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Character and temperament in major depressive disorder and a highly
anxious-retarded subtype derived from melancholia
Remco F.P. de Wintera,c, Ron Wolterbeekb, Philip Spinhovena,e,
Frans G. Zitmana,d, Jaap G. Goekoopa,d,⁎
aDepartment of Psychiatry Leiden University Medical Centre, Leiden, 2300 RC, The Netherlands
bDepartment Medical Statistics Leiden University, The Netherlands
cParnassia Psycho-Medical Centre, The Hague, The Netherlands
dRivierduinen, Oegstgeest, The Netherlands
eDepartment of Psychology Leiden University, Leiden, 2333 AK, The Netherlands
Background: An anxious-retarded subtype of major depressive disorder, defined by high scores for both anxiety and retardation, has been
derived from melancholia and appeared to have higher external validity in terms of poor outcome and vasopressinergic stress hormone
regulation. A specific personality could enhance the validity of this subtype, and the association with melancholia suggested the absence of a
personality disorder. As 2 character dimensions of the Temperament and Character Inventory (TCI), self-directedness (SD) and
cooperativeness, parsimoniously predict the presence of a personality disorder, the primary aim was to test whether patients with the highly
anxious-retarded subtype of depression have both normal SD and normal cooperativeness. A secondary aim was to optimally account for the
general personality characteristics of patients with a major depressive disorder.
Methods: Eighty-six patients with major depressive disorder and matched healthy controls were selected. Seventy patients were eventually
recruited for a 2-year follow-up encompassing 5 assessments of personality (TCI) and psychopathology (Comprehensive Psychopathological
Rating Scale). Full remission of depression was defined by the presence of less than 3 Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition items of depression during 2 weeks.
Results: State-dependent changes of SD and harm avoidance (HA) scores were found in all depressed patients. Fully remitted patients had
only high HA compared with healthy controls. Unexpectedly, fully remitted patients with the highly anxious-retarded subtype, in addition,
had low SD.
Conclusion: The temperament of high HA may be the predisposing TCI trait for major depressive disorder in general. Low SD may be a
specific presumably premorbid character trait for the highly anxious-retarded subtype derived from melancholia.
© 2007 Elsevier Inc. All rights reserved.
1. Introduction
Major depression with melancholic features according to
Diagnostic and Statistical Manual of Mental Disorders
(DSM), Fourth Edition (DSM-IV) represents the current
definition of endogenous depression. Its clinical description
is entirely based on signs and symptoms, in which it differs
from DSM, Revised Third Edition (DSM-III-R) melancho-
lia, and resembles the earlier DSM, Third Edition version.
A major difference characterizing the DSM-III-R version is
the presence of the item "absence of a personality
disturbance before the first depressive episode." This item
refers to a classic view of melancholic or endogenous
depression, which implies that this subcategory is related
with an "adequate" personality [1,2]. The absence of a
premorbid personality disorder was included in the DSM-
III-R criteria because it had repeatedly been associated with
favorable somatic treatment outcome, which was the
guiding principle in the discussion of candidate nonsymp-
tom features of the DSM-III-R melancholic subtype [3].
The decision to drop this DSM-III-R item in the DSM-IV
version of the melancholic subtype was not made on
scientific but on practical grounds because of the difficulty
Comprehensive Psychiatry 48 (2007) 426–435
This study was supported by a grant from Wyeth, Hoofddorp, The
⁎Corresponding author. Department of Psychiatry, Leiden University
Medical Centre, Rivierduinen, 2342 AJ, Oegstgeest, The Netherlands.
Tel.: +31 71 890 7618; fax: +31 71 890 7501.
E-mail address: firstname.lastname@example.com (J.G. Goekoop).
0010-440X/$ – see front matter © 2007 Elsevier Inc. All rights reserved.
Page 2
felt to reliably evaluate this absence of a personality
disorder [4]. There are therefore reasons to assume that the
discussion of this topic is not closed by adopting the DSM-
IV criteria. These reasons are the inherent heterogeneities
of DSM-IV melancholia, resulting from the operationaliza-
tion of the syndrome by the criterion of at least 4 of 7 signs
and symptoms [5], as well as the difficulty to assess the
personality of depressed patients.
In the present study, we used an improved "melan-
cholic" subcategory called highly anxious-retarded depres-
sion and tested the normality of the personality after full
remission of the depressive episode. The multidimension-
ally defined highly anxious-retarded subcategory has been
derived from DSM-IV melancholia [6]. It is defined by
above median scores on basic symptom dimensions of
autonomic dysregulation (anxiety) and motivational inhibi-
tion (retardation) assessed by the Comprehensive Psycho-
pathological Rating Scale (CPRS) [7] and has appeared to
be better validated than DSM-IV melancholia because it
was characterized by correlated plasma vasopressin (AVP)
and cortisol concentrations and a long time to full
remission within 2 years [6,7]. It may therefore be seen
as a better validated version of DSM-IV melancholia. This
suggested that it would also be characterized by the
absence of a personality disturbance. To test this hypoth-
esis, we used the 2 character dimensions of the Tempera-
ment and Character Inventory (TCI) [10] that specifically
predict the presence of a personality disorder [10,11]. The
TCI differentiates 3 character dimensions: self-directedness
(SD), cooperativeness (CO) and self-transcendence (ST),
and 4 temperament dimensions: novelty seeking (NS),
harm avoidance (HA), reward dependence (RD), and
persistence (PER). Several studies have shown that low
scores on SD and CO predict the presence of a DSM
personality disorder [10-13]. Continuous scores of SD and
CO predict with nearly equal weight the risk (11%-94%
[10]) of a personality disorder by the logistic regression
function: X = −6.21 + 0.11 (SD score) + 0.10 (CO score).
Dichotomized scores have been found to have a sensitivity
and specificity of 0.77 and 0.79 for low SD and 0.73 and
0.59 for low CO, resulting in hit rates of 77% and 68%,
respectively [14]. We therefore hypothesized both normal
SD and normal CO in fully remitted patients with the
highly anxious-retarded subtype. The use of these measures
to detect personality disorder style was preferred above the
use of a standardized axis-II interview for reasons of
economy (self-report) and parsimony (2 dimensions). The
hypothesis of normal personality in the highly anxious-
retarded subtype would be refuted by either low SD or low
CO. These low character scores, which would refer to the
inevitable comorbidity of personality disorders in patients
with major depression [15], were expected in the group of
non–highly anxious-retarded patients.
Secondary aims of this study were the maximally
attainable elimination of state-dependent report bias and
the maximally attainable differentiation between subtype-
specific traits and general presumably premorbid traits of
depression in fully remitted patients. In this context, we
investigated whether known relations between depression
and TCI scores could be replicated and whether the
differentiation of different sorts of relation could be
optimized. We recognized at least 4 types of relation [16]:
that of a vulnerability factor (a personality trait predisposing
to the development of a depressive disorder), pathoplastic
factor (a preexisting personality trait influencing intensity,
subtype, or outcome), complication of the depressive
disorder (a state-dependent personality change during the
acute episode), and a scar (a state-independent personality
change after ≥1 acute episodes). A personality characteristic
that changes during the course of remission towards
normality can be conceived as a complication of depression.
A personality characteristic in fully remitted patients
compared with healthy controls may be a candidate for a
vulnerability factor, pathoplastic factor, or a scar. If it is
related to recurrent depression or the number of previous
episodes, it may be interpreted as a scar, and if it
differentiates a depressive subcategory from all other
patients, it may have the role of a pathoplastic or even
specific vulnerability factor for that subcategory.
Previous TCI studies in depression have found the
following. During the acute episode, low SD and high HA
have been found most consistently, whereas incidentally,
high ST and low CO, NS, and PER were present [17-21].
These results do not enable the differentiation between
complication, pathoplastic or vulnerability factor, or scar.
Harm avoidance and SD have been found related with
depression intensity [19,20], which implies their involve-
ment as a complication. At time of remission, only high HA
has reproducibly been found. Low SD was present in only 2
studies, whereas both low and high CO were found in 2
separate studies (see Table 1). Only 1 study investigated TCI
relations with (remitted) melancholia, and no specific
association has been found [23]. These results suggest that
high HA after remission may correspond with a general
vulnerability factor for major depression. Low SD after
remission could refer to the premorbid trait of a subgroup of
patients with a personality disorder. An analogous relation-
ship between low CO and a subcategory of depression
cannot be refuted. The state-dependent changes of HA and
SD scores imply that the investigation of relations between
depression and presumably premorbid traits requires cau-
tious elimination of this report bias. Most TCI studies of the
relation between depression and personality, however, did
not investigate patients in full remission and generally relied
on a too-short period to follow-up (2-52 weeks) (Table 1). As
a consequence, part of the high HA or low SD in "remitted"
but not fully remitted patients could still be due to state-
dependent changes.
To optimize the differentiation between state-dependent
report bias and presumably premorbid personality of the
highly anxious-retarded subtype and depression in general,
we analyzed the relation between personality and depression
427R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 3
after full remission. In addition, we asked the patient to rate
himself as if in his premorbid condition, and we used strict
criteria for full remission [26]. To optimize the percentage of
fully remitted patients, we used a long (2-year) follow-up
period. To control for a potential scar effect, we controlled
for the relation between TCI score after full remission and
recurrence of major depressive episode.
The main question of the present study was, do fully
remitted patients with a highly anxious-retarded depression
have both normal SD and normal CO compared with healthy
controls? Secondary questions were related with the optimal
elimination of state-dependent report bias and differentiation
between subtype-specific and general traits after full
remission. These were: do all eventually fully remitted
patients with depression differ from normal control subjects
on HA (replication of high HA as presumably premorbid
factor)? Do these remitted patients exhibit a change of self-
report on TCI dimensions during the 2-year follow-up period
(replication of complications concerning HA and SD)? For
global comparison with previous findings during the acute
episode, we, in addition, investigated on which TCI
dimensions patients with major depression differ from
normal control subjects (replication study of low SD and
high HA most relevant and, to a lesser extent, ST, CO, NS,
and PER). Melancholic patients were similarly investigated
as the highly anxious-retarded subtype.
2. Method
2.1. Subjects
Newly referred in- and outpatients of the psychiatric
institute GGZ Leiden/Rivierduinen were referred for the
study by a psychiatrist who made the initial diagnosis of
depressive disorder. The diagnosis was confirmed by the
investigator (RFP de W) using a semistandardized interview,
the CPRS [27-29], which, in this context, was used to
operationalize the presence of the symptoms of a major
depressive disorder according to DSM-IV. DSM-IV symp-
toms that were not covered by the CPRS were separately
scored using a similar gradation of item severity to score the
clinically meaningful presence of a symptom. Each symptom
or set of symptoms was checked for its presence during the
last 2 weeks before assessment using the criterion ≥3 for
each CPRS item score (range, 0-6). Patients were included if
they fulfilled criteria for major depressive disorder according
the DSM-IV [28] and had a score of at least 21 on the
Depression Rating Scale (MADRS) [30]. Seventy patients
were included for the initial cross-sectional and 2-year
follow-up parts of the study. Nineteen were additionally
recruited for the initial cross-sectional part only because of
limited time availability, 3 of whom were excluded because
of invalid TCI data. This resulted in 86 patients for the initial
cross-sectional part. Of the70follow-up patients, 12 dropped
out of the follow-up, leaving 58 patients after 2 years.
Patients with organic, bipolar, schizoaffective, or schizo-
phrenic or other primary psychotic disorder were excluded,
as were patients with somatic disorders that could influence
AVP concentration, such as the syndrome of inappropriate
antidiuretic hormone secretion. Depressed patients with a
panic disorder were not included because they participated in
a different research project. The presence of a severe
personality disorder that, by the first psychiatrist, was
assumed to hamper the treatment of the mood disorder, was
an additional exclusion criterion. The exact number of
patients excluded this way is not known, but they generally
comprise less than 5% of all patients with major depression.
No patients had to be excluded because of the syndrome of
inappropriate antidiuretic hormone secretion. Written
informed consent was obtained from all patients. The Ethical
Committee of Leiden University Medical Centre approved
the consent protocol.
2.1.1. Normal controls
Normal control subjects (n = 86) were selected from
339 normative controls [31] who were randomly selected
from the national telephone book. They represented the
Table 1
Review of differences of TCI scores between depressed patients and
controls, TCI changes during follow-up, and TCI differences between
remitted patients and controls
and year
period in
Black and
et al
Sato et al
et al
et al
et al
15 6-10Completer –↑SD–
126 –Discharge↑HA,
b16, b8
57 4-52
Agosti and
HDRS indicates Hamilton Depression Rating Scale; CGI, Clinical Global
Impression. Arrows refer to decreased or low score and increased or
high score.
428R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 4
population with its inherent frequency of psychopathology
and vulnerability. The 86 control subjects were blindly and
individually selected by matching on age and sex of each
depressive patient.
2.2. Assessments
2.2.1. Subcategories and dimensions of psychopathology
The DSM-IV melancholic subtype (n = 42) was diagnosed
by a semistandardized diagnostic interview, the CPRS
[27,28], which, in this context, was used to operationalize
the presence of the symptoms of the melancholic subtype.
DSM-IV symptoms that were not covered by the CPRS,
were separately scored using a similar gradation of item
severity to score the clinically meaningful presence of a
symptom. Each symptom or set of symptoms was checked
for its presence during the last 2 weeks before assessment,
corresponding with a CPRS item score of 3 or higher (range,
0-6). A slightly modified version of the Family History of the
Research Diagnostic Criteria (RDC) Interview by Andreasen
et al [32] was used to assess familial depression [6].
The CPRS was used for rating severity of depression
by means of the MADRS and for rating basic dimensions
of psychopathology. To this end, all CPRS items were
scored from 0 to 6. Of the 6 factor-analytic subscales of
the CPRS the following 3 scales were scored: emotional
dysregulation, motivational dysregulation (inhibition and
disinhibition), and autonomic dysregulation [7]. The
highly anxious-retarded subcategory of depression (n =
30) was defined by ratings (≥median) on the dimensions
autonomous dysregulation (≥11) and motivational inhibi-
tion (≥8), hereafter called anxiety and retardation.
2.2.2. Personality
The Dutch translation [31] of Cloninger's TCI [10], was
used to assess the 3 dimensions of character and 4
dimensions of temperament. The questionnaire was filled
in within 2 weeks after recruitment and, subsequently, every
6 months until 2 years after recruitment. Patients were asked
to answer the questions as if they were in their premorbid
state to minimize state-dependent effects.
2.3. Treatment
The treatment protocol has been described extensively
before [9]. In short, all patients were treated according to a
standard pharmacotherapeutic protocol and a standardized
treatment with cognitive behavioral therapy, starting with
behavioral activation. If necessary, relational therapy, day-
time treatment, or clinical treatment was added. If a patient
was already taking an antidepressant, this treatment was
continued and increased after t1 to a maximal therapeutic
dose. If the antidepressant drug at entrance of this study had
to be changed because of lack of treatment effect at the start
of this study, drug withdrawal was performed after the first
assessment of the study. To account for potential drug effects
on the TCI scores, antipsychotic, antidepressant, and
benzodiazepine drug dosages at t1 and t7 were transformed
into equivalent dosages (haloperidol, imipramine, and
chlordiazepoxide equivalents) according to standard dosage
ranges [33]. Both effects of drug treatment and drug dosage
were analyzed.
2.4. Follow-up and outcome measures
Psychopathology was assessed with the CPRS at the
beginning of the treatment (t1); after 6 weeks (t2); and then
after 3, 6, 12, 18, and 24 months (t3-t7), as described before
[9]. TCI data were only available for t1, t4, t5, t6, and t7. Full
DSM-IVremission of depression was defined by a maximum
of 2 symptoms for major depression during at least the last
2 weeks. These full remission criteria as representation of the
current state were chosen, instead of criteria covering a
longer period, because the aim was only to maximally
enhance the percentage of patients with current state
remission. The background assumption that this short period
would suffice was based on the clinical impression that the
state-dependent fluctuation of character deficiencies imme-
diately parallel depressive state fluctuations. Partial remis-
sion was defined by a minimum of 3 and a maximum of 4
symptoms of major depression according DSM-IV during at
least the last 2 weeks [26].
DSM-IV criteria were assessed by using corresponding
CPRS items. For this purpose, the scores on the individual
items were dichotomised: scores of 3 or higher were taken as
representing the DSM-IV severity criterion of a symptom
being more present than absent. Increased appetite and
weight were rated separately. The absence of a DSM-IV
symptom was defined by a CPRS item score of 2 or lower.
2.5. Data analysis
Because in the general population sex has been found
related with RD, ST, NS, and HA, and age has been found
related with NS, CO, and ST [34,35], we analyzed covariate
effects for age and sex in all comparisons. Multiple analysis
of covariance (MANCOVA) was used to analyze, in the
depressed patients, relations between scores on the 7 TCI
dimensions and MADRS score, age, time since first episode
of depression, number of previous episodes, and level of
education, as well as the dichotomous variables sex, family
history, marital status, out- or inpatient status, and recurrent
depression. Separate assessments were used to detect
whether significant relations with TCI scores were based
on higher or lower scores or on positive or negative
correlations (Pearson's correlation). These analyses resulted
in using age and sex as covariates in all investigations, as
well as level of education, MADRS score, and recurrence in
all analyses at t1 that compared subgroups of depressed
patients. In addition, psychotropic treatment and dosage
were analyzed for their relation with the highly anxious-
retarded subtype and the TCI scores.
MANCOVAwith the 7 TCI scores as dependent variables
was used to compare depressed patients and healthy controls,
as well as subgroups of patients, at t1 and t7. As in fully
429R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 5
remitted patients at t7 level of education and MADRS were
not related to any dimension, and time since first episode
emerged as covariable, we added the latter and eliminated the
former covariables from analyses at t7. Separate assessments
were used to detect whether significantly differing TCI
scores were higher or lower. Since only lower SD or CO in
patients with fully remitted highly anxious-retarded depres-
sion would refute the 0-hypothesis, α was primarily set at .10
for this 1-sided difference on each of these dimensions. As
this refutation could be realized by both low SD and low CO,
an α of .05 was eventually required to a avoid chance
finding. MANCOVA with repeated measures (double multi-
variate analysis), using the 7 TCI scores at t1, t4, t5, t6, and
t7 as dependent variables and full-remission vs non–full
remission as independent variable, was used to detect the
general characteristics of changed report bias in depression.
All tests were carried out using SPSS for windows 12.0
(SPSS Inc, Chicago, IL).
3. Results
3.1. Demographic and clinical data
Table 2 shows the relevant demographic and clinical data
of the 86 patients. Forty-2 patients (49%) fulfilled criteria for
melancholic subtype according to DSM-IV, and 30 patients
(35%) had a highly anxious-retarded depression. From the
42 patients with melancholic depression, 25 patients (60%)
also had highly anxious-retarded depression, whereas 83%
of the latter subtype fulfilled criteria for DSM-IV melanch-
olia. No significant differences were found between the
highly anxious-retarded subtype and the group of all other
patients, except for the MADRS score, which was higher in
the highly anxious-retarded subgroup than in the non–highly
anxious-retarded patients (t = 8.097; df = 84; P b. 001). The
70 patients who were recruited for the follow-up study [9]
did not differ in any of these respects from the 86 patients of
the cross-sectional study at initial measurement. The 16
patients who were not included in the follow-up study
differed in age (37 years, standard deviation = 13 vs 29years,
standard deviation = 12; P = .023) from the 70 patients of the
follow-up study. The 12 dropouts from the follow-up did not
differ on any demographic or clinical measure from those
who remained in the study. Table 3 presents the numbers of
patients with depression and the initially melancholic,
anxious-retarded patients and in- or outpatients, as well as
of those with recurrent depression, at the 5 time points of the
follow-up and the numbers and percentages of nonremission,
partial remission, and full remission as well as the MADRS
scores at these time points.
No relation was found between the highly anxious-
retarded subtype and any pharmacologic treatment variable
at t1 or t7.
Table 2
Demographic and clinical data of acutely depressed patients and the
subgroups with the highly anxious-retarded subtype, all other patients, and
recurrent depression
(n = 86)
(n = 30)
All other
(n = 56)
(n = 48)
Age40 y
deviation =
12 y)
56 (65%)
deviation =
36 (42%)
48 (56%)
3 0
deviation =
42 y
deviation =
13 y)
18 (60%)
deviation =
12 (40%)
19 (63%)
deviation =
39 y
deviation =
11 y)
38 (68%)
3.2 (standard
deviation =
43 y
deviation =
12 y)
33 (69%)
3.4 (standard
deviation =
24 (43%)
29 (52%)
27 (standard
deviation =
20 (42%)
48 (100%)
31 (standard
deviation = 6)
No. of
1 . 7
deviation =
22 (26%)
deviation =
7 (23%)
1.6 (standard
deviation =
2.8 (standard
deviation =
15 (27%)14 (29%)
9 (11%)3 (10%)6 (11%)5 (10%)
Theoretical range for level of education: 1 to 6.
Table 3
Numbers of patients with depression and the initially melancholic, anxious-
retarded patients, and in- or outpatients, as well as of those with recurrent
depression at the 5 time points of the follow-up, and numbers and
percentages of remission rates as well as MADRS scores
Start6 mo12 mo18 mo24 mo
All patients
Partial remission
Full remission
Partial remission
Full remission
partial remission
Full remission
Partial remission
Full remission
Partial remission
Full remission
70 100% 22 34% 14 23% 12 22 %
–14 22% 12 20% 10 18%
–28 44% 35 57% 33 60%
33 100% 12 39%
–10 32%
– 9 29% 14 47% 17 65%
24 100% 10 44%
–7 30%
–6 26% 10 46% 10 50%
42 100% 12 31%
–6 15%
–20 54% 23 59% 21 62%
29 19
41 100% 12 33%
–8 22%
– 16 44% 20 56% 23 70%
9 16 %
8 14%
41 71%
5 18%
4 14%
19 68%
6 27%
15 68%
4 11%
4 11%
27 77%
6 17%
27 77%
8 27%
8 27%
5 19%
4 15%
9 41%
3 14%
7 35%
3 15%5%
9 23%
7 18%
7 21%
6 18%
9 25%
7 19%
7 21%
430R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 6
3.2. Cross-sectional investigation at initial measurement (t1)
3.2.1. Temperament and Character Inventory scores and
demographic and clinical data in depressed patients at t1
MANCOVA in the 86 patients with major depression at
t1, with age, level of education, MADRS score, number of
previous episodes, and time since first episode as
covariates and sex, marital status, recurrence, in- or
outpatient status and familial depression as fixed factors,
showed that female patients had different CO and RD
compared with male patients (F = 25.011; df = 1; P b .001
and F = 7.341; df = 1; P = .008). Separate comparison
showed higher CO and RD in females. Patients with
recurrent depression had different SD and HA (F = 6.738;
df = 1; P = .011 and F = 6.003; df = 1; P b .017). SD was
lower and HA was higher than in first-episode patients.
Level of education was significantly related with CO (F =
4.339; df = 1; P = .041). The correlation between CO and
educational level was positive. Age related significantly
with SD (F = 4.305; df =1; P = .041) and NS (F = 4.276;
df =1; P = .042). The correlation with SD was positive
and, with NS, negative. The MADRS related significantly
and positively with ST (F = 10.132; df =1; P = .002). No
relations were found between TCI dimensions and number
of previous episodes, time since first episode, out- or
inpatient status, marital status, and family history of
depression. These data resulted in the use of age and sex
as covariates in analyses comparing patients with healthy
controls, and in age, sex, level of education, recurrence,
and MADRS as covariates in analyses comparing sub-
groups of patients (see Table 2).
3.2.2. Depressed patients at t1 vs healthy controls
MANCOVA showed that patients and healthy controls
differed significantly on SD (F = 77.35; df = 1; P b .001)
and HA (F = 97.79; df = 1; P b .001) and weaker on CO
(F = 6.34; df = 1; P = .013), as well as on NS (F = 4.26;
df = 1; P = .041) and RD (F = 7.07; df = 1; P = .009). Sex
related most strongly with CO (F = 12.15; df = 1; P =
.001) and RD (F = 10.09; df = 1; P = .002) and to a lesser
degree with HA (F = 4.78; df = 1; P = .03). Age was only
related with NS (F = 15.03; df = 1; P b .001). Separate
assessment showed higher values for CO, RD, and HA in
females and lower NS in aged subjects. The main findings
are summarized in Table 4.
The question whether psychotropic drugs could influ-
ence the TCI scores in depressed patients was primarily
answered within the group of all depressed patients.
Relations between psychotropic treatment and TCI
dimensions at t1 were found in MANCOVAs using all
TCI scores as dependent variables; sex and recurrence as
fixed factors; age, level of education, and MADRS at t1
as covariates; and finally, psychotropic treatment or
dosage as additional covariates. Antidepressive treatment
was not associated with any TCI dimension. Antipsychotic
treatment was related with SD (F = 6.356; P = .014), HA
(F = 5.976; P = .017), and CO (F = 4.741; P = .033),
and benzodiazepine treatment, with NS (F = 7.208; P =
.009). Self-directedness and CO were relatively low, HA
was high in patients on antipsychotics, and NS was
relatively high in patients on benzodiazepine treatment. If
psychotropic dosage was used as independent variable
instead of psychotropic treatment, then the significance of
the relation between CO and the antipsychotic drug
increased slightly (CO [F = 4.027; df = 3; P = .012]),
whereas all other relations lost significance. We therefore
used psychotropic treatment as covariate in the following
analyses. Level of education related only with CO in these
depressed patients (F = 4.210; P = .046).
3.2.3. Highly anxious-retarded patients at t1 vs healthy
controls and all other patients at t1
MANCOVA, accounting for the effect of age and sex,
showed that highly anxious-retarded patients had different
SD (F = 35.40; df = 1; P b .001) and HA (F = 38.13; df =
1 and P b .001) compared with healthy controls. Separate
tests showed lower SD and higher HA in this subcategory.
MANCOVA showed that melancholic patients also had
significantly different SD (F = 55.74; df = 1; P b .001)
and HA (F = 51.00; df = 1; P b 0.001), and a slightly
different CO (F = 5.13, df = 1; P = .025). Separate
analyses showed lower SD and CO and higher HA. The
highly anxious-retarded and melancholic patients therefore
had the same lower SD and higher HA as all patients
compared to healthy controls.
When comparing the subgroup of patients with the highly
anxious-retarded subtype and the group of all remaining
patients, then no significant difference was found on any TCI
dimension between these subgroups (age, sex, level of
education, MADRS and recurrence, as well as psychotropic
treatments as covariates). The same was found for the
melancholic subtype.
Table 4
Means and changes of TCI scores between t1 and t7 in all patients, fully
remitted patients, and non-fully remitted patients
All patients
(n = 58)
(n = 41)
P Nonremitted
(n = 17)
Means and
Means and
t1- t7
Means and
b.001 −2.4.003
b.001 −6.9
431R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 7
3.3. General state-dependent personality change in patients
with major depression
Multiple analysis of variance with repeated measures
(double multivariate analysis) using the 7 TCI scores at t1,
t4, t5, t6, and t7 as dependent variables and full remission at
t7 as independent variable showed that eventually remitted
patients differed from nonremitted patients by change of both
SD (F = 5.538; df = 4; P b.001) and HA (F = 6.070; df = 4;
P b.001). If MANCOVAwas used, controlling for the effects
of age, sex, level of education, MADRS score at t1 and
recurrence, then these differences had lower strength but
were still statistically significant (F = 3.557; df = 4; P = .008
and F = 3.938; df = 4; P = .004). Separate assessment (see
Table 4) showed that SD increased and HA decreased in
eventually remitted patients and that HA increased in all
nonremitted patients.
3.4. Cross-sectional analyses after 2 years (t7)
3.4.1. Temperament and Character Inventory scores
and demographic and clinical data in fully remitted
patients at t7
MANCOVA in the 41 patients with fully remitted
depression at t7, with age, level of education, MADRS
score, number of previous episodes, and time since first
episode as covariates and gender, marital status, recurrence,
in-or outpatient status and familial depression as fixed
factors, showed that female patients had different CO and
RD compared with male patients (F = 16.267; df = 1; P b
.001, and F = 4.982; df = 1; P = .033). Separate comparison
showed higher CO and RD in females. Age related
significantly with persistence SD (F = 5.624; df =1; P =
.024), and this correlation was negative. Time since first
episode related negatively with CO (F = 4.812; df =1; P =
.036). No relations were found between TCI dimensions
and number of previous episodes, recurrence, out- or
inpatient status, MADRS score, level of education, marital
status, and family history of depression. The latter finding
suggests that HA and SD in fully remitted patients are
generally not influenced by a scar effect. The data resulted
in the use of age and sex as covariates in analyses
comparing patients with healthy controls and in age,
gender, and time since first episode as covariates in
analyses comparing subgroups of patients. If the 3
psychotropic treatments were added to the MANCOVA
model, then no relation was found between any type of
treatment and any TCI dimension.
3.4.2. Temperament and Character Inventory in fully
remitted and non–fully remitted depressed patients at t7 vs
healthy controls
MANCOVA showed that fully remitted patients after
2 years (n = 41) scored only significantly different on HA
(F = 19.94, df =1 and P = b.001) and on ST (F = 4.03,
df = 1; P = .047) compared with healthy controls (n = 86).
Separate comparison showed that HA was higher, whereas
ST was lower in remitted patients. MANCOVA showed
that the non–fully remitted patients (n = 17) after 2 years
still scored different on HA (F = 42.94; df =1; P b .001)
and SD (F = 17.38; df = 1; P b .001) compared with
healthy controls. Post hoc tests showed a higher HA and
lower SD.
3.4.3. Temperament and Character Inventory in fully
remitted highly anxious-retarded patients at t7 compared
with healthy controls
MANCOVA showed that after 2 years, the fully
remitted highly anxious-retarded patients (n = 15) scored
different on HA compared with healthy controls (n = 86)
(F = 9.595, df = 1; P = .003). Separate comparison
showed higher HA in the remitted highly anxious-retarded
patients. As far as the character dimensions are concerned,
SD (F = 4.804; df = 1; P = .031) was different in fully
remitted highly anxious-retarded patients compared with
healthy controls, whereas CO was not related to either
highly anxious-retarded or non–highly anxious-retarded
patients. Separate comparison against expectation showed
lower SD in the highly anxious-retarded subtype. Mean
SD score of the fully remitted non–anxious-retarded
subgroup was 30.6 (SD = 7.7) and of the highly
anxious-retarded subgroup 28.4 (SD = 7.9), and mean
HA score was 21.8 (SD = 7.9) and 21.5 (SD = 7.6),
respectively. MANCOVA also showed that fully remitted
melancholic patients scored only different on HA (F =
8.256, df =1; P = .005) compared with healthy controls.
Separate comparison showed an increased HA.
3.4.4. Temperament and Character Inventory in fully
remitted highly anxious-retarded patients at t7 compared
with fully remitted non–anxious-retarded patients at t7
Within the group of fully remitted patients, MANCOVA
showed no significant relation between SD or any other
TCI dimension at t7 and the highly anxious-retarded
subcategory, when the effect of age, sex, and time since
first episode was accounted for. The addition of psycho-
tropic treatment variables to the analysis did not change
this finding.
The mean MADRS score of the fully remitted non–
anxious-retarded patients was 8.3 (n = 26; standard
deviation = 5.0) and of the highly anxious-retarded
patients 11.1 (n = 15; standard deviation = 5.9). This
means a statistically nonsignificant difference of 2.8,
corresponding with 1 item now and then present in low
intensity, and a dubiously or very rarely present second
item. Within the fully remitted non–anxious-retarded
subgroup, the residual MADRS score correlated with the
HA score (r = 0.623; P = .001) and not with SD (r =
−0.233; P = .253), and also, in the anxious-retarded
subgroup, the residual MADRS score correlated better with
the HA (r = 0.466; P = .080) than with the SD (r =
−0.317; P = .250) score. This implies that the lower SD in
the highly anxious-retarded subgroup was not due to
residual psychopathology.
432R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 8
4. Discussion
This study confirms previous findings that HA and SD
are most generally involved in acutely depressed patients
[17,19-21]. We also found lower scores on RD, NS, and
CO. The latter 2 findings can be seen as a confirmation of
previous inconsistent findings and may relate to subgroups
of depressed patients. One of these is characterized by low
CO and RD scores and will be discussed separately
(Goekoop et al, submitted). The comparison between fully
remitted patients and healthy controls showed that the
dimensions of SD and HA are not involved in the same
way in their relation to depression. Although the scores on
both dimensions changed in the direction of normality
during the time to full remission, only HA remained higher
than healthy controls at time of full remission. At that
time, the difference on the character dimension SD had
disappeared. This means that reduced SD is generally
involved as a complication of a major depressive episode,
whereas increased or high HA is involved as a general
complication and as a presumably premorbid trait. We
interpret the state-dependent complications as state-depen-
dent report bias. The follow-up data further showed that
HA in eventually nonremitted patients increased over time.
This increase may therefore be seen as a complication of
chronic depression. Subtype analysis after full remission
showed that, like all other patients, those with the highly
anxious-retarded and melancholic subtypes also had high
HA after full remission. The highly anxious-retarded
subtype, however, was, in addition, characterized by low
SD and normal CO at time of full remission compared
with healthy controls, while the melancholic subcategory
did not differ on any character dimension. We assume that
these findings, that directly and indirectly depend on the
diagnosis of DSM-IV melancholia, are sufficiently repre-
sentative, as the percentages of melancholic patients (49%
of all patients, 60% of the inpatients, and 40% of the
outpatients) is comparable with that found in the other TCI
study of melancholic subjects (53% of a sample of
outpatients) [23], which, as already mentioned, also did
not detect any TCI relation.
The absence of a relation between SD scores and
psychotropic treatment at t7 suggests that the low SD in
fully remitted patients with the highly anxious-retarded
subtype is not due to drug treatment. The absence of any
relation between psychotropic treatment and TCI dimen-
sions after full remission permits the following conclusion
about relations found during the acute episode. The
association at t1 between antipsychotic treatment and low
SD and CO as well as high HA may be interpreted as due
to the antipsychotic treatment chosen to control the
psychopathology of the patients with these personality
scores, rather than as a personality change induced by
antipsychotic treatment. The same may be said of the
association at t1 between benzodiazepine treatment and
high NS.
The low SD score we found during full remission in the
highly anxious-retarded subtype could not be related to
minimal residual symptoms but could correspond to a pre-
existing immature personality [10-13]. Since remitted
highly anxious-retarded patients combine low SD with
normal CO, their personality may be interpreted as
dependent [35]. Their high HA predicts that they would
have an increased risk of a C-cluster personality disorder
according to DSM-IV. These patients are not impulsive or
aloof but rather purely dependent and depressive, so that
the personality abnormality may be primarily typical of
pure depressive disorders. Their low self-directedness may
mean that they tend toward dependency and helplessness.
Finally, it should be recognized in this context that, in the
present study, only a few patients with severe comorbid
personality disorder were not included because of severe
cluster B disorder. If these cases would have been
included, then the association between the highly
anxious-retarded subtype and low SD compared with
healthy controls would probably not have been influenced,
although it could have further decreased the difference
compared with non–anxious-retarded patients.
A limitation of this study is the small number of
patients, which may have hampered the detection of low
SD in fully remitted highly anxious-retarded patients,
compared with all other depressed patients. A second
limitation could be that only the DSM-IV definition of
full remission was used [26]. Recovery was not assessed,
which is defined by a period of full remission during 8
weeks or longer. On the other hand, the time to follow-up
was much longer, and the definition of full remission we
have used in this study was more precisely and generally
accepted than the time to follow-up and remission criteria
used up to now in most follow-up studies of TCI scores
(Table 1). Moreover, as already mentioned, the choice for
current state criteria of full remission was based on the
clinical impression that state-dependent fluctuation of
character deficiency immediately parallels depressive
state fluctuation. Several other potential limitations of
the design of this study deserve discussion. First,
matching of healthy controls on level of education
could have been useful, although low SD will rather
contribute to low level of education than the other way
round [36]. Secondly, the group of healthy controls could
not be the optimal control group because they would not
have the same amount of residual psychopathology, and
this could have caused subtle alteration of personality
scores in the patient sample. However, as far as after full
remission such an alteration could have played a role in
this study, the relation with the MADRS shows that this
would only have applied to the high HA score in all
patients and not to the low SD in the fully remitted
highly anxious-retarded subgroup.
In summary, this study shows that low SD is generally
involved as a reversible complication of depression. This
finding is in agreement with the state-dependent change of
433R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435
Page 9
the percentage of personality disorders in patients with
depression [15]. The present study further shows that high
HA may be involved in several ways: as a general
presumably premorbid factor for depression, as a
complication of the acute episode, and as a complication
of chronic depression. The most specific finding of the
present study is that low SD after full remission may
function as an additional presumably premorbid factor for
the highly anxious-retarded subcategory of depression.
These results may complement the finding of a recent
prospective study in adults representative of the general
population in which particularly high HA and low SD
were found to predict about 44% of the variance of the
change of depressive symptoms after 1 year [37]. The
present study confirms the involvement of these 2
premorbid personality traits in depressive disorders but,
in addition, supports their differential meaning for major
depression in general and the highly anxious-retarded
subtype in particular. This suggests a remarkable differ-
ence of the meaning of the relations between character
and temperament in personality disorder and depression.
Although in personality disorders the presence of the
disorder is predicted by low scores on character dimen-
sions of SD or CO and the subtype by temperamental
scores, in depression, the temperament of high HA would
predict the disorder and character dimensions would
define the subtype. This difference may be of importance
for optimal preventive and therapeutic measures.
Finally, as far as the highly anxious-retarded subtype is
concerned, this subcategory has already been shown to
exhibit a correlation between AVP and cortisol [8], which
supports the involvement of a vasopressinergic activation
of the hypothalamus pituitary adrenal axis. In addition,
this subtype has been found to be associated with a
longer time to full remission compared with non–highly
anxious-retarded patients [9]. The low SD may further
support the validity of this highly anxious-retarded
subcategory. Since no relation between this low SD and
high AVP concentration is involved, as this appeared to
be specifically related to low CO (Goekoop et al,
submitted), the low SD of the highly anxious-retarded
subcategory may play a role in the acquirement of stress-
induced up-regulation of the pituitary vasopressin recep-
tor [38], evidence of which has been found in
melancholia [39].
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[31] Duijsens IJ, Spinhoven PH, Goekoop JG, Spermon A, Eurelings-
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435R.F.P. de Winter et al. / Comprehensive Psychiatry 48 (2007) 426–435


text:
At The Accident Scene
Check to make sure everyone is okay. Don't get involved in extended conversations about what you were doing, where you were going, etc. Use your cell phone. Call 911 and report the accident and any injuries. Most phones are equipped with a camera so use it to take pictures of damage to your vehicle and THE VEHICLE THAT HIT YOU! If possible, take pictures of the vehicles before they are moved. Wait for the police to arrive, in most states it's the law! Many at fault drivers will say they are in a hurry or make up some excuse to leave. They want to just "exchange information" so they can leave before the police show up. DO NOT ACCEPT THEIR OFFER! Avoid telling anyone you are NOT INJURED, you might be. It's common after an accident to experience a rush of adrenaline which masks injury symptoms. People often injured in accidents don't experience pain or symptoms until later. Sometimes days or weeks later. If possible, get checked out by paramedics and go to the hospital.
Post Accident What Do Next
Report the claim to your insurance carrier. DO NOT give any statements to ANY insurance adjusters without an attorney. DO NOT accept any money from ANY insurance companies without an attorney. Many insurance companies send representatives to the homes of accident victims within days following an accident. They bring with them a check and a release. They're gambling that you have not hired an attorney and will attempt to get you to accept an amount of money right then and there (perhaps a couple thousand dollars) in exchange for a general release (this release does exactly that, it releases the insurance company and their insured for any claims which you may have). Get medical treatment for any injuries you suffered in the accident. If you've gone to the hospital make sure to follow up with your primary care doctor or doctor of your choice (chiropractor, etc.). If you did not go to the hospital and are starting to feel pain go see a doctor, immediately!
Importance Of Medical Treatment
One of the most important aspects in evaluating how much your case is worth is the medical treatment you received. That being said, the TWO BIGGEST CASE KILLERS that will de-value your claim and/or case is a DELAY in initial treatment (waiting weeks or months before ever seeing a doctor) and GAPS in your treatment (consistent medical treatment followed by periods usually weeks, months or years of no treatment). It's important that if your doctor says I want to see you in 4 weeks or 3 months that you make the appointment then go to it. Another area of concern is physical therapy. People tend to neglect or put off their physical therapy after surgery. If you have surgery often times whether or not the surgery is successful is dependent on the hard work and effort you put in at physical therapy. Not only can it effect your case it can effect your quality of life. SO DO IT!!
Hiring An Attorney & Finishing Your Case
If you have not done so, it's time to get legal counsel. Why? Because the insurance adjuster you are dealing with has MUCH MORE experience than you do. Your attorney will help you equal the playing field and maximize your recovery. It's not uncommon for an insurance company to deny liability (refuse to pay a claim) only to pay on the claim after an attorney becomes involved in the case. Attorneys are not created equal. Interview attorneys and ask questions! Do you feel comfortable with the attorney? If the answer is "no", FIND ANOTHER ATTORNEY! REMEMBER, the attorney works for YOU! Once you've hired an attorney and completed your medical treatment your attorney will prepare and send the insurance company a demand packet (bills, medical records, photographs, etc.) demanding money for the bodily injury you suffered because of the negligence of their insured. In most cases the insurance companies respond to the demand with a monetary offer. This offer can be negotiated.
Social Media
If you have been injured in an automobile crash DO NOT share it with the world. Social media has taken the world by storm and it is here to stay. IT WILL NOT HOWEVER HELP YOU WITH YOUR CASE OR CLAIM! I can't tell you how many cases have been devalued and/or lost because someone just had to post a picture or comment on Facebook or tweated something they didn't take time to think about. The post could have absolutely nothing to do with the case (often times it does not) but it could be misinterpreted, looked upon unfavorably and used as the basis to deny your claim or severely limit the offer made by the insurance company. It is much more harmful than it is beneficial. If your case goes into litigation the insurance company's attorney can try (and often does) to get access to everything from your social site (all of your photos, posts, chats, etc.). IT IS NOT WORTH IT. While your claim or case is pending it's better to communicate with your friends and family via telephone!

subset: commoncrawl


text:
We found 8 sites within 19 miles of Crewe with 2 bookable
Whitchurch, Shropshire, England Show on map
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|6 x
|From £17/€21.57/AU$31.23/$27.36 per night
Winsford, Cheshire, England Show on map
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text:
BLQ to LHR
Take off from Bologna and land at London Heathrow feeling relaxed and ready to start your next adventure.
Vols vers London
à partir de : €57 aller-simplefrom: Bologna, Avr 2015Réserver
Empruntez un vol British Airways pour profiter d'un service primé et d'un excellent rapport qualité/prix, sans aucun frais caché :
Take off from Bologna and land at London Heathrow feeling relaxed and ready to start your next adventure.
à partir de : €57 aller-simplefrom: Bologna, Avr 2015Réserver
Book your direct flights from Bologna to London Heathrow and enjoy award-winning, professional service. In just over 2 hours, you'll find yourself in the vibrant centre of the British capital, surrounded by iconic history, famed cultural attractions and world-renowned shopping and dining at every turn. There is truly something for everyone in London - an unbeatable, must-see destination for any globetrotter.
Our direct flights from Bologna to London leave multiple times every week, making it easy to find a flight time to suit you. With the added flexibility of free seat selection 24 hours in advance, a 23kg baggage allowance and three handy check-in options, you'll arrive into the heart of the action feeling relaxed and raring to go.
Fly with British Airways and touchdown at London Heathrow (LHR) just 2 hours and 5 minutes after departing from Bologna (BLQ). Our attentive cabin crew are on hand at all times to make sure your flight is comfortable and relaxed. Once you arrive London, you're just minutes from the centre of the action.
Make the most of your trip to London and fly direct from Bologna with British Airways. Our friendly cabin crew will make sure your trip is as comfortable as possible, whilst you enjoy the added convenience of free seat selection 24-hours in advance and a handy 23 kilogram checked baggage allowance as standard.
Get to central London hassle-free with a range of different transport options from Heathrow Airport. Buses and taxis can be found outside the terminal building, while the Heathrow Express train departs several times an hour and arrives into Paddington Station in just 15 minutes.
Get ready for your stay in London with some useful facts to make your arrival stress-free.
- Currency: British Pound (£)
- Country Code: +44
- Local Area Code: 20
- Electricity: 230 V, 50 Hz, UK 3 pin plug


text:
This place is quite small but very popular, so book ahead if you can - it is worth it. The food is relatively simple but very well cooked and very tasty. The service is helpful and friendly. The atmosphere is relaxed and laid- back. The servings are plentiful and you won't leave hungry, but if you can, leave room for the sticky-toffee cos its delicious.
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Staghorns and Elkhorns
tropicbreezentAugust 15, 2012
Thought I'd share these photos. I'm holidaying at the moment and yesterday I took a walk to some friends place who live here. A nice sunny day but cool breeze made it a good day for walking. Although through the "suburbs", the gardens and scenery were quite nice. I took photos along the way and these are some of the Platyceriums I saw. Although they're native to the area, most of these would have spread from gardens into the streetside trees and other garden trees. Not that anyone would mind. The suburban sprawl most probably cleaned out the original ones in the forests.
This is the Elkhorn, Platycerium bifurcatum. It's actually a 'colony' of many plants. The rhizomes branch out within the cluster and produce more plants.


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Dolphin Tale 2011 | Movie Watchlist
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Dolphin Tale is a heartwarming family film inspired by the true story of an adorable bottlenose dolphin named Winter, who was rescued by a young boy off the Florida coast and taken in by the Clearwater Marine Aquarium. Sure, the story of a boy and his anim… (more)
Released: 2011
Rating: PG
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A unique bond between a young boy and a dolphin that lost its tail in a crab trap leads to the locals helping the dolphin get a prosthetic tail.
A unique bond between a young boy and a dolphin that lost its tail in a crab trap leads to the locals helping the dolphin get a prosthetic tail.
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5 Small Dog Myths That Deserve Busting
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Hi: 9° Lo:4°
By Jamie Arrowsmith Thursday 01 November 2012 Updated: 07/11 12:31
BROMSGROVE maintained their unbeaten start to the MRHA West Midlands Two hockey season with an impressive 5-0 victory at West Brom on Saturday.
West Brom were relegated into the division at the end of last season but like Bromsgrove went in to Saturday's game having yet to taste defeat this season.
The visitors were nearly at full strength for the trip, with only Laurence Shah missing as his continuing thigh problem continues to give him problems. Summer signing Matthew Russell made a welcome return from injury.
After a tentative start from both sides, on what proved to be a slow pitch, Bromsgrove gradually gained control with Bevan Edwards and Tom Green taking control of the midfield.
West Brom manufactured a few half chances when venturing forward but a solid defence of White, Johns, Turner and McLaughlin was easily able to soak up the pressure.
The opening goal came in the 25th minute when a ball into the D broke kindly for Green to convert.
Bromsgrove felt they should have been awarded a penalty corner six minutes later when Troth was fouled after showing a good turn of pace but the umpire thought otherwise.
With just a one-goal lead to show for their efforts, Bromsgrove still had work to do in the second half but they were soon 2-0 ahead when Edwards converted Troth's short corner.
The second goal seemed to hit West Brom's resolve as Bromsgrove dominated the remainder of the contest.
Bruce Turner found Green with a superb 60-yard free hit to make it 3-0 before Edwards added a fourth after beating a number of defenders on his way to goal.
West Brom almost grabbed a late consolation but were denied by an excellent Uren save and it was from one of their attacks that the final goal came as Turner won possession and released Rammy Arafa down the right and he crossed well to allow Tom Jennings to tap home his fourth of the season.
Delighted captain Arafa said afterwards: "To go away to a side like West Brom and get a win is hard enough, but to win 5-0 is fantastic. I couldn't ask any more of the lads today, especially Bruce Turner who created so many openings."
Bromsgrove entertain Yardley tomorrow as they look to build on their solid start to the season.
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Discover the mysteries of coffee aromas: where does the aromatic profile come from? What processes influence it? How does coffee experts identify and select the most promising green coffee? How do they create you favorite Grand Cru?
Discover Nespresso holistic approach to sustainability across our value chain and key sustainability figures through an animated infographics


text: Bobcat Basketball Is Back For Another Season By Chris Griffin November 4, 2013 1:04 PM Share on Facebook Share on Twitter R. Dean Hendrickson Once again it's that magical time of the year, Bobcat Basketball returns to 1450 KMMS-AM! Follow all the action with the Men and Women opening the season this coming weekend. 2013-14 Women's Basketball Schedule 2013-14 Men's Basketball Schedule Go 'Cats! Category: Bozeman News Share on Facebook Share on Twitter More Leave a comment Send to a friend! Print this page Pin it! Reddit This! Share on Tumblr! Best of AM 1450 KMMS Recommended For You Around the Web


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Does not apply to Norse Projects, Ganni, Alden, PB 0110, Mansur Gavriel, Kathleen Whitaker or The Horse
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High quality Honduran coffee from Apolis and Handsome Coffee Roasters. Clean and sweet with hints of chocolate taffy, graham, and tangerine flavors.
Grown in Honduras
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Black Gamecock LA Iris
zlouiselouiseMarch 28, 2013
I have a Black Gamecock Louisiana Iris, i know that they are very happy in the water. I want to know if they can be grown in only water, no soil. I was thinking of having it at the bottom of a glass container but i'm not sure if it will thrive without any soil, anyone have any experience with this??
Thanks so much :)


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Inspired by Morning, a simple iPhone app animation, download the iPhone mockup (After Effects) from attachment.
Full 3D video: https://vimeo.com/98870007
Hope you guys can get some use from it and please let me know what you think!
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Hard Disk Sentinel is a hard disk monitoring application to find possible hard disk problems, performance degradations and failures. It can alert if a problem detected or if temperature is too high and it has other reporting options.
Reviewing 4.60 (Jan 14, 2015)
Simple and good software. Provides correct info about your SSD / HDD.
Reviewing 2.60 Beta (Aug 3, 2008)
It's seems to be working ok.
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Mind-Body-Spirit News
Mind-body fitness pros who are trained in relaxation techniques may want to teach clients these skills as part of a comprehensive wellness strategy. Stress impacts both physical and mental well-being. Excess stress can be a causal factor in certain health issues, or it can worsen conditions that are already present. Research findings support using relaxation techniques as part of an overall treatment for stress-related disorders.
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It's all about fresh food this time of year. I get these cravings for slices of tomatoes on crusty bread with olive oil, salt and pepper. We made dinner the other night and many colors were represented, from green to yellow to purple. We had striped candy beets, French green beans and locally grown corn. It was definitely a sign of nature's bounty. Ben and I had been to the Farmer's Market that day, and we were inspired.
Ben, however, is not yet so inclined to eat many vegetables. He likes, as he calls them, "mixed-up vegetables"—corn, peas and carrots, and not much else. He does eat cannellini beans, a mild white bean that he likes right now. We're glad because they are a good source of fiber, which helps keep everything running smoothly, if you get my meaning. Potty training was not the most fun aspect of Ben's development!
The more he sees us eat fresh foods the more he is likely to try them. Even better: He has visited a local farm and has seen firsthand how vegetables are grown. His preschool, Peace Through Play, went on a fieldtrip to Camphill Farm in Pomona, NY. It's a local organic farm run by John McDowell and Alex Spadea. John and Alex have also spearheaded the Rockland Farm Alliance. Its main goal is to bring local farming back to Rockland County and educate Rockland residents about farming and organic foods. The farm is a part of a movement to create more farms near urban centers.
Alex showed Ben and the other children around the farm, past the beehives, and they even helped weed the garden. They grow calendula, which is what we use in our Weleda Baby Care. She likes to have the children cup the colorful flowers in their hands and breathe in the scent of the flower. After working on the weeds, they ate homemade baked bread with butter. Ben planted a pot of lettuces, which now sits beside our basil plant in the window. They had a walk in the woods after lunch and played Duck, Duck Goose in honor of the farm duck, Rachel. It was a sweet time with a nice message about fresh, local foods. Hopefully it's something Ben will always remember.
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Ironman Training: the mind body connectionMarch 11th, 2015
February was the third month in my Ironman training plan. This is the month of mind body connection. When I first begin to train, the challenge of month one is to get back into the routine of working out 11 times a week and struggling to build fitness. The easy part is to sign up for the race, create a training plan, get excited about beginning again, and completing relatively short [Read the Rest…]
Ironman Texas: Winter training continuesFebruary 12th, 2015
January went by fast. I hope everyone is keeping their New Year's resolutions! For me, I hit every training session: swimming 24,500 yards, biking 552 miles and running 115 miles. I am also on target with weight loss, losing 8 pounds in January. Although, the weight always comes off so much slower than it goes on! Ironman Texas is roughly 15 weeks away. It seems long, but in training time [Read the Rest…]
Ironman Training: Success, set backs, and getting back to shapeJanuary 20th, 2015
Well 2014 was quite a ride – ups and downs – but all in all a very good year. My 2014 triathlon training totals were: Swimming, 255,774 yards (in my SwimEx); Bike, 5,414 miles; and Run, 1,279 miles. That translates into 108 hours of swimming, 297 hours of biking and 194 hours of running for a total of 330,000 calories burned or close to 100 pounds. It really looks quite [Read the Rest…]
Triathlon Time Off: How I start training again.December 8th, 2014
October presented me with a few bumps in the road. It was an adjustment going from working out 25 hours a week to no real training. I also had to recover from the nagging muscle issues that go along with 12 months of hard training. Work for me is always extra busy in the fall, plus I began taking 13.5 graduate school credits to get my Tier 2 School Administrator [Read the Rest…]
Pool Owners Use Aquatic Therapy for Arthritis – and for LifeDecember 5th, 2014
"We don't just love our Swimex – it has changed our family's lives for the better," says Leon Peeters who, with his wife Monique, purchased a SwimEx in 2009. "At first I wasn't sure the pool was the right choice for us," says Leon recalling his first visit to the SwimEx showroom. "I remember thinking then that I didn't need a test swim because I didn't like swimming. Well, that [Read the Rest…]
Kick board exercises: a great addition to your water workout.November 21st, 2014
Exercising in a SwimEx pool is a gentle but effective way to get a great water workout. The buoyancy and support of the water reduces stress on joints and encourages freer movement. And aquatic exercise offer twelve times the resistance than exercise movement against air. That's why the benefits aquatic exercise go far beyond the water, and are popular with professional sports teams, college programs, Olympic training centers and home owners [Read the Rest…]
A New SwimEx Pool in South GeorgiaNovember 19th, 2014
These new SwimEx owners live on a farm in South Georgia, right above the GA/FLA line. They put their SwimEx on a screened-in porch. It is housed in a new building the couple designed with the help of an architect. They planned the building to make the most of solar energy and the pool gets warmth from the sun. The standard cover that came with the SwimEx has also done [Read the Rest…]
The New Triton Pool: Making a Splash in Swim Spa PoolsNovember 5th, 2014
Our new Triton is already making a splash with buyers. This newest member of SwimEx's extensive line of fitness and therapy pools offers our innovative quality and construction at a more affordable price. "We developed the Triton to meet the demand of discerning customers who desired the luxury of the SwimEx brand at a lower price point," said Suzanne Vaughan, president of SwimEx, Inc. "We are extremely excited about [Read the Rest…]
The journey of Ironman TrainingOctober 17th, 2014
Ironman Lake Tahoe…For those who have been following my journey this year, you know it has been a tough year, and that I trained hard to be able to complete two Ironman competitions this year. The first Ironman took a lot of heart and perseverance. It then took a lot to recover and rebuild in a short period of time for Ironman Lake Tahoe. But, I was confident that I [Read the Rest…]
A Beautiful New England WeekendSeptember 26th, 2014
It's going to be a beautiful weekend in New England. Plenty of sun and a perfect time of year for leaf peeping. If you're up for a trip to see amazing foliage, check out the Yankee Foliage site for up-to-date reports. We plan to enjoy a few more wonderfully warm days. The weather looks like it's going to be great in Seattle too! Check out this Seattle SwimEx. What a [Read the Rest…]
Celebrate life!September 24th, 2014
It's Active Aging Week – a celebration of adults 50 years of age and older. Take a moment to enjoy your life. We recommend finding a water exercise class near you. We know you'll love it. If you do, check out the benefits of owning your own SwimEx pool and exercising at home.
Triathlon Training: Aquatic Fitness SwimEx StyleSeptember 15th, 2014
Training heats up for this SwimEx Ironman. Things are really starting to heat up in training. August has been a tough month with a significant build that included 38,700 yards swimming, 148 miles running and 710 miles of biking. That brings my yearly training totals up to 208,374 yards of swimming, 1,061 miles of running and 4,442 miles of biking (491 hours of training). August was particularly challenging because I [Read the Rest…]
Stunning Swim Spa Room in Madison, WIAugust 27th, 2014
Madison, WI – This home owner needed a pool to assist with physical therapy. The skylights were used to help increase the amount of sunlight and heat, especially with the long Wisconsin winters. The customer really enjoys the deep well and quiet motor. The subterranean addition also includes an added bathroom with a shower. The bathroom includes a glass block wall, pedestal sink, and beautiful wood flooring. The addition [Read the Rest…]
Coastal Living SwimEx StyleJuly 25th, 2014
The fall and winter come quick in Delaware but this owner of a SwimEx 500 OS swim spa made sure he can still enjoy the water year-round. The windows all open up to let the bay breeze in while keeping the cold elements out. Pool Specs: The 500 OS models utilize "side channels" as a water return system enabling a greater water depth and faster counter-current pool water speeds. These [Read the Rest…]
Swim in comfort all year long!July 17th, 2014
We may have had a rainy week here in New England but Seattle has to deal with wet weather most of the year. This makes it difficult to get your fitness or therapy swim time in. The solution is a SwimEx pool. Check out this simple, yet effective and tranquil setup one owner created for his 500 OS. Folding doors create a seamless transition to the outside but seals out the [Read the Rest…]


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Provides detailed, step-by-step guidance on how to write proposals for both quantitative and qualitative research. Numerous examples throughout the book make it easy to understand. Three complete proposals are presented at the end of the book.Edition/Copyright: 2ND 02
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With a three-year legal fight over, California's Institute for Regenerative Medicine needs to get on with the task of funding stem cell research, the San Francisco Chronicle said in an editorial. The institute faces limitations, the newspaper noted, but has the benefit of oversight by a group of universities and a research institute.
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B. Muralidhar Reddy
BATTICALOA: Sri Lanka has declared portions of Sampur in Trincomalee district in the east, captured from the Tamil Tigers in September last year, as a High Security Zone.
A number of such displaced persons of Sampur, housed in refugee camps in the town, told The Hindu that they had been told that they cannot return to their homes due to security reasons. For some of the refugees, it has been the fourth or fifth displacement since September.
Sri Lanka ousted the LTTE from Sampur after the Tigers posed a threat to the Trincomalee harbour. Colombo has announced that New Delhi has agreed to build a 500 MW thermal power plant there.
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Rated 3.5 out of 5 by 559 reviewers.
Rated 4 out of 5 by erichsdad Do not disturb With a "Do Nor Disturb" sign on my door and my having opted for no room service, one of the cleaning people decided to clean my room anyhow. I left my "valuables" such as computers out assuming no one would go in the room. What was missing were some receipts that seemed to have been cleaned up. May 24, 2013
Rated 4 out of 5 by Mabels21 Club Level Everything at the hotel was about as expected but I was disappointed in the club level. Morning was pretty good but the staff could have been friendlier and more helpful. The evening offerings were very disappointing. Again, the staff was not helpful and the food was a joke. I expected better. May 24, 2013
Rated 4 out of 5 by Edward98 Issues with Electric Outlets RM 542 had some issues with electric outlet and what could be plugged in at the same time. Refrigerator and microwave could not be plugged in simultaneously. Also, the lamp plugged into the same outlet did not work (switch broken off). Not sure if other rooms have the same issue, but 542 did. February 11, 2013
Rated 5 out of 5 by fontainerm Atlanti City Really was impressed with my stay! The staff was all very helpful and nice, very clean rooms and comfortable bed! Will definitely book a stay again there! I really wish was on the boardwalk because its better than the boardwalk casino hotels! But it is close enough during this time of year! October 3, 2012
Rated 4 out of 5 by thebutlers Lovely hotel, but limited dining options Just remember that if you arrive on a Sunday or Monday the bar is closed. Your only hotel dinner options any day is the Tun Tavern. However, there are many high end restaurants to have lunch and dinner in the city. The Club Lounge does NOT serve any alcohol. Staff very pleasant and helpful. December 14, 2012
Rated 5 out of 5 by Carla60 One night stay I booked for one night stay due to an early appointment in AC. First time at the Sheraton. Now I won't stay anywhere else. Rooms, beds, pillows, desk and chairs very comfortable. Bed and coverlets felt like heaven. Even used the hot tub. Now I wish I had more time to visit here. June 11, 2014
Rated 5 out of 5 by klh5000 Best, most accommodating staff The staff was over the top friendly and accommodating. We stay here because they allow pets, and we got a treat for our dog. We received maps and suggestions for things to do. Not one individual I met was rude or disrespectful. I wish the parking was a little bit more convenient though. July 16, 2013
Rated 5 out of 5 by SKW1 Nice Sheraton with Nice Club The lobby has Miss America gowns displayed -- fascinating. I was upgraded to presidential suite. club lounge spacious with good food and REAL bagels. Valet parking is expensive and delayed because garage is a long way away. August 22, 2014
Rated 5 out of 5 by Abaddon66 Our first time at a Sheraton As this was our first time a sheraton we didn't know what to expect. We selected this hotel for it's location next to the convention center. I must say we were blown away. Everything was very clean, the staff was super friendly and helpful. We will definitely stay at a sheraton again April 3, 2012
Rated 3 out of 5 by Popeye954 Cleanliness of hotel inconsistent Cleanliness of room great, however, cleanliness of common areas lacking. Mattresses are not up to the normal Sheraton standard of comfort. Paper thin walls makes for alot of noise between rooms. Overall, a little bit of a disappointment and I would think twice about returning here. August 21, 2012
Rated 3 out of 5 by CHI2012 Room Upgrades I was unable to get a room with a king bed when I made my reservation. Before I arrived, I was sent an E-Mail asking if I were interested in upgrading my room. I responded, yes. When I got to the hotel, upgrades were not available. Why was ever sent the E-Mail in the first place ? September 17, 2012
Rated 5 out of 5 by TLsal Very classy hotel My family and I had a terrific stay at the Sheraton in Atlantic City. The Sheraton is one of the few high-quality locations there that are not ugly or cheesy. Everything seemed elegant and well-run. The beds were especially comfortable. We would definitely return to this property. September 7, 2012
Rated 3 out of 5 by TWGNHBW Sheraton Atlantic City a Bust I have stayed at other Sheraton Hotels and this was my worst experience. The stay were not attentive and many times responded as those you were inconveniencing them. I was there for an annual conference and there were other groups having events, so maybe the staff was overwhelmed. April 21, 2013
Rated 2 out of 5 by Travelerwithapurpose Needs an overhaul This place is showing its age. The hallways smell musty and the carpets are dirty. Even the lobby looks rundown, even though it was once nice. My room was not clean when I checked in. There were candy wrappers in the room and dirt in the drawers. The bathroom hadn't been cleaned. October 23, 2012
Rated 5 out of 5 by erin05 Valet staff exceptional I wanted to commend your valet staff. During my stay, I unfortunately locked my keys in my trunk. Your staff was very professional, courteous and extremely kind. They made me feel comfortable and safe. They were able to retrieve my keys very quickly. I appreciate their kindness! January 7, 2013
Rated 4 out of 5 by Yazzy87 Great Stay I stood at this hotel for 2 nights. Everything was great. I have no major complaints except that as a SPG member I wish they had a better selection for their hors d'oeuvres as i could not really enjoy what they had. August 21, 2014
Rated 4 out of 5 by EastVillageDavid Don't stay in room 351 if you can avoid it Every year, I come down with my kids for a night to shop and swim. Usually it is great. But because of a convention of overly made-up, barely dressed teenagers, we were put into a room that couldn't move us out of: 351. The room is huge and clean, but freezing even with the heat turned all the way up and running all night. The room is a corner, so the bed is shoehorned in, and there's no way to watch the TV if you're laying down in the bed properly. The suite portion of it is a nice kitchenette with an unnecessarily massive round table. It's nice to have a place to sit and eat leftovers, but a small couch or overstuffed chair to relax in with a lamp so you don't disturb people sleeping in the other part of the room would have been better. Finally, that the room didn't automatically come with continental breakfast -- even though it really wasn't that much bigger than a standard room except for a long hallway in the middle of it -- is really unacceptable. Overall, the hotel is great. This room, definitely not. January 21, 2014
Rated 4 out of 5 by Thomasg66 Weekend shopping I purchased the shop ac reservation. Went to breakfast and charged fifteen dollars for drinks... Coffee and orange juice. Staff at check in fantastic. Room 425 was great until I showered in the a.m. Reached for a towel and it had a big gross hair ball on it . Yuck!!!!!!!!!!!!! December 15, 2013
Rated 4 out of 5 by Bibi14 Pet friendly The room is not ready at 2:30.im given an option to switch to another type,,not good,,I expect what I booked,,,the housekeeping manager had to order to clean the room ASAP,,club room has no ref, August 30, 2014
Rated 2 out of 5 by Fongol Needs a clean up Room has old upholstery, reeks of smoke, no fresh air. Ok'd green policy at check in, housekeeping knocked at 7:45am. Staff needs better communication, was given consistent wrong info regarding convention I was attending. Room service did not have a pen and confused. May 18, 2014
Rated 4 out of 5 by RonnieDunston Party in AC I booked 2 rooms at this Sheraton for my frat brother's birthday party. Though it was not located in a Casino it was still very close to the boardwalk/ Casino strip. So we were able to still enjoy ourselves. The only suggestion I would have is guests to have FREE parking. November 17, 2013
Rated 3 out of 5 by petedoc451 food service There is considerable room for improvement regarding the breakfast buffet. The eggs were dry and the pancakes hard as rocks. Lunch and dinner are served at a public pub located in the facility but a fairly long walk from the lobby. Room decor needs to be modernized. February 10, 2014
Rated 4 out of 5 by Myrtle12 !st Trip to Atlantic City The location was a bit farther from the Boardwalk than we anticipated, but the weather was great so we enjoyed the extra walking. It would be helpful to have a back entrance so you don't have to keep walking around the block to get to the heart of Atlantic City's Boardwalk area. Room was excellent,. We were on the Club Floor which added to our convenience. Our only disappointment was the lack variety in food, apetizer selctions, breakfast, etc. After staying on the Club floor in different cities this one rates lower. Also, if you wanted to order a glass of wine to enjoy or another beverage while in the Club Lounge, you could not do so. This we found very inconvenient. Please work on upgrading your Club Floor Lounge, especially for Starwood Members - Owners. We also had difficulty getting our extra 500 Starpoints if we did not have linen change - had our card out by the required time, but did not receive the points. Please improve on record keeping and communication. We shared these comments the front desk on departure. October 20, 2012
Rated 5 out of 5 by SuperSport SuperSport Very nice, staff excellent, overstuffed chairs in room could use a good cleaning or replaced otherwise very nice September 19, 2014
Rated 5 out of 5 by Brigbrat Staff is Outstanding The staff at the Sheraton Atlantic City is exceptional! Everyone says hello and they can not do enough for you! I would like to especially commend, Holly-Sales, Sharon-Event coordinator, and Joan-Food and Beverage, for their outstanding attention to our members! November 11, 2013
Rated 4 out of 5 by bobert1953 Needs free internet Overall the room was good.The toilet needed to be repaired.you had to hold the handle down to get it to flush,The light in the entry didnt work,the switch was broken.I resent that you have to pay for internet service,also pay extra to get service that is usable. July 4, 2013
Rated 5 out of 5 by Htowndeb Clean and comfortable stay Love this hotel...clean, comfortable beds, love the Tun Tavern and the Cafe'. Staff is awesome and especially love the shopping right there. What more can you ask for. Its a bit of a walk to the beach, but gave me the ability to walk off the food I was eating! September 26, 2012
Rated 4 out of 5 by Julz2381 Great Spot Perfectly located if you do not want to stay on the boardwalk or at a casino. Just a few blocks away, close to great shopping and had an excellent front desk team that were willing to answer any questions. Restaurant was short staffed, and a little overpriced. June 26, 2013
Rated 5 out of 5 by Tony2011 Good location Although this hotel does not have a casino, it's well situated that you can easily walk to the boardwalk and get to the Ceaser, Trump Plaza in 10 minutes. Close to all the shops. The rooms wwere comfortable and cleaned. I would strongly recommend this hotel. September 19, 2012
Rated 3 out of 5 by GinaD Hotel near everything I have stayed here several times. My recent stay was for shopping at the outlets and to see a show at 1 of the casinos. The only 2 things that i would comment about would be: 1) Their was a dog staying on our floor which barked a lot. 2) The buffet was cold. October 2, 2012


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C#.NET Web Image Viewer Introduction
With zero-footprint AJAX feature, RasterEdge Online Web Viewer is installed on servers, enabling to view, annotate, save, and print (convert) document on any device that uses a modern web browser, like IE, Firefox, Chrome & Safari. Written in 100% managed C# code, RasterEdge C#.NET web viewer control is suitable for .NET Framework 2.0 (or greater) applications. What's more, this Web Image Viewer for C# can be easily integrated into your own ASP.NET applications.
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This C#.NET ASP.NET web viewer creating control is a fully featured third-party .NET solution, which allows C# developers to process and edit document image files with various functions. In this section, we demonstrate all its supported functions, also with detailed guide links.
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Closet Snoop: Jordan DeGaish
CORPUS CHRISTI - Jordan DeGaish recently graduated from AMDA: College and Conservatory of the Performing Arts in Los Angeles with a bachelor's degree in musical theater.
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