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Exploring Regional Variation in Antipsychotic Coprescribing Practice: A Danish Questionnaire Survey
Lone Baandrup, MD, PhD; Peter Allerup, MSc; Merete Nordentoft, MD, PhD, DMSc; Henrik Lublin, MD, DMSc; and Birte Y. Glenthoj, MD, DMSc
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Objective: The pharmacologic treatment of schizophrenia is characterized by excessive use of antipsychotic polypharmacy, which reflects a gap between evidence and practice. The aim of the present study was to investigate regional differences in treatment setting characteristics and in physician and nurse attitudes toward antipsychotic polypharmacy and clinical guidelines.
Method: Cross-sectional postal questionnaire survey directed to physicians and nurses at 2 pairs of treatment settings in Denmark, characterized by low and high prevalence of antipsychotic polypharmacy, respectively. The questionnaire investigation was conducted during November 2007 to February 2008.
Results: Satisfactory response rates were obtained (physicians: 93%; nurses: 87%). The treatment settings with low use of antipsychotic polypharmacy were characterized by raised knowledge/awareness of local antipsychotic treatment guidelines (P = .02 for physicians; P = .01 for nurses). Among physicians, these settings were also characterized by an elevated confidence in these guidelines (P = .01), frequent local educational activities (P < .0001), and increased recent involvement in research (P = .01). Among nurses, a perception of an overwhelming work load (P = .01) and time pressure (P = .003) was significantly more prevalent in treatment settings with high rates of antipsychotic coprescribing, as was the belief in the benefit of antipsychotic polypharmacy augmentation (P = .001).
Conclusion: Albeit no causal relationships can be inferred from this cross-sectional observational study, we recommend the furtherance of a treatment environment characterized by easily accessible clinical guidelines, frequent academic activities, and an unruffled atmosphere.
J Clin Psychiatry
Submitted: April 8, 2009; accepted June 9, 2009.
Online ahead of print: October 19, 2010 (doi:10.4088/JCP.09m05270yel).
Corresponding author: Lone Baandrup, MD, PhD, Center for Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Psychiatric Center Glostrup, Nordre Ringvej 29-67, DK-2600 Glostrup, Denmark (firstname.lastname@example.com).
J Clin Psychiatry 2010;71(11):1457–1464
© Copyright 2010 Physicians Postgraduate Press, Inc.
Concomitant prescription of more than one antipsychotic agent (antipsychotic polypharmacy) is not a novel concept. This controversial treatment regimen has been debated since the introduction of the first-generation antipsychotics in the 1950s.1 The debate gained new momentum with the advent of the second-generation antipsychotics, because potentially beneficial combinations have been suggested on the basis of the different receptor profiles alone. The recent rise in antipsychotic polypharmacy, with prevalence rates reaching some 50%,2–5 has fueled a growing concern because evidence of the superior efficacy of polypharmacy compared with antipsychotic monotherapy is lacking.6–9 Moreover, it has been indicated that the main advantage of the second-generation antipsychotics, ie, their tendency to induce fewer and less severe side effects associated with dopamine D2 receptor blockade (extrapyramidal side effects and hyperprolactinemia),10 is neutralized when they are being combined with first-generation agents.5,10,11 Furthermore, antipsychotic coprescribing is strongly associated with increased total dose of antipsychotic medication12–14 and, as such, with an increased rate of side effects.14 Antipsychotic polypharmacy also augments the general disadvantages of polypharmacy, including reduced compliance,15 increased risk of pharmacokinetic and pharmacodynamic interactions,16 medication errors,15 and increased costs.3,17,18
Reflecting this array of potential disadvantages and the very few potential benefits, the various antipsychotic treatment guidelines for schizophrenia19–23 recommend several sequential trials of antipsychotic monotherapy, including clozapine, before progressing to antipsychotic polypharmacy. Thus, there is a wide gap between recommended treatment regimens and actual care, and explanations for the high prevalence of antipsychotic polypharmacy despite recommendations of the opposite are still broadly lacking. The most common reasons for antipsychotic coprescribing stated by psychiatrists include a wish to (1) reduce positive and negative symptoms, (2) decrease the total amount of medication, and (3) reduce extrapyramidal side effects.24,25 Despite these cited reasons for combining antipsychotics, psychiatrists do not perceive this treatment strategy to be particularly effective in reducing psychotic symptoms, improving overall functioning, or reducing rehospitalization.26
Regional Variation in Prescribing Patterns
The lack of adherence to evidence-based treatment guidelines is matched by much discrepancy between countries and across hospitals in prescription patterns, including prescription of antipsychotic polypharmacy.27–29 It has recently been suggested that the regional variation in prescribing habits could be used to identify which factors drive this variation and thus to gain insight into why guidelines are readily implemented in some treatment settings, but not in others.30
The Prescribing Process
Psychiatric drug prescribing has been described by Benson31 as a sequential decision-making process that involves physician-, patient-, and treatment-setting characteristics. Hemminki,32 who mainly reviewed the field of general practitioners, discussed how the following factors affect drug prescribing in general: education, advertising (underlining the role of the drug industry), colleagues, control and regulation measures, demands from society and patients, and doctor characteristics. Cabana et al33 extensively reviewed barriers to physician adherence to clinical guidelines and created a framework consisting of barriers affecting physician knowledge, attitudes, and behavior. We used elements from these frames to develop a questionnaire to be distributed among physicians and nurses at treatment settings with varying prevalence of antipsychotic polypharmacy.
The Aim of the Study
The aim of the present study was to investigate regional differences in treatment setting characteristics and in physician and nurse attitudes toward antipsychotic polypharmacy and clinical guidelines. It was hypothesized that settings with increased antipsychotic coprescribing frequency were associated with the following structures:
Knowledge and attitudes:
Treatment setting characteristics:
Behavioral characteristics:
Selection of Inclusion Settings
In collaboration with the Danish National Board of Health and the Danish Medicines Agency, register linkage data from 2004 was used to determine the prevalence of antipsychotic polypharmacy in each municipality in Denmark. For this purpose, antipsychotic polypharmacy was defined as the filling of prescriptions for more than one antipsychotic agent within 30 days during the calendar year 2004. For each of the 98 municipalities (according to the 2007 reform), we determined the number of outpatients with diagnoses of schizophrenia spectrum disorders (International Classification of Diseases, 10th Revision: F20–F29), 18–64 years of age, and treated with antipsychotic polypharmacy compared with the total number of antipsychotic-treated schizophrenia spectrum patients. This ratio was termed the APP fraction. The national mean was 48.5%, and all municipalities with an APP fraction above and below this mean were further evaluated. Finally, 4 municipalities were chosen: 2 with low and 2 with high APP fractions compared with the national mean. Two municipalities from each of these categories were chosen in order to increase the study population size. Inclusion criteria: An effort was made both within and between the pairs to select municipalities with comparable need for mental health services determined by a priori selected socioeconomic variables known to predict the need for mental health services in a certain region.34 It was also essential that the eligible municipalities had a balanced organization of the psychiatric treatment system in which the outpatient services were located in the same municipality as the inpatient services. Furthermore, the catchment areas had to be of a certain size to ensure a sufficient number of employed physicians. The only combinations of municipalities fulfilling these requirements were
Settings with a low APP fraction:
Settings with a high APP fraction:
Frederiksberg is situated in the middle of the capital (Copenhagen). The other 3 municipalities are all located well outside the capital region. Frederiksberg is usually known as a high-income and wealthy area, but analysis of socioeconomic variables showed homogeneity between the municipalities, except that Frederiksberg tended to be more, not less, burdened compared with Odense, Esbjerg, and Viborg, reflecting a metropolitan effect (data not shown). All the treatment settings in the selected municipalities agreed to participate.
This classification into low- and high-prevalence regions was based on 2004 register linkage data because of the inevitable time lag associated with register data. To verify that these APP fractions still applied when the questionnaire investigation was conducted during November 2007 to February 2008, we (1) obtained access to an updated 2007–2008 register linkage survey when these data became available in January 2009 and (2) manually registered the APP fractions of the actual outpatients (cross-sectional status as of January 1, 2008) in the selected regions. Table 1 shows that the manually calculated APP fraction was higher than would be expected from the 2004 register data in the 2 high-prevalence regions, but it was also somewhat higher in Frederiksberg, one of the low-prevalence regions. Because the APP fraction in Frederiksberg was higher than expected (but still below the national mean and as such still classified as a low-prevalence region), it was decided to include a sensitivity analysis with only Odense as a low-prevalence region and with Frederiksberg excluded. The 2004 frequencies were grossly replicated in the updated 2007–2008 register linkage data, indicating that the APP fraction in our inclusion settings had remained stable since 2004. As expected, the manually calculated APP fractions were generally a bit higher than the corresponding 2007–2008 register linkage data (based on filled prescriptions) due to noncompliance.
Click figure to enlarge
To demonstrate that the different APP fractions were not attributable to differences in disease severity, we used register data from The Danish National Indicator Project (NIP), which measures the quality of care provided by the health care system across a range of medical conditions, in casu, schizophrenia. From this NIP database, we extracted the Global Assessment of Functioning (GAF) scores and substance abuse data for the schizophrenia patients in the 4 chosen geographical regions.
The Questionnaires
In the absence of an appropriate existing questionnaire, we designed a questionnaire for this particular purpose, following basic recommendations for questionnaire design.36–39 It was hypothesized that both physicians' and nurses' knowledge and attitudes affected antipsychotic polypharmacy prescribing practices.40,41 We therefore designed questionnaires for these 2 groups that were basically identical, but differed where cognitive interviews had indicated that differences were appropriate. Topics were defined and questions formulated to explore the study hypotheses, and extra information was obtained to be able to describe demographic variables. To confirm face validity, the questionnaire was presented to a group of consultant psychiatrists who also had research experience. The questionnaires were tested in 3 cognitive interviewing rounds42 with 5 subjects in each round. Physicians and nurses engaged in one of the main psychiatric departments in the capital region served as test subjects and as such belonged to the target population. The cognitive interviewing technique applied was primarily think-aloud, but elements from verbal probing were also utilized.42 The questions were rephrased and response categories optimized to make them comply with the results of the interviews. Cognitive interviewing has been developed to minimize problems involving the comprehension, recall, decision, and response processes necessary to adequately answer a questionnaire, and in our study the process served to confirm the content validity of the questionnaire.
For attitude questions, we used a Likert scale with 4 response categories ranging from "strongly agree" to "strongly disagree." This was supplemented by a neutral response category when required according to interview feedback. The remaining questions were supplied with a sufficient number of response categories to ensure that they would cover possible respondent answers. It was aimed to use short sentences, simple and direct language, and to provide variation (both open and closed questions, mix of positively and negatively phrased statements) to maintain the respondents' interest. The open-ended questions concerned partly numerical variables, partly the subject of courses, and research in which analytic categories were chosen a priori (related to psychopharmacology or not). Consequently, quantitative analysis methods were not applied. In order to keep the questionnaire at a reasonable length (and thereby increase the chance of satisfactory response rates), we did not explicitly address all of the proposed issues in the aforementioned theoretical framework,31–33 but selected those that seemed most relevant in our context. A copy of the questionnaire is available on request.
Sample sizes were estimated according to testing hypotheses for differences between 2 population proportions, as described by Lwanga and Lemeshow.43 Using the first item as an example, we judged it clinically important to be able to identify a difference of minimum 35% between the proportions (in the low- and high-prevalence settings, respectively) agreeing on that item. Demanding a power of 80% and a significance level of .02, this yielded a sample size of 32 in each group of physicians and nurses in each of the combined prevalence groups (a total of 64).
The Survey
The questionnaire was distributed to all physicians and nurses in the psychiatric departments and outpatient clinics servicing inhabitants in the selected municipalities. Sections only involved in the treatment of the elderly were excluded. None of the nurses in the study were authorized to prescribe medication. We did not include psychiatrists working in private clinics because they are treating only a negligible fraction of the patients with schizophrenia in Denmark.
The participants received a cover letter, the questionnaire, and a stamped reply envelope. Questionnaires were sent out according to the following scheme in which each subsequent step was only taken toward nonrespondents to the previous step: electronic form when e-mail addresses were available, electronic reminder after 1 week, postal questionnaire after 2 more weeks, postal reminder after 2 more weeks, and a telephone reminder after 1 more week.
To further encourage participation, we introduced an economic incentive in the form of a gift token to a respondent (in each of the 4 regions) chosen by lot. Anonymized data were entered into a database independently by 2 persons (L.B. being one of them in each case).
Categorical variables were evaluated using χ2 test (or Fisher exact test when expected cell values fell below 5) and continuous variables using nonparametric Wilcoxon test to investigate if there was any association between the variables and the 2 combined antipsychotic polypharmacy prevalence regions. The response categories to each question were dichotomized before statistical analysis in order to simplify the interpretation. The response categories for the attitude questions were dichotomized into "agree" ("strongly agree" and "agree" combined) and "disagree" ("disagree" and "strongly disagree" combined). The analysis focused on affirmative answers ("agree"), and the neutral response was pooled with the negative answers ("disagree"). For the remaining questions, the response categories were dichotomized a priori into natural and clinically relevant categories. To correct for multiple testing, we used an a priori–defined significance level of .02 (further discussed in the Strengths and Limitations section below). For the questions that reached this level of statistical significance, an odds ratio (OR) was also calculated followed by a 98% confidence interval (CI).
To compare administrative variables among the settings, supplementary data from the individual treatment settings in the inclusion areas were collected: proportion of occupied beds (data available from the National Board of Health44), research activity, number of academic staff, existence/accessibility of a local antipsychotic treatment guideline (as perceived by the head of the department), when it was last updated, and initiatives to encourage adherence to such a guideline.
The study was approved by the regional research ethics committee of the capital region and the Danish Data Protection Agency.
All analyses were performed using SAS version 9.1 (SAS Institute Inc., Cary, North Carolina).
A total of 78 physicians (93%) and 230 nurses (87%) responded to the questionnaire, giving an overall response rate of 89% (Table 2). Therefore no statistical analysis of nonrespondents was carried out. The analysis revealed that one of the questions about work load was ambiguous (despite our efforts to prevent this) and it was therefore excluded. Generally, the frequency of missing data (respondents not answering individual items) was between 0 and 6 percent with a few exceptions (see footnotes in Tables 3, 4, 5, 6, and 7 for details).
The distribution of age, gender, position, and staff turnover was not significantly different between the low and high APP fraction settings (Tables 3 and 4).
To compare the functional level of the patient population in the low- and high-prevalence areas, data were extracted from the NIP database (covering > 90% of the schizophrenic population) and shown in Table 5. Although there was a statistically significant difference between the patient populations in terms of GAF scores and abuse of benzodiazepines and central stimulants (lower and higher in high-prevalence areas, respectively), the differences seemed of minor relevance from a clinical point of view.
The items of the questionnaires are shown in condensed form in the left column of Tables 6 and 7.
For physicians, the following structures revealed significant differences between the low- and high-prevalence treatment settings (Table 6):
Raised knowledge/awareness of local antipsychotic treatment guideline in settings with a low APP fraction as compared with settings with a high APP fraction (OR = 3.67, P = .02). This difference was just at the level of our a priori–defined significance level, but it was confirmed in the sensitivity analysis, in which a P value of .002 (OR = 15.40) was found. The OR indicates the odds of being aware of local antipsychotic treatment guideline in low- compared with high-prevalence treatment settings.
Physicians in low APP fraction settings believed less in the value of personal experience than in antipsychotic treatment guidelines (OR = 0.26, P = .01, sensitivity analysis: OR = 0.13, P = .01).
Physicians in low-prevalence regions were offered local educational sessions more often than their high-prevalence counterparts (OR = 30.76, P < .0001, same P value in sensitivity analysis), but we found no statistically significant differences in the frequency of attendance to these educational activities.
Physicians in low-prevalence regions were more engaged in recent scientific activity than physicians in high-prevalence regions (OR = 4.57, P = .01, sensitivity analysis: OR = 4.59, P = .02).
For nurses, the following structures revealed significant differences between the low- and high-prevalence treatment settings (Table 7):
Raised knowledge/awareness of local antipsychotic treatment guideline in settings with a low prevalence of antipsychotic polypharmacy as compared with settings with a high prevalence (OR = 2.11, P = .01, sensitivity analysis: OR = 5.82, P < .0001).
Significantly fewer nurses in low-prevalence regions were convinced that antipsychotic polypharmacy was a useful means for increasing the effect of antipsychotic treatment (OR = 0.37, P = .001, sensitivity analysis: OR = 0.41, P = .01).
Nurses in low-prevalence regions were offered local educational activities less often than their high-prevalence counterparts (OR = 0.52, P = .01), which was contrary to our expectations, but this association did not persist in the sensitivity analysis and was therefore considered weak.
Significantly more nurses in low-prevalence regions than in high prevalence-regions found that they had sufficient time for each patient (OR = 2.27, P = .003, sensitivity analysis: OR = 2.29, P = .01).
Nurses in the former regions also felt less burdened by the work load than nurses in the latter (OR = 0.46, P = .01, sensitivity analysis: OR = 0.39, P = .01). This tendency to increased time pressure in the high-prevalence settings was also found for the physicians, but differences in this group did not reach statistical significance.
Research activity as determined by the number of published articles in peer-reviewed journals in 2006 ranged from 8 to 11 in the low APP fraction settings and 0 to 1 in the high APP fraction settings. Regarding the number of academic staff, only Odense stood out, having 7 associate professors (1 in Frederiksberg, 0 in Esbjerg, and 1 in Viborg) and 1 professor (none in the other settings). The head of all participating treatment settings reported to have a local antipsychotic treatment guideline. The latest update was in June 2007 for the low-prevalence settings and 2004 and 2007 for the high-prevalence settings. All settings reported that they engaged in some form of activities to ensure implementation of the antipsychotic treatment guideline in the clinic (mostly discussions at conferences and audit) and systematic differences between low- and high-prevalence settings could not be distinguished from the answers. Using data from 2006 and 2007, we discovered that the proportion of occupied beds as a crude proxy of work pressure gave the following results: 94% and 100% for the 2 low-prevalence areas and 96% for both of the 2 high-prevalence areas. Thus, no systematic pattern could be distinguished.
This study addressed the regional variation in the frequency of antipsychotic coprescribing patterns and identified some structures, especially attitudinal and academic, characterizing the different treatment settings. Our findings are in line with previous reports that suggest an association between antipsychotic polypharmacy and the following factors: nurses' request (to increase the current dosage or add another drug)41 and physician-related factors such as psychiatrists' knowledge and perception of medication, skepticism toward algorithms, and time pressure.40,41,45
The differences in perception of work load and time pressure were noticeable for both physicians and nurses, but were only statistically significant for nurses. We interpret this finding as a marker of a more harassed working environment in the high-prevalence settings where, perhaps, the time pressure could be part of the causal chain in antipsychotic polypharmacy prescribing.
It has previously been shown that nonteaching hospitals tend to prescribe polypharmacy more often than teaching hospitals46; however, the grounds for this have not yet been explored. Only the 2 low APP fraction settings were situated in university cities, but medical students were received in both low- and high-prevalence settings and both categories therefore had teaching responsibilities. It is possible that the distance to the nearest academic environment had some impact on the prescribing habits, but this impact was operating through some underlying factors, some of which may very well be those identified in this study. This is also reflected in the fact that the low-prevalence settings had published a total of 19 articles in peer-reviewed journals during 1 year compared with only 1 in the high-prevalence settings. Obviously, there is no direct link between the number of published articles and the frequency of antipsychotic coprescribing, but it may serve as a marker of an innovative and critical environment, in which new guidelines are more easily implemented.
We found no differences in the frequency of attendance to educational activities sponsored by a pharmaceutical company and could therefore not support what others have found in this respect.26 Although only covering one aspect of prescribing habits, we consider this finding important, because education offered by the pharmaceutical industry is often questioned ethically.
Strengths and Limitations
The satisfactory response rates across all settings indicate that our sample was highly representative of the staff in the selected settings, which is essential to a questionnaire survey. The persistency of the results as evidenced by the sensitivity analysis testifies to the robustness of the results.
It was not possible to assess the prescribing habits of the individual physicians participating in the questionnaire survey, and we therefore could not correlate the physician responses with the individual physicians' prescribing practices.
Likewise, we compared GAF score and substance abuse between the inclusion areas at a group level and could therefore not investigate any association with antipsychotic coprescribing frequency in individual patients. However, other studies investigating individual patient variables as predictors of antipsychotic polypharmacy have not found higher rates in substance abusers, whereas the data regarding disease severity are inconclusive.28,47–49
Apart from the demographic variables, another 20 items (18 for nurses) were tested for their association with antipsychotic coprescribing frequency. This gives rise to the statistical problem of multiple testing (increased risk of type I error when testing several hypotheses simultaneously), which may be corrected for by means of the Bonferroni method. However, precise determination of the Bonferroni-corrected significance level was complicated because of difficulties in determining the independency of the individual questionnaire items. Bonferroni correction is only required for independent tests, and using n = 20 would yield a much too conservative estimate (a P value of .05/20 = .003) because of the intertwined nature of the individual items. The items were grouped into 3 categories (knowledge and attitudes, treatment setting characteristics, and behavioral characteristics), and therefore it was judged reasonable to apply a significance level of .02 (.05/3).
Generally, the cross-sectional design of the study prohibits any causal inferences. Furthermore, because of its observational design, it is possible that the study groups differed with regard to important, but unmeasured variables that may have accounted for part of the differences in antipsychotic coprescribing.
Development of a new questionnaire is always a laborious task with many possible pitfalls.37,38 The content validity was optimized by the cognitive interviewing process, which placed special emphasis on the phrasing of the first item to ensure that all possible respondents knew what the concept "antipsychotic treatment guideline" covered. Despite these efforts, it was evident (from stray handwritten notes next to the question on a few nurse questionnaires) that an unknown proportion of the nurses mistook the term for a general drug catalog (covering all drugs with regard to indication, recommended dosage, side effects, etc).
We did not test the reliability in a systematic test-retest paradigm before the study. However, 5 of the respondents answered the questionnaire twice because their first response and the reminder crossed in the mail. These 5 pairs of responses were evaluated to get an indication of the test-retest reliability of the questionnaire. The κ value for the questions on attitude (measured on the Likert scale) was computed, which resulted in a κ value of 0.88 corresponding to a very good strength of agreement.
The method applied for sample size calculation assumes random sampling, and because our respondents were sampled in clusters, there is a risk that the study is underpowered, especially with regard to physicians, which was the limiting category. This important limitation is also reflected in the much wider CIs for physicians than for nurses.
Albeit no causal relationships can be inferred from this cross-sectional observational study, we recommend the furtherance of a treatment environment characterized by easily accessible clinical guidelines, frequent academic activities, and an unruffled atmosphere. The identified structures appear so general and unrestricted to antipsychotic polypharmacy that high transferability to other domains in psychiatry is likely, but this remains to be proven.
Drug names: clozapine (Clozaril, FazaClo, and others).
Author affiliations: Center for Neuropsychiatric Schizophrenia Research, Copenhagen University Hospital, Psychiatric Center, Glostrup (Drs Baandrup, Lublin, and Glenthoj); Centre for Research in Compulsory Schooling, School of Education, University of Aarhus, Copenhagen NV (Mr Allerup); and Copenhagen University Hospital, Psychiatric Center, Bispebjerg (Dr Nordentoft), Denmark.
Potential conflicts of interest: Dr Nordentoft has served as a speaker for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Janssen-Cilag. Dr Lublin has served as a speaker and as a chairman of symposia for AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Janssen-Cilag, Lundbeck, and Pfizer and has received research grants from AstraZeneca, Lundbeck, and Pfizer. Dr Glenthoj has served as a speaker for or as chairman of symposia sponsored by AstraZeneca, Bristol-Myers Squibb, Eli Lilly, and Lundbeck; has received unrestricted grants for university-generated research from AstraZeneca and Lundbeck; and has one PhD student paid by a shared grant from the University of Copenhagen, the Danish Medical Research Council, and Lundbeck (one-third each). Dr Baandrup and Mr Allerup report no competing interests.
Funding/support: Dr Baandrup was supported by the National Board of Health in Denmark (0-204-03-9/9) and by the Wørzner Foundation.
Acknowledgments: We thank all physicians and nurses who participated in the survey; the participating organizations for collecting the administrative data; and the Danish National Board of Health, the Danish Medicines Agency, and the Danish National Indicator Project for providing the register data. We also thank research nurses Gitte Saltoft Andersen, BSN, and Katherina Alfsen, BSN, of the Center for Neuropsychiatric Schizophrenia Research, for their help in entering the completed questionnaires into the database. Mss Andersen and Alfsen have no potential conflicts of interest to report.
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32. Hemminki E. Review of literature on the factors affecting drug prescribing. Soc Sci Med. 1975;9(2):111–116. PubMed doi:10.1016/0037-7856(75)90103-1
33. Cabana MD, Rand CS, Powe NR, et al. Why don't physicians follow clinical practice guidelines? a framework for improvement. JAMA. 1999;282(15):1458–1465. PubMed doi:10.1001/jama.282.15.1458
34. Analysis of the psychiatric specialty: differences and similarities in the region [in Danish]. The Capital Region. Report from the Psychiatric and Social Subcommittee; 2007.
35. Statistics Denmark. www.statbank.dk. Accessed autumn 2007.
36. Leung W-C. How to design a questionnaire. Student BMJ. 2001;9:187–189.
37. Boynton PM. Administering, analysing, and reporting your questionnaire. BMJ. 2004;328(7452):1372–1375. PubMed doi:10.1136/bmj.328.7452.1372
38. Boynton PM, Greenhalgh T. Selecting, designing, and developing your questionnaire. BMJ. 2004;328(7451):1312–1315. PubMed doi:10.1136/bmj.328.7451.1312
39. Burgess TF. A General Introduction to the Design of Questionnaires for Survey Research, Edition 1.1; Leeds, United Kingdom: University of Leeds; 2001.
40. Koyama A, Ito H, Nakanishi M, et al. Addition of antipsychotics to medication regimens during schizophrenic inpatient care. Psychiatry Clin Neurosci. 2008;62(1):56–64. PubMed doi:10.1111/j.1440-1819.2007.01776.x
41. Ito H, Koyama A, Higuchi T. Polypharmacy and excessive dosing: psychiatrists' perceptions of antipsychotic drug prescription. Br J Psychiatry. 2005;187(3):243–247. PubMed doi:10.1192/bjp.187.3.243
42. Willis GB. Cognitive Interviewing. A "How To" Guide. Reducing Survey Error through Research on the Cognitive and Decision Processes in Surveys. Short course presented at the 1999 Meeting of the American Statistical Association. Research Triangle Institute; 1999.
43. Lwanga SK, Lemeshow S. Sample Size Determination in Health Studies: A Practical Manual. Geneva, Switzerland: WHO; 1991.
44. Proportion of occupied beds [in Danish]. http://www.sst.dk/Indberetning%20og%20statistik/Landspatientregisteret/Belaegningsprocenter.aspx. Accessed February 2009.
45. Bjerrum L, Søgaard J, Hallas J, et al. Polypharmacy in general practice: differences between practitioners. Br J Gen Pract. 1999;49(440):195–198. PubMed
46. Johnson DAW, Wright NF. Drug prescribing for schizophrenic out-patients on depot injections: repeat surveys over 18 years. Br J Psychiatry. 1990;156(6):827–834. PubMed doi:10.1192/bjp.156.6.827
47. Biancosino B, Barbui C, Marmai L, et al. Determinants of antipsychotic polypharmacy in psychiatric inpatients: a prospective study. Int Clin Psychopharmacol. 2005;20(6):305–309. PubMed doi:10.1097/00004850-200511000-00004
48. Kreyenbuhl JA, Valenstein M, McCarthy JF, et al. Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns. Psychiatr Serv. 2007;58(4):489–495. PubMed doi:10.1176/appi.ps.58.4.489
49. Sim K, Su A, Chan YH, et al. Clinical correlates of antipsychotic polytherapy in patients with schizophrenia in Singapore. Psychiatry Clin Neurosci. 2004;58(3):324–329. PubMed doi:10.1111/j.1440-1819.2004.01239.x


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Tweets from @TBHomeTeam/writers
MORE from our HomeTeam writers.
Thu. April 25, 2013 | Joey Knight | Email
Nineteen Robinson athletes, including a dozen members of the the Knights' 11-2 football team, will sign college paperwork Monday morning, the school announced.
Among them are QB Zain Gilmore, Jr., who will sign with Division I-AA Eastern Kentucky after receiving an offer late last week. Linemen Ted Kelly and Brooks Lovely, who formed the right side of a veteran Knights offensive front that helped Robinson amass 215 rushing yards a game, will sign with Maine Maritime Acadey and Maryville (Tenn.) College, respectively.
Two-way speedster Carlos Duclos, who overcame a series of setbacks including a brief kidney failure and torn left ACL during his career, will attend Ellsworth Community College in Iowa Falls, Iowa.
Swimmer John Nolte, who earned three bronze freestyle medals at last fall's Class 2A state meet, will sign with Florida Atlantic.
Here's the full list of signees:
Chris Rodriguez, William Penn University (Oskaloosa, Iowa)
Jeremy Andujar, William Penn
Damien McKinzie, William Penn
John Nolte, FAU
Zack Sabo, Saint Leo
Carlos Duclos, Ellsworth Community College (Iowa Falls, Iowa)
Austin Eads, Hiram (Ohio) College
Zain Gilmore, Eastern Kentucky
Dominic Jennings, Webber International
Brooks Lovely, Maryville (Tenn.) College
Preston Mackabee, Hiram College
Andres Nader, John Carroll University (University Heights, Ohio)
Demetrius Page, Ridgewater (Minn.) College
Nahshon Simmons, Webber International
John Taylor, Beloit (Wis.) College
Ryan Woehlert, Chowan University (Murfreesboro, N.C.)
Alexandria Gaertner, Maryville College
Girls Basketball
Cornika Wright, Southeastern University

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text:
Cast: Chandrakala, Jamuna, Ranga Rao, S.V, Sobhan Babu, Venkateswararao, Gummadi and others
Dialogues : Venkata Ramana, Mullapudi
Music : Mahadevan, K.V
Director: Bapu
Sampurna Ramayanam with Subtitles – Watch Online:
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CD:2 : Part-1 || Part-2 || Part-3 || Part-4 – Subs
Story Line:
Sampurna Ramayanam is a story from the Epic Mythology of all times 'The Ramayan'. Rishi Vishwamitra the saint wanted to perform a Yagna however he was troubled a lot by the Rakshasa and hence to seek help he went to King Dasrath. Dasrath asked his sons to go with Rishi to Mithila. There Rama fulfilled a condition of the king of Mithila and consequently married his daughter Sita. Happily all returned home. Sometime later Dasrath decided to abdicate in favour of his son Rama but his step-mother ill advised by his maid Manthara raised an obstacle and requested Dasrath to make her own son Bharat the King. Rama was asked to leave the palace with his wife Sita and brother Lakshman for 14 years. In the forest Rama came across Shoorpankha who tried to entice the two brothers in her love trap but failed to achieve her object and hence attacked them. Lakshman on the contrary cut off her nose. She felt insulted went back to her brother Ravan who wild with vengence abducted Sita and took her to his kingdom. Rest of the story is how Rama finds Sita with the help of Hanuman and what happens then ?
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Thatch, Compaction and Shade
Thatch, Compaction and Shade
Part of Ep. 403 Lawn Care Special
Join UW-Madison Soil Scientist Wayne Kussow as he explores the best methods for keeping your soil and lawn healthy.
Premiere date: Jul 31, 1996
- Wisc Gardener Transcript:
We've already talked about weeds and diseases. Common, basic soil health is also important to have a healthy lawn. I'm with uw-madison soil scientist, Wayne Kussow. How does the health of our soil effect the health of our lawn?
Wayne Kussow:
Well, a healthy soil means a healthy lawn. We need the soil for water, air and nutrients.
So, basics.
That's right, exactly.
I hear a lot of gardeners talk about their concerns about thatch. Is that something I have here in my yard? Is that this brown stuff? Do I need to be concerned about it?
Well, Shelley, if we just take a knife and scratch a little bit, you'll see all we're dealing with is grass clippings. That's no problem.
It's from my mulching mower.
You're actually just recycling nutrients and reducing fertilizer needs.
So, that's good?
That's good. But, if you do have a brown layer of stemmy material, that's thatch. That's dead stuff. If that stuff is less than half an inch don't worry about it. It's cushioning your lawn. It's helping water stay in place to infiltrate and wash into the soil. It's good.
So, if it gets above a half an inch...
Above a half an inch-- then it starts to repel water and it becomes a haven for insects and disease.
Then, it's a problem.
Then it becomes a problem.
What do we do?
Well, if it's at that point, you can just go ahead and rake it off. Or, you can rent a dethatching machine and take it off that way. If it gets too thick, the grass roots start growing in it...
Instead of the soil...
That's right. In that case, if you take it off, you've destroyed the lawn because you're removing the roots.
You're taking the grass with you.
That's correct.
So, then what do we do?
In that case, what you want to do is to try to improve the thatch as a medium for plant growth. You do that by adding soil. That gets us into the issue of aeration. Aeration is something we think about when we talk about compaction. Do you have some compaction?
In this yard? I wouldn't be surprised. Let's go look.
Ah, Shelley, this is what I was talking about: soil compaction. See how hard that surface is? There's no pores open so that the water can infiltrate.
Kind of like concrete.
Right, you've closed things off. You've destroyed what I call the plumbing and ventilation system of the soil.
So, this is caused by walking on it a lot, high traffic.
High traffic areas. And this is what we see here. Now, we've brought along a couple of tools that we might use on a small area, anyway, to alleviate the problem. Nothing more than a garden fork or a pitch fork. All you need to do is simply push it into the soil a couple of inches, rock back and forth move forward and do it again. What you want to do, is leave some holes in there so you get some water and air coming in.
What about this one? This is kind of neat looking.
This is a hand aerator. You see the hollow tubes? These take cores of soil out. If you want me to demonstrate here a second-- you can find these in lawn and garden centers-- simply push it into the soil and pull it out. See the nice holes? Tap the cores out. Simply move forward and repeat the process.
These work great in a small area like this. But what if it's my entire lawn?
If it's the entire lawn, contract with a lawn care service or landscaper to come in and do it mechanically with special machines.
Do they know what they're doing?
I would keep an eye on them to make sure they're going at least two inches deep to be truly effective. What about those funny shoes that have spikes on them? I've seen some of my neighbors use those.
Uh, they probably provide good exercise! The spikes-- first of all, the holes are too small. They close up so quickly that they don't do much good. Secondly, you don't get the uniform coverage that you need as you're just walking along.
So, something this size is more effective.
Exactly. But, I think you have another problem here, Shelley:. How much sunlight do you get, here?
About four hours.
I thought so. Because right here, is a classic indicator of two things. Soil compaction and lack of sunlight.
The lovely green moss?
The lovely green moss. And what happens, is you keep the soil surface moist, you don't have enough sunlight for the grass to grow so the moss comes in. Now, if you have more than four hours of sunlight, then you might try a fine fescue.
That would be the grass I've kind of been experimenting with.
Exactly. Now, if that doesn't solve the problem, then you have to eliminate shade. That means pruning, maybe taking some trees out. If you aren't willing to do that, then you're going to have to think ground covers. Hostas, for example, are an excellent ground cover in Wisconsin. Now, if you have four to six hours of sun the fescue should grow fine. If you have more than six hours, then you can start to think of the traditional kentucky bluegrass lawn.
The classic green lawn.
So, we have to decide what we're going to do with our site.
That's right.
Okay. Thanks, Wayne. So, if it's shade, plant ground covers. If it's compacted, aerate it.
No-Mow Mix
Learn about alternatives to a traditional manicured lawn from Neil Diboll of Prairie Nursery. Slow growing, draught resistant fine fescues are environmentally friendly and require little maintenance.
Thatch, Compaction and Shade
Join UW-Madison Soil Scientist Wayne Kussow as he explores the best methods for keeping your soil and lawn healthy.
Reclaiming a Weedy Lawn
Using a "freedom lawn" at the O. J. Noer Turfgrass Center, Amy Sausen discusses what works and what doesn't when dealing with a weed infested lawn.
Lawn Establishment
Join Dr. Frank Rossi, UW-Extension turfgrass specialist, as he explains how to seed your lawn and why you should plan on doing so between August 15 and September 15.
Funding for The Wisconsin Gardener is provided, in part, by The Wisconsin Master Gardener Association.


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Mariah Carey's Twins Are Too Cute and All Grown-Up (PHOTOS)
Mariah Carey took adorable #fall photos of her twins Moroccan and Monroe yesterday, October 13. Find out what their dad Nick Cannon has to say.
Mariah Carey names twins Monroe and Moroccan - Tabloid Hell - NME
Singer names babies after Marilyn and apartment interior
Mariah Carey And Nick Cannon Share Personal Pictures Of Their ...
18.09.2012 [Huffington Post] - Mariah Carey, Monroe Cannon and Moroccan Cannon. Mariah Carey (C), Monroe Cannon and Moroccan Cannon taken during the past six months as part of Mariah Carey and Nick Cannon's personal photo collection. (Photo by Fresh Air Fund/WireImage)
Mariah Carey and Nick Cannon Share Adorable Pics of Dem Babies!
29.08.2012 [E! Online] - Mariah Carey and Nick Cannon posted a handful of ridiculously adorable photos of their one-year-old twins, Moroccan and Monroe, on their family website, dembabies.com. Mariah Carey, Nick Canon, Monroe, Moroccan, DemBabies dembabies.com
Mariah Carey Reveals Twins' Names: Moroccan and Monroe - ABC News
Millions of moms will celebrate Mother's Day on Sunday. One may do so with a few more butterflies and exclamation points than the rest. Mariah Carey, 41, and Nick
'Paashaas' Mariah Carey deelt kiekjes|Prive| Telegraaf.nl
FOTO - 'Paashaas' Mariah Carey heeft haar man Nick Cannon en de tweeling Moroccan en Monroe (2,5 jaar) onvergetelijke Paasdagen ...
Mariah Carey reveals babies' names - Celebrities and Entertainment...
Mariah Carey has put to rest speculation about the names of her newborn twins -- her baby daughter will be named Monroe and her son Moroccan ...
Google Blogs: Mariah Carey & Nick Cannon show off their cute kids | BabyCenter ...
29.05.2012 Cute times two! Dad Nick Cannon shared this adorable new photo of his twins Moroccan and Monroe – also known as 'Roc and 'Roe or 'dem babies' – on Twitter yesterday. The pic shows the kids riding in style, sharing a ...
Mariah Carey & Monroe Spotted Out and About in NYC [Photos]
24.10.2012 - Take a look at these adorable photos of Mariah Carey and daughter Monroe out and about in New York City yesterday. So
Google Blogs: [PICS] Mariah Carey & Nick Cannon's Twins Celebrate First Birthday
12.05.2012 Click through these adorable pics of Monroe and Moroccan celebrating their first birthday.
Mariah Carey Shares Cute Photo of her Twins Kissing
21.09.2012 [Opposing Views] - Mariah Carey shared this adorable picture of her 17-month-old twins kissing yesterday afternoon. The picture shows Monroe leaning in to kiss her brother Moroccan, and Mariah saying "You love me and don't u forget it!" The young siblings were pictured
Mariah Carey And DemBabies Make A Splash! | Radar Online
05.06.2012 By Alexis Tereszcuk - Radar Entertainment Editor DemBabies spent a fun day in the pool with mama Mariah Carey and RadarOnline.com has super cute photos from their splashy day! Twins Monroe and Moroccan were in ...
Easter Bunnies: Mariah Carey, Irina Shayk, JLo... - Emirates 24|7
Mariah Carey and Nick Cannon shared a fun family photos as they got into the Easter spirit with their twins Moroccan and Monroe. (Instagram).
Family values: Nick Cannon, Mariah Carey reunite for Easter - Rolling...
Nick Cannon and newly single Mariah Carey reunite for Easter. On Saturday, April 15, the ex-lovebirds gathered with their twins, Monroe and Morrocan, 5, for a...
Mariah Carey Jet Sets from NY to LA With Monroe & Moroccan |...
Sep 09, 2015 · Mariah Carey Jet Sets from NY to LA With Monroe & Moroccan Mariah Carey takes a ride on the swings at the Malibu Chili Cook Off fair on Monday …
Mariah Carey & Nick Cannon Reunite For Some Holiday Fun With The...
The whole gang's here! Nick Cannon took to Instagram on Friday, to share some sweet shots of him, Mariah and their twins Moroccan and Monroe getting in the...
Mariah Carey Shares Adorable Fall Photos with Twins Moroccan and...
Dem Babies just keep getting cuter! Mariah Carey is getting into the autumn spirit with her adorable four-year-old twins Moroccan and Monroe! The
Mariah Carey carves pumpkins with twins Moroccan and Monroe
Mariah Carey started her Halloween celebrations early by carving pumpkins with her twins Moroccan and Monroe on Wednesday
Mariah Carey enjoys a moment with children Monroe and Moroccan in...
The 45-year-old is currently working on her directorial debut - A Christmas Melody - a holiday film for the Hallmark Channel.
Mariah Carey takes twins Moroccan and Monroe out for pizza following...
Never one to be described as demure or a wallflower, the 44-year-old stood out like a sore thumb in her black and white patterned wrap dress, strappy platform...
Mariah Carey poses with her twins while getting early start on...
The 45-year-old looked flawless as she posed with her twins, Monroe and Moroccan, while carving a pumpkin in a Instagram photo she posted Wednesday morning.
Mariah Carey's Daughter Sings "Supernatural" Off Her New Album(VIDEO)...
With Mariah Carey's new album officially in-stores, she posted a video of her and her daughter Monroe singing her album cut
Mariah Carey Reveals Holiday Plans With Twins Moroccan & Monroe |...
Mariah Carey is beaming about spending the holidays with her family – especially her twins Moroccan and Monroe.
Mariah Carey enlists daughter Monroe to hold heat lamp over her...
The Instagram picture shows Mariah getting a pedicure as her two-and-a-half-year-old holds a light, perhaps a heat lamp, over her feet.
Mariah Carey reveals her daughter Monroe Cannon is 'featuring' on new...
It seems there is little doubt that her children will be following in her own superstar footsteps. Mariah Carey has revealed how her two-year-old daughter...
Mariah Carey and Nick Cannon together for the holidays | wdvd-fm
Nick Cannon posted this on his Instagram page on Friday of him in a candy-themed eatery with Mariah Carey and 4-year-old twins Monroe and ...
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Mariah Carey, Nick Cannon and their 2-year-old twins Moroccan and Monroe have been enjoying their stay in Aspen, Colorado. On Sunday (December 29) ...
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It's been four years since Mariah Carey released an album and a lot has changed in her life since, especially the birth of
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Beryl REID (1920-1996)
THIS IS YOUR LIFE - Beryl Reid, actress and comedienne, was surprised by Eamonn Andrews in the car park of Thames Television's Teddington Studios.
Beryl began her acting career in 1936 in music hall, moving on to variety shows and pantomimes during the 1940s. Her first big success came in the BBC radio show Educating Archie as naughty schoolgirl Monica and later as the Brummie, "Marlene".
Beryl, a popular character actress on stage and screen, received critical acclaim for her roles in such films as Entertaining Mr Sloane and The Killing of Sister George.
"I can't go. I'm busy!"
Beryl recalls her experience of This Is Your Life in her autobiography So Much Love...
My passion for cars goes right back to childhood. I've always driven myself to work, sometimes hundreds of miles at a time, so much so that some of my friends have thought occasionally I was being silly. When I was taken to the Motor Show and could afford it, I bought a Lancia Fulvia Zigato, which was very 'goey', except it was really useless for driving into London every day, because it has twin carburettors which have to be tuned – so you spend all the time at the garage with an expert carburettor tuner, who is something like a piano tuner! I then went to a BMW, so when Thames Television asked me if I would go and do a programme called 'Drive-In', I felt I had really quite a lot to say on the subject.
I prepared a little programme, including some of the improvements I believed should be made, like windscreen wipers on the side mirrors. I also thought there should be windscreen wipers on the headlamps, because when you're on the motorway in dirty weather, everything gets gunged up so you haven't got clear vision or good lights – you haven't got anything that's good – and you get the spray from all the other cars.
I was quite prepared to go and do this programme about cars, but when the day dawned I had Olivia and Terry staying with me in the flat I had then in London, and I said to them, 'I don't want to do this at all – I feel awful.' Then Joan Bisett's daughter, Margaret, who was helping me in the house at that time, said, 'Why don't you have your hair done?' I was supposed to be going out to dinner, and she obviously thought this would cheer me up. I said, 'Not likely, I'm not going to bother to have my hair done to go out to dinner!' Margaret said, 'Oh, it would be nice if you had your hair done' – everybody tried to get me to make the best of myself.
Terry Ward, Olivia's husband, took me to the car and I said, 'I don't feel a bit like going, Terry: the back of my nose is all raw and I feel as if I'm going to have a cold, and I feel thirsty ….' He said, 'Oh, well you'll feel better when you get there.' I said, 'What I'd really like to be doing is staying at the flat with you and just watching the television and having a bit of gas, you know, a gossip.' But I got into the car and drove to Teddington Studios, and they interviewed me, and I thought it rather strange that at that time in the afternoon – it was about half-past three or four o'clock – the bar was open. There was this one lady, whom I knew well because I've been going there for years, and she said, 'Now, would you like a drink, Beryl?' She expected me to say 'a Courvoisier brandy', but I said, 'No, actually I feel as if I'm going to have a cold; I'd like a glass of soda water with a piece of lemon in it, you know, nice and cold – a long thirsty drink.' She said, 'Oh' – and was really quite disappointed, but she said, 'Well, that's fine.'
I thought this was a little bit strange, but obviously they knew I was doing a programme and thought I might be thirsty. I said, 'Will I be able to get into the car park?' That was an impossibility at Teddington, unless you've had your name down for three weeks, but they said, 'Oh yes,' and there was the car I drove in, I think it was a BMW, and a lot of other cars assembled there, all of which I drove round the car park. The one I liked very much was a Scirocco, which is a Volkswagen, and so I said, 'Oh this is a smashing car – I'd love one of these,' and, in fact, I've had nothing else since – I've had three of them, because if I keep them for two years I get the maximum amount of service out of them, without them having to be sold for nothing.
I did try an enormous car, which cost something like £46,000, and was hand built, but it had an automatic gear-change and I've no time for those. I like driving, I like actually changing gear and being in charge of the car. I said, 'Oh, no, I wouldn't have one of those: I'm sure it's beautiful, but I certainly wouldn't have automatic gears,' so that was that car written off in one.
They said, 'Are you ready to start filming?' I'd got this rather nice little suit on, which is something I would have worn outside and I asked if I should put some make-up on. They said, 'Yes, just an ordinary sort of television make-up,' which I do myself anyway. I always say to the make-up artists, 'I'll do it, and you make all the improvements!' and then nobody's offended.
I started talking, about my invented windscreen wipers and how fabulous I thought cat's eyes were in the road and that they were one of the best inventions of the century; then I saw this big car pull round and Richard O'Sullivan was driving it. Eamonn Andrews got out and I thought, 'Why ever has he got make-up on – how ridiculous!' Still nothing – I mean, I must be very thick – but nothing entered my head. He came over to me and said, 'Beryl Reid, This Is Your Life!'
I said, 'I'm very sorry – I'm very busy with a programme called "Drive-In", Eamonn. Get off' and sort of pushed him back. He said, 'No, no, this is your life.' I said, No, no – "Drive-In".' This was the opening of the programme, of course, and eventually it dawned upon me that it was my life. I was in a total state of shock and he said, 'Just leave your car there.' I said, 'Who's going to collect it?' He said, 'That's all arranged,' and we were on the way, driving to London and I said, 'Nobody'll be there, Eamonn – everybody I know is dead! What am I going to wear – I've no clothes with me,' and so on. He said, 'No, all that's been seen to; Margaret's bringing your dress.' I said, 'How's she going to know what dress I want to wear?' And, of course, she did bring exactly what I would have chosen to wear.
I had no idea what was going to happen, I was put in this very nice dressing-room with a lot of little presents around it, and flowers. Knowing me, they had this security man standing outside, because they knew I'd try to get out to see who was going to be on the programme. I was really quite well behaved and didn't try to escape. Little did I know what was in store.
My brother Roy was there and his wife, Pat, my niece Susan, my nephew Peter and his wife: Andrew Gardner was there, Richard O'Sullivan, of course, whom I'd done a television series with at Teddington, called 'Alcock and Gander', Jack Tripp, Reggie Vincent and Pat Kirkwood – lots and lots of people – and Warren Crane, my dearest, dearest friend from New York was flown over as my big treat after they'd located him in some motel in California. Mind you, I don't know what he was doing there, but as he's Californian-born he was probably doing something quite all right! It was the most over-exciting evening in the world: in a way, I don't think they should do it to people. Unless you've got a very strong heart you could drop dead with excitement.
I was so excited I couldn't possibly go to sleep for two nights after seeing all these people, having not really realised at all that it was going to happen to me. I hadn't had a clue. Olivia and Terry knew – that's why she tried to get me to have my hair done – everybody but me knew. My brother and his wife had had to register in a hotel under her born name, which is Hall, so they were Mr and Mrs Hall, not Mr and Mrs Reid – they and Reggie and Jack Tripp and all the people who were going to be on the programme had stayed at the same hotel, had all had breakfast, lunch and dinner together for the last three days and been driven about in a great white Rolls-Royce all over London, peeping round corners in case they saw me.
You can imagine it is one of the biggest possible surprises in your life. The marvellous thing is I have photographs of my brother, who died quite recently – I am very fond of him and miss him dreadfully – I have his voice on record, and that is something I would never have had, unless this had happened to me, because he was very shy altogether. It was only occasionally, when he'd been here a little while and had a couple of Pimms, he would perhaps juggle with three oranges and say, 'This is the life, you know, Beryl,' and that sort of thing. We were so totally opposite, yet we were such great friends.
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Y u k o Model
Ken EdenPhotographer Male Vista, California, US
My Website: Ken EdenMy MM URL: http://www.modelmayhem.com/KenEden
Mayhem # 1009341
About Me
Model and automotive photographer. I strive to create unique photos, showcase hard work, and build relationships. Based in San Diego, often shooting in Los Angeles and San Francisco. TFP for unique concepts.
My style is dynamic and technical. I try to capture motion and energy while getting the best out of the equipment I have at the time.
Photography is my social artistic outlet. Other hobbies are fitness, classic car restoration, motorcycling, costume making, kinks, and many more. I especially enjoy of shooting my hobbies and adding variety to models' portfolios.
Nerd toys talk: 5D Mkii, 24-70L, 16-35L, 135mm f.2.0L, 50mm, 70-300mm, various lighting including flashes and softbox set-ups.
Contact: PM on this site or Ken(at)KenEden.com
Mayhem #1009341
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Credit Notes
Models/Photographers that I have worked/collabed with:
Etaru, Model, MM #860354, Helena, Montana
Abbott Wang, Photographer (http://www.abbottwang.com/)
Andy, Photographer (Asianschoolboy.com)
Cabusi Photography, Photographer, MM #1013662, San Diego, CA
Daniel Wright, Photographer (http://www.sojians.com/)
Eric Ng, Photographer (http://bigwhitebazooka.com/)
Eurobeat King, Photographer (Cosplay.com)
Hikaru, Model
Lionel Lum, Photographer (Usagichan.com)
Martin Wong, Photographer (http://www.facebook.com/martinwongphotography)
Minh Phan, Photographer, Newport Bech, CA (http://www.flickr.com/photos/moondabor)
Rachael Ing, Photographer (http://www.flickr.com/photos/chibi_masako/)
Richard Bui, Photographer (http://buiphotography.com/)
Yosidha Itsumo, Photographer, Los Angeles, CA (http://www.yosiphotography.com/)
Y u k o Model
Ashlie Campbell HAIRMUA Makeup Artist
Glow Photo Photographer
Autumn Black Model
Coris Playhouse Model
Etaru Model
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Reproduction is permitted for noncommercial purposes.
Luminescent semiconductor nanocrystals or quantum dots (QDs) are a recently developed class of nanomaterial whose unique photophysical properties are helping to create a new generation of robust fluorescent biosensors. QD properties of interest for biosensing include high quantum yields, broad absorption spectra coupled to narrow size-tunable photoluminescent emissions and exceptional resistance to both photobleaching and chemical degradation. In this review, we examine the progress in adapting QDs for several predominantly
The most common method of detecting and quantitating biomolecules still remains the use of fluorescence [
Since their first description in a biological context [
The breakthrough in synthesizing high quality colloidal semiconductor QDs can be traced to the work of Murray, Norris and Bawendi at the Massachusetts Institute of Technology [
Several QD photophysical properties clearly stand out and are unparalleled in comparison to conventional fluorophores. The first is the ability to tune the photoluminescent emission as a function of core size and quantum confinement effects for binary combinations of semiconductors. This unique property allows one to control or 'dial in' the emission of the QD by controlling the core size [
The physical size of the QD material deserves some discussion. QDs are almost an order of magnitude larger than many of the conventional organic dyes in use (
Since QDs with high optical properties are usually synthesized from organometallic precursors and salts they have no intrinsic aqueous solubility. The native coordinating organic ligands on the surface of the QDs must either be exchanged or functionalized with a ligand or 'cap' that can impart both solubility and potential bioconjugation sites if desired. A wide variety of these ligands exist, however, each comes with its own benefits/liabilities. Examples of pertinent capping issues include complicated synthetic schemes, short usable half-lives, pH dependency or a considerable increase in overall QD-ligand size [
The first and most common method is to attach biomolecule(s) to a functional group displayed on the QD ligand surface covalent modification chemistry. Examples of such groups include amines, thiols or carboxyls. Amines can be modified with
We have developed a variety of methods for attaching antibodies and other proteins to primarily dihydrolipoic acid (DHLA) capped QDs based on the above described metal-affinity coordination and self-assembly driven by electrostatic interactions (see
Regardless of the method chosen for bioconjugation important issues still remain [
There has been a concerted effort geared towards using QDs as generalized sensors based upon detecting changes in their photoluminescence as they interact with a variety of targets. It is believed that the observed increases in QD PL in this scenario are most likely the result of surface passivation by the target molecule which has a net result of reducing the electric field effects on the QD [
Although interesting, there are several aspects of this biosensing approach which are less than ideal. The exact mechanism responsible for these changes still remains speculative. As such, the interactions cannot be predicted
The unique advantages that QDs offer over conventional dyes has increasingly led to their use in immunoassay detection [
Goldman and coworkers have been at the forefront of small molecule detection using antibody-conjugated QDs, as exemplified by the immuno-detection of the explosive 2,4,6-trinitrotoluene (TNT). A TNT analog was immobilized onto the surface of microtiter plates and competed with dissolved TNT for binding sites on QD-anti-TNT antibody bioconjugates in the same solution [
Protein detection and especially Western blot analysis of proteins expressed in tissues or cells has also benefited from QD-based fluorescence detection [
QD-immunolabeling has proven effective in identifying bacterial and protozoan cells as well as certain types of virus. For these type of assays the QDs are usually conjugated to either the primary or secondary antibodies. This labeling has been successfully used for the detection of
For biosensing, the greatest potential of QD-antibody bioconjugates is in multiplexing. In a demonstration of this potential, Goldman
A number of different nucleic acid sensing modalities are expected to benefit from using QD-based detection methods. Of these, the principle technology that would benefit most from the QDs optical properties is the DNA microarray, which has consistently provided flexibility and a high-throughput capacity to a number of related DNA analyses. These include gene expression monitoring, mutation detection and single nucleotide polymorphism (SNP) typing. In particular, multiplex microarray formats can directly facilitate pathogen identification and cancer diagnosis/evaluation as they allow the simultaneous comparison of different genomes or genetic markers. Again, the photophysical limitations of the organic dyes commonly used in these assays has hampered their full implementation.
Specific hybridization of four different QD-DNA conjugates on surfaces containing complementary DNA strands was first demonstrated by Gerion
QDs multiplexing capacity may be specifically advantageous to the use of optically encoded microspheres, which is an alternative approach for DNA analysis that benefits from higher flexibility and faster binding kinetics [
The use of QDs probes in fluorescent
QDs can also bring significant benefits to single-molecule DNA imaging, as demonstrated by Crut and coworkers [
Fluorescence resonance energy transfer (FRET) between donor and acceptor molecules has been extensively used in biophysical and biochemical studies to probe ligand-receptor binding and molecular structural changes [
Several studies have demonstrated the effective use of QD FRET donors to detect small analytes by utilizing a common strategy that relies on conjugating QDs to target binding receptors which can be either proteins [
QD FRET donors have also been used for DNA detection. QDs donors were used to follow telomerization, replication dynamics, hybridization and cleavage of QD-conjugated DNA through the incorporation of acceptor-labeled nucleotides [
The main limiting factor in the performance of QDs as FRET donors lies with their size because the FRET efficiency depends on the center-to-center separation between donor and acceptor. Three variables contribute to overall QD donor size: 1-core shell radius, 2-coating and 3-bioconjugation. The CdSe-ZnS core-shell radius ranges from ∼2.5 nm for 510 nm QDs to 5 nm for 610 nm QDs, to which an additional 0.5 to 10 nm may be added for the coating or functionalization shell, depending on its structure [
An improvement in the viable sensing distance range may result from QD quenching by nanometer gold particles, which has shown very high efficiencies at large distances [
Finally, its worth noting that some of the very same optical properties that make QDs excellent FRET donors may also hinder their use as FRET acceptors [
There have been other QD biosensing demonstrations that do not fall into the above categories. The Leblanc group has reported that QD bioconjugates formed with the enzyme organophosphorus hydrolase (OPH) could detect the organophosphorus compound paraoxon in solution [
Several groups have also tried to harness QD-electrochemical properties as a basis for biosensing. Strategies to accomplish this have focused on two different approaches: 1-monitoring of QD electrochemistry directly or 2-monitoring of QD photoelectrochemistry. In an example of the first approach, Hansen and coworkers used a mixed monolayer of thiolated aptamers attached to a gold substrate to capture either lysozyme or thrombin that had been attached to appropriate QDs via EDC-chemistry [
QDs are not meant to replace fluorescent dyes and proteins, but rather to be a specialized tool that can augment and complement them. As such, the first consideration should be whether QDs are warranted for a particular application. Does the desired sensing require something specialized that only QDs can provide such as an excitation wavelength far from the emission, a high photobleaching threshold, a long fluorescent lifetime or a complicated multiplexing scheme? Once committed to using QDs, the next issue is the choice of materials. As stated previously, in the visible region of the optical spectrum (500-620 nm), the best choice of material remains CdSe-ZnS core-shell QDs [
With the exception of a few specialized assays, the physical size of the QD should not be a limiting issue for most biosensing applications that are performed
Finally, it is clear from reviewing the many different strategies that multiplexing represents the largest untapped potential of QDs in biosensing and appropriate considerations are also warranted here. Care should be taken in choosing QDs whose emission spectra are well separated for easier identification/deconvolution. Additionally based upon where the sample is spectrally illuminated, some QDs in the mixture may fluoresce more than others due to excitation at an absorbance corresponding to a higher extinction coefficient. This can be easily corrected through spectral deconvolution or by the relative concentrations of QDs that are used together [
K.E. Sapsford and T. Pons contributed equally to this work. The authors acknowledge NRL and L. Chrisey at the Office of Naval Research (ONR grant # N001404WX20270) for support. T.P. acknowledges a post-doctoral fellowship from the Fondation pour la Recherche Medicale (France).
Comparison of organic/protein fluorophore and quantum dot properties.
|Quantum Dots
|Absorption spectra
|Variable/narrow generally a mirror of the emission spectra
|Broad spectra, steadily increases towards the UV from the first absorption band edge
|Molar extinction coefficients
|Variable, Generally < 200,000 M-1 cm-1
|High, 10-100X that of fluorophores
|Emission spectra
|Broad, asymmetric red-tailed emission
|Narrow-full width at half-maximum 25-40 nm for CdSe core materials
|Maturation time
|Needed for fluorescent proteins
|Effective Stokes shifts
|Generally < 100 nm
|> 200 nm possible
|Tunable emission
|Unique to QDs / can be size-tuned from the UV to IR
|Quantum yield
|Variable, low to high
|Generally high, 0.2 to 0.7 in buffer depending upon surface coating
|Fluorescent lifetime
|Short < 5 ns
|Long ∼ 10-20 ns or greater
|Spectral range
|Necessitates a different dye every 40-60 nm
|UV-IR depending upon binary/ternary material Vis - CdSe
|Variable to poor
|Excellent, strong resistance to photobleaching several orders of magnitude that of dyes
|Multiphoton cross section
|Variable to poor
|Excellent >2-3 orders of magnitude that of dyes
|Single-molecule capabilities
|FRET capabilities
|Variable, mostly single donor- single acceptor configurations
|Excellent donors, size tune emission to improve the overlap with an acceptor dye, single donor-multiple acceptor configurations possible
|Multiplexing capabilities
|Excellent, largely unexplored
|Intermittency (blinking)
|Maybe problematic in isolated circumstances (single molecule tracking)
|Chemical resistance
|Multiple reactivities commercially available
|Limited conjugation chemistries available
|Mono-valent attachment
|Multi-valent attachment
|Rare – mostly
|Good possibilities, can attach several molecules to QDs depending upon size
|Physical size
|< 0.5 nm
|4 – 7 nm diameter for CdSe core material
|Largely untapped
|Cost effectiveness
|Very good / multiple suppliers
|Poor / 2 commercial suppliers


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text:
Subject: [htdig3-dev] Re: ExternalTransport and shell escaping
From: Geoff Hutchison (firstname.lastname@example.com)
Date: Mon Feb 14 2000 - 11:36:50 PST
Jonathan Stark <firstname.lastname@example.com> just pointed out as a bug report
(PR#774) that the ExternalTransport mechanism doesn't really shell escape
the URLs. So for example:
parser https "https://www.blah.com/&rm" /etc/htdig/htdig.conf
This comes from this code:
command << ' ' << _Protocol << " \"" << _URL.get() << "\" " << configFile;
He thinks we should send the URL on STDIN to the script. I said that my
initial feeling was to make this analogous to ExternalParser and pass it
on the command-line. (IMHO, the command-line argument also makes it easier
to debug the script itself.)
Evidently, we'd need to escape shell meta-characters because they have
higher priority than the quotes.
So I think this requires some feedback--do we want to switch to passing in
the URL on the STDIN, or do we want to shell-escape all the
To unsubscribe from the htdig3-dev mailing list, send a message to
You will receive a message to confirm this.
This archive was generated by hypermail 2b28 : Mon Feb 14 2000 - 11:39:41 PST


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Popular Malayalam actor Prithviraj was recently spotted with actress Meghna Raj in Kodaikanal. Before you let your naughty imagination, let me tell you that they were there for the shooting for their upcoming flick Memories. After a long time, the serene beauty of Kodaikanal will be seen in a song sequence of the film. Prithviraj, Meghna and Baby Mythily participated in the filming of the song.
Directed by Jeethu Joseph, Memories tells the story of police officer Sam Alex. Prithviraj plays the role of a responsible police officer in the film, who is in charge of an investigation. He is also seen as a responsible family man. The director says the film is surely going to be a unique one. The film unit has already completed the shooting except a song. The movie has mainly been shot in Kochi.
As per the production team the song sequence that has shot in Kodaikanal is very important for the film. It helps the narration as it throws light on the personal life of Sam Alex. Song 'Thirayum theeravum...', penned and composed by Sejo Joseph was shot in Kodaikanal. Gayathri Reghuram was the choreographer.
Checkout the slideshow to know more about the film...
A New Onscreen Pair
Prithviraj and Meghna are pairing up for the first time. Hope their chemistry will work out in the film.
Prithviraj Again A Police Officer
Prithviraj has played police officer in several movies. He appeared as cop in Mumbai Police and Aurangzeb, which hit the screens earlier this year.
Meghna Raj – The Rising Star
Meghna has become one of the promising actress in Mollywood. The kind of role, she portrayed in the film Beautiful is beyond words.
Jeethu Joseph Likes Experimenting
Director Jeethu Joseph seems to like experimenting things. The movies Mummy & Me, Detective, Nayakan- all shows how particular he is in selecting the script.


text: Our Verdict Cheap enough, but for not much more money you can get so much better For Price crisp sound good value Against Cheap construction noise unsteady motion colours are washed out Reviewed on 20th September 2010 Technika is Tesco's own brand and, as a notch above the very cheapest, still represents good value despite a cheap feel to its construction. The sound is clear and crisp, although it lacks the detail and dynamics of pricier cables. Unfortunately the colour palette is washed out, with scenery appearing dull, and skin tones looking unnatural and plastic. The picture is subject to noise, blurring and unsteady motion. Three stars it is – and that's just for the price; for just £15 more you could have the QED Profile. More after the break Follow whathifi.com on Twitter Join whathifi.com on Facebook Related News Wednesday Wrap: "World's thinnest" Bluetooth speaker, Spotify update, Netflix in Europe Wed, 21 Jan 2015, 11:32am CES 2015 highlights - Day 2: Sony, Samsung, LG, Philips and Panasonic Tue, 06 Jan 2015, 11:13am CES 2015: Monster launches SuperStar waterproof speaker, iSport headphones, 4K HDMI cables Tue, 06 Jan 2015, 01:28am Accessories HDMI HDMI cables Technika Stay on top of your sound with What Hi-Fi? in your inbox every week Thank you for registering for our Newsletter We will send you relevant emails and updates.


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Olivia Wilde and Jason Sudeikis may have crushed engagement rumors, but the two seems to be going stronger. In fact, the actress just took to Twitter to publicly confess her love for the funnyman.
While watching her 37-year-old boyfriend's performance on SNL, the 28-year-old actress couldn't help herself but be in awe. She took to Twitter and tweeted, "Nothing puts a smile on my face like the love of my life dancing in a track suit and curly wig."
Sudeikis joined the SNL cast and appeared on the "What Up With That" skit, where he sported a red tracksuit and a curly wig as he rocked did the Running Man.
Just last week, Olivia took to Twitter to shoot down engagement rumors, after reports of the one-year couple moving in together. She set the record straight saying, "No I'm not engaged. But I AM at the Stones show and holy s–t Ronnie Wood you got style, boy. It's just a fact. Trying to score a shoe pic."
Photos by: Kyle Blair/WENN.com


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A laundrette owner who was found dead yesterday morning has been named locally as Bhasker Amin.
Mr Amin, who was in his mid-60s, was discovered in the back room of The Laundrette in Ballards Lane, Finchley.
It is believed that the family man, who had a wife and three adult children, died in his sleep after deciding to spend the night in the office behind his business.
Mr Amin lived in Dartford, Kent, and commuted to Finchley every day to run the business he had owned for about eight years.
It is thought that he started to head home on Saturday evening but found the trains delayed so decided to spend the night in his laundrette instead.
He was discovered at 10.15am yesterday by a member of staff who went to open the shop.
The employee initially thought his boss was asleep but could not wake him so ran over the road to Dave's Trade Centre looking for help.
Pradip Dave, owner of the trade centre, and a friend of Mr Amin, rushed over to help.
He found Mr Amin on the floor of his office and was also unable to rouse him so he called an ambulance and the police.
Mr Dave said: "We were absolutely shocked. He was a good friend.
"He was a very jolly person and we will miss him. He was a proper character.
"When I saw him I just knew he was dead from the look of his face."
Mr Amin was pronounced dead at the scene but the cause of death is not yet known.
The Laundrette has reopened today and is being run by Mr Amin's employee and a friend, Ashish Kakade.
Mr Kakade said: "I was shocked when I heard what had happened.
"I saw him on Friday. He waved and we had a little chat.
"It was a real shock. You just don't expect it, especially when you have just seen someone."
Police are not treating Mr Amin's death as suspicious.


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Salem-Keizer starts eight-game homestand Tuesday
Two series packed with promotions at Volcanoes Stadium
By Rob Schreier / Salem-Keizer Volcanoes | July 21, 2014 7:21 PM ET
Keizer, Ore. - The Salem-Keizer Volcanoes return home Tuesday, July 22, for an eight-game homestand packed with unique promotions at Volcanoes Stadium.
The Volcanoes start the second half of the 2014 Northwest League regular season with a five-game series against the red-hot Spokane Indians. The homestand concludes with three games against I-5 rival Eugene from Sunday through Tuesday.
Faith and Family night presented by First Baptist Church comes to Volcanoes Stadium on Wednesday, July 23. The night starts with a special one-hour pregame concert beginning at 5 p.m. performed by Melody and Truth, a husband and wife team of Nate and Lizz Dunn from First Baptist Church. Join us along with several congregations from the Mid-Valley as we celebrate the heartbeat of spirituality at Volcanoes Stadium. The game will also feature touching player testimonials about their faith walks. It's also another Hill Meats $1 Family Feast nights. All hot dogs, soda, popcorn and select ice cream products are just one dollar all night long.
Kick off the weekend right on Thursday, July 24, as we host $1 Adult Beverage Night at Volcanoes Stadium, where select adult beverages are just one dollar in the Stadium's Lava Lodge all night long.
Friday features Striking Out Meth in Marion-Polk Counties presented by SELCO Community Credit Union, Law Enforcement for Youth, and Marion Foster Care. Striking Out Meth in Marion-Polk Counties is an evening of celebration and recognition in our fight against meth and other dangerous drugs in our community. This event includes the baseball game, fireworks, family activities, interactive displays, demonstrations, prizes, and positive, family-friendly messages. Another Fantastic Friday Night Fireworks show will cap off the special night.
Saturday, July 26, is Ladies Night Out at Volcanoes Stadium, dressed by The Shabby Chic Bride in Salem. Let the good times roll with brides running the bases and all kinds of games and promotions for your female friends. It's also another Souvenir Saturday with the first hundreds of fans through the gates at Volcanoes Stadium receiving awesome free giveaways. Be there early on Saturday night.
The McDonald's of Salem-Keizer Youth Baseball and Softball Clinic caps off the weekend as the Volcanoes players teach the tricks of the trade before the game. Join us on the field at 3 p.m. Sunday afternoon for the clinic, as your child can stand shoulder-to-shoulder with San Francisco Giants professional players. There will be eight rotating stations teaching skills from hitting to base running to fielding on the field at Volcanoes Stadium. That's all in advance of the Avamere Senior Sunday game as we start the three-game series with the Eugene Emeralds. All seniors get a fantastic meal deal with a hamburger or hot dog plus a soda for just one dollar
Monday, July 28 is Bi-Mart Monday. All Bi-Mart members get one dollar off admission price when you present your membership card at the ticket window. It's also another Kid's Night at Volcanoes Stadium. All kids age 12 and under get in free with a voucher from our owner, Jerry Walker. Send Mr. Walker an email (firstname.lastname@example.com) to request the free ticket. Print off as many vouchers as you need at home and present the voucher at the ticket window for a free youth outfield ticket.
Tickets are available by calling the Volcanoes Stadium box office at 503-390-2225 or online at volcanoesbaseball.com
About the Volcanoes: The Salem-Keizer Volcanoes are a minor league affiliate of the San Francisco Giants. Home games are played at Volcanoes Stadium in Keizer from mid-June through early-September. Tickets start at just $8. For more information call the Volcanoes at (503) 390-2225.
This story was not subject to the approval of the National Association of Professional Baseball Leagues or its clubs.View More


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Juian Marley Headlines Spring Fever at Breck on March 24th
Sunny skies + Breck Parks + Julian Marley = One hell of a good time in Breckeridge this weekend. If you've found yourself coming down with a case of "S.A.D." as Breck calls it in this video, get yourself up there this weekend to cure it. A free concert, extended hours on chair 5 and warm temps are on tap. Can't ask for much more.


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Get Involved
At Kings we encourage everyone to play an active part in our life together. That's why you'll often hear people at Kings saying "Get Involved!"
There are three main ways we encourage everyone at Kings to get involved:
1. Come Along on Sundays
Sunday Mornings
10.30am-noon, Fonteyn Ballroom, Dunelm House. This is our main weekly gathering. More info.
Sunday Evenings
6.00pm-7.00pm, Crux, Riverside Cafe, Dunelm House. More info.
7.45pm-9.15pm, Connecting with God, Riverside Cafe, Dunelm House. More info.
At all our gatherings we encourage everyone to actively participate in worship and in seeking to hear from God. We encourage members of the congregation to bring Scriptures and prayers during our times of worship and we are open to the full range of the gifts of the Holy Spirit being expressed during our times together.
2. Join a Small Group (or Pastorate)
We encourage students at Kings to get stuck into one of our Student Pastorates, which are groups of 20-40 students that meet together three times a term and in cell groups on other weeks. To get involved please email the student team or speak to Chris Juby or Phil Trainer on a Sunday.
If you live in Durham all year round we'd like to encourage you to join one of our resident cell groups which meet on Wednesday and Thursday evenings at various locations around the City. Please email the office or speak to Ruth Perrin on a Sunday.
3. Participate...
...In Mission and Community Work
As a church we're involved in a variety of activities in the local community - some regular activities and some one-off events (see what we've been up to). Details of these activities and how to get involved can be found on the Mission and Community page.
We encourage everyone at Kings to get involved in our outreach activities - whether this is once a term, once a week or more regularly. Keep an eye on the noticesheet for details of upcoming activities and details of how to get involved.
...On Sundays
There are plenty of opportunities for everyone to get involved on a Sunday - here are a few ideas to get you started:
- Worship band
- Supporting kids work
- Meeting set-up
- Serving teas and coffees
- Bringing prayers and Scriptures during worship
If you would like to get involved in any of these activities please contact Clare in the office, speak to a member of staff or see the 'Get Involved' box on the Sunday notice sheet for specific email contact details.
...In Other Areas of Church Life
- Monthly Prayer Evenings
- Working with International Students - Interact, Ustinov Bible Study


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India House Backpackers Hostel, New Orleans, USA
India House Backpackers full of atmosphere and great people. I loved this place maybe not cleanest or neatest place where I have stayed but it was fun and I enjoyed a lot. Recommending this place to anyone who wants to meet people, chill in the hostel and have a place to remember. Not for the princess types. Thanks India House you where great!
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Amazing staff. Super friendly and always keen to help. Only thing what I miss was air conditioner in my room. Good kitchen and nice set up on the backyard.
Hostelworld Mobile Apps
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text:
ONE WOMAN'S FLAME By Elena McFadden '95
This wildland firefighter looks forward to every part of her job, from digging in the dirt to the outstanding people with whom she works.
INVENTION AND REALITY By Rachel Simon '81
A novelist ponders the divide between fact and art, fiction and non-fiction, in writing about her sister, Beth, who was diagnosed as an infant with mental retardation and has created a dynamic life by riding on city buses.
POP CULTURE POST 911 By Dorothy Silver Samuels '73
New York Times editorial board member Dorothy Silver Samuels looks at the American obsession with celebrities and "reality TV," parodied in her first novel, that continues even in the wake of the events of September 11.
Growth and Structure of Cities 185: "Urban Culture and Society" with Professor Gary McDonogh and Assistant Professor Juan Arbona.
Alumnae/i Books
September 11 remembered
Canaday Library exhibition: Dedicated to the Cause: Bryn Mawr Women and the Right to Vote."
Co-deans of the Graduate School of Social Work and Social Research named.
Harris L. Wofford honored.
Undergraduates get hands-on experience during summer internships.
Summer science research projects.
New artificial intelligence and robotics lab.
Swindler Prize awarded.
Faculty Obituaries: Paul Weiss, Phyllis Pray Bober.