapy will work for their patient. Knowing the research evidence on the efficacy of psychotherapy will increase the therapist's credibility in making such statements. (5) Foster a therapeutic alliance. Efforts to foster the therapeutic alliance should occur early on in therapy when the risk of premature termination is high, and as also therapy progresses. Early efforts should focus on making sure there is an agreement on the goals and tasks before jumping to treatment interventions.
Author email: Joshua.Keith.Swift@gmail.com
Do Therapists Cry in Psychotherapy?
Blume-Marcovici, A. C., Stolberg, R. A., & Khademi, M. (2013). Do therapists cry in therapy? The role of experience and other factors in therapists' tears. Psychotherapy. Advance online publication. doi:10.1037/a0031384
There is almost no research on therapists crying during psychotherapy, and on its correlates and impact. A survey of therapists' ethical behavior conducted 25 years ago asked a single question about crying, and 56.5% of respondents indicated that they cried in the presence of a client. By contrast there are several such surveys in medicine. Notably, a study of medical students and interns found that 68% medical students and 74% of medical interns had cried with patients. A recent survey by Blume-Marcovici and colleagues is the first of its kind since it was devoted to therapists crying in therapy and associated factors. They defined crying as: "tears in one's eyes due to emotional reasons". The authors surveyed U.S. psychologists and had 541 respondents. The sample included 59% graduate students, and 41% licensed clinicians who had an average of 9.6 years experience. Seventy six percent were women, mean age was 36 years, 35% had a cognitive behavioural therapy (CBT) orientation, and 33% had some psychodynamic orientation (PDT). Respondents reported that 72% had cried in therapy. Those who cried reported crying in 6.6% of their sessions in the past 4 weeks. There were no differences between men and women, and there was no association between therapist crying and therapist personality traits or level of empathy. Therapists who cried more often in their daily life tended to cry more in therapy. PDT and CBT therapists did not differ in the amount they cried in their daily lives, however PDT therapists (88.9%) reported crying more often than CBT therapists (50.1%) in therapy. Further, older and more experienced therapists reported crying more often in therapy in the past month than younger and less experienced therapists. It is possible that older therapists may become more comfortable in using their clinical judgment, and so have fewer restrictions on their own affective displays. Of therapists who cried, 45.7% felt that the therapeutic relationship improved, and 1% reported that the relationship deteriorated due to crying. Patients, however, were not surveyed for their opinion about their therapist's crying.
Practice Implication
Crying among therapists may happen relatively frequently. Although this study is novel, it is the only one of its kind so one should be cautious about drawing practice implication. The challenge of therapists crying in therapy is that it can bend or break the therapeutic frame (e.g., is the therapist crying because of being overwhelmed and acting on his or her own needs, or is the therapist genuinely responding for and with the patient?). The survey suggests that therapist crying can strengthen the therapeutic relationship. This is more likely true when the therapist is attuned to the patient's needs, and when the crying signals a moment of positive emotional connection in the midst of painful feelings in the client. As with any event in therapy, a genuine and skilful exploration by the therapist and patient of the therapist's crying has the potential to strengthen the relationship.
Author email: ablume@alliant.edu
Psychotherapy Practice Research Network (PPRNet)
136 Jean-Jacques Lussier
Vanier Hall, Room 4012
Ottawa, Ontario, Canada K1N 6N5
PPRNet@uOttawa.ca


Those who have played competitive sports know there comes a point in time during the game when one needs to dig ever deeper for the intestinal will and fortitude to press on in pursuit of victory.
As a nation, I firmly believe we are at that very point. Will we answer the call or allow our opponents to determine the manner in which the game is played and seriously influence the outcome? The fact is the "game" I talk about today is in fact no game at all. I am talking about the future of our nation. . . . and I am pissed off and sick and tired as I think about this topic. What topic?
A random scroll through this blog packs more than enough evidence of the assault on our nation and our values.
I am not here today to talk about the respective candidacies of those running for President. I am talking about a principle and a purpose far greater than a mere political office. I am talking about that most prized virtue which readers of this blog have hopefully come to know me by. I am talking about the truth.
Day after day, week after week, and now month after month I believe we experience incessant and insidious attacks on the truth. We witness it from both sides of the political aisle and every corner of society. Are we to think that these assaults come without a price? We would be exceptionally naive to accept that premise. Are we to allow these assaults under the guise that the ends justify the means or this is mere politics at play? Mere politics? These attacks upon the truth occur daily. Ends justifying the means? Many would seem to embrace this badly misguided and ill-conceived notion.
I truly believe the very future well being of our nation for our children and our children's children lies in the wake.
Caddell added that it is one thing for the news to have a biased view, but "It is another thing to specifically decide that you will not tell the American people information they have a right to know."
He closed his talk with these words: "The press's job is to stand in the ramparts and protect the liberty and freedom of all of us from a government and from organized governmental power.
When they desert those ramparts and go to serve—to decide that they will now become an active participants—when they decide that their job is not simply to tell you who you may vote for, and who you may not, but, worse—and this is the danger of the last two weeks—what truth that you may know, as an American, and what truth you are not allowed to know, they have, then, made themselves a fundamental threat to the democracy, and, in my opinion, made themselves the enemy of the American people.
And it is a threat to the very future of this country if…we allow this stuff to go on, and…we've crossed a whole new and frightening slide on the slippery slope this last two weeks, and it needs to be talked about."
Let's talk about it. What do readers think?
I am sure there will be some in the audience who will attack Caddell. Others may care to attack me. I welcome it and would issue the following challenge in return. Are you comfortable attacking the truth, the very bedrock upon which this nation lies?
Lonely may be the truth tellers but I would rather stand alone than with the cowards for whom the prized virtue of the truth is a foreign concept.
I hope readers will speak their minds on this commentary because I believe this erosion of the truth is actually far more important than any election.
Gut check . . . navigate accordingly.


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Wendy's Company WEN
The Wendy's Company. A NASDAQ-listed firm that runs a chain of fast-food restaurants. Yahoo! Finance
G.E. Splits Into 3 Companies
GE will split its conglomerate into three separate aviation, healthcare, and energy companies. The company hopes that each of its smaller branches will be able to provide more growth.
Germany DAX 30 Is Set to Become Germany DAX 40
Germany's DAX index is set to expand later this month. Testing company QIAGEN is set to feature among the 10 companies that will join the index.
Why Did Zoom's Shares Fall After a Billion-Dollar Quarter?
Investors baulked at Zoom Video Communications by selling off the stock, despite the company registering a $1 billion record-breaking revenue. What were their reasons?


An amazing online tool to shrink and convert your images with transparent background in SVG. Based on the idea from Using SVG to Shrink Your PNGs, but adapted to use data URIs instead of external images. Include on your page as inline SVG, using a tag, or as a background-image.
With Flexbox and Grid, we have the ability to create layouts that used to be extremely difficult to implement, when not flat out impossible.
The last link of this roundup is a nice collection of loading animations written entirely in CSS. Each animation is limited to a small subset of CSS properties in order to avoid expensive painting and layout calculations.


text:
class base_node
{
public:
	 base_node(int id, bool us, const int con_count, bool is_static,  bool ut);
	 base_node();
	 base_node(int id);
	 virtual ~base_node();
	virtual void update(float timestep = 0.0f);
	virtual void init();
	bool enabled;
	bool updated_values;
	int nid;
	bool is_value_static;
	bool use_serial_recieve;
	bool use_timer;
	virtual void load_node_parameters(std::string params);
	virtual void serial_income(std::string message);
	virtual void  set_connection(int pos, base_node* ptr, int dest_pos);
	virtual void set_value(int position, float value);
	virtual void set_value(int position, int value);
	virtual void set_value(int position, bool value);
	virtual void set_value(int position, std::string value);
	virtual float get_value_f(int position);
	virtual int get_value_i(int position);
	virtual bool get_value_b(int position);
	virtual std::string get_value_s(int position);

private:

};

redpajama_set_name: RedPajamaGithub


text:
OnPolitics Today: Your SOTU viewing guide
Everything you need to know about tonight's State of the Union
OnPolitics Today: Your SOTU viewing guide Everything you need to know about tonight's State of the Union Check out this story on USATODAY.com: https://usat.ly/2Fvk0DS
Jessica Estepa, USA TODAY Published 6:21 p.m. ET Jan. 30, 2018 | Updated 6:58 p.m. ET Jan. 30, 2018
When President Trump addresses a joint session of congress Tuesday night, he will undoubtedly say that the State of the Union is strong, and he's right. The economy is growing, the stock market is booming, and unemployment is low. USA TODAY
If you're reading this newsletter, we're assuming you're the kind of person who is going to tune in to President Trump's very first State of the Union tonight (and maybe even considered paying $35 to see your name scroll by during the live stream).
So we here at OP have your back (with a lot of help from USA TODAY's Paul Singer).
What time does it start?
9 p.m. ET (but nerds can tune in a little earlier to watch the "red carpet" arrivals of Cabinet members, military officials, Supreme Court justices and the like).
How long will it be?
About an hour, give or take.
What will Trump talk about?
Trump will likely stick to the formula of State of the Union addresses from years past: Discussing his accomplishments (hello, tax overhaul and the booming market) and looking to the future (hopes for immigration and infrastructure deals).
Will he talk about the Russia investigation, which he has consistently called a "witch hunt" and "fake news"? Probably not. But if he does, we have a task for you*.
Who's giving the Democratic response?
The opposing party has traditionally responded to the address since the 1960s. This year, the honor goes to Rep. Joe Kennedy III. Others giving non-official responses: Sen. Bernie Sanders and Rep. Maxine Waters (and, you know, everyone who is interviewed in Statuary Hall after the speech).
Trump's own guest list includes a child who has organized the placement of flags and flowers on soldiers' graves, the parents of children killed by MS-13 gang members and the man who founded the Cajun Navy.
You also might catch a glimpse of Bill Nye the Science Guy, several DREAMers and #MeToo survivors. You also will see some lawmakers wearing black for the #MeToo movement, and others wearing red, white and blue for the troops.
Who won't be there? A number of lawmakers boycotting the speech and some Supreme Court justices.
*Drink!
If you aren't working, then tonight is as good a night as any to enjoy a beverage or three. Take a drink whenever the president does any of the following:
Talks with his hands
Says the tax overhaul is the biggest in U.S. history
Calls for a border wall
Uses the word "beautiful"
Says, "Believe me"
And finish your drink if he mentions the Russia investigation or utters the phrase "witch hunt."
PSA: Please drink responsibly!
Elsewhere in politics
Todd Ricketts to assume top fundraising post at the RNC
Gymnasts call congressional action to prevent abuse a turning point in history
EPA's Pruitt says challenge to endangerment finding still on the table
House Speaker Paul Ryan supports releasing controversial GOP intelligence memo
Ohio medical board investigating former Cleveland Clinic surgeon over rape allegations
Read or Share this story: https://usat.ly/2Fvk0DS
Donald Trump slams Paul Ryan in late-night Twitter rant: 'Couldn't get him out of Congress fast enough!'
Trump tells congresswomen to 'go back' to the 'crime infested places from which they came'
Mike Pence got a first-hand look at border detention facilities in McAllen and Donna, Texas. What he saw
Donald Trump says the House Democrats he insulted should apologize day after his 'go back' tweets
'The crisis is real': Mike Pence sees 'tough stuff' and 'compassionate work' at Texas border facilities
5 things to know about the upcoming immigration raids in major U.S. cities


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text:
Evening Standard British Film Awards for 2012 – nominations
The Evening Standard has announced the nominations for the 40th annual Evening Standard British Film Awards for the year 2012.
Leading with three nominations were Ben Wheatley's Sightseers and Sally El Hosaini's My Brother the Devil. The nominations for Sightseers included Film of the Year as well as Best Actress (Alice Lowe) and the Peter Sellers Award for Comedy. The nominations for My Brother the Devil were for cinematography and Most Promising Newcomer for both writer/director El Hosaini and actor James Floyd.
Competing for Film of the Year are Peter Strickland's Berberian Sound Studio and the James Bond film Skyfall by Sam Mendes.
The 40th annual Evening Standard British Film Awards ceremony will take place at the London Film Museum in County Hall on February 4. The event will be hosted by Stephen Mangan.
Complete list of nominations for the 40th Evening Standard British Film Awards
Berberian Sound Studio, Peter Strickland
Sightseers, Ben Wheatley
Skyfall, Sam Mendes
Daniel Day-Lewis, Lincoln
Toby Jones, Berberian Sound Studio
Eddie Redmayne, Les Misérables
Alice Lowe, Sightseers
Charlotte Rampling, I, Anna
Andrea Riseborough, Shadow Dancer
Tom Bradby, Shadow Dancer
Malcolm Campbell, What Richard Did
Paul Laverty, The Angels' Share
London Film Museum Award for Technical Achievement
Jacqueline Durran, costume design, Sarah Greenwood, production design and Seamus McGarvey, cinematography, Anna Karenina
David Raedeker, cinematography, My Brother the Devil
Ben Richardson, cinematography, Beasts of the Southern Wild
Peter Sellers Award for Comedy
Chris O'Dowd for his performance in The Sapphires
Seven Psychopaths writer/director Martin McDonagh
Sightseers director Ben Wheatley
Most Promising Newcomer
Paul Brannigan for his performance in The Angels' Share
Sally El Hosaini writer/director My Brother the Devil
James Floyd for his performance in My Brother the Devil
The Imposter, Bart Layton
London: The Modern Babylon, Julien Temple
Marley, Kevin Macdonald
Labels: awards, critics, European, film, International, press


Jon's team have put petitions in over 20 local shops around Dagenham, and Jon is now urging residents to collect signatures down their streets. To join the campaign just email your name and address including your postcode to andrew.achilleos@parliament.uk – you will then receive a petition via the post with a freepost return for completed petitions. Alternatively you can leave a message on the phone with your name and address; 020 8984 7854.
The MOPAC consultation on police stations is open until October 6th however Jon Cruddas will be collating all of the returned petitions and submitting them as part of his consultation response. So the Jon is asking that all petitions are sent back to his office by no later than Thursday 31st August.


It would be futile to ask what you would choose between bad breath and fresh breath. It is commonly accepted fact that fresh breath is an important indicator of a person's health and vivacity. Mouth rinses serve a variety of purposes like they mask bad breath, fight cavities or prevent the buildup of plaque, the sticky material that contains germs and is known to contribute to oral diseases. People with immune system problems are at greater risk of oral infections and inflammation, and already undergoing some dental treatment. Mouthwash can provide added protection against these problems. Many people turn to mouthwash as an easy and effective way to maintain a clean and fresh feeling mouth. Mouth rinses are especially well suited for persons who, for whatever reason, are unable to brush or floss their teeth as often as they should, and are conscious about their dental health.
You have the choice of picking up either therapeutic or cosmetic (medicated or non-medicated) variety of mouthwash, while some may be a combination of both. Mouthwash is a liquid solution that is swished around inside the mouth to cover the teeth, gums and tongue, and then is spit out. Preventive dentistry is however based upon sound diagnosis. Both types of rinses help wash away oral debris prior or post brushing, restrains bad breathe, abate bacteria in the mouth, and leaves a pleasant taste in the mouth to refresh it. The only difference between the two types of oral rinses is the presence of an active agent against certain oral diseases. Therapeutic rinses can be classified according to use: antiplaque, antigingivitis rinses and anticavity fluoride rinses. Therapeutic rinses are prescribed for severe oral problems such as caries, periodontal disease, gum inflammation and xerostomia (dry mouth). Anticavity rinses with fluoride, however, have been clinically proven to fight up to 50 percent more of the bacteria that cause cavities. India dental clinics typically recommend Fluoride mouthwashes for children under age 18 and adults who are experiencing a lot of new dental cavities.
Mouthwash is intended to be a supplement to (not a replacement for) good oral hygiene practices, such as daily brushing and flossing, and using different toothpastes or tooth powder. The medicated mouthwashes are usually prescribed by the dentist for specific conditions like gum infections, ulcers, or after gum surgery. These may contain Chlorhexidine gluconate having pronounced antiseptic properties. Other mouthwashes available may contain chemicals like Stannous Fluoride, Cetylpyridinium Chloride, Sanguinarine, Sodium Benzoate, etc. These may be classified as either medicated or non-medicated, as their constituents are such that no prescription is required, but their use cannot be decided on by the patient himself. The patients wearing dentures, tooth crown, bridge, or dental implants may ask their dentist the dental care instructions for any specifically recommended mouth rinses.
Mouthwash is typically used after brushing and flossing and is not diluted unless patient finds some alcoholic variety difficult to handle due to weak oral health. When mouthwash is used, patients should follow the directions provided by their dentist or on the product packaging. Mouthwash should be swished around vigorously so that it rinses the front and sides of the mouth equally. In some cases the dental specialists in India may direct the patients to gargle. This type of rinsing is especially effective at reaching the back of the tongue, where bacteria may accumulate. Although mouth rinses do wash away debris and bacteria, they should never be used as permanent substitute for proper dental care. The advanced packaging technology has made easy the availability of herbal oral care products in India and dentistry abroad in various convenient shapes and economical sizes.


text:
https://www.barrons.com/articles/bankruptcies-like-hertz-are-a-great-investing-opportunity-hedge-fund-ceo-says-51591997302
Bankruptcies Like Hertz Are a Great Investing Opportunity, Hedge Fund Head Says. He's Not Talking About Its Stock.
Luisa Beltran
Marc Lasry.
Photograph by Christopher Goodney/Bloomberg
Marc Lasry, co-founder and head of hedge fund Avenue Capital Group, believes that the biggest opportunity for investment right now is in bankrupt companies or those that are restructuring, otherwise known as distressed debt.
Lasry, who made the comments during a SALT Talks webinar, pointed to Hertz Global Holdings (ticker: HTZ), the car rental chain that filed for bankruptcy protection in May. "No one was willing to lend them more money. All their collateral was in bonds," Lasry said during the webcast. Avenue Capital does own some Hertz debt, Lasry told Barron's.
Hertz had $18 billion in debt when it filed for chapter 11 on May 22. Its stock closed at 56 cents the day it filed for bankruptcy and then saw its shares increase tenfold, closing at $5.58 on June 8, according to a June 11 bankruptcy filing. This spurred Hertz debtors to ask a bankruptcy judge on Thursday to allow the rental company to take advantage of the trading and sell 246.8 million shares through Jefferies, the filing said.
The sale would allow Hertz to raise capital on terms that are better than any debtor-in-possession financing it could get, Hertz debtors said, and the company could use the proceeds for general working capital purposes. The Delaware bankruptcy court on Friday granted Hertz debtors' motion to sell shares, according to a bankruptcy filing. Hertz can sell no more than 246,775,008 shares valued at up to $1 billion. Hertz didn't return calls for comment.
Hertz selling shares is better for debtholders, Lasry said. Hertz wouldn't need to pay interest on the equity the way it would for a debtor in possession, or DIP, loan, he said. "We own bonds and debt, any equity that is put in is beneficial because its always junior to me," Lasry said. "That means I get paid first."
Avenue Capital, of New York, invests in distressed debt and other special situations. It manages an estimated $9.7 billion in assets as of May 31. The firm typically invests in companies when they file for chapter 11, Lasry said. The Covid-19 recession has pushed many companies, including Gold's Gym, J.Crew, and J.C. Penney (JCP), into bankruptcy.
Bankruptcies represent good opportunities to buy from noneconomic sellers or people who need to sell, Lasry told Barron's. This means firms like Avenue Capital can buy debt assets at a discount, he said. "If things turn out, I will do exceptionally well. If a company has to liquidate that's OK, because I'll make money on the liquidation," Lasry said during the webinar. Lasry, who is Avenue Capital's chairman and CEO, said he considered distressed debt a "massive opportunity," estimating the global market opportunity at from $500 billion to $1 trillion.
The SALT Talks webinars feature Anthony Scaramucci interviewing business leaders and policy experts. Scaramucci is the founder and co-managing partner of SkyBridge Capital, the hedge fund, and the chairman of the SkyBridge Alternatives Conference, or "SALT."
The Avenue Capital CEO said he feels more confident investing today, than he did 12 years ago when the country was suffering during the great financial crisis. Lasry said his biggest worry in 2008 was whether the banks could survive that recession. By comparison, the biggest issue facing companies today is whether they will have enough liquidity to survive until people return, he said.
Lasry made the comments as U.S. businesses are beginning to reopen. States, including Alabama, Alaska and Arizona, have lifted their "stay-at-home" orders that were put in place earlier this year to stop the spread of the virus. People, in some states, are turning out to restaurants and bars.
"Today we all know something," Lasry said during the SALT webinar. "We will be fine in two years. People will be back out, there will be a vaccine. The question is how long will it take to get back to normal."
Write to Luisa Beltran at luisa.beltran@dowjones.com


The Photographic electronic Narrative (PeN) project is part of an Independent Social Research Foundation (ISRF) mid-career fellowship. The PeN project aims are twofold, to work as a personal development tool for trainees, whilst fostering dialogue between trainees and supporters in order to challenge social exclusion.
LandWorks is hosting the PeN project in order to provide supporters and the wider community with an insight into trainees journey during their time on the scheme.
Trainees are provided with basic digital cameras for their use whilst they are on site only. There will be no identifying photographs posted on the blog and all participants choose pseudonyms (fake names). Any photographs taken by trainees are discussed with the lead researcher and decisions made on what photographs and narratives to upload.
All photographs and accompanying narratives uploaded on to this blog and/or any other social media platforms are made by the lead researcher only. Trainees have no direct input into this part of the PeN project.
All information, photographs and quotes are not to be reproduced without the permission of the blog owner and are subject to the usual copyright laws.


Sorry, we do not have any Maple Ridge Occupational Health and Safety lawyers registered with our service. But if you use our free lawyer referral service we will forward your information to an appropriate lawyer in Maple Ridge. They will contact you directly.


text:
Монурики — необитаемый остров в Тихом океане, входит в группу островов Маманука — государство Фиджи. Остров протяжённостью примерно 1 км в длину и 600 м в ширину. Монурики — остров вулканического происхождения, площадью 0,4 км², окружён со всех сторон коралловыми рифами. На острове есть несколько живописных лагун и пляжей из белого песка. Остров стал туристической достопримечательностью после выхода на экраны фильма «Изгой» с Томом Хэнксом в главной роли. Теперь остров называют не иначе как «остров Изгоя». Во время съёмок на территории острова проживали 100 человек съёмочной группы.

Остров характеризуется каменистым дном, сильными течениями и штормами. Монурики — самый южный из островов Маманука.

Флора и фауна
Растительность в основном состоит из сосен, пандануса, кокоса и связанных с ними видов прибрежных лесов. Существует план разведения игуан.

Примечания

Острова Фиджи
Острова Австралии и Океании


A nicely styled curved arm and front armchair. Its tapered mahogany legs have there original brass embellishers with original brass/ceramic casters.
The chair is currently in its original Edwardian fabric.
The frame is costructed from solid beech and mahogany.
Will look stunning fully restored in the fabric of your choice.
Please call for details and price, if the chair is of interest to you!
Dimensions - height 88 cms, width 69 cms, depth 80 cms.


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More than 2800 of your favorite internet retailers and travel sites including Amazon, eBay, Target, Apple, Expedia, and more have joined forces with GoodShop.com to donate part of every purchase to the Cancer Research Institute! It takes just a few seconds to go to www.goodshop.com, make sure that Cancer Research Institute is your selected charity, and then click through to your favorite store and shop as usual. One percent to five percent of your purchase price will be donated to CRI depending on your purchase.
Go to www.GoodShop.com to see a full list of participating retailers.


text:
Report on Kujusan (Japan) — April 1996
Kujusan
Bulletin of the Global Volcanism Network, vol. 21, no. 4 (April 1996)
Kujusan (Japan) Seismicity and steam plume without ash
Global Volcanism Program, 1996. Report on Kujusan (Japan) (Wunderman, R., ed.). Bulletin of the Global Volcanism Network, 21:4. Smithsonian Institution. https://doi.org/10.5479/si.GVP.BGVN199604-282120
33.086°N, 131.249°E; summit elev. 1791 m
High seismicity around Kuju was recorded between 1 and 3 April. The monthly total number of earthquakes was 196. No volcanic tremors were observed. The height of the white ash-free plume remained at 100-300 m throughout the month, but it was ~ 500 m high on 21, 25, and 26 April.
Geological Summary. Kujusan is a complex of stratovolcanoes and lava domes lying NE of Aso caldera in north-central Kyushu. The group consists of 16 andesitic lava domes, five andesitic stratovolcanoes, and one basaltic cone. Activity dates back about 150,000 years. Six major andesitic-to-dacitic tephra deposits, many associated with the growth of lava domes, have been recorded during the Holocene. Eruptive activity has migrated systematically eastward during the past 5000 years. The latest magmatic activity occurred about 1600 years ago, when Kurodake lava dome at the E end of the complex was formed. The first reports of historical eruptions were in the 17th and 18th centuries, when phreatic or hydrothermal activity occurred. There are also many hot springs and hydrothermal fields. A fumarole on Hosho lava dome was the site of a sulfur mine for at least 500 years. Two geothermal power plants are in operation at Kuju.
Information Contacts: Volcanological Division, Seismological and Volcanological Department, Japan Meteorological Agency (JMA), 1-3-4 Ote-machi, Chiyoda-ku, Tokyo 100 Japan.