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During the last decade, a number of meta-analyses questioned the clinically relevant efficacy of antidepressants. Part of the debate concerned the method used in each of these meta-analyses as well as the quality of the data set.
Materials and methods
The Kirsch data set was analysed with a number of different methods, and eight key questions were tackled. We fit random effects models in both Bayesian and frequentist statistical frameworks using raw mean difference and standardised mean difference scales. We also compare between-study heterogeneity estimates and produce treatment rank probabilities for all antidepressants. The role of the initial severity is further examined using meta-regression methods.
The results suggest that antidepressants have a standardised effect size equal to 0.34 which is lower but comparable to the effect of antipsychotics in schizophrenia and acute mania. The raw HDRS difference from placebo is 2.82 with the value of 3 included in the confidence interval (2.21–3.44). No role of initial severity was found after partially controlling for the effect of structural (mathematical) coupling. Although data are not definite, even after controlling for baseline severity, there is a strong possibility that venlafaxine is superior to fluoxetine, with the other two agents positioned in the middle. The decrease in the difference between the agent and placebo in more recent studies in comparison to older ones is attributed to baseline severity alone.
The results reported here conclude the debate on the efficacy of antidepressants and suggest that antidepressants are clearly superior to placebo. They also suggest that baseline severity cannot be utilized to dictate whether the treatment should include medication or not. Suggestions like this, proposed by guidelines or institutions (e.g. the NICE), should be considered mistaken.
Keywords:Antidepressants; Depression; Meta-analysis; Effect size; Baseline severity
Recently, a number of meta-analytic studies questioned the clinical usefulness of antidepressants. It has been shown that there is a significant bias in the publication of antidepressant trials [1] and that the effect size of the medication group in comparison to that of the placebo is rather small [2-9]. On the basis of these results, a 'conspiracy theory' involving the Food and Drug Administration (FDA) was proposed [10,11]. Furthermore, by 'overstretching' the interpretation of the data, it has been suggested that because they do not incur drug risks, alternative therapies (e.g. exercise and psychotherapy) may be a better treatment choice for depression [10]. These triggered much interest from the mass media and from intellects outside the mental health area, often with a biased and ideologically loaded approach [12]. However, the most important suggestion was that initial severity plays a major role and antidepressants might not have any effect at all in mildly depressed patients [5,6,8].
Following this conclusion, several authors and agencies like the National Institute of Clinical Excellence (NICE) suggested the utilisation of 'alternative' treatment options (e.g. exercise and psychotherapy) in mildly depressed patients and pharmacotherapy only for the most severe cases. Among other things, these authors and authorities did not take into consideration that, peculiarly, similar findings were reported concerning psychotherapy [13-16].
Several authors criticised the above by focusing on the limitations of randomised clinical trials (RCTs), on clinical issues and, especially, on the problematic properties of the Hamilton depression rating scale (HDRS) and on the fact that the effectiveness of antidepressants in clinical practice is normally optimised by sequential and combined therapy approaches. It has been proposed that the effect is significant in a subgroup of patients [17]. So far, only two efforts were made to re-analyse the same data set with different methodological approaches [18,19]. These two efforts independently reported the results that are quite similar between them but different from those of the study of Kirsch et al.
All the meta-analytic studies mentioned above were based on five 'data sets'. The data sets are the Khan et al. set [8,20], the Turner et al. set [1], the Kirsch et al. set [5], the Fournier et al. set [6] and the Undurraga and Baldessarini set [9].
All the meta-analyses are shown in Table 1 with respect to the methodology used and results. In this table, Undurraga and Baldessarini [9] was not included because these authors utilised a different outcome measure. The Fournier et al. [6] analysis was also not included because this data set is highly heterogeneous and includes primary care patients with dysthymia and major depressive patients who accepted to be randomised to medication, psychotherapy or placebo, fixed as well as flexible dosage studies and medication up to 50 mg of paroxetine but only up to 100 mg of imipramine [21-25]. It is interesting that a common denominator of the studies included in this specific meta-analysis was that the efficacy of psychosocial interventions depends also on initial severity, the same way the medication does. In the Unduraga and Baldessarini set, variance measures are missing in many trials. However, in the Khan et al. data set, only 21 out of 45 studies reported a standard error of measurement or a standard deviation of mean change. The data of the Turner et al. set are not available to the authors of the current paper except for the effect sizes of individual studies. On the other hand, the Kirsch et al. set is more complete and available online.
Table 1. Estimation of the overall effectiveness and magnitude of heterogeneity
The data set of Kirsch et al. [5] might serve as a paradigm since it has been independently re-analysed by two other groups [18,19] and is based on FDA data which seem to be free of bias [26]. Thus, the current study will utilise the Kirsch et al. (reference) data set and will focus on the debate following its analysis and re-analysis.
It is important to define the specific questions that arise from the debate. According to our judgement, they are the following:
1. What is the bias in the Kirsch data set? How complete is this data set?
2. What is the magnitude of the heterogeneity (τ2) of the studies in this data set?
3. Which is the most appropriate method for meta-analysis of this data set?
4. What is the standardised mean difference (SMD) for the efficacy of antidepressants vs. placebo?
5. What is the raw HDRS mean difference (RMD) for the efficacy of antidepressants vs. placebo?
6. Is the SMD or the raw score more appropriate to reflect the difference between the active drug and the placebo?
7. Are all antidepressants equal in terms of efficacy?
8. What is the role of the initial severity?
9. Is there a change in the difference between active drug and placebo in more recent RCTs in comparison to older ones?
There is some hierarchical interrelationship between the aforementioned questions, which requires sequential answers in order to clarify the issue. The current paper will tackle these questions and will try to provide answers with the use of multiple methods of meta-analysis.
Materials and methods
The Kirsch et al. database as published by these authors [27] was used in the current analysis. The complete set used in the current study is shown in Additional file 1.
Additional file 1. The complete set used in the current study.
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Since one element of the debate was the use of different methods of meta-analysis, a number of methods were used in the current study and their results were compared. These were (a) simple random effects (RE) meta-analysis (simple REMA), (b) network RE meta-analysis (NMA), (c) simple RE meta-regression and (d) NMA RE meta-regression, in both Bayesian and frequentist frameworks. The description, advantages and disadvantages of each of these methods can be found in Additional file 2.
Additional file 2. The description, advantages and disadvantages of each of the methods.
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All approaches have been undertaken under the RE model [28-30], so as to account for between-study heterogeneity due to the differences in the true effect sizes, rather than chance. We selected the RE meta-analysis since our prior belief was that treatment effects vary across studies, and our aim was to infer on the distribution of the effects. In case there is no statistical variability in the effects, RE model simplifies to fixed effects model with τ2 equal to zero. We further applied meta-regression methods for the synthesis of the data, as it allows for the inclusion of study-level covariates that may explain the presence of heterogeneity. We explored whether two moderators, the initial severity and publication year, were associated with the treatment effect. One of the studies in the database was considered by Kirsch et al. to be an outlier. We therefore performed all meta-regression analyses with and without this particular study. In NMA models, we ranked all antidepressants using the probability of being the best [31] in the frequentist setting and the cumulative ranking probabilities in the Bayesian framework [32]. All methods were carried out employing both RMD and SMD scales.
The main differences between Bayesian and frequentist methods regard the estimation of heterogeneity. In meta-analysis, the choice of the method for estimating heterogeneity is a great issue since imprecise or biased approaches might lead to invalid results. Several methods have been suggested for estimating heterogeneity. In the frequentist methods, we estimated a 'fixed' parameter of the heterogeneity and we employed the commonly used DerSimonian and Laird (DL), or in case DL was not available, we performed the popular restricted maximum likelihood estimator. In the Bayesian framework, we accounted for the uncertainty in the estimation of heterogeneity, assuming it is a random variable. The magnitude of uncertainty associated with heterogeneity is included in the results and may have a considerable impact on our inferences. However, the Bayesian estimation of the heterogeneity under different prior selections for τ2 can be shown problematic when few studies are available [33,34]. We therefore consider 12 different prior distributions for the heterogeneity in the NMA RE meta-regression model so as to evaluate any possible differences in the results.
The complete results of the analyses are shown in Additional file 3.
Additional file 3. The complete results of the analysis.
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What is the bias in the Kirsch data set? How complete is this data set?
The funnel plots (Section 1 in Additional file 3) according to both RMD and SMD, treatment effects suggest that there is no asymmetry in the way the data points lie within the region defined by the two diagonal lines, which represent the 95% confidence limits around the summary treatment effect. Thus, there is no evidence for the presence of bias, as both funnel plots are visually symmetrical.
What is the magnitude of the heterogeneity of the studies in this data set?
All RMD analyses showed the presence of important heterogeneity, and all RMD Bayesian approaches apart from simple RE meta-regression analysis showed that τ2 is significantly greater than zero. On the contrary, SMD exhibited lower and not statistically significant heterogeneity. This is in agreement with previous empirical findings [35] suggesting that SMD is more consistent than RMD as baseline varies. To investigate the presence of heterogeneity, we employed the RE meta-regression analysis with initial severity as a covariate. The RMD RE meta-regression analysis reduced the magnitude of heterogeneity, suggesting that initial severity explains part of the magnitude of the heterogeneity, whereas SMD suggests that initial severity does not play a significant role in the variance of the treatment effects.
The magnitude of heterogeneity when the SMD RE meta-regression model was employed with 12 different prior distributions for τ2 ranged in between 0.00 and 0.04 with all cases apart from the weakly informative gamma prior distribution being not statistically significant. However, the RMD heterogeneity ranged in between 0.24 and 1.29 with all credible intervals, apart from the two non-informative uniform priors for the logarithm of τ2, being significantly greater than zero. We therefore observe that RMD scale is sensitive in the prior selection of τ2, which impacts on the results and may lead to different statistical inferences. The two scales suggest different results regarding the magnitude of heterogeneity due to their different properties. The heterogeneity of the data according to different methods is shown in detail in Section 2 in Additional file 3. The estimation of heterogeneity is important in choosing the appropriate model for the analysis of data [33,34].
Which is the most appropriate method for meta-analysis of this data set?
The selection of the effect size relying only on the magnitude of heterogeneity is not appropriate and can be shown problematic. It is suggested that the choice of the effect measure should be guided by empirical evidence and clinical expertise. Empirical investigations have shown that the SMD scale is less heterogeneous than RMD and that gives more reliable results as baseline risks vary, which is in agreement with our findings. However, it has been found that the SMD for small trials (number of included patients per group less than 10) bias the results towards to the null value in around 5%–6% of the cases even when the small sample correction factor is used [35]. Although this bias can contribute to the decreased heterogeneity of SMD, in our data set, all study arms apart from one included more than 10 patients. In our different analyses, the SMD scale was more consistent than the RMD, suggesting more valid results.
Although simple RE meta-analysis provides the most reliable evidence, it only gives insights on the effectiveness between the two treatments. Our data set includes evidence on multiple interventions, and the need to compare and rank these treatments suggests the use of NMA. However, the presence of heterogeneity in NMA analysis should be investigated. We therefore explore any possible reasons for its presence by employing NMA RE meta-regression with initial severity as covariate. However, since initial severity forms part of the definition of both SMD and RMD, there is a strong relationship between the covariate and the effect size (mathematical coupling). It is therefore very likely in the frequentist setting to find a significant relationship between initial severity and treatment effectiveness. In the Bayesian setting though, we 'correct' for this artefact by adjusting towards the global mean [36-39]. In the Bayesian NMA RE meta-regression model, we assume a fixed coefficient (β) for all treatment comparisons and we assign to it an uninformative prior. The method is more powerful than carrying out several independent pairwise meta-regressions.
We therefore conclude that Bayesian NMA RE meta-regression model using the most consistent scale (SMD) is the most appropriate method to meta-analyse these data.
What is the SMD for the efficacy of antidepressants vs. placebo?
The SMD in simple RE meta-analysis under the frequentist approach is 0.33 (0.24–0.42) and under the Bayesian approach is 0.32 (0.25–0.40). Accounting for initial severity in all antidepressants, we apply a simple RE meta-regression analysis reflecting an SMD under the Bayesian approach at 0.34 (0.27–0.42), which does not change after the omission of the outlier study. In essence, all methods give a similar SMD value (see Sections 4 and 5 in Additional file 3).
What is the raw HDRS mean difference for the efficacy of antidepressants vs. placebo?
The RMD in the simple RE meta-analysis under the frequentist approach is 2.71 (1.96–3.45) and under the Bayesian approach is 2.61 (1.94–3.30). We investigate the relationship between initial severity and treatment efficacy via the simple RE meta-regression analysis which under the Bayesian approach gives an RMD at 2.77 (2.18–3.36). After excluding the outlier, the raw HDRS value is 2.82 (2.21–3.44) (see Sections 4 and 5 in Additional file 3).
Again, all methods give a similar result, and all confidence intervals extend above the value of 3 which represents the NICE criterion for clinical relevance.
Is the SMD or the raw score more appropriate to reflect the difference between the active drug and the placebo?
As written above, the use of SMD with a Bayesian approach would be the most appropriate method to meta-analyse these data, since it is associated with the least heterogeneity.
Are all antidepressants equal in terms of efficacy?
The comparison of antidepressants with placebo as reference suggests that according to all methods used, all antidepressants are superior to placebo.
Venlafaxine is probably the most effective followed by paroxetine, while fluoxetine is the least effective according to all analyses, except for NMA RE meta-regression using RMD that suggests venlafaxine and nefazodone are similar and more effective than the others.
The hierarchical classification of agents has been done by the use of SUCRA values in the Bayesian analysis [40] or the posterior probabilities in the frequentist analysis [31]. Although both methods give insight on the ranking of treatments, the Bayesian approach using SUCRA values would be the most valid method. The main difference between SUCRA values and the probability of each treatment to be the best is that the former takes into account the uncertainty around the mean of the distribution of the effects, whereas the latter relies only on the mean of the distribution. Although confidence intervals overlap, SUCRA values give a strong probability of which agent performs better. The fact that confidence intervals overlap puts doubt on whether there is a true difference between agents.
NMA methods using RMD measure suggest that fluoxetine is clearly inferior to venlafaxine, since credible intervals of these two agents do not overlap. Similarly, the SMD scale suggests that venlafaxine is superior to all antidepressants but not significantly different (see Section 7 in Additional file 3).
What is the role of the initial severity?
When the RMD is used in the calculations, both frequentist and Bayesian methods suggest a significant influence of the initial severity. This, also, explains the reduction of the amount of the heterogeneity from simple RE meta-analysis to simple RE meta-regression and from NMA to NMA RE meta-regression analysis.
However, when the SMD is considered, the frequentist simple RE meta-regression suggests a significant influence for initial severity, while in contrast, the Bayesian methods (simple RE meta-regression and NMA RE meta-regression) suggest no such an influence exists. It is possible that different effect sizes can lead to different inferences regarding baseline. Relying on the Cochrane Handbook, the effect size that is 'close to no relationship with baseline risk is generally preferred for use in meta-analysis'. Moreover, the investigation of the relationship between treatment effects and initial severity under the frequentist methods can lead to inappropriate results, since they are inherently correlated [36]. However, the use of uninformative prior distribution for the regression coefficient and the adjustment for the mean baseline in the Bayesian setting relaxes the strong correlation between the treatment effect and the initial severity resulting in more reliable inferences for this relationship [36]. The results under the SMD effect measure suggest that there is no significant role of initial severity in the treatment outcome.
Is there a change in the difference between active drug and placebo in more recent RCTs in comparison to older ones?
Although there seems to be a change in the difference between the active drug and placebo in more recent RCTs in comparison to older ones, the use of simple RE meta-regression with two covariates (initial severity and year of publication) using either RMD or SMD suggests that the year of publication is not important while initial severity is. This means that the attenuated difference can be attributed to a lower initial severity in newer RCTs in comparison to older ones.
The use of the 'year of publication' is an arbitrary variable. Alternatively, we could have used only the two last digits of it or the years since the oldest trial included. At any case, this analysis gives only a hint that initial severity is important and not the years passed (reflecting change in other factors). A method to quantify the years passed (except from the arbitrary year of publication) is an unanswered question.
For the last 10 years, after the Khan et al. meta-analysis, and especially after the Kirsch et al. publication [5,8], the efficacy of antidepressants in the treatment of major depression was under dispute. The current multi-meta-analysis utilised the Kirsch et al. data set and suggests that the most appropriate methods to meta-analyse these data are RE meta-regression models in a Bayesian setting using the SMD scale. It is important to decide which method of meta-analysis is best for the current data set, since different methods and different effect measures have different properties and can therefore result in different estimates [35,41,42].
The use of SMD in a Bayesian RE meta-regression model suggests that the standardised effect size of antidepressants relative to placebo is 0.34 (0.27–0.42), and there is no significant role for the initial severity of depression. The most probable raw HDRS change score is 2.82 (2.21–3.44) extending above 3. Our analysis showed that antidepressants are not equally effective. Bayesian NMA approaches suggest that venlafaxine is more effective than the rest with fluoxetine being the least effective among antidepressants.
The Kirsch hypothesis concerning depression is that there is a response which lies on a continuum from no intervention at all (e.g. waiting lists) to neutral placebo, then to active and augmented placebo including psychotherapy and finally to antidepressants which exert a slightly higher efficacy probably because blinding is imperfect because of the side effects (enhanced placebo) [10,43-48]. The full theory of Kirsch and its criticism can be found elsewhere [49,50].
The meta-analytical methods applied so far have advantages and limitations and much of the discussion focused on these limitations, and biases are introduced (Table 1). In the analysis of Kirsch et al. [5], the authors calculated the mean in drug change and the mean in placebo change and then took their difference. This breaks the randomisation and introduces bias, as it ignores the studies' characteristics and the sample size [51-53]. The so-called naïve comparisons are liable to bias and overprecise estimates. Horder et al. [19] used simple meta-analysis in a frequentist approach. They used standard meta-analytic approaches (fixed and random effects meta-analysis) and applied meta-regression in frequentist approach where the drug change vs. placebo change is plotted. Meta-regression, the way they used it, also breaks the randomisation as it does not account for the correlation between the change in placebo and the change in drug. Fountoulakis and Moller [18] used two methods: (a) sample size weighting which is appropriate when a set of independent effect sizes (e.g. RMD, SMD) is combined, but again, it breaks the randomisation and introduces bias. (b) Inverse variance weighting which applies weight as the inverse variance or the precision of each arm in each study. The precision of the effect estimates is the most accurate estimation of the summary effect size. It calculates the standardised change both for drug and placebo and then takes their difference. However, this again breaks the randomisation and introduces bias. Khan et al. [8] applied simple regression in frequentist approach where the drug change vs. baseline is plotted and the correlation coefficient is calculated. However, the precision of each study and the heterogeneity is not taken into account as in a meta-regression analysis. Then, in order to draw conclusions, the authors divided the sum of the number of early discontinued patients by the sum of the number of total patients in each arm and then calculated the chi-square. This is not an appropriate analysis as it also breaks the randomisation.
We believe that the current paper resolves the debate concerning the efficacy of antidepressants and its possible relationship to the initial severity in a definite manner.
The argument that an SMD of 0.30–0.35 is a weak one and suggests that the treatment is not really working or it does not make any clinically relevant difference neglects the fact that such an effect size is the rule rather than the exception [54]. Traditionally, an SMD of around 0.2 is considered to be small, around 0.5 is considered medium and around 0.8 is considered to be large [55], but this is an arbitrary assumption. However, in the real world of therapeutics, things are quite different. For comparison, one should look at the acute mania meta-analyses which suggest an SMD of 0.22 [56] or 0.42 [57], while clinically, acute mania is one of the easiest-to-treat acute psychiatric conditions. Also, the SMD of antipsychotics against the positive symptoms of schizophrenia is 0.48 [58].
The present study suggests that in this data set, the SMD results in more meaningful inferences than the RMD effect measure, since a greater amount of heterogeneity is produced using RMD. However, all calculations of RMD suggested a mean close to 3 and confidence intervals including the value of 3, thus suggesting that the RMD is not lower than the suggested NICE criterion. However, this criterion is arbitrary and unscientific, both in terms of clinical experience as well as in mathematical terms (because of the mathematical coupling phenomenon, see below), but this discussion is beyond the scope of the current paper [59,60].
Because the earlier meta-analyses suggested that initial severity is related to outcome with more severe cases responding better to antidepressants in comparison to placebo, some authors suggested that medication might not work at all for mildly depressed patients. Thus, they argued that for these patients, medication should not be prescribed; instead, alternative treatments which presumably lack side effects should be preferred, in spite of the possibility that the difference between medication and psychotherapy is similar to that between medication and placebo [61]. The suggestion to avoid pharmacotherapy in cases of mild depression is adopted also by the most recent NICE guidelines CG90. An immediate consequence of this is that patients suffering from mild depression are deprived from receiving antidepressants, on the basis of this conclusion and the overvaluation of 'alternative therapies'.
'Common sense' among physicians leads to the belief that patients with greater disease severity at baseline respond better to treatment. The relation between baseline disease severity and treatment effect has a generic name in the statistical literature: 'the relation between change and initial value' [62] because treatment effect is evaluated by measuring the change of variables from their initial (baseline) values. In psychology, it is also well known as the 'law of initial value' [63].
However, the concept of 'mathematical coupling' , which was demonstrated for the first time by Oldham in 1962, suggests that there is a strong structural correlation (approximately 0.71) between the baseline values and change, even when 'change' is calculated on the basis of two columns of random numbers [59]. Mathematical coupling can lead to an artificially inflated association between initial value and change score when naïve methods are used [60]. The problem is that Bayesian methods, which are able to partially correct for this artefact to a significant degree, are not routinely applied in meta-analytic paper researches [64-66]. However, even these methods are not completely free from this phenomenon.
Taking into account that our data form a 'star-shaped' network, where all agents are compared to placebo effect, we employed a more advanced statistical method than other authors in the past, which is the NMA that is calculated for all treatments, the probability of being the best [31], and the SUCRA values [32]. In our case (star network pattern), NMA method relies only on the indirect comparison via placebo to contrast the different agents. In comparison, Huedo-Medina et al. [27] employed the naïve method of pooling the results, which has been criticised in meta-analysis bibliography that is liable to bias [53]. Conclusively, the results of the current paper suggesting that the use of Bayesian approach returns no role for initial severity should be considered to be strong. This finding is in accord with the conclusion other authors reached by analysing different data sets [67,68].
An important limitation in the Kirsch et al. data set is that it includes aggregate data rather than individual patient data. It has been recently shown that inference on patient-level characteristics, such as initial severity, using meta-regression models and aggregated evidence can be problematic due to aggregation bias [69]. As clearly stated in Additional file 2 (simple meta-regression in Section 3), this method has low power to detect any relationship when the number of studies is small.
A more complex issue which is beyond the scope of the current article is the intrinsic problems in the methodology of RCTs [70]. These problems tend to reduce the effect size for a number of reasons, with most prominent being the quality of recruited patients and the problems with the quantification of psychiatric symptoms, including the psychometric properties of the scales used. Even the concept of 'severity' is not satisfactorily studied. For example, some items like 'depressed mood' manifest a ceiling effect as severity grows while others like 'suicidality' manifest a floor effect as severity is reduced [71-81]. Both the HDRS and the MADRS describe a construct of depression which corresponds poorly to that defined by the DSM-IV and ICD-10 and include items corresponding to non-specific symptoms (e.g. sleep, appetite, anxiety; they might respond to a variety of non-antidepressant agents) or even side-effects (e.g. somatic symptoms) [77,78,82]. Also, it is obvious that the last observation carried forward method significantly contaminates efficacy with tolerability. However, no other results are usually available to analyse. Taking together that in many RCTs, agents like benzodiazepines are permitted in the placebo arm, the final score might not reflect the actual effect of the drug vs. placebo per se but somehow the add-on value of antidepressants on benzodiazepines. The RCTs are necessary for the licensing of drugs as safe and effective by the FDA, the EMEA, the MHRA, etc., but their usefulness should not be overstated, and their data should not be overused. Maybe it is time the raw data to be in the public domain, at least for products whose patent has expired. The way the lay press and especially the way medical scientists write for the lay press concerning antidepressants [83,84] cannot be considered in any other way but as being a reflection of a new type of stigma for depressed patients.
The results of the current study also suggest there is no 'year' effect; however, the changing severity of patients recruited over the years might result in a change in the observed difference between placebo and active drug. This is largely in accord with the conclusions of Undurraga and Baldessarini [9].
The series of meta-analysis performed during the last decade made antidepressants maybe the best meta-analytically studied class of drugs in the whole of medicine. The results of the current analysis conclude the debate and suggest that antidepressants are clearly superior to placebo, and their efficacy is unrelated to initial severity. Thus, there is no scientific ground to deny mildly depressed patients the use of antidepressants, especially since they constitute the best validated treatment option for depression.
Competing interests
KNF has received support concerning travel and accommodation expenses from various pharmaceutical companies in order to participate in medical congresses. He has also received honoraria for lectures from Astra-Zeneca, Janssen-Cilag, Eli-Lilly and a research grant from Pfizer Foundation. MS has received support concerning travel and accommodation expenses from various pharmaceutical companies. HJM has received grants or is a consultant for and on the speakership bureaus of AstraZeneca, Bristol-Myers Squibb, Eisai, Eli Lilly, GlaxoSmithKline, Janssen Cilag, Lundbeck, Merck, Novartis, Organon, Pfizer, Sanofi-Aventis, Schering-Plough, Schwabe, Sepracor, Servier and Wyeth. AAV has no competing interest.
Authors' contributions
KNF and HJM designed the study, wrote the first draft and the shaped the final draft. AAV made the analysis, wrote the additional files and interpreted the results. MS participated in writing all drafts and organized the material. All authors read and approved the final manuscript.
No funding was available for the current study from any source. Areti Angeliki Veroniki received funding from the European Research Council (IMMA, Grant nr 260559).
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Horder J, Matthews P, Waldmann R: Placebo, prozac and PLoS: significant lessons for psychopharmacology.
J Psychopharmacol 2011, 25(10):1277-1288. PubMed Abstract | Publisher Full Text
Khan A, Warner HA, Brown WA: Symptom reduction and suicide risk in patients treated with placebo in antidepressant clinical trials: an analysis of the Food and Drug Administration database.
Arch Gen Psychiatry 2000, 57(4):311-317. PubMed Abstract | Publisher Full Text
Barrett JE, Williams JW Jr, Oxman TE, Frank E, Katon W, Sullivan M, Hegel MT, Cornell JE, Sengupta AS: Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years.
J Fam Pract 2001, 50(5):405-412. PubMed Abstract
DeRubeis RJ, Hollon SD, Amsterdam JD, Shelton RC, Young PR, Salomon RM, O'Reardon JP, Lovett ML, Gladis MM, Brown LL, Gallop R: Cognitive therapy vs medications in the treatment of moderate to severe depression.
Arch Gen Psychiatry 2005, 62(4):409-416. PubMed Abstract | Publisher Full Text
Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK, Atkins DC, Dunner DL: Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression.
J Consult Clin Psychol 2006, 74(4):658-670. PubMed Abstract | Publisher Full Text
Elkin I, Shea MT, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP: National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments.
Arch Gen Psychiatry 1989, 46(11):971-982.
discussion 983PubMed Abstract | Publisher Full Text
Philipp M, Kohnen R, Hiller KO: Hypericum extract versus imipramine or placebo in patients with moderate depression: randomised multicentre study of treatment for eight weeks.
BMJ 1999, 319(7224):1534-1538. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Khan A, Khan SR, Leventhal RM, Krishnan KR, Gorman JM: An application of the revised CONSORT standards to FDA summary reports of recently approved antidepressants and antipsychotics.
Biol Psychiatry 2002, 52(1):62-67. PubMed Abstract | Publisher Full Text
Huedo-Medina T, Johnson B, Kirsch I: Kirsch et al. (2008) calculations are correct: reconsidering Fountoulakis & Moller's re-analysis of the Kirsch data.
Int J Neuropsychopharmacol 2012, 15:1193-1198. PubMed Abstract | Publisher Full Text
Caldwell DM, Ades AE, Higgins JP: Simultaneous comparison of multiple treatments: combining direct and indirect evidence.
BMJ 2005, 331(7521):897-900. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Cooper NJ, Peters J, Lai MC, Juni P, Wandel S, Palmer S, Paulden M, Conti S, Welton NJ, Abrams KR, Bujkiewicz S, Spiegelhalter D, Sutton AJ: How valuable are multiple treatment comparison methods in evidence-based health-care evaluation?
Value Health 2011, 14(2):371-380. PubMed Abstract | Publisher Full Text
Mills EJ, Ghement I, O'Regan C, Thorlund K: Estimating the power of indirect comparisons: a simulation study.
PLoS One 2011, 6(1):e16237. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
White IR: Multivariate random-effects meta-regression: updates to mvmeta.
Salanti G, Ades AE, Ioannidis JP: Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial.
J Clin Epidemiol 2011, 64(2):163-171. PubMed Abstract | Publisher Full Text
Lambert P, Eilers PH: Bayesian proportional hazards model with time-varying regression coefficients: a penalized Poisson regression approach.
Stat Med 2005, 24(24):3977-3989. PubMed Abstract | Publisher Full Text
Lambert PC, Sutton AJ, Burton PR, Abrams KR, Jones DR: How vague is vague? A simulation study of the impact of the use of vague prior distributions in MCMC using WinBUGS.
Stat Med 2005, 24(15):2401-2428. PubMed Abstract | Publisher Full Text
Friedrich JO, Adhikari NK, Beyene J: Ratio of means for analyzing continuous outcomes in meta-analysis performed as well as mean difference methods.
J Clin Epidemiol 2011, 64(5):556-564. PubMed Abstract | Publisher Full Text
Higgins J, Green S: Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration; 2011.
http://www.cochrane-handbook.org webcite
Sutton AJ, Abrams KR: Bayesian methods in meta-analysis and evidence synthesis.
Stat Methods Med Res 2001, 10(4):277-303. PubMed Abstract | Publisher Full Text
Sharp SJ, Thompson SG: Analysing the relationship between treatment effect and underlying risk in meta-analysis: comparison and development of approaches.
Stat Med 2000, 19(23):3251-3274. PubMed Abstract | Publisher Full Text
Thompson SG, Smith TC, Sharp SJ: Investigating underlying risk as a source of heterogeneity in meta-analysis.
Stat Med 1997, 16(23):2741-2758. PubMed Abstract | Publisher Full Text
Salanti G, Ades AE, Ioannidis JP: Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial.
J Clin Epidemiol 2010, 64(2):163-171. PubMed Abstract | Publisher Full Text
Deeks JJ: Issues in the selection of a summary statistic for meta-analysis of clinical trials with binary outcomes.
Stat Med 2002, 21(11):1575-1600. PubMed Abstract | Publisher Full Text
Engels EA, Schmid CH, Terrin N, Olkin I, Lau J: Heterogeneity and statistical significance in meta-analysis: an empirical study of 125 meta-analyses.
Stat Med 2000, 19(13):1707-1728. PubMed Abstract | Publisher Full Text
Kirsch I: Placebo psychotherapy: synonym or oxymoron?
J Clin Psychol 2005, 61(7):791-803. PubMed Abstract | Publisher Full Text
Kirsch I: Conditioning, expectancy, and the placebo effect: comment on Stewart-Williams and Podd (2004).
Psychol Bull 2004, 130(2):341-343.
discussion 344–345PubMed Abstract | Publisher Full Text
Kirsch I, Johnson BT: Moving beyond depression: how full is the glass?
BMJ 2008, 336(7645):629-630. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Kirsch I: Antidepressant drugs 'work' , but they are not clinically effective.
Kirsch I: Challenging received wisdom: antidepressants and the placebo effect.
Mcgill J Med 2008, 11(2):219-222. PubMed Abstract | PubMed Central Full Text
Kirsch I, Moncrieff J: Clinical trials and the response rate illusion.
Contemp Clin Trials 2007, 28(4):348-351. PubMed Abstract | Publisher Full Text
Fountoulakis KN, Moller HJ: Antidepressant drugs and the response in the placebo group: the real problem lies in our understanding of the issue.
J Psychopharmacol 2011, 26(5):744-750. PubMed Abstract | Publisher Full Text
Fountoulakis K, Möller H: Antidepressants vs. placebo: not merely a quantitative difference in response.
Int J Neuropsychopharmacol 2011, 14:1435-1437. Publisher Full Text
Glenny AM, Altman DG, Song F, Sakarovitch C, Deeks JJ, D'Amico R, Bradburn M, Eastwood AJ: Indirect comparisons of competing interventions.
Health Technol Assess 2005, 9(26):1-134.
iii-ivPubMed Abstract | Publisher Full Text
Song F, Altman DG, Glenny AM, Deeks JJ: Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta-analyses.
BMJ 2003, 326(7387):472. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Song F, Loke YK, Walsh T, Glenny AM, Eastwood AJ, Altman DG: Methodological problems in the use of indirect comparisons for evaluating healthcare interventions: survey of published systematic reviews.
BMJ 2009, 338:b1147. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Leucht S, Hierl S, Kissling W, Dold M, Davis JM: Putting the efficacy of psychiatric and general medicine medication into perspective: review of meta-analyses.
Br J Psychiatry 2012, 200(2):97-106. PubMed Abstract | Publisher Full Text
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Tarr GP, Glue P, Herbison P: Comparative efficacy and acceptability of mood stabilizer and second generation antipsychotic monotherapy for acute mania - a systematic review and meta-analysis.
Yildiz A, Vieta E, Leucht S, Baldessarini RJ: Efficacy of antimanic treatments: meta-analysis of randomized, controlled trials.
Neuropsychopharmacology 2011, 36(2):375-389. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Leucht S, Arbter D, Engel RR, Kissling W, Davis JM: How effective are second-generation antipsychotic drugs? A meta-analysis of placebo-controlled trials.
Mol Psychiatry 2009, 14(4):429-447. PubMed Abstract | Publisher Full Text
Oldham P: A note on the analysis of repeated measurements of the same subjects.
J Chronic Dis 1962, 15:969-977. PubMed Abstract | Publisher Full Text
Tu YK, Maddick IH, Griffiths GS, Gilthorpe MS: Mathematical coupling can undermine the statistical assessment of clinical research: illustration from the treatment of guided tissue regeneration.
J Dent 2004, 32(2):133-142. PubMed Abstract | Publisher Full Text
Cuijpers P, Van Straten A, Van Oppen P, Andersson G: Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies.
J Clin Psychiatry 2008, 69(11):1675-1685.
quiz 1839–1641PubMed Abstract | Publisher Full Text
Blomqvist N: On the relation between change and initial value.
Jin P: Toward a reconceptualization of the law of initial value.
Psychol Bull 1992, 111:176-184. PubMed Abstract | Publisher Full Text
Goodman SN: Toward evidence-based medical statistics. 2: the Bayes factor.
Ann Intern Med 1999, 130(12):1005-1013. PubMed Abstract | Publisher Full Text
Goodman SN: Toward evidence-based medical statistics. 1: the P value fallacy.
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Johnson SR, Tomlinson GA, Hawker GA, Granton JT, Feldman BM: Methods to elicit beliefs for Bayesian priors: a systematic review.
J Clin Epidemiol 2009, 63(4):355-369. PubMed Abstract | Publisher Full Text
Gibbons RD, Hur K, Brown CH, Davis JM, Mann JJ: Benefits from antidepressants: synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine.
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Melander H, Salmonson T, Abadie E, Van Zwieten-Boot B: A regulatory apologia–a review of placebo-controlled studies in regulatory submissions of new-generation antidepressants.
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Petkova E, Tarpey T, Huang L, Deng L: Interpreting meta-regression: application to recent controversies in antidepressants' efficacy.
Stat Med 2013, 32(17):2875-2892. PubMed Abstract | Publisher Full Text
Turner EH, Rosenthal R: Efficacy of antidepressants.
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Bech P: Rating scales for affective disorders: their validity and consistency.
Acta Psychiatr Scand Suppl 1981, 295:1-101. PubMed Abstract
Bech P: Assessment scales for depression: the next 20 years.
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Bech P: The instrumental use of rating scales for depression.
Pharmacopsychiatry 1984, 17(1):22-28. PubMed Abstract | Publisher Full Text
Bech P: Rating scales in psychopharmacology. Statistical aspects.
Acta Psychiatr Belg 1988, 88(4):291-302. PubMed Abstract
Bech P: Rating scales for mood disorders: applicability, consistency and construct validity.
Acta Psychiatr Scand Suppl 1988, 345:45-55. PubMed Abstract
Bech P: Psychometric developments of the Hamilton scales: the spectrum of depression, dysthymia, and anxiety.
Psychopharmacol Ser 1990, 9:72-79. PubMed Abstract
Bech P: Modern psychometrics in clinimetrics: impact on clinical trials of antidepressants.
Psychother Psychosom 2004, 73(3):134-138. PubMed Abstract | Publisher Full Text
Bech P: Rating scales in depression: limitations and pitfalls.
Dialogues Clin Neurosci 2006, 8(2):207-215. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
Bech P: Applied psychometrics in clinical psychiatry: the pharmacopsychometric triangle.
Acta Psychiatr Scand 2009, 120(5):400-409. PubMed Abstract | Publisher Full Text
Bech P, Allerup P, Gram LF, Reisby N, Rosenberg R, Jacobsen O, Nagy A: The Hamilton depression scale. Evaluation of objectivity using logistic models.
Acta Psychiatr Scand 1981, 63(3):290-299. PubMed Abstract | Publisher Full Text
Bech P, Gram LF, Dein E, Jacobsen O, Vitger J, Bolwig TG: Quantitative rating of depressive states.
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Bagby RM, Ryder AG, Schuller DR, Marshall MB: The Hamilton Depression Rating Scale: has the gold standard become a lead weight?
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The Epidemic of Mental Illness: Why? http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/?pagination=false webcite
The Illusions of Psychiatry http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/?pagination=false webcite


text:
Histopolis sorts surnames ignoring any capitalization, spaces, accents or punctuation
in the name. Histopolis sorts
Mac Collum
as "maccollum" and the following surnames sort the same way (meaning
they are spelled the same but differ only by capitalization, spaces, accents or punctuation).
Accoring to the US Census Bureau, MacCollum ranked #149,328 in frequency out of 151,671 surnames for which statistics were released from the 2000 Census. 101 people, or approximately 1 in every 2,670,912 individuals in the US had this surname in 2000.
Source: "Genealogy
Data: Frequently Occurring Surnames from Census 2000", US Census Bureau.
Histopolis currently has
1 grave(s) with the surname
Mac Collum.
Search the
Histopols Grave Index
for the surname
Mac Collum.
The surname
Mac Collum
has a Soundex code of
M245. The following
surname(s) may sound similar to
Mac Collum
since they share the same Soundex code.

subset: commoncrawl


text:
Main page
Linux in the news
Back page
All in one big page
See also: last week's Distributions page.
Please note that security updates from the various distributions are covered in the security section.
Caldera OpenLinuxCaldera's mailing lists are back in action as of September 25. Caldera switched the lists over to ezmlm as they were fixing their problems, and it appears that not all subscribers from the old lists got set up on the new ones. If you were a subscriber to a Caldera mailing list, and you are still not getting anything, it's time to head over to the "User to User Forums" page and resubscribe.
Macmillan and Caldera Systems have teamed up to form "Caldera Press." This new publishing operation will concentrate on business-oriented titles.
Conectiva LinuxThe Conectiva Road Show started off on September 23rd, in Caracas, Venezuela with the announcement of the release of the Spanish version of their CL-4.0 and CL- Server Edition packages. The road show will hit the US, Colombia, Peru, Mexico, Chile and Argentina. Conectiva Linux is a Red Hat-derived and compatible distribution. "Sandro Henrique, Conectiva's commercial director, believes that the interest for Linux by Latin American countries denotes similar motives as the Brazilian consumers: 'Low purchase power, anti-fraud laws, and a strong desire to improve the platform, which is causing companies and users to migrate.' "
Debian GNU/LinuxWhere are Debian developers? All over, according to the Debian developers location map. There are still many developers who remain unrepresented, however; if you hack on Debian you may want to consider adding your location to the list.
Linux-MandrakeLinuxcare and Macmillan have announced a deal wherein Linuxcare will provide support for Macmillan's (Mandrake-based) Linux distribution.
Mandrake's internationalization efforts continue as demonstrated by this announcement of support for Lithuanian and Estonian...
Red Hat LinuxRed Hat 6.1 will be released on Monday, October 4, if this TechWeb article is to be believed. "Red Hat Linux 6.1... will feature a streamlined installation, online software updates, and enhancements for managing distributed computing architectures..."
Red Hat certification in the UK. Red Hat has announced the establishment of a London training facility which is able to administer the Red Hat Certified Engineer exam. Courses begin in October.
Slackware LinuxJoe Orton points out that the current Slackware change logs show a new addition - the whole set of GNOME libraries and utilities.
SuSE LinuxSuSE has reworked its web sites on both www.suse.de and www.suse.com. The old world map is gone... Some pages have moved, so if you have a site with links into SuSE's pages, you may want to give them a quick check.
Along those lines, the SuSE partner page has moved, and no longer can be found at the location we published in last week's LWN.
Section Editor: Liz Coolbaugh
September 30, 1999
Lists of Distributions


text:
Would you like a music category in the forums?, Discussion of genres/artists/albums..
- No Warez. This includes warez links, cracks and/or requests for help in getting illegal software or copyrighted music tracks!
- No Spamming or Trolling on the boards, this includes useless posts, trying to only increase post count or trying to deliberately create a flame war.
- No Hateful or Disrespectful posts. This includes: bashing, name-calling or insults directed at a board member.
- Click here for complete Hydrogenaudio Terms of Service
Would you like a music category in the forums?, Discussion of genres/artists/albums..
Jul 18 2003, 22:23
Post #1
Group: Admin
Posts: 2958
Joined: 26-August 02
From: Nottingham, UK
Member No.: 1
Like the topic says. We're thinking of adding a few new forums to the site, and this is one of the ideas that has come up multiple times. What do you guys think? Obviously this would not be a trading community of any sort, it'd just be for discussion of music related issues that are normally outside the scope of other HA topics. It seems that there have been an increasing number of these topics being made in the off-topic section to the point where they may warrant their own special forum even.
Jul 18 2003, 22:26
Post #2
Group: Members (Donating)
Posts: 676
Joined: 5-June 02
From: New York
Member No.: 2224
Good idea, Dibrom.
Being that this is an audio website, everybody here seems to have a greater interest in music than most people I have met on the street. A forum would be a great way to discuss music in general, old and new bands, and would probably introduce people to new music that they hadn't previously heard of/considered listening to. I'm for it!
|Lo-Fi Version
|Time is now: 25th November 2015 - 21:42


text:
id you think there wouldn't be a lot of Magic happening at PAX Prime? That's crazy! Why would you think that? It's in Seattle, which is very close to Wizards of the Coast's headquarters. Some of us (like me!) actually drive past the Convention Center every day on our way to work. It's going to be full of Magic!
So let's take a look at some of the action that will fill the Washington State Convention Center in Seattle, Washington from August 26-28!
You'll definitely want to stop by the Wizards of the Coast booth to get your first look at the expansion for Duels of the Planeswalkers 2012. And there's going to be a big party on Saturday night that will have Innistrad information that will blow your mind. But let's say you're not here for the big, exciting events. Why is that? What's the matter with you? Well, whatever it is, if it can be treated with Magic tournaments, you're in luck!
As soon as the hall opens, the Magic Into Pack league kicks off. And if you're playing in that, you get free entry into specified Standard tournaments. And there's a Commander League and Win-a-Box tournaments and, oh, just all sorts of tournaments. You should probably just look at the complete list of Paper Magic Tournaments.
PAX was created mostly for celebration of digital games, so of course Magic Online is going to be there. Magic 2012 Drafts and Sealed Deck tournaments will be going on all weekend. Whee!
Seriously, you definitely want to be at this party on the evening of Saturday, August 27. You'll be able to earn an invitation by participating in PAX Prime. Stop by the Wizards of the Coast booth for details!
© 1995-2015 Wizards of the Coast LLC, a subsidiary of Hasbro, Inc. All Rights Reserved.
Terms of Use | Privacy Statement | Code of Conduct


text:
The entire Shadow Cabinet should be forced to drink Waitrose's free coffee
Ed Miliband's more-Blairite-than-Blair triumph of breaking the power of the trade union bosses in the Labour Party was nearly overshadowed by a silly row about Waitrose's free coffee.
Andy Sawford, a Labour frontbencher, criticised Waitrose for giving its customers free coffee (scroll down), because it undercuts coffee shops and "is acting in a way that will [...]
By John Rentoul | Eagle Eye | Sunday, 2 March 2014 at 11:57 am
Blairite for Cameron
As a result of my lukewarm welcome for Ed Miliband's pitch to the middle classes on Tuesday, Alex Massie commented on Twitter that he didn't see how I was going to be able to bring myself to vote for a party led by Ed Miliband.
Nonsense, I said. I live in a constituency represented by a fine [...]
By John Rentoul | Eagle Eye | Friday, 17 January 2014 at 1:46 pm
What is a Blairite?
My esteemed colleague Steve Richards, writing in a rival newspaper, says that Blairites "do not exist". I was ready to text him with a polite "ahem", when I realised that he had specifically included me (and Tony Blair) in the category of non-existent Blairites.
I am thus forced to set out my rather inadequate definition of [...]
By John Rentoul | Eagle Eye | Wednesday, 9 October 2013 at 10:54 am
When I Ruled the World
Modesty restrained me from further advertising my billing as "the world's leading Blairite" by my esteemed colleague Steve Richards in The Independent last month, but let us lift the bushel:
It is easy to imagine some of Cameron's advisers working for Blair and vice versa. Take a look at a quartet of brilliant columnists. The writer [...]
By John Rentoul | Eagle Eye | Tuesday, 9 July 2013 at 2:47 pm
Latest from Independent journalists on Twitter


text:
Barbara J. Saint André, Principal
BARBARA J. SAINT ANDRÉ's practice focuses on municipal law, land use and zoning, housing, and civil litigation. Prior to joining Petrini & Associates, Ms. Saint André was a principal at Kopelman and Paige, P.C., where she practiced for 21 years as counsel to numerous cities and towns across the Commonwealth. Ms. Saint André has extensive experience in all areas of municipal law, particularly in land use areas such as subdivision control, zoning, comprehensive permits, public health, wetlands protection, Chapter 40R, enforcement and permitting. She has represented dozens of communities across the state as town counsel, providing advice in all aspects of municipal law including town meetings, licensing, appellate tax board, municipal finance, open meeting law, contracts, conflict of interest, real estate, and general municipal law. She has represented cities and towns in every court of the Commonwealth, including arguing cases before the Supreme Judicial Court and Appeals Court, as well as the federal courts.
Ms. Saint André has served as a speaker on both land use and general municipal topics at forums sponsored by Massachusetts Continuing Legal Education, Massachusetts Bar Association, Massachusetts Municipal Management Association, Massachusetts Health Officers Association, Massachusetts Association of Planning Directors, Massachusetts Chapter of The National Association of Housing & Redevelopment Officials, and regional planning agencies. She has taught a number of land use courses for the Massachusetts Citizen Planner Training Collaborative on zoning and subdivision issues. Many of these speaking engagements were in relation to the comprehensive permit law, Chapter 40B, an area in which she has been representing cities and towns for over 20 years.
Prior to working at Kopelman and Paige, Ms. Saint André worked at Murphy, Lamere, and Murphy for three years in the areas of municipal law, litigation, and labor law. She graduated cum laude from Suffolk University Law School in 1981, and received her B.S. in Government summa cum laude from Suffolk University in 1979. Upon graduation from law school, she served as a judicial law clerk for the Justices of the Massachusetts Superior Court. She was an elected Town Meeting Member in her hometown for 20 years, a member of the Housing Authority for nine years, and served on other town committees, including the Finance Committee.
Ms. Saint André is admitted to practice in the Commonwealth of Massachusetts, the United States District Court for the District of Massachusetts, and the United States Courts of Appeals for the First Circuit and the District of Columbia and the United States Supreme Court.


text:
Face to face with the future
In August, Research invited six young researchers to join a round table discussion about what it's like coming into the industry. We asked them to talk about their first jobs in the business, what they love about the work and to share some words of advice for this year's intake of graduates.
Watch the video and then check out the discussion transcript here.


text:
|Nationwide Experience of Cardio- and Cerebrovascular Complications During Infrainguinal Endovascular Intervention for Peripheral Arterial Disease and Acute Limb Ischaemia.
MedLine Citation:
|PMID: 23333098 Owner: NLM Status: Publisher
|OBJECTIVES: Endovascular treatment for peripheral arterial disease (PAD) is increasingly used and also continuously applied to more severe vascular pathology. Only few studies report on systemic complications during these procedures, but it is important to address these risks. We report the results of a recent national audit on cardio- and cerebrovascular complications after endovascular procedures for PAD. METHODS: Data from the Swedish Vascular Registry (Swedvasc) were retrieved on all infrainguinal endovascular procedures performed between May 2008 and December 2011. A total of 9187 cases were analysed regarding the prevalence of myocardial infarction and major stroke within 30 days post-intervention. A literature review in PubMed and Cochrane databases was conducted. RESULTS: The risk of myocardial infarction was 0.3% in intermittent claudication, 1.2% in critical limb ischaemia and 1% in acute limb ischaemia. Corresponding risk of major stroke was 0.4%, 0.3% and 1.4%. Thrombolytic therapy was associated with a threefold risk of major stroke. Only a few studies relevant to the subject were found during the literature review. CONCLUSIONS: In this population-based study we found a low risk of cardiac complications, but catheter-administered thrombolytic therapy entailed a non-negligible risk of major stroke.
|J Nordanstig; K Smidfelt; M Langenskiöld; B Kragsterman
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Publication Detail:
|Type: JOURNAL ARTICLE Date: 2013-1-17
Journal Detail:
|Title: European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery Volume: - ISSN: 1532-2165 ISO Abbreviation: Eur J Vasc Endovasc Surg Publication Date: 2013 Jan
Date Detail:
|Created Date: 2013-1-21 Completed Date: - Revised Date: -
Medline Journal Info:
|Nlm Unique ID: 9512728 Medline TA: Eur J Vasc Endovasc Surg Country: -
Other Details:
|Languages: ENG Pagination: - Citation Subset: -
Copyright Information:
|Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
|Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden. Electronic address: firstname.lastname@example.com.
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Citrus flavonoid naringenin inhibits TLR2 expression in adipocytes.
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text:
November 30, 2015
AP - Brandon Webb, who won the NL Cy Young Award in 2006 and was one of the top pitchers in baseball before being beset by arm injuries, is retiring.
The right-hander's agents, Mike Montana and Jonathan Maurer of Millennium Sports Management, confirmed Monday night that Webb was calling it a career.
The 33-year-old Webb hasn't pitched in the majors since 2009 because of shoulder problems. He came up with Arizona in 2003 and had a 2.84 ERA in 180 innings. He pitched more than 200 innings each of the next five seasons, using his heavy sinker to win a Cy Young and earn three All-Star selections.
He threw four innings with the Diamondbacks in 2009. In 2011, he signed with the Texas Rangers, but never pitched in a regular-season game.
Click Here to access the online Public Inspection File
Viewers with disabilities can get assistance accessing this station's FCC Public Inspection File by contacting the station with the information listed below. Questions or concerns relating to the accessibility of the FCC's online public file system should be directed to the FCC at 888-225-5322, 888-835-5322 (TTY), or email@example.com.


text:
Get the latest Flash player
Date: 3 years ago
Runtime: 11:24
Views: 65,304
Top Comments
All Comments
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ja, genau so läuft es! sehr geil. da muss ich unbedingt mal dabei sein! ficken=1!
oué oué putain les keums, ça pilonne grave le trou de la pute crado, bonnard
wish he was my master. would love to be owned by him
Wonderfull couple! his face look so pretty when he is over his partner taking control of his body fucking him in everyposition posible and then his partner is willing to take his load in his mouth and he go on fucking him to he cums too. that's awesome
trop bien........
Super hot videos
frank-willy's cock deserves at least ten slaves to worship it constantly!


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Les Claypool is a part of a new project called "Duo de Twang" and they put together a cover of Alice In Chains "Man In A Box", which you can enjoy here.
Tag Archives: alice in chains
ALICE IN CHAINS Release Two New Music Videos
Alice in Chains have released not one but TWO new music videos for your viewing pleasure! The videos are for the tracks "The Devil Put Dinosaurs Here" and "Voices", both off of their most recent effort The Devil Put Dinosaurs Here. You can check out both of them after the jump.
ALICE IN CHAINS Release New Lyric Video
Alice in Chains have released a new lyric video for their track "Voices", which comes from the band's new record The Devil Put Dinosaurs Here. The video cycles through images of faceless figures while the song's lyrics appear on screen. It's a little underwhelming but aren't most lyric videos? You can view the video below if you desire.
There Must Be Blood: Long Lost BL'AST! Album To Be Released!
BL'AST! are a legend in the hardcore community and they remain as a mainstay of hardcore music even today. BL'AST! called it quits after the release of their 1989 album Take The Manic Ride and nothing new was heard from the band after that. Until now, that is.
Earlier this year, BL'AST! guitarist Mike Neider contacted Southern Lord Records/SUNN O))) member Greg Anderson and notified him that Mike had discovered some never-before-heard BL'AST! master tapes in a locker. Greg handed the material off to master producer and BL'AST! maniac fan Dave Grohl (Nirvana, Foo Fighters) to do his magic. Continue reading
Review: ALICE IN CHAINS-"The Devil Put Dinosaurs Here"
By Lane Oliver
When Alice in Chains announced they were working on new material back around 2008 with new vocalist William DuVall, a lot of people were skeptical including me. I pondered how will Alice in Chains sound after over a decade between albums and with someone other than the late great Layne Staley on vocals. 2009's Black Gives Way to Blue shattered all denial for me and confirmed that after all of these years the band still had it. I can't necessarily compare DuVall era Alice to Staley era Alice since they are both their own respective entities. Black Gives Way to Blue showed us a band that did not want to reunite just revel in their former glory; it showed us a hard working band who is interested in moving forward. Four years later Alice in Chains give us The Devil Put Dinosaurs Here; the fifth full length album from the band. This highly anticipated record had a lot riding on it since it being the follow up to a pretty solid comeback album. So is The Devil Put Dinosaurs Here a big step forward or two steps back?
Cold, Dry, Stone: ALICE IN CHAINS Release New Lyric Video
Fucking incredible. That's what I thought about Alice In Chains' first single off of their new album The Devil Put Dinosaurs Here. When "Hollow" was released, I was taken aback, for I had not even dabbled in the band's previous album Black Gives Way To Blue. I fell in love with "Hollow" and now I have fallen for another new song called "Stone." Continue reading
The Devil Put This Album Title Here: ALICE IN CHAINS Reveal Upcoming Album Title
Alice in Chains have revealed the title for their highly anticipated new album, which will be released sometime in May. The band have assigned the title The Devil Put Dinosaurs Here to the new effort. It's obviously supposed to be humorous and I am cool with that. It's still a little surprising coming from then. Then again, they did have a record simply titled Dirt. I honestly have heard far worse titles from death metal bands. Silly album titles aside I am really looking forward to new music from them. Check out the video for their track "Hollow" below.
Don't Be Weird, Watch This New ALICE IN CHAINS Video
Remember that cool fan-made music video for Alice In Chains' "Hollow?" You should because it was great. Not only was it a really awesome video, the song is incredibly infectious. I cannot get it out of my head. Ever. Well, luckily for me and everyone else, the track has finally been released digitally and you can download it here. Not only that, Alice In Chains have also released an official music video for "Hollow!" Continue reading
Hollow As A Mountain: ALICE IN CHAINS Release New Lyric Video
Well, well, well. This is pretty great. I have expressed my undying love for Layne Staley-era Alice In Chains before but I don't think I ever expressed me feelings about the last record, and William DuVall's vocal debut, Black Gives Way To Blue. When it was first released, I didn't listen to it. I couldn't. Layne Staley was one of the greatest vocalists of all time and seeing Alice In Chains push on just didn't settle right with me. I finally did listen to Black Gives Way To Blue and it's not bad. Not bad at all, actually. William DuVall has an amazing voice and he is clearly influenced by Layne's vocal styling.
Well, a new Alice In Chains song has surfaced and it is absolutely beautiful. Continue reading
Don't You Dare Smile: SMILE EMPTY SOUL Cover ALICE IN CHAINS
If any of you listened to rock radio in the early 2000s then you probably (at some point) heard Smile Empty Soul's hit single "Bottom Of A Bottle." Smile Empty Soul is a band that I thought long gone. I haven't heard anything about the band since, like, 2004. Well, apparently they are still going strong and they released a new album back in May on eOne Music. That's not the point of this post, however because I care nothing about this band. The point of this post is that Smile Empty Soul along with HURT have recorded a cover of the Alice In Chains classic "No Excuses." Continue reading
OCTOBER STAFF PICKS: Lane's Three Albums To Kill Yr Idols To
These are three album that I have been listening to a lot lately and I hope you thoroughly hate them. Wink Wink.
Sonic Youth-Confusion is Sex [Plus Kill Yr Idols]
Ah, Sonic Youth's first full length record Confusion is Sex (more so the 1995 re-release with Kill Yr Idols) will always be one of my favorites of theirs. The entire album is is dissonant, nearly inharmonious sounding (due to the usage of prepared guitars with screwdrivers) and overall unnerving to listen to at times. It is one of the most important album in the No Wave and noise rock scene and still sounds fresh today in my opinion. We need more unique sounding bands like Sonic Youth today and I really wish they would release something new. But until then, if it ever happens, I will be listening to them extensively. Especially this record.
Got It Covered…
The first in this edition of Got It Covered… we have a doozy from psychopathic grinders Ed Gein. This track is a cover of the classic Nirvana song which is one of my personal favorites. Ed Gein, of course, put their own spin on this track but it still maintains that Nirvana edge to it. Pretty great. One of my favorite covers.
Bring Me The Horizon Kill Slipknot (song)
Okay, not literally, but emotionally, they killed the song "Eyeless" off of Slipknot's debut album, Slipknot. Now, seeing as I utterly despise BMTH, it is not hard to believe that I am just now hearing this track off of BMTH's (also) debut album Count Your Blessings. I can't say I am really surprised by the fact that they covered (or should I say butchered) a Slipknot song, but it brings to mind the question of "Why?" With so many scene bands out there putting out horrible music, couldn't Good Ole' Olli pick a song that better suit the band instead of one that came of of, at least to me, an album that served as the gateway to Nu-Metal. I remember listening to Slipknot in Spanish class every day for a year. I loved that album. To this day, it is my favorite Slip' album (although I stopped listening half-way through Vol. 3). So again I ask, why are these new, trendy, skinny jeans wearing bands ATTEMPTING to cover songs from the good old days? Suicide Silence's "Engine No. 9"? Okay, that sucked, but I dealt with it. When they covered "Them Bones," that was the final straw. I have never been a big fan of Suicide Silence either, so it wasn't hard to be turned off by these abominations. Now BMTH kills a Slipknot song and I know this won't be the end of it. Have you heard any more scene bands covering classic or at least decent songs from back in the dizay? e-mail me and let me know. Here is BMTH's cover of "Eyeless" via Youtube.
No scene kids were hurt in the typing of this post.


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Stink bugs swarm over and feed on a nectarine.
- Filed Under
The stink bugs are back with a vengeance, and the USA could be heading for the worst season for the pests on record, even surpassing the watershed year of 2010.
These smelly pests that first hitched a boat ride to the USA from Asia in the late 1990s have now been spotted in 40 states: "Their range has expanded dramatically recently, from coast to coast and from border to border," says University of Maryland entomologist Mike Raupp.
Though the bugs seemed to be everywhere in 2010, Raupp says this year will be "as bad or worse." Just two years ago, in 2011, they had only been seen in 33 states. ...


text: By-law Enforcement Body ContentMaking a Difference: a resident guide to By-law Enforcement Ever wonder what the rules are for parking on the street in front of your house? Thinking about installing a pool or hot tub and not sure what permits are required? Want to make sure you are meeting the standards for yard maintenance but not sure what they are? All of this information and much, much more can be found in one place – Making a Difference, an easy-to-use guidebook that is now available from Enforcement and By-law Services. Information is organized into sections that target each enforcement area including the home, yard, street, neighbourhood and park. Every resident plays a part in keeping Brampton safe and attractive. This guidebook can help all of us do our part to make a difference. City Hall Brampton Public Libraries Enforcement Services at 485 Chrysler Drive (southeast corner at Williams Parkway) To view it online, click here.


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Senate Democrats Defeat the Thune Gun-Rights AmendmentJuly 22, 2009 - by Donny Shaw
For the first time this session, Senate Democrats have successfully filibustered a Republican amendment to loosen federal gun laws. The Senate today voted 58-39 on Sen. John Thune's [R, SD] amendment to allow people who are legally allowed to carry concealed weapons in their home state to carry their weapons in any of the 48 states that have some form of concealed carry law. SIxty votes were needed for the amendment to pass.
The Associated Press called today's vote "a rare win for gun control advocates."
Twice already this session of Congress, the Democratically-controlled Senate voted in favor of Republican gun-rights amendments. In February, the Senate voted 62-36 to allow people to carry guns in Washington D.C. and in May they voted 67-29 to allow people to bring guns into national parks. But the Thune amendment is significantly broader than those amendments, and some Democrats who voted for the other pro-gun amendments were unwilling to vote in favor of Thune's. Paul Kane at the Washington Post says the amendment is "considered the most far reaching federal effort ever proposed to expand laws to allow weapons ownership."
The amendment was proposed as an add-on to the must-pass FY10 Department of Defense Authorizations Act (S. 1390).
Opponents of the amendment argued that it would let gun owners from states with more liberal gun laws, like Vermont or Florida, carry their guns into states that require more training and where it's much harder for a person to get a gun, like Massachusetts and New Jersey. "The passage of this amendment would have done more to threaten the safety of New Yorkers than anything since the repeal of the assault-weapons ban," Sen. Charles Schumer [D, NY] said after the vote. "If this had passed, it would have created havoc for law enforcement and endangered the safety of millions of New Yorkers. We will remain vigilant to prevent any legislation like this from passing in the future."
Two Republicans crossed party lines to vote with Democrats against the amendment. If both had voted with the rest of their party, the amendment would have passed. They are:
Sen. Richard Lugar [R, IN]
Sen. George Voinovich [R, OH]
Twenty Democrats joined the Republicans in voting for the amendment. They are:
Sen. Max Baucus [D, MT]
Sen. Evan Bayh [D, IN]
Sen. Mark Begich [D, AK]
Sen. Michael Bennet [D, CO]
Sen. Robert Casey [D, PA]
Sen. Kent Conrad [D, ND]
Sen. Byron Dorgan [D, ND]
Sen. Russell Feingold [D, WI]
Sen. Kay Hagan [D, NC]
Sen. Tim Johnson [D, SD]
Sen. Mary Landrieu [D, LA]
Sen. Blanche Lincoln [D, AR]
Sen. Ben Nelson [D, NE]
Sen. Mark Pryor [D, AR]
Sen. Harry Reid [D, NV]
Sen. Jon Tester [D, MT]
Sen. Mark Udall [D, CO]
Sen. Tom Udall [D, NM]
Sen. Mark Warner [D, VA]
Sen. Jim Webb [D, VA]
Noting Democratic Majority Leader Reid's "yes" vote, Glenn Thrush notes that "this is also a victory of sorts for Majority Leader Harry Reid, who was able to make a pro-gun vote to please the 2010 voters in Nevada without really facing any consequences in terms of actual policy."
Read all blog posts here, or subscribe to our RSS feed.


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The veteran journalist talks to Libby Powell about the dearth of tweeting Tuaregs, reporting war crimes and the scourge of guinea worm.
Filed in: Media
Big Bad World, political cartoons by polyp
Page 6 of 10
The veteran journalist talks to Libby Powell about the dearth of tweeting Tuaregs, reporting war crimes and the scourge of guinea worm.
Filed in: Media
Conservative Capitalism has won, time to say goodbye to the Age of Enlightenment says Anna Chen.
Filed in: Culture
Peru is said to be booming but the poor would never know it. Stephanie Boyd reports.
Inspiration, fears, and being drawn to Birmingham.
Filed in: And finally...
Indian shortlisted Booker prize author speaks to Amy Hall about inspiration (overrated) and constructing an off-world station for gun-lovers.
Filed in: And finally...
Zoe Leigh Smith reports on the tiny Caribbean island's strangling debt burden.
Wame Molefhe describes her joy as the first rains chase winter away.
Filed in: Botswana
How can Egyptians make sure last year's uprisings have a lasting legacy? Maria Golia looks forward.
Filed in: Egypt
With the presidential election looming, many Americans are finding their right to vote under assault says Mark Engler.
Filed in: United States
A new leftwing café gives Steve Parry a break from empty consumerism and massive cups.
Filed in: Steve Parry
It may seem counter-intuitive, but this is just one more reason for voting for Barack, says Mark Engler.
Filed in: Politics and United States
Videos from visionOntv's globalviews channel.
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|Effect of the addition of insulin-transferrin-selenium and/or L-ascorbic acid to the in vitro maturation of prepubertal bovine oocytes on cytoplasmic maturation and embryo development.
MedLine Citation:
|PMID: 20688373 Owner: NLM Status: In-Process
|This study examines the effects of adding insulin-transferrin-selenium (ITS) and/or L-ascorbic acid (ASC) to a conventional medium for maturing prepubertal calf oocytes on chromosome organization, cortical granule (CG) distribution, and embryo development to the blastocyst stage. Cumulus-oocyte complexes (COCs) were matured in medium TCM 199 containing PVA and EGF (control), and supplemented with ITS and/or ASC for 12 or 24 h at 38.5 °C in a 5% CO(2) atmosphere. Calf oocytes matured with ITS + ASC or ASC for 12 h showed significantly higher percentages of peripherally distributed CG (83.3% and 86.2% respectively) than control oocytes (71.4%) or those matured with ITS alone (71.4%). No effects on chromosome organization were detected. Conversely, 24 h of supplementation did not affect CG distribution patterns, while the addition of ASC gave rise to significantly higher percentages of oocytes showing a normal alignment of their chromosomes (72.9%) compared to controls (58.7%). At 48 hpi, similar cleavage rates were observed among treatments regardless of the treatment time. However, the presence of ITS + ASC for 12 h rendered significantly higher blastocyst rates than those recorded in the remaining groups. Supplementation for 24 h with ITS or ITS + ASC had no significant effects on the percentage of blastocysts obtained, while the presence of ASC significantly reduced the proportions of embryos developing to the blastocyst stage. Our data suggest that ITS plus L-ascorbic acid supplementation during the first 12 h of in vitro maturation improves cytoplasm maturation and the developmental competence of embryos produced from prepubertal calf oocytes.
|B Córdova; R Morató; D Izquierdo; T Paramio; T Mogas
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Publication Detail:
|Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2010-08-05
Journal Detail:
|Title: Theriogenology Volume: 74 ISSN: 1879-3231 ISO Abbreviation: Theriogenology Publication Date: 2010 Nov
Date Detail:
|Created Date: 2010-10-06 Completed Date: - Revised Date: -
Medline Journal Info:
|Nlm Unique ID: 0421510 Medline TA: Theriogenology Country: United States
Other Details:
|Languages: eng Pagination: 1341-8 Citation Subset: IM
Copyright Information:
|Copyright © 2010 Elsevier Inc. All rights reserved.
|Departament de Medicina i Cirurgia Animals, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Export Citation:
|APA/MLA Format Download EndNote Download BibTex
|MeSH Terms
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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Download This New Dating App, Your Love Life Will Thank You
With the launch of the Coffee Meets Bagel app, the love match is sent right to your iPhone or iPod, providing an on-the-go way to meet your potential match even on the busiest of days. Let's face it, it may be a better story to tell the grandkids that you "met at noon on a rainy day when you were both reaching for a kombucha tea," but we think "we met at noon when I finally got a chance to charge my phone because it died sometime between my five meetings that morning" sounds pretty darn sweet, too. Watch the demo below, download the new app now, and — bonus — check the site for details on how to win a $100 Uber prize in honor of this kickofff.


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With high temperatures and drought conditions in parts of the state, fire officials are warning about the risk of wildfires and urging people to be careful in dry areas.
Part of the state is still covered with green vegetation, which reduces the risk of fire, but the landscape can change quickly in a heat wave, said Tom Fasteland, a coordinator with the Minnesota Interagency Fire Center in Grand Rapids.
"You might start seeing some of that green vegetation start to die off," Fasteland said. "I think a lot of people are starting to see where their lawns, when they mow their lawns, that they're all turning brown. And that's again just a sign that their soils are very dry."
People should be careful in recreational parts of the state, he said. Areas around Bemidji, Detroit Lakes and Cass Lake are dry, and in parts of northern and central Minnesota the fire-danger rating is "high" or "very high."
The state Department of Natural Resources identified Bemidji as the city with the highest potential in Minnesota. The area received 1.5 inches of rain between July 1 and Friday, almost 5 inches less than the 6.3 inches that fall on average in August alone, the National Weather Service said.
The agency has been ramping up its staffing levels and watching for increased chances for wildfires, said Bemidji DNR Forester Jon Drimel. Officials are also on call at night in case a major fire flares up, he added.
The weekend weather might help ease fire risks.
If the area doesn't get enough rain, the state's Interagency Fire Center has the power to restrict campfires or cancel burning permits.
"This is a really key weekend," Fasteland said. "We'll see how widespread and how much rain we'll get."


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State Sen. Barbara Buono, the Democratic candidate for governor, meets with members of the New Jersey Education Association who were affected by superstorm Sandy, on Saturday at the Town and Country Inn in Keyport.
- Filed Under
Lois Flicek, a former teacher, fought back tears and dabbed her eyes with a napkin as she shared her traumatic experience of losing her Highlands apartment and seeing all of her belongings destroyed due to superstorm Sandy flooding.
Democratic gubernatorial candidate Barbara Buono met with members of the New Jersey Education Association who also were victims of superstorm Sandy on Saturday morning at the Town and Country Inn, here.
Buono shared her goal of offering more help to those who continue to struggle. ...


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New Hope in the Minefields
Page 3 of 5
Improving Creep and Probe
We believe three currently available technologies, when used together, could offer a 10- to 20-fold improvement over today's demining rate within the next two years. These technologies include detection by a variant of the electronic metal detector (called the meandering winding magnetometer); safe and swift excavation by a device called an air knife; and detonation by a cheap and easily deployed foam-like explosive. All three of these improved demining technologies still require field testing and refinement, but the development tasks look modest.The basic operating principle of the new meandering winding magnetometer (MWM) detector is the same as that of conventional metal detectors that use a pulsed-electromagnetic induction sensor. But whereas conventional detectors generate an electromagnetic field and sense if it is disturbed by conducting material in their path, MWM detectors generate a varying magnetic field that excites currents in metallic objects that align primarily in one direction and can be read by the detector. An MWM detector slightly larger than a conventional metal detector can thus obtain a crude hint of the size and shape of a buried metallic object by combining readouts of these so-called eddy currents. The MWM detector now being developed by Jentek Sensors Inc., of Brighton, Mass., can reportedly determine the rough size, shape, depth of burial, and type of material of the outer shell of a buried metal object. Laboratory evidence indicates that the device can provide enough information for an experienced operator to discern whether a buried object is mere clutter, a mine, or a larger piece of unexploded ordnance.
Field tests of a first-generation MWM prototype indicate that it can lower the false-alarm rate by a factor of 5 to 10 below that of a conventional metal detector. Given such discriminating power, a refined version of such an MWM device could reduce the time spent examining a square meter of scrap-rich ground from 10 to 20 minutes to a fraction of a minute.
Once a mine is detected, the air knife, now commercially available although not in field-ready form, offers a significant improvement in efficiency and safety over the stick commonly used in today's demining efforts. The air knife blows high-pressure air through a small hand-held probe and can blow away most dirt to expose mines without disturbing them enough to detonate them. Existing air knives are powered by a 3-horsepower gasoline engine, like those that run power lawnmowers, and cost a few thousand dollars. A version adapted for demining could replace the simplest manual probes, greatly speeding up a searcher's ability to expose a mine while improving safety at the same time by obviating the need to dig in the ground with a stick.
The use of the product Lexfoam will also aid demining efforts. The product, much like shaving cream in appearance, is a dilute dispersion of an explosive contained within a foaming plastic substance. Lexfoam is safe and simple to apply and can be set off by an ordinary detonation cap, removing the delicate and hazardous task of wiring a charge onto an unearthed mine. We estimate the use of such a product to blow up the exposed mine would considerably speed up the overall demining process, perhaps by as much as a factor of 2 to 5.
The air knife would require an air compressor (or compressed air supply) carried on a hand-drawn wheeled cart, packaged into a backpack-like portable unit, or built into a small motorized vehicle that carries the MWM metal detector, air knife, and Lexfoam dispenser. In a small, relatively new humanitarian demining unit at Fort Belvoir in Virginia, the U.S. Army is now assembling such a vehicle that combines an MWM detector, compressor, air knife, an operator's plastic shield to protect against explosion, an air-operated weed-cutter, and a Lexfoam dispenser. Col. Harry (Hap) Hambric, who directs development and testing in this unit, estimates that the combined use of these relatively simple technologies where terrain is suitable could speed up demining by a factor of 10 within a year or two, and another factor of 10 with refinements to come.
Just as creep-and-probe methods can find quick technological improvements, though, the brute force demining of open spaces, like field and paddy, can also profit almost at once by the adoption of simple technical improvements. One promising approach proposes to use a small-sized tined roller with hinged spring-loaded prods that can set off anti-personnel mines as it passes over them. The rope-towed (or winched) roller is simple, inexpensive, and easy to repair. It contains hundreds of closely spaced, stiff, spring-mounted fingers able to penetrate up to 25 centimeters into the ground; the roller is towed back and forth across the target area using power supplied by animals or motor vehicles kept at a safe distance.
Tests under controlled conditions performed by the U.S. Army at Fort Belvoir in 1995 proved that the roller was capable of exploding or otherwise destroying small anti-personnel mines even in the mud bottom of rice paddies and other soft floored terrain. A footpath-sized version of the roller also proved to be easily repaired using simple hand tools and hardware. The roller was effective against mines in soft ground and mud. With some design modifications it could be configured to operate on harder surfaces, including areas bearing light foliage.
Thus in certain terrain this technology will allow the welcome option of clearing anti-personnel mines without detecting them first. The Fort Belvoir experts estimate the cost of this multi-pronged roller to be under $20,000, adding that it could drop to as low as $5,000 if the device were mass-produced. The group hopes to field test the system shortly. Taking tools of this sort into the field-even these initial aids imply further improvements-will make a large difference at whatever scale they are put to work. The whole job cannot be finished soon; indeed, a long-lasting culture of understanding and vigilance in the whole countryside, and a reliable source of technical aid from beyond the village-including personnel, equipment, and training-will have to be established in the most affected countries. Determination to keep up and extend the good work will thrive if visible progress comes soon in one or two places.


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Published on June 28th,2009 at 9:54 AM
By >Daimaou - G.G-B
By >Daimaou - G.G-B
Let's Visit Tokyo – Meguro Gajoen
Meguo Gajoen is one of Tokyo oldest hotels, better known as ryokan. If today Tokyo Gajoen is an ordinary modern luxury hotel, it is still possible to visit an historic section with a dedicated tour guide where you can learn how guests in the past were treated in a gorgeous traditional wooden ryokan.
It is very interesting to notice that the Meguro Gajoen still keeps an open 100m exhibition hall, with traditional Japanese paintings and cultural items, changing regularly for our pleasure.
Meguro Gajoen also has a private Japanese park with a (unfortunately fake) waterfall and a nice little pond of Koi fish.
Let's Visit Tokyo Video 11 Meguro Gajoen, HDTV
(DivXHD 720p Direct Download "Right click, Save as…")
5 Comments
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