text:
Q: Downloading PDFs with requests and scrapy So I've been trying to use the requests library in the pipeline to attempt to download PDFs. However the PDFs are always 0 bytes when downloaded. And I get an Error: error processing URL that traces back to the line where I makes the original requests though I can't seem to find what's wrong based on previous questions and documentation I've read. The URL is passed in through the Item URL field. Would anyone be able to tell me what I'm doing wrong.
# Define your item pipelines here
#
# Don't forget to add your pipeline to the ITEM_PIPELINES setting
# See: http://doc.scrapy.org/en/latest/topics/item-pipeline.html
import requests

class SherlockPipeline(object):

 def process_item(self,item, spider):
    #pdf_url = []
    #pdf_url.append(item['url'])
    pdf_url = item['url']
    local_filename = item['url'].split('/')[-1]
    request = requests.request('GET', pdf_url)
    with open(local_filename, 'wb' ) as f:
       for buff in request.iter_content(128):
            f.write(buff)#write it to file
    return item

The log output is the following:
2015-12-03 17:42:42 [requests.packages.urllib3.connectionpool] INFO: Starting new HTTP connection (1): www.privacybydesign.ca
2015-12-03 17:42:42 [requests.packages.urllib3.connectionpool] DEBUG: "GET/content/uploads/2014/09/pbd-de-identifcation-essential.pdf HTTP/1.1" 302 275
2015-12-03 17:42:42 [requests.packages.urllib3.connectionpool] INFO:Starting new HTTPS connection (1): www.privacybydesign.ca
2015-12-03 17:42:43 [scrapy] ERROR: Error processing {'url': u'http://www.privacybydesign.ca/content/uploads/2014/09/pbd-de-identifcation-essential.pdf'}
Traceback (most recent call last): File "C:\Users\pinky\Anaconda2\lib\site-packages\twisted\internet\defer.py", line 588, in _runCallbacks
  current.result = callback(current.result, *args, **kw)
File "C:\Users\pinky\Documents\work\sherlock\sherlock\pipelines.py", line 16, in process_item
  request = requests.request('GET', pdf_url)
File "C:\Users\pinky\Anaconda2\lib\site-packages\requests\api.py", line 50, in request
   response = session.request(method=method, url=url, **kwargs)
File "C:\Users\pinky\Anaconda2\lib\site-packages\requests\sessions.py", line 468, in request
   resp = self.send(prep, **send_kwargs)
File "C:\Users\pinky\Anaconda2\lib\site-packages\requests\sessions.py", line 597, in send
   history = [resp for resp in gen] if allow_redirects else []
File "C:\Users\pinky\Anaconda2\lib\site-packages\requests\sessions.py", line 195, in resolve_redirects
   **adapter_kwargs
File "C:\Users\pinky\Anaconda2\lib\site-packages\requests\sessions.py", line 576, in send
  r = adapter.send(request, **kwargs)
File "C:\Users\pinky\Anaconda2\lib\site-packages\requests\adapters.py", line 433, in send
  raise SSLError(e, request=request)

A: Scrapy already has pipelines to download files and images  which works well.

A: Try using requests with stream keyword argument as True:
request = requests.get(pdf_url, stream=True)

Also, as you may see, there is no need to make requests like this:
request = requests.request('GET', pdf_url, stream=True)

For more information regarding stream, please see:
https://requests.readthedocs.io/en/latest/user/advanced/#body-content-workflow

A: So I couldn't change anything in the pipeline to solve the issue, so I changed the spider to yield a dictionary instead of an item and that worked, though I'm not sure why.


text:
Search Jobs Research Options
High Paying Jobs Overview
Get a Great High Paying Job!
100kJobFinder > High Paying Jobs Overview > Attending Elite Private Schools vs. Public Universities
Attending Elite Private Schools vs. Public Universities
An American Express/Harrison survey of millionaires reported that half ran their own business, with 1/3 having a professional practice or experience working in the corporate field. "The Millionaire Mind" states that the median college GPA for millionaires is 2.9, the average SAT score 1190, and 59% of millionaires attended a state college or university according to AmEx/Harrison. Just under half of all millionaires surveyed held an advanced degree. Getting to the front of the pack with pay can take a combination of school, innovation, who you know and how hard you work.
How Important is it to Attend an Elite School?
College costs are rising at a scary rate, and students have an average of $21,500 in college student loans. Meanwhile, salaries for B.A.s are falling. New data and studies suggest that attending a good program at a less elite school and continuing with a higher degree may be a better investment than putting all your funds toward an elite undergraduate.
The college ranking system by U.S. News and World Report, although the most widely referenced and respected, is also the target of criticism from some independent groups and individuals. "The rankings are a measure of wealth, exclusivity and fame, not quality," says Kevin Carey, research manager at the nonprofit Education Sector. Carey claims that the rankings inflate the draw of some schools, which brings more applicants, which in turn brings more rejections and the ability to class a school as superior.
Forbes counters the sacred U.S. News rankings with their own list, based on the quality of undergraduate experience and the quality of professors, with no involvement from the colleges in the rankings.
The list, in order:
Yale University, and
Columbia University.
Less than 1% of students attend Ivy League schools, and "middle class families [are at a] disadvantage in the system" when it comes to aid and financial access. 80% of undergrads in the U.S. attend public colleges, which are also raising tuition rates – college costs have seen a 439% rise since 1982. The debate over whether an elite college is worth it is raging, and Ohio University economics professor Richard Vedder claims in his "Going Broke for Degree" that there is "virtually no date that allows families to evaluate the quality of [an elite college's] educational offerings or the outcome of its graduates."
A study by the Brookings institution showed that having a B.A. increased the chances of entering the top-income earning bracket, regardless of whether or not it was from an Ivy League school. Does a top education result in better outcome for life?
Different studies have disputed the myth that elite schools automatically mean better salaries. A well-known paper by Princeton economist Alan Krueger and researcher Stacy Berg Dale at the Andrew W. Mellon foundation compared the salaries of graduates who earned degrees from top tier colleges with those of graduates who were accepted to the same schools, but chose to attend less selective schools. Both groups of graduates ended up with similar income, drawing the conclusion that strong students will excel no matter where they get their degree. The one exception pointed to low-income students who benefited from the social networking they experienced at the most selective colleges.
Another study conducted at the University of Pennsylvania claimed that degrees from elite schools are not as valuable at major corporations as they were twenty-five years ago. The percentage of top executives at Fortune 100 companies with undergraduate degrees from Ivy League schools fell by nearly one-third, from 14% to 10%. The percentage that attended other highly ranked schools (Notre Dame, etc.) fell from 54% to 42%, while public university graduates rose from 32% to 50%.
Vedder claims that when comparing the best private and public undergraduate programs, private schools do not often offer an "unbeatable advantage." Cooper Union, a free tuition school, has a highly ranked engineering program, which again begs the question of whether it's worth it to shell out for a big name. Financial advisers recommend that student loan payments not exceed 10% of starting salaries, requiring some decision-making regarding the cost of school and expected starting pay.
Learn More: Significance of MBA, EMBA, Ph.D. Degrees
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redpajama_set_name: RedPajamaCommonCrawl


Yesterday I had featured a couple of homes that had been decked out by Connecticut interior designer Heide Hendricks (here and here). Today I thought I would share a bit more of her designs because I am pleasantly surprised by how much I enjoy her traditional spaces. Must be because she gives them a bit of an edge with coloured trim, vintage light fixtures and mid-century chairs. The result is eclectic and unexpected and spaces I would absolutely enjoy hanging out in.
Painting the woodwork – so simple and stylish. The kitchen was a little too much woodwork, but I'd probably go wild for it with a cooler color. like the pale bedroom – that one would be heaven to sleep in. But my favorite is the urban kitchen with the best view of any window seat ever. The little period touches – wooden knobs, handfuls of flowers stuffed in vases, big veggies on display – are really adorable.
Absolutely inspiring. I will so much change for darker trims. Love the cohesiveness.
I love the book alcove and the stairway art. Books and art- what more do you need?


text:
TOMB OF NOSTALGIA: HELL NIGHT (1981)
January 31, 2014 by MonsterZero NJ in Tomb Of Nostalgia and tagged 80s horror, Hell Night, Jenny Neumann, Jimmy Sturtevant, Kevin Brophy, Linda Blair, Peter Barton, Randy Feldman, Suki Goodwin, Tom DeSimone, Vince Van Patten
Hell Night is a cheesy 80s slasher flick that has gained a bit of a reputation over the years and a bit of a cult following, too. It was another flick I caught on one of the grind house screens at the Oritani Theater in Hackensack, N.J. and while it was fairly entertaining, I don't remember being all that overly impressed. I recently had a chance to revisit this slasher and there is definitely some entertainment to be had and the 80s nostalgia added some fun to a flick now revered by some as a cult classic. If you're a fan of 80s slasher flicks, it's definitely worth a look and is undeniably a good time.
The story takes place on "Hell Night" a night were fraternity and sorority pledges are initiated to prove their worthiness to join their organization of choice. To enter the Alpha Sigma Rho fraternity, four co-eds, Marti (Linda Blair), Jeff (Peter Barton), Seth (Vince Van Patten) and Denise (Suki Goodwin) are tasked with staying overnight locked inside Garth Manor…a creepy abandoned mansion where twelve years earlier Raymond Garth murdered his family and then killed himself, though local legends say deformed son Andrew escaped his father's wrath and still roams the grounds. Of course Alpha Sigma Rho president Peter (Kevin Brophy) has had the place rigged and he and cronies, Scott (Jimmy Sturtevant) and May (Jenny Neumann), sneak in after our four are secured inside and plan to scare the wits out of them with scream emitting speakers and ghostly projections. But there is always some truth behind urban legends and someone on the grounds wants prankster and pledge alike dead… and in gruesome fashion. Will any of them survive Hell Night?
As directed by Tom DeSimone, Hell Night has its entertainment value, though is not perfect. It is a rather slow paced and by-the-numbers horror, at least in it's first two thirds. For the most part victims can be spotted a mile away, as basically they are the ones who wander off, or are left alone, so there is little suspense in the 'who's gonna get it' department. The film follows the 80s slasher formula with little diversion or surprises and the script by Randy Feldman does have it's share of holes…like why didn't the 'killer' off Peter and company when they were initially inside the house rigging their pranks earlier? Despite the creepy old house locations, the film has the look and feel of a 70s TV movie and, at 101 minutes, is at least 10 minutes longer then it needs to be. It takes about a half hour before we get our first kill and it is about an hour in before things start to pick up. It's then that director DeSimone starts to give us some atmosphere and a little suspense, as our surviving co-eds are engaged in a fight for their lives in the catacombs beneath the spooky old house and through it's maze-like hallways. It's the last act that delivers a good deal of what fun and action the flick has, with the first two acts moving very slowly and most of the kills being fairly routine, when the somewhat two dimensional characters are being slaughtered. There is a nice electronic score by Dan Wyman to add a little 80s flavor and the make-up FX are adequate enough to make our villains creepy.
The cast are all adequate enough for an 80s horror flick. Blair and Barton being the hero and heroine are fine, though don't get really animated till they are running and screaming for their lives. Blair especially perks up in the last few minutes as her role of final girl intensifies. I don't consider that a spoiler as she has star billing and is the only person featured on the movie poster, so I think that part of the story is fairly obvious from the get-go as to who our final girl will be. Suki Goodwin is cute and hot as the saucy, sexy blonde, but as all horror fans know, saucy, sexy blondes rarely make it to the last act. Van Patten is your typical horny frat boy and Brophy your typical elitist, fraternity douche. Jenny Neumann and Jimmy Sturtevant fill out the cast as Brophy's lackeys and killer fodder.
So, overall, Hell Night can be an amusing watch and it does have some nice nostalgia, especially for me, since I got to see it with friends in a theater where movies like this should be seen. While it is very slow to really get going, the last act does kick in gear and deliver some nice action and a little suspense. If today's audiences are patient enough to get to that point, then they should be satisfied with what the last 40 minutes delivers. Maybe not an outright classic, but if you are a fan of the 80s slasher era, it deserves a look and will probably entertain you just fine when all is said and done…and sometimes that and a few brews are all one needs in a movie.
UPDATE: The flick is now available from the awesome folks at Scream Factory! Here's my Blu-Ray review…LINK!
Rated 3 *out of 4) Blairs!
← SCARLETT SIZZLES IN NEW BLACK WIDOW CHARACTER POSTER!
MONSTERZERO NJ'S SATURDAY NIGHT DOUBLE FEATURE: ABBY and JD'S REVENGE →
6 thoughts on "TOMB OF NOSTALGIA: HELL NIGHT (1981)"
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text:
Q: Is it Possible to update body of file before uploading in salesforce using trigger? Need to update the body of the file before uploading into salesforce.
Here is the sample code i am using it for updating attachment
trigger SetTitleToAttachment on Attachment(before insert) {
    for (Attachment att: Trigger.new) {
        if (att.ContentType == 'text/plain') {
            String s = att.body.toString();
            att.body = blob.valueOf('Text Encryption\n' + s);
        }
    }
}

A: I have worked on this and finally got the solution(trigger) which will help us to update the file before uploading. We can update title,body etc....
trigger setcontentdoclink on ContentDocumentLink(before insert) {

    ContentVersion cont = new ContentVersion();
    ContentVersion cont1 = new ContentVersion();

    for (ContentDocumentLink cd: Trigger.new) {

        if (cd.ContentDocumentId != null) {
            cont.ContentDocumentId = cd.ContentDocumentId;
        }
        cont1 = [SELECT VersionData FROM ContentVersion where ContentDocumentId =: cd.ContentDocumentId limit 1];

    }
    cont.PathOnClient = 'file_' + Datetime.now().getTime() + '.txt';
    string docbody = 'Eventdex Enchryption\n' + cont1.VersionData.toString();
    cont.VersionData = Blob.valueOf(docbody);
    cont.Origin = 'H';
    insert cont;

}

redpajama_set_name: RedPajamaStackExchange


text:
RFS Briefings - October 2017
October 2017 issue of RFS Briefings has some timely and encouraging updates on women in science, particularly:
Announcing 2017 Blavatnik Regional Awards for Young Scientists Winners, blavatnikawards.org, October 12, 2017
The Blavatnik Family Foundation and the New York Academy of Sciences announced the three Winners and six Finalists of the 2017 Blavatnik Regional Awards for Young Scientists. All winners and finalists were men.
Isabella L. Karle Dies at 95; Findings on Molecules Helped Husband Win Nobel, October 26, 2017
Isabella L. Karle, whose experiments elucidating the shapes of molecules contributed crucially to her husband's Nobel Prize in Chemistry, died on October 3 at the age of 95. She was an expert in bouncing X-rays off crystals to deduce the structure of molecules by observing patterns in the deflected rays.
MacArthur Foundation Names 2017 'Genius' Grant Winners, nytimes.com, October 11, 2017
The MacArthur Foundation fellowships were announced and two women in science were named recipients: Regina Barzilay, a computer scientist who developed machine learning methods that enable computers to process and analyze large amounts of data, and Betsy Levy Paluck, a psychologist who examines how social networks and norms influence our interactions with one another.


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Stone Crushing & Screening Plant :Star Trace offers turnkey solutions for stone crushing Star Trace offers turnkey solutions for stone crushing & screening plants.


text:
Miss Ko is a Taiwanese-American singer-songwriter and rapper signed to Universal Music Group. Ko has released three studio albums and is the winner of Best New Artist of 24th Golden Melody Award in Taiwan, the first rapper/hip-hop artist to win the award.

Life and career
Christine Ko was raised in Queens, New York. She graduated from Brooklyn Technical High School and attended Five Towns College.

Ko released her first album in 2009, while based in New York. She studied Mandarin at National Taiwan Normal University, and during that time participated in a rap competition, which brought her to the attention of an executive at the music label KAO!INC. She left a master's program at New York University to pursue her music career in Taiwan. In 2010, Miss Ko was regarded as a "newcomer to the scene," and Meredith Schweig observed that there were no other professional women rappers in Taiwan at the time.

2012–2015: Knock Out and XXXIII
Ko released her debut album Knock Out on August 15, 2012. Knock Out peaked No. 1 on local music charts and won Ko Best New Artist at the 24th Annual Golden Melody Awards, in addition to "Most Outstanding Asian-American Youth Overseas" that same year.

On December 31, 2014, Ko released her second album XXXIII (33), which featured various artists such as Crowd Lu, Billie, and Amber An.

2016–present: Queen of Queens

In 2016, Ko signed with Universal Music Group. On December 22, 2016, Ko released her third album Queen of Queens. The album reached No. 1 on i-Tunes and Spotify.

Ko was nominated for Best Female Artist at the 28th Annual Golden Melody Awards.

On March 27, 2018, Ko was announced as the spokesperson for McDonald's.

Discography

Albums
 Knock Out (August 15, 2012)
 XXXIII (December 31, 2014)
 Queen of Queens (December 22, 2016)

Collaborations
 "Walk This Way" by adidas unite all originals also feat. MC Hot Dog and  (2013)
 "Melting Gold" by Soft Lipa also feat. Show Lo (2013)
 "疯起来/Feng Qi Lai" by Sun Sheng Xi (2014)
 "愛不來/No Love" by Khalil Fong (2014)
 "跳進來/Jump In" by A-mei 張惠妹 (2014)
 "Extrication" by  (2016)

Other ventures

On August 14, 2015, Ko performed and threw the ceremonial first pitch for her hometown team, the Mets, at Citi Field.

References

External links

1985 births
Living people
21st-century American singers
Feminist musicians
Brooklyn Technical High School alumni
Sex-positive feminists
New York University alumni
American musicians of Taiwanese descent
American women musicians of Chinese descent
American feminists
Musicians from Queens, New York
American emigrants to Taiwan
Taiwanese feminists
American women rappers
21st-century women rappers
Taiwanese rappers
21st-century American women singers
Rappers from New York City
American women singer-songwriters
Taiwanese singer-songwriters
Universal Music Group artists
National Taiwan Normal University alumni
Singer-songwriters from New York (state)

redpajama_set_name: RedPajamaWikipedia


text:
Search in titles only Search in Philosophy & Metaphysics only
Philosophy & Metaphysics
What are some holes in evolution of one species into another?
Matthew Mussolini
I like how a bird had a stub for a gazillion years that eventually evolved into a flying apparatus with hollow bones that enable it to soar through the air. But the stub didn't help it much for a while.
Not to mention a single cell organism came out of the water, grew legs and
Became:
Your mum!
Everyone is God. God keeps evolving. So does Mussolini.
I don't believe in the Bible, neither do you have to to believe in other supernatural entities assisting the energy that created the big bang and evolution.
Fuck Darwin though! He reminds of Adolf Shitlah! He would say I'm guilty of bestiality for sleeping with women who have afros.
Energy came out of nothing and a big bang that doesn't have a lot of reason for creating round looking sphere planets with life and the sun and moon in the right place and shit did it for the fuck of it and without reason but not on accident.
Fuck you Dawkins! The biggest difference between you and me is a thing called transparency and honesty.
Last edited by Matthew Mussolini; 09-30-2020, 06:34 PM.
And now apes make space ships that fly to the moon with cell phones and credit cards and chip implants to find your missing dogs.
While chimps still shit on the ground and invent the same tools they invented thousands of years ago.
Yeah, they really show signs of evolving!
Maybe God exists, he's just not just and kind of an ass hole and prefers to remain a mystery and let you rot in misery! But reward you in the next life?
I'd be interested in utilizing that girl's holes to initiate the next step in the evolution process.
OP, you misunderstand evolution, humans didn't evolve from chimps or gorillas, we share a common ancestor (perhaps plural) that reaches much further back in the evolutionary timeline, we're talking many millions of years. There are even extinct species within our same genus that go back a few million years. While the common ancestor(s) of Humans and other Great Apes was most likely more chimp-like, it's an erroneous assumption to suggest that chimps are the same as them. I think it's natural to have an anthropocentric bias given how prolific our species is and our incredible technological innovations but the same technology is pointing to a significant amount of overlap with Human and Ape genomes, the same technology is validating Darwin's general theory, although perhaps tweaking some mechanisms here and there, based on the fossil records.
I don't really have an example for the specific title question, it definitely has solid foundation, even if questions in "transitional" species lost to time remain. Probably the biggest mystery or hole in understanding is in regards to cladistics. I think cladistics has superceded other methods of classifying species but apparently there are some mysterious exceptions to clades, like Iirc a caterpillar and a butterfly are in two different clades, which I think suggests either something is wrong with cladistics or there are still aspects of evolution not fully understood.
Din Djarin commented
What about the platypus and cladistics?:P


text:
Who was David Cameron's son Ivan, what is Ohtahara syndrome and when did the former PM's son die?
FORMER Prime Minister has revealed the "shock" he went through when his son Ivan was diagnosed with an extremely rare neurological disorder.
But what do we know about late Ivan's condition Ohtahara syndrome?
David Camerons son Ivan passed away in 2009 aged just six years old[/caption]
Who was David Cameron's son Ivan?
The former Prime Minister and wife Samantha welcomed son Ivan into the world in 2002.
By his second week he was making jerky movements and quickly reducing in weight.
Ivan was later diagnosed with Ohtahara syndrome, which is a very rare epilepsy syndrome characterised by seizures.
David said of the condition that is was so rare that "there was barely a diagnosis – yet alone a cure."
He's revealed in The Times how Ivan underwent numerous, often painful, tests before a diagnosis was made, and he was given up to 20 different drugs each day.
Ivan was unable to move his limbs or speak, and his only self-conscious movements were to smile and raise his eyebrows.
David pictured with wife Samantha, and kids Nancy, Arthur and Ivan[/caption]
When did the former PM's son die?
Ivan passed away in 2009, aged just six years old and it is understood his parents were with him as he died.
A statement posted on the Conservative party's website said: "David and Samantha are grateful for all the warm messages of support and condolence that they have received."
It was asked that people wishing to pay their respects could send a donation to one of five charities: Mencap, Friends of Jack Tizard School, Friends of St Mary's Hospital, Paddington, Helen & Douglas House, Twickenham, and Shooting Star children's hospice.
The Camerons also have two daughters, Nancy and Florence, and a son called Arthur.
Paul Grover
Ivan was diagnosed with Ohtahara syndrome, which is a very rare epilepsy syndrome[/caption]
What is Ohtahara syndrome?
Ohtahara syndrome is rare epileptic condition where seizures typically start before three months of age.
It affects around one in 500 epileptic sufferers and is caused by an underlying structural brain abnormality.
This can be caused by brain damage before and around the time of birth, or it can be passed on in the genes.
Babies can suffer jerking limbs or spasms, and doctors will typically monitor any seizures before making a diagnosis.
The seizures are often resistant to medicine, and babies will often have little developmental progress.
Many sufferers die before the age of two from complications such as repeated chest infections.
Those who survive are typically severely disabled and will experience continued seizures even with treatment.
Ohtahara syndrome is caused by an underlying structural brain abnormality[/caption]
RANDY ROYAL
Courtney Love claims Prince Andrew turned up at her house 'looking for sex'
Little church hides big secret as owners turn it into ultimate adult playground
DEATH TOLL RISES
Six killed in Spanish floods and thousands evacuated during deadly storm
BABY PANIC
'World's oldest mum', 74, in intensive care along with husband, 78, after birth
HOSPITAL THIEF
Paramedic caught flogging stolen life-saving medical equipment on Facebook
What did he write in his new book?
In his new memoir For The Record, Cameron expressed his love for his children, saying he was particularly proud of Nancy and Elwen.
He wrote: "Nancy and Elwen had been so engaged in the campaign, and so sweet and supportive to me.
"I knew they knew I was stressed, because they'd been hugging me more than usual.
"Nancy had been taking my 'Conservative in' campaign badges and giving them to her friends."
Mr Cameron also reveals how son Elwen gave a brilliant account of himself in a school debate — on the morning his dad revealed he was leaving No 10.
He writes: "On the morning I gave my resignation speech outside No 10, Elwen was in a school project in which they would act out the UN having a debate on human rights.
"They had been rehearsing, with a German girl in his class playing Angela Merkel, an American boy playing Barack Obama and Elwen playing me.
"The teachers asked him that morning if he wanted to go ahead, or if it would be too upsetting, given what had just happened. 'I want to do it for my dad', he replied. His performance apparently had the watching parents in tears."
David Cameron's memoir For The Record is out on September 19[/caption]
We pay for your stories! Do you have a story for The Sun Online news team? Email us at tips@the-sun.co.uk or call 0207 782 4368 . We pay for videos too. Click here to upload yours
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Last weekend we celebrated Josh's 24th birthday. We also had the real pleasure of having the two Dutch guys who were traveling with Josh at the time of his accident, come to stay. Dominique Zondervan and Don Zweedijk"s visit was a very special moment as they were the last people to spend time with Josh before he died. They had only known Josh for two weeks so it was also a good opportunity for them to find out more about him from all his friends here.


text:
Psychotherapy mediated by remote communication technologies: a meta-analytic review
Penny E Bee1,
Peter Bower2,
Karina Lovell1,
Simon Gilbody3,
David Richards3,
Linda Gask2 &
Pamela Roach1
BMC Psychiatry volume 8, Article number: 60 (2008) Cite this article
Access to psychotherapy is limited by psychopathology (e.g. agoraphobia), physical disability, occupational or social constraints and/or residency in under-served areas. For these populations, interventions delivered via remote communication technologies (e.g. telephone, internet) may be more appropriate. However, there are concerns that such delivery may influence the therapeutic relationship and thus reduce therapy effectiveness. This review aimed to determine the clinical effectiveness of remotely communicated, therapist-delivered psychotherapy.
Systematic review (including electronic database searching and correspondence with authors) of randomised trials of individual remote psychotherapy. Electronic databases searched included MEDLINE (1966–2006), PsycInfo (1967–2006), EMBASE (1980–2006) and CINAHL databases (1982–2006). The Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDAN-CTR). All searches were conducted to include studies with a publication date to July 2006.
Thirteen studies were identified, ten assessing psychotherapy by telephone, two by internet and one by videoconference. Pooled effect sizes for remote therapy versus control conditions were 0.44 for depression (95%CI 0.29 to 0.59, 7 comparisons, n = 726) and 1.15 for anxiety-related disorders (95%CI 0.81 to 1.49, 3 comparisons, n = 168). There were few comparisons of remote versus face-to-face psychotherapy.
Remote therapy has the potential to overcome some of the barriers to conventional psychological therapy services. Telephone-based interventions are a particularly popular research focus and as a means of therapeutic communication may confer specific advantages in terms of their widespread availability and ease of operation. However, the available evidence is limited in quantity and quality. More rigorous trials are required to confirm these preliminary estimates of effectiveness. Future research priorities should include overcoming the methodological shortcomings of published work by conducting large-scale trials that incorporate both clinical outcome and more process-orientated measures.
Psychological disorders account for over 15% of the total burden of disease within established economies, a significant proportion of which manifests in depressive and anxiety-related disorders [1]. For these disorders, effective treatment options often include non-pharmacological as well as pharmacological interventions. Consensus guidelines recommend the use of cognitive-behavioral and interpersonal therapies for major depression [2–4] and cognitive behavioral therapy for panic disorder [5]. Research has also highlighted the potential value of these approaches in the treatment of dysthymia, phobia and generalized anxiety disorder [6].
Despite evidence of its efficacy however, most adults diagnosed with depressive or anxiety-related disorders do not receive psychotherapeutic care [6, 7]. Insufficient numbers of mental health professionals impede access to effective interventions, with people living in remote or under-served areas often having to travel long distances to obtain face-to-face services [8]. Other recognized barriers include time and economic constraints, caring responsibilities, psychological or physical impairment and concerns regarding the potential stigma of attending outpatient appointments [9–11].
Remote communication technologies such as the telephone, internet or videophone have the potential to mitigate many of these inequalities [12, 13]. The telephone in particular is a widely available telecommunication technology [14] that is being used increasingly as a mechanism for support and treatment delivery [15, 16]. The establishment of 1–900 counseling services alone illustrates a long but ongoing commitment to its use within psychotherapy service provision. More recently, the emergence of computer-aided technology alongside growth in the popularity of the Internet have increased multifold the opportunities for real time, long-distance consultations [17].
Conventional wisdom still insists however, that for most purposes, psychological therapies should be delivered face-to-face. The central premise to this argument is that the effectiveness of such interventions depends upon on the development of a high quality therapeutic alliance between therapist and client [18]. Within the context of this relationship, visual as well as auditory information is reflected in behaviours such as eye contact, physical expression, posture and voice [19]. The use of the telephone or internet will invariably eliminate many of these cues whilst the use of teleconferencing will limit physical presence and touch. Whether or not an effective alliance can be delivered in the absence of interpersonal contact thus remains a topic of some debate [20–22].
Evidence to support the efficacy of non face-to-face psychotherapy service models is accumulating. Recent studies of collaborative care provision, in which telephone support is often provided as an adjunct to other interventions, have documented positive outcomes [23–27]. Reviews and meta-analyses of computer-delivered CBT packages [28, 29] and self-help treatments [30–33] also provide promising results. These interventions however are often considered as stand-alone technologies requiring little or no contact between therapist and client. One recent meta-analysis of internet-based cognitive behavioral therapy for depression and anxiety [34] has suggested that the efficacy of these psychological interventions may ultimately be higher where therapist support is available.
The ability to deliver more intensive psychological therapy via remote communication media has the potential to confer multiple benefits for patients by combining real time, scheduled contact with increased accessibility. As yet however, the efficacy of delivering psychotherapy via such means has received comparatively little attention [19]. This article reports the findings of a systematic review conducted to determine the clinical effectiveness of remote psychotherapy.
This research was conducted using systematic review techniques [35] and meta-analysis to assess the clinical effectiveness of psychotherapy delivered via remote communication.
Studies eligible for inclusion were published randomised controlled trials (RCTs). Due to a lack of financial resources for translation facilities, the review was restricted to English language publications. There were no specific methodological quality criteria for inclusion in the review. Instead data were extracted from all studies on key methodological issues (see 'Methods of the review' below).
Interventions eligible for inclusion included any treatment incorporating a psychological intervention mediated by remote communication. Psychological interventions were defined as treatments with an explicit psychological orientation [36]. 'Mediated by remote communication' was defined as a treatment where all or the majority (i.e. with the exception of an initial or final contact meeting) of the psychological intervention was delivered by a therapist to a patient on a scheduled and repeated one-to-one basis through an appropriate technology (rather than face-to-face). Group and marital therapies or any other intervention involving interaction between a therapist and more than one client simultaneously were excluded from the review. Trials examining emergency crisis interventions (e.g. telephone helplines) or the efficacy of medication management programs in the absence of psychotherapy were excluded. Minimal interventions in which the majority of therapy was delivered i) outside of client-therapist interaction time (e.g. self-help therapy) or ii) via technology with little or no therapist contact (e.g. computerized CBT) were also excluded. Studies measuring changes in mental health symptoms as a by-product of counseling for physical illness were excluded.
Populations eligible for inclusion included any group seeking treatment for a mood disorder or functional (non-organic) mental health problem recognized by ICD-10 [37] or DSM criteria [38]. Studies involving therapy for substance misuse or addictions were excluded. Trials examining the efficacy of remote therapy for healthy populations at risk of mental health difficulties were also excluded.
Electronic literature searches were performed using the Ovid electronic database on the MEDLINE (1966–2006), PsycInfo (1967–2006), EMBASE (1980–2006) and CINAHL databases (1982–2006). The Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDAN-CTR) were also searched. All searches were conducted to July 2006. Subject headings were used to identify all papers indexed as containing material relevant to mental/psychiatric health, psychological therapies/interventions and communication technologies. These headings were augmented by text words that included the full and abbreviated names of specific mental disorders, types of psychological therapy and modes of communication. Full details of the search terms used are appended.
Authors of published and ongoing studies were contacted for further studies and information on the progress of ongoing work: 50% replied with information. Reference lists from identified papers and from reviews in the area were searched by hand.
Methods of the review
Eligibility judgements and data extraction were done independently by two reviewers. No formal measure of the reliability of data extraction was calculated but disagreements were resolved by discussion with other members of the project team.
A standardised data extraction recorded information on study context, population, interventions, outcomes and methodological quality. Methodological quality was assessed using standard criteria originally developed by the Cochrane Collaboration for Depression, Anxiety and Neurosis (CCDAN). The CCDAN quality rating scale [39] scores each study according to 23 elements of design and conduct including randomisation methods, sample size, follow-up period, power and appropriateness of analysis. Each criterion is scored from 0–2, giving a maximum score of 46.
The CCDAN criteria, like other validated scales of RCT quality [40], include a score pertaining to the adequacy of blinding procedures. Since it is not feasible to blind patients to an active intervention, this criterion was not relevant to the present review. A second criterion pertaining to the recording of pharmacological side-effects was similarly omitted from the review. Thus overall quality scores for the CCDAN criteria were in this study only able to reach a maximum of 42.
Methods of analysis
All analyses were conducted using Comprehensive Meta Analysis [41]. Continuous measures were translated into a standardised effect size, Cohen's d [42]. Dichotomous variables were translated into standardised effect sizes by computing the log odds ratio, and then conversion to d using procedures in the meta analytic package. Initial meta-analyses used a fixed effect model [43] to provide an overall pooled measure of effect. Between-study heterogeneity was assessed using the I2 statistic [44], which describes the percentage of total variation across studies that is due to heterogeneity rather than chance. The I2 statistic has several advantages over other measures of heterogeneity, including greater statistical power to detect clinical heterogeneity when fewer studies are available. As a guide, I2 values of 25% may be considered 'low', 50% 'moderate' and 75%, 'high'. Where heterogeneity was 'high' (i.e. I2 values of 75% or above), a random effects model was employed.
For the purposes of analysis, three main comparison groups were created: i) remote communication therapy versus a control group (e.g. usual care, waiting list); ii) remote communication therapy versus conventional face-to-face therapy, and iii) different types of remotely communicated therapy. Where studies compared two different types of remote therapy with a control, both comparisons were entered into the meta-analysis separately, but control group sample sizes were halved to ensure that they were not double counted [45].
Studies examining depression underwent a separate analysis to those focussing on anxiety or anxiety-related disorders (e.g. anxiety, agoraphobia with panic, OCD). Studies assessed outcome over a range of time points. For the purposes of analysis, outcome assessments were categorised into two time periods, representing outcomes in the short (0–6 months), and longer term (7 months and over). Where studies reported assessments at multiple time points, data with the longest duration were used. Effect sizes were only calculated for the primary outcome measure (where specified), or the measure deemed most relevant to the mental health disorder under study (judged by KL and LG). When studies reported more than one relevant measure (e.g. BDI and HRSD), these were combined by taking an arithmetic mean [46].
Thirteen studies were included in the review. Of 40 studies identified but subsequently excluded, the most common reasons for rejection were i) a lack of a mental health primary outcome measure (n = 11); ii) the use of a minimal intervention (e.g. guided self help) or an intervention with no clear psychological orientation (n = 10); iii) the use of a technology-based therapy requiring no direct therapist involvement (n = 18) or iv) group therapy (n = 1). One further study was identified as ongoing and this may be of relevance for later versions of the review. Summaries of the included studies are given in table 1, with corresponding methodological details in table 2. A list of excluded studies is available from the authors.
Table 1 Interventions in the review
Table 2 Characteristics of the included studies
Scope of the included studies
Nine studies reported 11 comparisons of technology-mediated therapy versus a control, three studies focussing on anxiety-related disorders [47–49] and six on depression [50–55]. Four of these studies used usual care as the comparative arm and four a waiting list or no treatment control. The remaining study did not provide a clear description of its control group. Two studies reported comparisons of technology-mediated therapy with conventional face-to-face interventions, one in an anxiety-related disorders (OCD) [56] and one in depression [57]. Three studies reported comparisons between different types of therapy mediated by the same technology, one in anxiety [58] and three in depression [54, 55, 59].
Ten studies assessed the efficacy of psychological therapy mediated by telephone, two by internet and one by videoconference (Table 1). Participants were recruited via primary care screening or GP referral (five studies), secondary care outpatient screening (one study), by public advertisement (two studies), through case registers of Multiple Sclerosis patients (two studies), via longitudinal research (one study) and by access to a pool of psychology students (one study). One study focusing on depressed children did not provide a clear description of its recruitment context. Patients included those with PTSD, OCD, agoraphobia with panic disorder and depression (Table 2). The number of participants randomized within each trial ranged from 23 to 600 (mean 121), with losses at follow-up of between 9% and 73%. Length of follow-up ranged from 6 weeks to 1 year. No data on costs were reported in any of the studies.
Quality of the included studies
All studies were RCTs, although in two studies methods of allocation were only quasi-randomised with the possibility of bias [50, 58]. Only two out the 13 studies reported details of allocation concealment [55, 56]. Less than half of the included studies (n = 5) defined a main outcome a priori [50, 51, 54–56] and only five reported conducting a power analysis [49, 54–57]. Although all studies conducted largely or wholly appropriate analyses of their data this failed to include an intention to treat analysis in eight instances [47–51, 54, 57, 58]. Seven studies controlled for between-group differences at baseline [47, 48, 51, 53, 55, 56, 59] and all but two studies presented sufficient data for re-analysis [50, 57]. Only two studies involved more than 100 participants per trial arm [51, 55], the vast majority (n = 9) recruiting less than 50.
The mean methodological quality score for the included studies was 23 (SD = 7.33). The highest scores were 38 [55], 36 [56] and 31 [59].
Quantitative results
Pooled effect sizes for each of the main comparison groups are presented in table 3. In both meta analyses using multiple studies, the I2 statistic was zero (indicating no heterogeneity beyond that expected by chance) and thus fixed effect models were used.
Table 3 Results of meta-analyses
For depressive disorders, the pooled effect size for remotely delivered therapy compared to control conditions (e.g. waiting list or usual care) was 0.44 (95% CI 0.29 to 0.59), demonstrating a statistically significant 'medium' effect [42] (figure 1).
Analysis of technology-mediated therapy versus control (depression).
For anxiety-related disorders, remotely delivered therapy demonstrated a 'large' effect compared to control conditions (figure 2, 3 comparisons, n = 168). The pooled effect size was 1.15 (95% CI 0.81 to 1.49) (figure 2).
Analysis of technology-mediated therapy versus control (anxiety).
Comparisons between technology-mediated and face-to-face interventions and comparisons between different forms of technology-mediated therapy were limited by the small number of studies reporting relevant data (table 3).
The aim of this review was todetermine the clinical effectiven ess of psychotherapy delivered by remote communication technologies. Compared to control conditions, technology-mediated therapy demonstrated a 'large' effect for anxiety-related disorders and a 'medium' effect for depression. The majority of included studies suffered at least some methodological limitations and few comparisons of remote versus face-to-face psychotherapy were found.
Overall, the effect size calculations would suggest that remotely delivered psychotherapies do have the potential to be clinically effective, although the magnitude of this effect varies and may be more evident for anxiety than for depression. The comparison of technology-mediated psychotherapy against control conditions for depression produced a pooled effect size of 0.44 in favor of therapy. This finding remains in accordance with an effect size of 0.42 reported by an earlier meta-analysis [60] comparing conventional face-to-face therapy with no treatment controls in depression. A second more recent meta-analysis of face-to-face psychotherapy for depression reports standardized mean differences of 0.63 up to 3 months and 0.56 at 6–9 month follow-up in favor of face-to-face therapy over treatment as usual or waiting list controls [36].
For comparative purposes, meta analyses of lower intensity psychological interventions (e.g. guided self help) for anxiety and depressive disorders report mean effect sizes of between 0.40 and 1.19 [30, 31, 33, 34, 36, 61], However, these reviews include studies of treatments that, by definition, use technology to reduce rather than mediate professional therapist input. The effects of such interventions have been shown to be greater for some disorders than others [31, 33], with certain problems (e.g. anxiety disorders) responding better to self-help packages supported by increased therapist contact [30, 33]. The characteristics of patients accessing such treatments are likely to differ substantially from those requiring more traditional and higher intensity therapies, not least in terms of their problem severity and/or motivation for treatment.
A definitive conclusion as to the relative efficacy of technology-mediated versus face-to-face administered psychotherapy can only be drawn from randomized controlled trials comparing the two interventions. A comparison of the efficacy of technology-mediated versus face-to-face psychotherapy was conducted within the present review, with a large but non-significant effect size of 0.55 for depression and a smaller difference of -0.11 for anxiety-related disorders being obtained. However, a shortage of literature limits the utility of this result. Only two of the 13 studies included in the review directly compared the efficacy of face-to-face psychotherapy with an equivalent intervention delivered via more remote means. It should be acknowledged that even in these studies, meaningful comparisons may be difficult. The ability for remote therapy to overcome multiple physical, psychological and geographical constraints means that the clinical populations who may wish to access such treatments may differ markedly from those in face-to-face services.
Ultimately, the published evidence base for clinical effectiveness of psychotherapies delivered solely or largely via remote communication methods is limited, both in size and quality. Therefore, the effect size estimates reported in the current review can at best only be viewed as preliminary. The majority of identified studies were of relatively small sample size with common shortcomings noted in relation to allocation procedures, identification of primary outcome measures and statistical analyses. From a possible maximum score of 42, overall quality ratings for the included studies ranged from 13 to 38 with a median of 22 (SD = 7.33). Despite the above limitations, these scores remain slightly higher than those observed elsewhere, a recent meta-analysis of brief psychological treatments for depression reporting a mean score of 19 (SD 7.3) for 63 controlled trials assessed against the same quality criteria [36]. Given that the financial implications of remote therapy are likely to be a key factor of interest, it is disappointing that no economic data were available.
Attrition rates for the studies ranged from 9 to 73% depending upon the population studied, the nature of the intervention and the length of the follow-up period. This heterogeneity suggests that whilst technology-mediated psychotherapies have the potential to be more effective than delayed or usual care, different treatment modalities may differ in their perceived acceptability. Data from earlier systematic reviews suggest that attrition rates of alternative models of treatment delivery can also vary widely. Randomized trials of face-to-face therapy for depression report post-treatment drop-outs of between 0 and 60% [7]. Trials of written self help materials for anxiety and depressive disorders report comparable figures of between 0 and 61% [62], although attrition from open access online therapy is generally assumed to be higher and may be as much as 99% [63], Once again however, differences in study context, recruitment and sample characteristics can often prevent any direct comparison of attrition rates across different modes of treatment.
Four of the studies included in the review provided a quantitative measure of patient satisfaction, all indicating a preference for, or equivalent satisfaction with, technologically-mediated care as compared to face-to face delivery [56, 57] or usual care [51, 55]. Two other studies also provided data to suggest that levels of patient satisfaction with remote psychotherapy are high, although in these instances no comparable data from control conditions were available [48, 53]. Eighty-three per cent of participants in one trial expressed a favorable attitude towards the use of the telephone to deliver psychotherapy and 75% expressed a desire to continue treatment either now in the future through this medium [53]. However, whether or not these preferences remain consistent across different technologies and communication modalities is unclear. The vast majority of studies included in the present review focused on therapy delivered via the telephone, with very little research effort being directed towards newer and increasingly available resources such as the web. Only one study in the original review examined the efficacy of psychotherapy delivered via videoconferencing and only two studies used the internet, both of which were conducted by the same research team.
A scoping search of literature published since the original searches were undertaken has returned only a small number of additional studies [64–66]. One presents data already included in the present review [64]. Another, examining telephone psychotherapy for depression and conducted as a follow-up to one of trials in the present meta-analysis reports maintenance of clinical benefits when compared to usual care [65]. A third trial that has recently compared face-to-face therapy with a comparable intervention delivered via telepsychiatry reports no significant differences in effect [66].
Whilst the telephone undoubtedly confers specific advantages in terms of its widespread availability and ease of operation, research suggests that videoconferencing may also be particularly suited to psychotherapeutic use. A recent systematic review has shown real time telepsychiatry to represent a highly feasible method of conducting mental health treatments and assessments, often with clinical outcomes and rates of attendance equivalent to those obtained face to face [67]. However, criteria for inclusion and exclusion in this review were not explicitly stated and therefore it is unclear whether or not these observations are based on high quality evidence from randomized trials.
The present review has its limitations. It includes studies examining the effectiveness of psychotherapy delivered via remote communication technology on a scheduled and repeated one-to-one basis and as such, excludes trials examining the effectiveness of more minimal, technology-based interventions. A number of reviews have already been published examining the clinical effectiveness of self-help treatments delivered via technology, and thus the decision was made to conduct a more focused review of optimal relevance to more traditional therapy formats. Nevertheless, publication bias is a problem for any review of controlled trials and given the high dependence on electronic database searching it cannot be certain that unpublished studies do not exist. Due to the small number of studies eligible for the review, funnel plots to assess publication bias were not created in line with recommendations [68]. The analysis treated 'usual care' and waiting list' controls as equivalent to 'no treatment', although it should be noted that previous studies have suggested that effects in usual care may be significantly lower [69]. Translating dichotomous outcomes into standardised effect sizes for the purposes of the meta analysis does allow the most comprehensive summary of the outcome data, but these transformations are based on assumptions which may not always be warranted.
Technology-mediated psychotherapy provision has the potential to overcome many of the barriers to care associated with more traditional face-to-face interventions. Data suggest that good treatment effects and by implication therapeutic alliance may not be dependent on a patient and therapist being co-located. However, the limited amount of evidence that is available and the restricted number of studies in any one subgroup as yet prevents any definitive conclusions from being drawn. Future research priorities should include overcoming the methodological shortcomings of published work by conducting large-scale trials that incorporate both clinical outcome and more process-orientated measures. In particular, these studies should seek to compare remote psychotherapy with more conventional face-to-face methods by quantifying levels of patient and therapist satisfaction and exploring the potential impact of different modes of communication on therapeutic outcome and examining the quality of the therapeutic alliance that is established,
Electronic search strategy
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internet/or computer assisted instruction/or virtual reality/or Electronic Mail/
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email.mp. or (electronic and mail).mp. or (electronic and communication).mp.
(virtual and reality).mp. or VR.mp.
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internet.mp. or online.mp. or worldwide web.mp. or web based.mp.
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(computer and based).mp.or (computer and mediated).mp. or (computer and assisted).mp.
(remote and consultation).mp.
1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14
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psychotherap$.mp. or psychodynamic therap$.mp. or PDT.mp. or psychoanalytic therap$.mp.
Behavior Therapy/or Cognitive Therapy/or Cognitive Behavior Therapy/or Rational Emotive Behavior Therapy/or Behavior Modification/
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Relaxation Therapy/or relaxation therap$.mp.
Family Therapy/or Interpersonal Psychotherapy/or Psychodynamic Psychotherapy/or Marital Therapy or Group therapy/
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family therap$.mp. or marital therap$.mp. or group therap$.mp. or support group$.mp.
GROUP COUNSELING/or PSYCHOTHERAPEUTIC COUNSELING/or EDUCATIONAL COUNSELING/or COUNSELING/or MARRIAGE COUNSELING/or COUNSELING PSYCHOLOGY/or PARENT COUNSELING/or FAMILY COUNSELING/or PATIENT COUNSELING/
counsel?ing.mp.
Self Help/or Self Management/or exp Self Help Techniques/
self treatment.mp. or self help.mp. or self directed.mp. or self management.mp.
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limit 33 to English
remove duplicates from 34
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The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/8/60/prepub
School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
Penny E Bee
, Karina Lovell
& Pamela Roach
National Primary Care Research And Development Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
Peter Bower
& Linda Gask
Department of Health Sciences, University of York, University Road, Heslington, York, YO10 5DD, UK
Simon Gilbody
& David Richards
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Correspondence to Penny E Bee.
PEB participated in the study design, search strategy development, retrieval of articles, screening of articles, quality assessment, data extraction, data synthesis, and writing of manuscript. PB participated in the study design, quality assessment, data extraction, meta-analysis, data synthesis, and writing of manuscript. KL, SG, DR and LG participated in the study design, quality assessment, data extraction, and writing of manuscript. PBarnes participated in the retrieval of articles, screening of articles, quality assessment, data extraction, and writing of manuscript. All authors read and approved the final manuscript.
Bee, P.E., Bower, P., Lovell, K. et al. Psychotherapy mediated by remote communication technologies: a meta-analytic review. BMC Psychiatry 8, 60 (2008) doi:10.1186/1471-244X-8-60
DOI: https://doi.org/10.1186/1471-244X-8-60
Usual Care
Therapeutic Alliance
Remote Communication